{"version":"1.0.0","segments":[{"startTime":0.575,"endTime":3.511,"body":"Today we tackle the question, what's the difference between"},{"startTime":3.543,"endTime":6.447,"body":"IUI and ivf? What is diminished"},{"startTime":6.471,"endTime":9.343,"body":"ovarian reserve? And we check the mailbag."},{"startTime":9.519,"endTime":12.068,"body":"I'm, Dr. Mark Amol, and this"},{"startTime":12.408,"endTime":15.308,"body":"is Topo about Fertility Tuesday."},{"startTime":29.628,"endTime":32.628,"body":"You ever have one of those moments where"},{"startTime":32.628,"endTime":35.42,"body":"you have an epiphany and you"},{"startTime":35.444,"endTime":38.368,"body":"think, wow, I didn't know that."},{"startTime":39.508,"endTime":41.248,"body":"Well, I had that this week."},{"startTime":42.388,"endTime":43.928,"body":"I had a patient of mine"},{"startTime":45.108,"endTime":47.408,"body":"who has gone through two IUIs,"},{"startTime":47.988,"endTime":50.928,"body":"and unfortunately, they haven't worked."},{"startTime":52.668,"endTime":55.556,"body":"And she says to me, you know, what can"},{"startTime":55.572,"endTime":57.848,"body":"we do next? And we talk about some options."},{"startTime":59.138,"endTime":61.914,"body":"And one of the things I said is, we can try"},{"startTime":61.986,"endTime":64.492,"body":"another iui. If, that doesn't"},{"startTime":64.516,"endTime":67.516,"body":"work, we can go on to something like IVF or"},{"startTime":67.548,"endTime":70.42,"body":"more testing. And then she"},{"startTime":70.46,"endTime":72.48,"body":"says to me, well,"},{"startTime":73.58,"endTime":76.036,"body":"if this next IUI doesn't work, we're probably going to"},{"startTime":76.068,"endTime":79.036,"body":"stop, because if IUI didn't work,"},{"startTime":79.148,"endTime":81.6,"body":"there's no reason to waste your time going on the IVF."},{"startTime":83.08,"endTime":85.38,"body":"And that shocked me, because"},{"startTime":86.48,"endTime":89.08,"body":"IUIs and IVF are not the same"},{"startTime":89.12,"endTime":92.048,"body":"thing. They don't even treat the"},{"startTime":92.064,"endTime":95.04,"body":"same things. I mean, it's clearly"},{"startTime":95.08,"endTime":97.928,"body":"obvious if you have no sperm or low"},{"startTime":97.984,"endTime":100.42,"body":"sperm, that you have to do things like ivf"},{"startTime":101.2,"endTime":103.447,"body":"and, your tubes are blocked. You'd have to do some, like"},{"startTime":103.479,"endTime":106.015,"body":"ivf. But it"},{"startTime":106.063,"endTime":108.935,"body":"never dawned on me"},{"startTime":108.983,"endTime":111.861,"body":"that a patient. We think if an IUI"},{"startTime":111.901,"endTime":114.853,"body":"doesn't work, then IVF wouldn't work. And"},{"startTime":114.877,"endTime":116.481,"body":"that's not true. I explained to her,"},{"startTime":117.781,"endTime":120.477,"body":"if you went and ate a Junior"},{"startTime":120.589,"endTime":123.333,"body":"Whopper and"},{"startTime":123.397,"endTime":126.253,"body":"you liked it, then if you"},{"startTime":126.277,"endTime":129.261,"body":"go on to the main Whopper, you'll probably like that, too."},{"startTime":129.301,"endTime":132.061,"body":"Just like if you didn't like the Junior Whopper, you probably wouldn't like the big Whopper,"},{"startTime":132.101,"endTime":134.885,"body":"because it's just kind of more of the same, right?"},{"startTime":135.053,"endTime":137.505,"body":"But if you had a Junior"},{"startTime":137.553,"endTime":139.781,"body":"Whopper and you didn't like it,"},{"startTime":141.121,"endTime":144.049,"body":"and then someone said, hey, do you want to try, let's"},{"startTime":144.065,"endTime":147.039,"body":"say a, taco? Well,"},{"startTime":147.539,"endTime":150.507,"body":"you can't say you're notnna like the taco. The burger and the taco have"},{"startTime":150.523,"endTime":151.759,"body":"nothing to do with each other."},{"startTime":153.979,"endTime":156.819,"body":"Who wouldn't like a taco? I mean, this is already crazy talk."},{"startTime":156.859,"endTime":157.959,"body":"But the point is,"},{"startTime":159.979,"endTime":162.955,"body":"what blew me away was to"},{"startTime":162.987,"endTime":165.987,"body":"think that an IUI does"},{"startTime":166.003,"endTime":168.931,"body":"the same thing as ivf. They're not just"},{"startTime":168.955,"endTime":171.603,"body":"like a taco is not a"},{"startTime":171.611,"endTime":173.999,"body":"burder. So"},{"startTime":174.659,"endTime":176.319,"body":"I explained to her that"},{"startTime":177.579,"endTime":180.435,"body":"an IUI is only"},{"startTime":180.467,"endTime":183.279,"body":"done because they're low cost and they're easy."},{"startTime":184.259,"endTime":187.139,"body":"No one does IUIs because"},{"startTime":187.179,"endTime":188.479,"body":"they think they work. Well,"},{"startTime":189.789,"endTime":191.969,"body":"the only reason we do IUIs"},{"startTime":192.869,"endTime":195.826,"body":"are because of the fact that they'low cost and that"},{"startTime":195.898,"endTime":197.67,"body":"with multiple IUIs,"},{"startTime":198.41,"endTime":201.11,"body":"approximately 50% of people would be pregnant."},{"startTime":202.13,"endTime":205.098,"body":"Now, I personally look"},{"startTime":205.114,"endTime":208.03,"body":"at IUIS as a treatment choice."},{"startTime":209.09,"endTime":211.27,"body":"And not every patient"},{"startTime":211.81,"endTime":214.31,"body":"should do IUIs. For"},{"startTime":214.35,"endTime":217.094,"body":"example, I put patients into"},{"startTime":217.142,"endTime":219.57,"body":"four groups for IUIs."},{"startTime":220.83,"endTime":222.99,"body":"The first group are people that should"},{"startTime":223.07,"endTime":225.45,"body":"absolutely do IUIs."},{"startTime":225.95,"endTime":228.566,"body":"These are the people with sperm"},{"startTime":228.638,"endTime":230.97,"body":"issues, progressive motility issues,"},{"startTime":231.67,"endTime":234.438,"body":"problems with motility, minor sperm"},{"startTime":234.494,"endTime":237.446,"body":"issues, but the count still about"},{"startTime":237.518,"endTime":240.406,"body":"20 million or above that when we"},{"startTime":240.438,"endTime":243.382,"body":"was the sperm. There'll be plan sperm and they should get pregnant. It would"},{"startTime":243.406,"endTime":245.93,"body":"be crazy for them not to do IUIs."},{"startTime":247.87,"endTime":250.729,"body":"The fourth group are, the people who are"},{"startTime":250.769,"endTime":253.681,"body":"crazy who want to do IUIS and should not do IUIs."},{"startTime":253.825,"endTime":256.721,"body":"These are the people when their tubes are"},{"startTime":256.745,"endTime":259.429,"body":"blocked and they still want to do IUIs. And I say, well,"},{"startTime":260.049,"endTime":262.841,"body":"that's impossible. I mean, there's no reason to do that,"},{"startTime":263.025,"endTime":265.921,"body":"or their sperm counts so severe, there's no way IUI is"},{"startTime":265.945,"endTime":266.749,"body":"going to work."},{"startTime":268.959,"endTime":271.695,"body":"The two middle groups are really the groups for"},{"startTime":271.727,"endTime":273.219,"body":"unexplained infertility."},{"startTime":275.319,"endTime":278.151,"body":"If your unexplained infertility is"},{"startTime":278.215,"endTime":280.863,"body":"mild, meaning there's no endometriosis, there's no"},{"startTime":280.951,"endTime":283.847,"body":"other issues going on. All it is is just you've been trying for a"},{"startTime":283.863,"endTime":286.799,"body":"year, you have been got pregnant and everything came"},{"startTime":286.839,"endTime":289.135,"body":"back normal, and you have unexplained"},{"startTime":289.167,"endTime":292.031,"body":"infertility. I think there's approximately"},{"startTime":292.055,"endTime":294.415,"body":"a 50% chance after you do three"},{"startTime":294.607,"endTime":297.139,"body":"artificial inseminations, which are IUIs,"},{"startTime":297.839,"endTime":300.819,"body":"will lead to a pregnancy 50% of the time."},{"startTime":302.119,"endTime":305.015,"body":"However, if you've been trying for"},{"startTime":305.087,"endTime":307.899,"body":"three years, and"},{"startTime":309.359,"endTime":310.739,"body":"during those three years"},{"startTime":311.999,"endTime":313.899,"body":"you've been ovulating every month,"},{"startTime":315.559,"endTime":318.191,"body":"or if you have any type of other medical issues such"},{"startTime":318.215,"endTime":320.943,"body":"as endometriosis or multiple"},{"startTime":320.991,"endTime":323.339,"body":"surgeries, any other complex history,"},{"startTime":324.409,"endTime":327.065,"body":"the IUIs really don't work that"},{"startTime":327.097,"endTime":329.766,"body":"well. It's definitely below 50% m"},{"startTime":329.851,"endTime":332.791,"body":"in my experience, maybe 20,"},{"startTime":332.874,"endTime":335.865,"body":"25% of people get pregnant that. And so I generally tell"},{"startTime":335.897,"endTime":338.829,"body":"people, if it's been three years and you've been ovuling every month,"},{"startTime":340.089,"endTime":343.001,"body":"why would an IUI really work? Because what an"},{"startTime":343.025,"endTime":345.993,"body":"IUI is doing is you're just"},{"startTime":346.041,"endTime":348.905,"body":"bypassing the cervix. The thought"},{"startTime":348.937,"endTime":351.841,"body":"is that maybe there are sperm antibodies, maybe there's some reason the"},{"startTime":351.865,"endTime":354.369,"body":"sperm is not getting in, but three"},{"startTime":354.409,"endTime":357.329,"body":"years. 97% of people are usually"},{"startTime":357.369,"endTime":360.129,"body":"pregnant by three years within the first three months of"},{"startTime":360.169,"endTime":362.625,"body":"trying, not even really trying. I mean, just watching a little"},{"startTime":362.657,"endTime":365.029,"body":"chocolatee movie or something and having a kid,"},{"startTime":366.209,"endTime":368.593,"body":"you have about a 50% chance. By the third"},{"startTime":368.641,"endTime":371.393,"body":"month, by six months 70% of people are"},{"startTime":371.401,"endTime":374.369,"body":"pregnant by one year, 85% by three years."},{"startTime":374.529,"endTime":376.789,"body":"97% of people."},{"startTime":377.929,"endTime":380.509,"body":"If 97% of people are pregnant"},{"startTime":381.919,"endTime":384.855,"body":"in three years, why would doing an IUI"},{"startTime":384.887,"endTime":387.863,"body":"get you pregnant? I'm not saying it won't work, but in reality, if"},{"startTime":387.871,"endTime":390.751,"body":"it does work, it probably would have worked with emine"},{"startTime":390.775,"endTime":393.359,"body":"Ms. Anyways, because it"},{"startTime":393.479,"endTime":396.339,"body":"probably is just a coincidence. Now,"},{"startTime":397.919,"endTime":399.619,"body":"the point of all this was"},{"startTime":400.759,"endTime":403.615,"body":"I explained to her that she has"},{"startTime":403.647,"endTime":406.259,"body":"unexplained inf feertility. She has endometriosis."},{"startTime":406.714,"endTime":409.709,"body":"Ah. At this point, don't"},{"startTime":409.749,"endTime":412.289,"body":"think of IUIs not working because"},{"startTime":412.629,"endTime":415.517,"body":"you failed IUIs, but the"},{"startTime":415.533,"endTime":418.349,"body":"IUIs aren't working because IUIs can't"},{"startTime":418.389,"endTime":421.253,"body":"work for you. Because if there are"},{"startTime":421.301,"endTime":424.037,"body":"things that are wrong that we can't test"},{"startTime":424.093,"endTime":427.021,"body":"for, an IUI will never work."},{"startTime":427.125,"endTime":429.773,"body":"For example, just because your"},{"startTime":429.821,"endTime":432.801,"body":"tubes are open does not mean that"},{"startTime":432.825,"endTime":434.869,"body":"your tubes are functional."},{"startTime":435.889,"endTime":438.353,"body":"There are many women who have normal"},{"startTime":438.401,"endTime":441.029,"body":"hysosy pingograms which are also"},{"startTime":441.369,"endTime":444.289,"body":"HSGs, and their"},{"startTime":444.329,"endTime":447.241,"body":"fallopian tubes don't work. They don't"},{"startTime":447.305,"endTime":449.549,"body":"pull the eggs towards it, it doesn't"},{"startTime":450.449,"endTime":452.993,"body":"grab the egg. And in that situation,"},{"startTime":453.161,"endTime":455.465,"body":"no IUI will ever"},{"startTime":455.617,"endTime":456.309,"body":"work."},{"startTime":459.029,"endTime":461.769,"body":"Another issue is sperm penetration."},{"startTime":462.469,"endTime":465.005,"body":"We know there are some women and"},{"startTime":465.037,"endTime":468.005,"body":"men, when you put the sperm and egg together,"},{"startTime":468.197,"endTime":471.197,"body":"they don't fertilize. And"},{"startTime":471.213,"endTime":474.141,"body":"then that, I mean, the sperm can literally look like Brad Pitt and"},{"startTime":474.165,"endTime":476.461,"body":"it can't get in that egg. And that's just because"},{"startTime":476.525,"endTime":478.849,"body":"sometimes some sperm"},{"startTime":479.469,"endTime":482.249,"body":"can't get in. It's good looking as it this."},{"startTime":483.249,"endTime":485.869,"body":"And in that situation,"},{"startTime":487.209,"endTime":490.069,"body":"no IUI is ever going to work."},{"startTime":491.129,"endTime":493.849,"body":"So again, when an IUI"},{"startTime":493.889,"endTime":496.269,"body":"doesn't work and it's unexplained infertility,"},{"startTime":496.569,"endTime":499.425,"body":"the question isn't, oh, if this"},{"startTime":499.457,"endTime":502.065,"body":"didn't work, my case must be so bad that IVF won't"},{"startTime":502.097,"endTime":504.865,"body":"work. The question really needs to be"},{"startTime":504.897,"endTime":507.264,"body":"is, hey, I'm,"},{"startTime":507.553,"endTime":510.285,"body":"eating a Junior Whopper. And"},{"startTime":510.317,"endTime":513.309,"body":"that, my friend, is a taco. And we"},{"startTime":513.349,"endTime":516.181,"body":"know tacos are the best. And so"},{"startTime":516.245,"endTime":519.221,"body":"IDVF is superior not just in"},{"startTime":519.245,"endTime":522.197,"body":"the fact that the pregnancy rates are higher, but in the fact that"},{"startTime":522.213,"endTime":524.369,"body":"we bypass most of the problems."},{"startTime":525.109,"endTime":527.329,"body":"There's nothing magical about ivf."},{"startTime":528.029,"endTime":530.805,"body":"If you've got bad eggs and every single leg is bad, IVF"},{"startTime":530.837,"endTime":533.597,"body":"won't work. If you have no sperm,"},{"startTime":533.693,"endTime":536.253,"body":"IVF won't work. But what IVF does"},{"startTime":536.301,"endTime":538.769,"body":"is, is it bypasses everything."},{"startTime":539.429,"endTime":542.077,"body":"It takes the eggs out of the body. So now we"},{"startTime":542.093,"endTime":544.845,"body":"can stimulate you aggressively"},{"startTime":545.037,"endTime":547.981,"body":"and not have to worry about multiples. We can"},{"startTime":548.005,"endTime":551.003,"body":"then, pull the eggs out and look at the eggs, see"},{"startTime":551.011,"endTime":554.011,"body":"if we see issues with them. We can then"},{"startTime":554.155,"endTime":557.051,"body":"fertilize the eggs by injecting the spermum, getting rid"},{"startTime":557.075,"endTime":559.559,"body":"of any type of fertilization disorder."},{"startTime":560.899,"endTime":563.819,"body":"We then watch the embryos, grow them out a petri dish and can"},{"startTime":563.859,"endTime":566.675,"body":"see any issues developing and then pick the best"},{"startTime":566.747,"endTime":569.509,"body":"embryos and put them back. We can even take test them"},{"startTime":570.849,"endTime":573.601,"body":"and put back only normal"},{"startTime":573.745,"endTime":574.589,"body":"embryos."},{"startTime":576.449,"endTime":578.961,"body":"When we do the transfer, we can"},{"startTime":578.985,"endTime":581.389,"body":"evaluate whether the transfer is the right timing."},{"startTime":582.329,"endTime":585.313,"body":"We can adjust the progesterone. We can adjust so much with the"},{"startTime":585.321,"endTime":588.029,"body":"IVF that it's not magical,"},{"startTime":589.489,"endTime":592.369,"body":"it's just we're controlling every"},{"startTime":592.409,"endTime":594.993,"body":"parameter. They give it the highest assess"},{"startTime":595.041,"endTime":597.149,"body":"rate. Whereas with an iui,"},{"startTime":599.209,"endTime":601.389,"body":"we're just praying and hoping"},{"startTime":602.249,"endTime":605.017,"body":"that those little sperm can make it"},{"startTime":605.153,"endTime":606.229,"body":"to that egg."},{"startTime":610.649,"endTime":613.029,"body":"Stay with us. We'll be right back."},{"startTime":614.689,"endTime":616.589,"body":"Levant po"},{"startTime":617.489,"endTime":620.265,"body":"the Latin Minute is your new favorite byil lingual comedy"},{"startTime":620.297,"endTime":623.289,"body":"podcast where two Latinos living in southwest Florida"},{"startTime":623.329,"endTime":625.569,"body":"servru up some spicy takes, on the hottest celebrities,"},{"startTime":625.649,"endTime":628.337,"body":"gossip, juicy cheeseme, and just a"},{"startTime":628.353,"endTime":631.153,"body":"sprinkle of politics. With humor, culture and"},{"startTime":631.201,"endTime":634.201,"body":"plenty of laughs, this podcast brings the best of both"},{"startTime":634.265,"endTime":637.193,"body":"worlds. So make sure to check out the Latin Minute."},{"startTime":637.241,"endTime":640.129,"body":"You can follow us On Apple Podcast,"},{"startTime":640.289,"endTime":642.681,"body":"iHeart and Spotify."},{"startTime":642.865,"endTime":645.649,"body":"Also visit our Facebook page, the Latin Minute."},{"startTime":645.689,"endTime":646.749,"body":"We'll see you there."},{"startTime":654.589,"endTime":655.809,"body":"So, in summary,"},{"startTime":657.509,"endTime":660.245,"body":"don't confuse a"},{"startTime":660.277,"endTime":663.213,"body":"junior whopper for a taco. They"},{"startTime":663.221,"endTime":666.133,"body":"aren't the same. I don't care what any would tell you. I don't care if"},{"startTime":666.141,"endTime":669.077,"body":"they tell you it's a burger daco. It's not a"},{"startTime":669.093,"endTime":669.809,"body":"burger."},{"startTime":671.789,"endTime":674.005,"body":"An IUI is not"},{"startTime":674.077,"endTime":676.929,"body":"ivf. It is not a little bit better."},{"startTime":677.089,"endTime":679.449,"body":"It is a completely different"},{"startTime":679.489,"endTime":682.441,"body":"animal. And don't be worried"},{"startTime":682.545,"endTime":685.314,"body":"if IUIs don't work that, now IVF has a"},{"startTime":685.33,"endTime":687.006,"body":"lower chance. It does not."},{"startTime":688.546,"endTime":690.726,"body":"IVF is something completely different,"},{"startTime":691.426,"endTime":693.846,"body":"just like a taco"},{"startTime":696.666,"endTime":698.806,"body":"diminished ovarian reserve"},{"startTime":699.386,"endTime":702.334,"body":"do. I"},{"startTime":702.35,"endTime":704.468,"body":"find this is, a difficult subject for people"},{"startTime":704.652,"endTime":707.628,"body":"because unlike a"},{"startTime":707.652,"endTime":709.86,"body":"lot of things inf ferility that are very"},{"startTime":709.988,"endTime":712.892,"body":"straightforward, diminish ovarian reserve"},{"startTime":713.044,"endTime":714.656,"body":"is quite complex."},{"startTime":715.796,"endTime":718.676,"body":"And part of this complexity is"},{"startTime":718.716,"endTime":721.256,"body":"because there really is not a good definition."},{"startTime":721.596,"endTime":724.056,"body":"The word diminished ovarian reserve,"},{"startTime":724.746,"endTime":726.646,"body":"it's kind of like the word automobile."},{"startTime":728.866,"endTime":731.834,"body":"An automobile could be a car, it"},{"startTime":731.85,"endTime":733.846,"body":"could be a truck, could be a van."},{"startTime":734.906,"endTime":736.406,"body":"They're all automobiles."},{"startTime":737.506,"endTime":740.326,"body":"Well, din ovarian reserve is kind of the same way."},{"startTime":741.306,"endTime":744.154,"body":"You can have poor egg quality and be called diminished"},{"startTime":744.17,"endTime":747.082,"body":"ovarian reserve. You can have a low ovarian"},{"startTime":747.114,"endTime":750.018,"body":"reserve mean you don't have many eggs, and that's"},{"startTime":750.082,"endTime":752.98,"body":"considered diminish ovarian reserve. You can even have"},{"startTime":753.028,"endTime":756.016,"body":"poor egg recruitment where you just don't make a lot of eggs."},{"startTime":756.436,"endTime":758.656,"body":"And that also could be dimensional of arro reserve."},{"startTime":759.476,"endTime":762.156,"body":"The point is, when"},{"startTime":762.196,"endTime":765.092,"body":"patients hear the word diminish ovarian reserve, they"},{"startTime":765.124,"endTime":768.124,"body":"assume they're in this category that"},{"startTime":768.14,"endTime":771.052,"body":"is always bad, and"},{"startTime":771.124,"endTime":774.028,"body":"it's not always bad. It depends on if"},{"startTime":774.052,"endTime":776.576,"body":"it's theality"},{"startTime":777.256,"endTime":780.064,"body":"or is it poor egg recruitment."},{"startTime":780.16,"endTime":782.744,"body":"I would rather get three eggs from someone with great"},{"startTime":782.8,"endTime":785.768,"body":"quality than get 16 eggs"},{"startTime":785.832,"endTime":788.676,"body":"from someone with poor egg quality."},{"startTime":791.016,"endTime":793.716,"body":"So because all clinics"},{"startTime":794.536,"endTime":797.48,"body":"don't speak the same language, the problem"},{"startTime":797.528,"endTime":800.4,"body":"that happens for patients is they compare themselves"},{"startTime":800.448,"endTime":803.2,"body":"to other people with this category, diminished"},{"startTime":803.208,"endTime":806.11,"body":"ovarian reserve. Now, you can do that if you have pcos. You"},{"startTime":806.118,"endTime":808.526,"body":"can do that if you have other"},{"startTime":808.686,"endTime":811.598,"body":"diagnoses that can be compared. But to miss, ovarian"},{"startTime":811.622,"endTime":814.526,"body":"reserve is so broad and"},{"startTime":814.566,"endTime":816.346,"body":"so incorrectly understood"},{"startTime":817.326,"endTime":819.066,"body":"that doctors use that term"},{"startTime":820.366,"endTime":823.014,"body":"when they really should break it into what type of diminished"},{"startTime":823.03,"endTime":824.426,"body":"ovarian reserve it is."},{"startTime":826.046,"endTime":828.866,"body":"And I think that would lead to less"},{"startTime":829.286,"endTime":832.056,"body":"anxiety for patients if they realize that"},{"startTime":832.096,"endTime":834.556,"body":"they're not the same diminishion ovarian reserve"},{"startTime":835.216,"endTime":838.2,"body":"as some other bad cases. In"},{"startTime":838.248,"endTime":840.716,"body":"addition to the term being ambiguous,"},{"startTime":841.696,"endTime":844.608,"body":"I think there's a lot of confusion with regards"},{"startTime":844.672,"endTime":847.6,"body":"to the testing for ovarian reserve and then"},{"startTime":847.648,"endTime":850.296,"body":"people thinking they have diminished ovarian reserve based off of"},{"startTime":850.336,"endTime":850.916,"body":"numbers."},{"startTime":852.776,"endTime":855.616,"body":"Ovarian reserve testing is"},{"startTime":855.656,"endTime":858.612,"body":"how we test egg"},{"startTime":858.644,"endTime":860.536,"body":"quality, quantity,"},{"startTime":861.716,"endTime":864.34,"body":"and the overall idea of how much"},{"startTime":864.388,"endTime":867.268,"body":"time women have for their"},{"startTime":867.292,"endTime":868.096,"body":"fertility."},{"startTime":870.156,"endTime":873.132,"body":"Now, there are essentially three tests"},{"startTime":873.284,"endTime":876.188,"body":"that you can test ovarian reserve. The"},{"startTime":876.212,"endTime":879.02,"body":"first test is called an antral"},{"startTime":879.148,"endTime":882.004,"body":"follicle count, sometimes"},{"startTime":882.1,"endTime":884.456,"body":"abbreviated afc."},{"startTime":885.476,"endTime":888.476,"body":"And this is the amount of eggs that are"},{"startTime":888.516,"endTime":891.132,"body":"seen on your ovaries at the beginning of"},{"startTime":891.164,"endTime":894.012,"body":"each menstrual cycle. Think"},{"startTime":894.044,"endTime":896.972,"body":"of this as the amount of eggs"},{"startTime":897.044,"endTime":899.516,"body":"that month that you can maximum"},{"startTime":899.556,"endTime":901.716,"body":"make. So when you're talking about things like"},{"startTime":901.756,"endTime":904.7,"body":"IVF or IUIs, that is the"},{"startTime":904.748,"endTime":907.496,"body":"absolute amount of eggs you can make per month."},{"startTime":909.056,"endTime":911.968,"body":"It doesn't matter if you have great egg quality. It"},{"startTime":911.992,"endTime":914.596,"body":"doesn't matter if you have a low fsh,"},{"startTime":915.216,"endTime":918.12,"body":"you can't make more eggs. Then they're there at the"},{"startTime":918.128,"endTime":921.08,"body":"beginning of the month. The second"},{"startTime":921.128,"endTime":923.632,"body":"test is called an fsh,"},{"startTime":923.784,"endTime":926.676,"body":"stands for follicle stimuli hormone."},{"startTime":927.576,"endTime":929.664,"body":"Think of this as the"},{"startTime":929.72,"endTime":932.408,"body":"gasoline that pushes the"},{"startTime":932.432,"endTime":935.304,"body":"engine to run. How much hormone the"},{"startTime":935.32,"endTime":938.246,"body":"brain has to send down represents how"},{"startTime":938.286,"endTime":941.15,"body":"hard it has to work to make an"},{"startTime":941.158,"endTime":944.022,"body":"egg. If your body takes a"},{"startTime":944.054,"endTime":946.894,"body":"lot of hormone to"},{"startTime":946.91,"endTime":949.566,"body":"make one egg, then when I give it extra"},{"startTime":949.606,"endTime":951.786,"body":"hormone, it won't respond as well."},{"startTime":952.926,"endTime":955.414,"body":"If the brain only has to send a little bit of"},{"startTime":955.43,"endTime":958.306,"body":"hormonesh to the ovary"},{"startTime":958.606,"endTime":961.446,"body":"to still make one egg. Then I know if I give"},{"startTime":961.486,"endTime":964.094,"body":"extra hormone, it will make more"},{"startTime":964.19,"endTime":964.986,"body":"eggs."},{"startTime":966.686,"endTime":968.746,"body":"FSH is"},{"startTime":969.766,"endTime":972.102,"body":"inversely related to estrogen."},{"startTime":972.294,"endTime":975.102,"body":"Therefore an FSH must be"},{"startTime":975.134,"endTime":978.102,"body":"taken with an estrogen. This is because"},{"startTime":978.134,"endTime":980.694,"body":"if the estrogen is elevated, it will make the"},{"startTime":980.71,"endTime":983.582,"body":"FSH falsely lower. So"},{"startTime":983.654,"endTime":986.198,"body":"any FSH must have an estrogen"},{"startTime":986.342,"endTime":988.866,"body":"usually below 50 to be valid."},{"startTime":989.776,"endTime":992.72,"body":"I can make any woman'fsh look low if"},{"startTime":992.728,"endTime":995.312,"body":"I give her enough hormones. And so"},{"startTime":995.504,"endTime":997.036,"body":"always take an FSH"},{"startTime":998.016,"endTime":1001.016,"body":"parameter in consideration to the estrogen"},{"startTime":1001.056,"endTime":1003.256,"body":"level. The last"},{"startTime":1003.296,"endTime":1006.168,"body":"hormone is amh, which stands for"},{"startTime":1006.232,"endTime":1009.063,"body":"antiolarin hormone. Now, this hormone"},{"startTime":1009.207,"endTime":1011.851,"body":"is made by the small"},{"startTime":1012.151,"endTime":1015.123,"body":"follicular cells in the"},{"startTime":1015.147,"endTime":1017.779,"body":"ovary. So the cells around the egg"},{"startTime":1017.875,"endTime":1020.699,"body":"are making this hormone. And since they are making the"},{"startTime":1020.715,"endTime":1023.131,"body":"hormone, that means it's directly"},{"startTime":1023.211,"endTime":1025.751,"body":"related to the number of eggs you have."},{"startTime":1026.731,"endTime":1029.707,"body":"Now, the amount of eggs you can make per"},{"startTime":1029.739,"endTime":1032.683,"body":"month is due to your antral follicle"},{"startTime":1032.707,"endTime":1035.667,"body":"count. Because again, if you only have three follicles"},{"startTime":1035.699,"endTime":1038.511,"body":"on your ovary, you can't make more than three that month."},{"startTime":1038.851,"endTime":1041.491,"body":"But the AMH represent"},{"startTime":1041.791,"endTime":1044.743,"body":"how much is there for the rest of your life. It"},{"startTime":1044.767,"endTime":1047.431,"body":"kind of gives us an idea of, do you have a lot of time"},{"startTime":1047.471,"endTime":1050.011,"body":"left? Now,"},{"startTime":1050.631,"endTime":1053.303,"body":"one of the things when you look at these hormones and you look at these"},{"startTime":1053.367,"endTime":1055.731,"body":"numbers is that"},{"startTime":1056.111,"endTime":1058.919,"body":"you can misunderstand them sometimes because"},{"startTime":1058.975,"endTime":1061.767,"body":"there are relationships. And so, for"},{"startTime":1061.799,"endTime":1064.783,"body":"example, people will say, well, if the"},{"startTime":1064.847,"endTime":1067.327,"body":"EMH is high, I must have good"},{"startTime":1067.359,"endTime":1070.237,"body":"fertility. And that's actually"},{"startTime":1070.269,"endTime":1072.565,"body":"not true. You can have a very high"},{"startTime":1072.613,"endTime":1075.197,"body":"AMH and have poor fertility."},{"startTime":1075.389,"endTime":1078.141,"body":"An example would be there are some women with"},{"startTime":1078.181,"endTime":1081.076,"body":"polycystic ovarian syndrome who have very high AMH M"},{"startTime":1081.469,"endTime":1084.341,"body":"levels but have a very difficult time getting"},{"startTime":1084.381,"endTime":1086.973,"body":"pregnant. Now, technically, yes, their eggs are"},{"startTime":1087.037,"endTime":1088.721,"body":"good, especially if they're young,"},{"startTime":1089.861,"endTime":1092.733,"body":"but having a high AMH s doesn't"},{"startTime":1092.757,"endTime":1095.725,"body":"guarantee they're going to get pregnant. A matter of fact, I find"},{"startTime":1095.893,"endTime":1098.317,"body":"women with pcos do very"},{"startTime":1098.429,"endTime":1100.601,"body":"poor in IVF"},{"startTime":1101.341,"endTime":1104.221,"body":"when they have extremely high AMH levels."},{"startTime":1104.381,"endTime":1106.965,"body":"Because a lot of these women have high inflammation"},{"startTime":1107.013,"endTime":1109.757,"body":"levels and that inflammation can"},{"startTime":1109.789,"endTime":1112.321,"body":"cause problems. However, I digress."},{"startTime":1112.941,"endTime":1115.789,"body":"My main point here is saying just because your"},{"startTime":1115.805,"endTime":1118.197,"body":"FSH is high doesn't mean you can't get"},{"startTime":1118.229,"endTime":1120.991,"body":"pregnant. Just because your AMH is low"},{"startTime":1121.101,"endTime":1123.779,"body":"doesn't mean you can get pregnant and vice versa. If"},{"startTime":1123.795,"endTime":1126.683,"body":"your FSH is low, it doesn't mean"},{"startTime":1126.787,"endTime":1129.473,"body":"you're always going to be better. And, if your antal"},{"startTime":1129.497,"endTime":1132.329,"body":"follicle count is high doesn't mean things are going to be"},{"startTime":1132.345,"endTime":1135.281,"body":"better. But what I want to do is go over what each of these"},{"startTime":1135.321,"endTime":1138.209,"body":"tests mean and how you can use them to"},{"startTime":1138.225,"endTime":1140.921,"body":"determine how well you'll do in"},{"startTime":1140.961,"endTime":1143.889,"body":"treatment. I think it's very important to understand"},{"startTime":1143.945,"endTime":1146.481,"body":"that IVF is not"},{"startTime":1146.521,"endTime":1149.279,"body":"normal. No human was ever"},{"startTime":1149.335,"endTime":1152.175,"body":"made to make this many eggs. God intended"},{"startTime":1152.223,"endTime":1154.611,"body":"do to make one egg per month."},{"startTime":1155.271,"endTime":1158.199,"body":"So although it's frustrating when you're spending a"},{"startTime":1158.215,"endTime":1161.031,"body":"lot of money to do IVF and you're"},{"startTime":1161.071,"endTime":1164.047,"body":"only getting five eggs, keep in mind that"},{"startTime":1164.079,"endTime":1165.771,"body":"really isn't abnormal."},{"startTime":1166.871,"endTime":1169.731,"body":"For example, I love basketball."},{"startTime":1170.471,"endTime":1173.343,"body":"I can't jump three to four feet in the air. Now, that doesn't mean"},{"startTime":1173.367,"endTime":1176.367,"body":"I'm bad at basketball, doesn't mean I can't"},{"startTime":1176.399,"endTime":1179.143,"body":"play basketball. It just means like most"},{"startTime":1179.207,"endTime":1181.959,"body":"humans, most of us can't jump three to four feet in the"},{"startTime":1181.975,"endTime":1184.695,"body":"air. And that is why there are professionals."},{"startTime":1184.863,"endTime":1187.655,"body":"Well, when it comes to ivf, it's the same"},{"startTime":1187.703,"endTime":1190.679,"body":"thing. I get women all the time who"},{"startTime":1190.695,"endTime":1193.591,"body":"have had several kids and come in for family"},{"startTime":1193.631,"endTime":1196.551,"body":"balancing and they don't make a lot of eggs."},{"startTime":1196.631,"endTime":1199.023,"body":"And they say to me, what's going wrong? I said, well,"},{"startTime":1199.047,"endTime":1201.935,"body":"nothing. This is what God intended. They"},{"startTime":1201.983,"endTime":1204.815,"body":"intended you to make one egg per month. We're"},{"startTime":1204.863,"endTime":1207.767,"body":"asking you to do something that's not normal."},{"startTime":1207.959,"endTime":1210.911,"body":"And when you don't respond, we don't think there's something wrong"},{"startTime":1210.951,"endTime":1213.831,"body":"with you. We just say, okay, you can't jump"},{"startTime":1213.871,"endTime":1216.251,"body":"three to four feet like most people can."},{"startTime":1217.311,"endTime":1219.871,"body":"I find this analogy helps"},{"startTime":1219.911,"endTime":1222.703,"body":"people understand the test. So using those"},{"startTime":1222.767,"endTime":1225.647,"body":"descriptions we talked about with the amh, the antral"},{"startTime":1225.679,"endTime":1227.891,"body":"follicle count and FSH and estrogen,"},{"startTime":1228.511,"endTime":1231.461,"body":"let's discuss analogy. So"},{"startTime":1232.001,"endTime":1234.345,"body":"imagine in life, instead of having"},{"startTime":1234.393,"endTime":1237.049,"body":"eggs, God gives you this big"},{"startTime":1237.185,"endTime":1239.461,"body":"bowl and says you,"},{"startTime":1239.961,"endTime":1242.849,"body":"this is all the eggs you're ever going to have. But I'm not going to call them eggs."},{"startTime":1242.865,"endTime":1245.521,"body":"We're going to call them M\u0026MS. Because"},{"startTime":1245.681,"endTime":1248.449,"body":"we all like chocolate. And"},{"startTime":1248.505,"endTime":1251.137,"body":"instead of being every color of them and M,"},{"startTime":1251.249,"endTime":1253.781,"body":"they're going to be red and they're going to be green."},{"startTime":1254.761,"endTime":1257.725,"body":"And this bowl is going to have a lot of M and M. A matter of fact, it's going to have"},{"startTime":1257.833,"endTime":1260.453,"body":"2 million M\u0026M'in it the day you're"},{"startTime":1260.477,"endTime":1263.389,"body":"born. And"},{"startTime":1263.485,"endTime":1266.189,"body":"what's interesting is this bowl, as you"},{"startTime":1266.245,"endTime":1269.241,"body":"expect every month you take some of the M\u0026M's out"},{"startTime":1269.861,"endTime":1272.725,"body":"and so that bowls getting smaller and smaller through your life. This is going"},{"startTime":1272.733,"endTime":1275.197,"body":"to represent your egg count through your"},{"startTime":1275.229,"endTime":1277.968,"body":"life. Now, interesting enough, that"},{"startTime":1277.992,"endTime":1280.436,"body":"bull actually had 6 million M\u0026Ms. In"},{"startTime":1281.136,"endTime":1283.636,"body":"when you were 18 weeks in your mother's womb."},{"startTime":1284.186,"endTime":1287.122,"body":"So by the time you were born, you're"},{"startTime":1287.154,"endTime":1290.098,"body":"down to 2 million eggs. And the reason for this is a lot"},{"startTime":1290.122,"endTime":1292.898,"body":"of these eggs undergo a process called atresia, just a"},{"startTime":1292.922,"endTime":1295.086,"body":"fancy word. She can't steal my job saying"},{"startTime":1295.666,"endTime":1297.366,"body":"the eggs die off."},{"startTime":1297.986,"endTime":1300.682,"body":"Now, from the day you're"},{"startTime":1300.714,"endTime":1303.674,"body":"born, there are two types of"},{"startTime":1303.69,"endTime":1306.482,"body":"M and Ms. In there, red and green. The green ones"},{"startTime":1306.514,"endTime":1309.41,"body":"will represent every good egg you have. Now, when"},{"startTime":1309.418,"endTime":1312.308,"body":"we say good, what do we mean? We're talking about eggs"},{"startTime":1312.332,"endTime":1315.06,"body":"that don't have a chromosomal"},{"startTime":1315.108,"endTime":1317.684,"body":"problem. That doesn't mean it can't have a"},{"startTime":1317.7,"endTime":1320.416,"body":"genetic issue such as cysted fibrosis."},{"startTime":1320.996,"endTime":1323.612,"body":"We're talking about chromosomal. This is things like down"},{"startTime":1323.644,"endTime":1326.028,"body":"syndrome, tris to be 13, tries to be 18,"},{"startTime":1326.212,"endTime":1329.096,"body":"Turner's syndrome, things that cause miscarriages,"},{"startTime":1329.396,"endTime":1331.956,"body":"things that cause you not to get pregnant,"},{"startTime":1332.036,"endTime":1334.892,"body":"or even things that cause things"},{"startTime":1334.924,"endTime":1337.616,"body":"like Downs syndrome. Those will represent the red minem."},{"startTime":1338.596,"endTime":1341.492,"body":"The green ones will represent all of the eggs"},{"startTime":1341.524,"endTime":1344.428,"body":"that don't have a chromosomal problem. Now, if you looked"},{"startTime":1344.452,"endTime":1347.316,"body":"in that bowl when you were five years"},{"startTime":1347.356,"endTime":1349.841,"body":"old, you wouldn't see redin m"},{"startTime":1349.892,"endTime":1352.612,"body":"m'but not because they're not there. They are"},{"startTime":1352.644,"endTime":1355.612,"body":"definitely there. It's just there's so"},{"startTime":1355.644,"endTime":1358.588,"body":"many more green to red. You don't see the red"},{"startTime":1358.612,"endTime":1361.548,"body":"em thems. Fast forward now all"},{"startTime":1361.572,"endTime":1363.456,"body":"the way to puberty."},{"startTime":1364.296,"endTime":1367.216,"body":"And now you look in that bowl and"},{"startTime":1367.336,"endTime":1370.248,"body":"still see very few red mns because there's so many"},{"startTime":1370.272,"endTime":1372.422,"body":"more green. But now you're down to 350,000m"},{"startTime":1372.593,"endTime":1374.64,"body":"andms. That means more than"},{"startTime":1374.728,"endTime":1377.672,"body":"75% of your eggs have been"},{"startTime":1377.704,"endTime":1380.12,"body":"used before you even started your"},{"startTime":1380.168,"endTime":1383.024,"body":"period. Now, from this point, you're going to"},{"startTime":1383.04,"endTime":1385.076,"body":"use about a 1000 MLMSS a month"},{"startTime":1386.256,"endTime":1389.008,"body":"over the rest of your life. It decreases here and"},{"startTime":1389.032,"endTime":1391.076,"body":"there, but the point is about 1,000,"},{"startTime":1391.946,"endTime":1394.526,"body":"by the time you get to 28, you look in that bowl,"},{"startTime":1394.826,"endTime":1397.086,"body":"you start to see their M\u0026MS."},{"startTime":1397.946,"endTime":1400.846,"body":"By the time you're 35, that boill ISS down to now"},{"startTime":1401.306,"endTime":1404.006,"body":"35,000 M\u0026MS."},{"startTime":1404.746,"endTime":1407.166,"body":"And now about a third of them are red."},{"startTime":1408.146,"endTime":1410.714,"body":"But what's really interesting is your fertility"},{"startTime":1410.77,"endTime":1413.698,"body":"rate didn't drop much. You would think if I"},{"startTime":1413.722,"endTime":1416.606,"body":"lost 90% of my M\u0026Ms, clearly"},{"startTime":1417.406,"endTime":1420.342,"body":"my fertility rate would be much, much lower, but it's"},{"startTime":1420.374,"endTime":1423.07,"body":"actually not. It goes from about"},{"startTime":1423.158,"endTime":1425.998,"body":"20% near puberty down to 15%"},{"startTime":1426.062,"endTime":1428.742,"body":"at 35. And when I say"},{"startTime":1428.774,"endTime":1431.518,"body":"fertility rate, we're talking about the live birth rate, the"},{"startTime":1431.542,"endTime":1433.746,"body":"chances of having a baby successfully."},{"startTime":1434.846,"endTime":1437.71,"body":"Now, why is that possible? How is it possible that you can lose"},{"startTime":1437.758,"endTime":1440.27,"body":"so many and"},{"startTime":1440.438,"endTime":1443.37,"body":"not have a big ah decrease in your fertility rate."},{"startTime":1443.558,"endTime":1446.394,"body":"Well, the reason is because it's not"},{"startTime":1446.45,"endTime":1449.086,"body":"about the number, it's about the quality"},{"startTime":1450.706,"endTime":1453.634,"body":"of the eggs. And so as long as you're getting that green M"},{"startTime":1453.65,"endTime":1456.554,"body":"and M, it's still fine. And there's still a lot more green M\u0026M's."},{"startTime":1456.73,"endTime":1459.682,"body":"Now this keeps going down. By the time"},{"startTime":1459.794,"endTime":1462.698,"body":"you're 38, the half of that bowl is"},{"startTime":1462.722,"endTime":1465.65,"body":"red M and M'AND. By the time you're 42, the"},{"startTime":1465.698,"endTime":1468.474,"body":"whole bowl is red M\u0026Ms."},{"startTime":1468.57,"endTime":1471.348,"body":"Now you're searching and searching for the green"},{"startTime":1471.372,"endTime":1474.252,"body":"M\u0026MS. See, life likes the green"},{"startTime":1474.231,"endTime":1476.882,"body":"M\u0026MS. It eats those first and you're left them with the red"},{"startTime":1476.914,"endTime":1479.766,"body":"ones. Now, if we take"},{"startTime":1480.866,"endTime":1483.738,"body":"the testing we talked about and compare it to"},{"startTime":1483.762,"endTime":1486.642,"body":"this analogy, it will help you"},{"startTime":1486.714,"endTime":1488.726,"body":"understand the testing. So"},{"startTime":1489.906,"endTime":1492.406,"body":"AMH anti malarin hormone"},{"startTime":1493.026,"endTime":1494.766,"body":"is the size of that bowl."},{"startTime":1495.886,"endTime":1498.878,"body":"So it doesn't represent how many green or"},{"startTime":1498.902,"endTime":1501.558,"body":"red MMs are in it, it just"},{"startTime":1501.622,"endTime":1504.266,"body":"represents the size of the bowl. However,"},{"startTime":1504.966,"endTime":1507.726,"body":"people who have low AMHs probably have"},{"startTime":1507.766,"endTime":1510.678,"body":"smaller bowls because it represents that."},{"startTime":1510.862,"endTime":1513.054,"body":"And those are usually older women."},{"startTime":1513.19,"endTime":1515.758,"body":"So people have become"},{"startTime":1515.782,"endTime":1518.306,"body":"accustomed to seeing a low MH and meaning"},{"startTime":1518.846,"endTime":1520.786,"body":"that your egg reserve must be low."},{"startTime":1521.636,"endTime":1524.536,"body":"And that is true when you're older. If you're 42"},{"startTime":1525.196,"endTime":1527.924,"body":"and your AMH is low, then yes,"},{"startTime":1527.98,"endTime":1530.668,"body":"the reason why your fertility is"},{"startTime":1530.692,"endTime":1533.548,"body":"decreased is because of your age"},{"startTime":1533.612,"endTime":1536.156,"body":"having more red M and Ms. S. And by the way,"},{"startTime":1536.196,"endTime":1538.844,"body":"there's also this association that you have"},{"startTime":1538.9,"endTime":1541.78,"body":"less eggs. But someone who's"},{"startTime":1541.828,"endTime":1544.812,"body":"21 years old who has"},{"startTime":1544.884,"endTime":1547.864,"body":"a low MH, that doesn't mean that"},{"startTime":1547.88,"endTime":1550.316,"body":"their bowl is full of red M\u0026Ms."},{"startTime":1550.616,"endTime":1553.502,"body":"There's a good chance they have a lot of green M and Ms. Because of their"},{"startTime":1553.534,"endTime":1556.262,"body":"age. But"},{"startTime":1556.374,"endTime":1558.798,"body":"people will tell them that their chances are low when in"},{"startTime":1558.822,"endTime":1561.726,"body":"reality it's not. Their"},{"startTime":1561.766,"endTime":1564.614,"body":"bowl is still good. They just have fewer eggs and so"},{"startTime":1564.67,"endTime":1567.462,"body":"their time left"},{"startTime":1567.614,"endTime":1570.426,"body":"is going to be lower because there are fewer eggs."},{"startTime":1570.806,"endTime":1573.294,"body":"Now remember, there are always exceptions to every rule,"},{"startTime":1573.35,"endTime":1576.346,"body":"but in general that's how I would think, of"},{"startTime":1576.386,"endTime":1579.326,"body":"about it. Now, the next thing"},{"startTime":1579.786,"endTime":1582.778,"body":"is the antral follicle count, remember I mentioned that, is"},{"startTime":1582.802,"endTime":1585.706,"body":"the amount of eggs you can remove each month."},{"startTime":1585.866,"endTime":1588.722,"body":"So when you go through IVF, if your antral"},{"startTime":1588.754,"endTime":1591.714,"body":"follical count is 12, I know I should be"},{"startTime":1591.73,"endTime":1594.482,"body":"able to get about 12 xggs, whereas if your antral"},{"startTime":1594.514,"endTime":1597.266,"body":"follicle count is 3 like my wife"},{"startTime":1597.306,"endTime":1599.842,"body":"was, you're not going to get as many"},{"startTime":1599.874,"endTime":1602.388,"body":"eggs. So think of this from the"},{"startTime":1602.412,"endTime":1605.148,"body":"analogy. This is how big your hand is"},{"startTime":1605.252,"endTime":1608.216,"body":"going into that bowl and pulling out the M\u0026Ms."},{"startTime":1608.636,"endTime":1611.508,"body":"If you'got a big giant hand, you got a high"},{"startTime":1611.532,"endTime":1613.964,"body":"antropocle count because you can get a lot of"},{"startTime":1613.98,"endTime":1616.972,"body":"eggs. But if you got a little trump hand"},{"startTime":1617.124,"endTime":1619.924,"body":"right, you're not going to get as many eggs because that hand is too small."},{"startTime":1620.06,"endTime":1622.876,"body":"They can't get a lot of that those eggs. And so you get less than"},{"startTime":1622.916,"endTime":1624.656,"body":"them in handful."},{"startTime":1626.176,"endTime":1629.048,"body":"Now when"},{"startTime":1629.072,"endTime":1631.648,"body":"you associate that with diminish ovarian"},{"startTime":1631.672,"endTime":1634.6,"body":"reserve, it kind of makes sense. It women get"},{"startTime":1634.648,"endTime":1637.472,"body":"older, they usually have lower antral follicle"},{"startTime":1637.504,"endTime":1640.368,"body":"counts and that's why low antero"},{"startTime":1640.392,"endTime":1643.248,"body":"follicle counts are associated with decreased"},{"startTime":1643.272,"endTime":1645.992,"body":"ovarian reserve. But there are some people,"},{"startTime":1646.064,"endTime":1648.984,"body":"like my wife when we were young at 28, who make"},{"startTime":1649.04,"endTime":1652.04,"body":"very few eggs but still have great ovarian reserve"},{"startTime":1652.088,"endTime":1654.6,"body":"because the bowl of M and Ms. Are"},{"startTime":1654.648,"endTime":1657.4,"body":"still green. So we can get away with getting"},{"startTime":1657.448,"endTime":1658.036,"body":"less."},{"startTime":1660.456,"endTime":1662.752,"body":"Now, when it comes to the"},{"startTime":1662.784,"endTime":1664.996,"body":"FSH and estrogen levels,"},{"startTime":1665.816,"endTime":1668.64,"body":"this is how well the body responds"},{"startTime":1668.688,"endTime":1671.248,"body":"the medication. So this would be equivalent to"},{"startTime":1671.432,"endTime":1674.352,"body":"when you take a handful of Those M\u0026Ms, how well"},{"startTime":1674.384,"endTime":1677.104,"body":"your hand can grasp with them in"},{"startTime":1677.12,"endTime":1680.112,"body":"them. So if you've got that big giant hand we were talking"},{"startTime":1680.144,"endTime":1682.436,"body":"about which has the potential,"},{"startTime":1682.926,"endTime":1685.87,"body":"they get a big handful of M ms, but that"},{"startTime":1685.918,"endTime":1688.782,"body":"hand has arthritis, which would be equivalent to having"},{"startTime":1688.814,"endTime":1691.646,"body":"a very high fsh, it won't be able to"},{"startTime":1691.686,"endTime":1694.246,"body":"grasp all those M\u0026Ms, and so"},{"startTime":1694.286,"endTime":1696.598,"body":"then it might only get three"},{"startTime":1692.59,"endTime":1697.426,"body":"M\u0026Ms,"},{"startTime":1697.726,"endTime":1700.226,"body":"even though the hand should be able to get 10."},{"startTime":1700.886,"endTime":1703.846,"body":"And that smaller hand which"},{"startTime":1703.966,"endTime":1706.742,"body":"should only get three M\u0026Ms, can get all three of those"},{"startTime":1706.774,"endTime":1709.086,"body":"M\u0026Ms, so in the end"},{"startTime":1709.546,"endTime":1712.058,"body":"they're equal. And so someone with a high"},{"startTime":1712.162,"endTime":1714.17,"body":"afc, with a high"},{"startTime":1714.218,"endTime":1717.194,"body":"fsh, may get fewer eggs even"},{"startTime":1717.21,"endTime":1719.906,"body":"though their potential is higher. And the person who"},{"startTime":1719.946,"endTime":1722.802,"body":"has a low AFC with a"},{"startTime":1722.834,"endTime":1724.946,"body":"small hand in that M emine M jar"},{"startTime":1725.486,"endTime":1728.278,"body":"but has a good response, which is a"},{"startTime":1728.302,"endTime":1731.174,"body":"normal fsh, can get all three with"},{"startTime":1731.19,"endTime":1734.118,"body":"their hand. This is exactly what happened with my"},{"startTime":1734.142,"endTime":1736.834,"body":"wife and I. We could not get a lot of"},{"startTime":1736.85,"endTime":1739.802,"body":"eggs, but the eggs we got were"},{"startTime":1739.834,"endTime":1741.966,"body":"good eggs. So"},{"startTime":1742.546,"endTime":1745.258,"body":"what does this mean for you? If you're a"},{"startTime":1745.282,"endTime":1747.906,"body":"patient coming through and you have"},{"startTime":1747.946,"endTime":1749.606,"body":"either high fsh,"},{"startTime":1750.546,"endTime":1753.362,"body":"low AMH or low antralonical"},{"startTime":1753.394,"endTime":1753.966,"body":"count."},{"startTime":1756.146,"endTime":1759.074,"body":"The thing you need to look at is what's"},{"startTime":1759.09,"endTime":1761.006,"body":"your situation and what's your problem."},{"startTime":1762.786,"endTime":1765.706,"body":"Age always represents egg"},{"startTime":1765.746,"endTime":1768.706,"body":"quality. Doesn't mean you can't get pregnant at 45."},{"startTime":1768.746,"endTime":1771.554,"body":"It just means you're always going to have a higher percentage"},{"startTime":1771.69,"endTime":1773.806,"body":"of red M and ms, the green M and ms,"},{"startTime":1774.706,"endTime":1777.618,"body":"the same thing. If you have a high"},{"startTime":1777.682,"endTime":1780.578,"body":"FSH it's always going to be harder because"},{"startTime":1780.602,"endTime":1783.286,"body":"it's going to be hard for your body to make the eggs"},{"startTime":1783.746,"endTime":1786.642,"body":"when you have a high fsh. It's not that"},{"startTime":1786.674,"endTime":1789.304,"body":"you can't get pregnant. The problem"},{"startTime":1789.36,"endTime":1792.344,"body":"is as a doctor, it's hard for"},{"startTime":1792.36,"endTime":1795.16,"body":"us to help you. One of the"},{"startTime":1795.208,"endTime":1797.996,"body":"issues when you have a high FSH"},{"startTime":1799.256,"endTime":1801.88,"body":"is that as a doctor we"},{"startTime":1801.928,"endTime":1804.792,"body":"can't make more eggs because your"},{"startTime":1804.824,"endTime":1807.768,"body":"body won't respond. So if you have an"},{"startTime":1807.792,"endTime":1810.076,"body":"FSH of let's say 30,"},{"startTime":1810.696,"endTime":1812.156,"body":"that means your body"},{"startTime":1813.376,"endTime":1816.164,"body":"has to requires"},{"startTime":1816.26,"endTime":1819.252,"body":"a high level of FSH just to"},{"startTime":1819.284,"endTime":1822.228,"body":"make one egg. So if we give"},{"startTime":1822.252,"endTime":1825.22,"body":"you more hormones, we can't get those hormones"},{"startTime":1825.268,"endTime":1828.012,"body":"high enough to make another egg. So it's not"},{"startTime":1828.044,"endTime":1830.816,"body":"that we don't want to help you,"},{"startTime":1831.436,"endTime":1834.036,"body":"it's just that unfortunately we"},{"startTime":1834.076,"endTime":1834.736,"body":"can't."},{"startTime":1836.636,"endTime":1839.348,"body":"So I get asked a lot of times,"},{"startTime":1839.492,"endTime":1842.076,"body":"how many IVF cycles should I do, when should I"},{"startTime":1842.116,"endTime":1845.104,"body":"quit? And this is asked to me"},{"startTime":1845.12,"endTime":1847.956,"body":"a lot by people with diminish ovarian reserve."},{"startTime":1848.976,"endTime":1851.716,"body":"And I think you have to take this all into account."},{"startTime":1853.016,"endTime":1855.516,"body":"If you are 42"},{"startTime":1856.136,"endTime":1859.128,"body":"and you only make one or two eggs"},{"startTime":1859.152,"endTime":1861.712,"body":"per month, it is going to be very"},{"startTime":1861.784,"endTime":1864.676,"body":"difficult to get pregnant because"},{"startTime":1866.656,"endTime":1869.526,"body":"how are you going to get enough eggs to make this work?"},{"startTime":1869.696,"endTime":1872.61,"body":"It's going to take somewhere around five"},{"startTime":1872.658,"endTime":1875.282,"body":"to eight eggs to even have a small chance"},{"startTime":1875.434,"endTime":1878.026,"body":"of having a normal egg. And"},{"startTime":1878.066,"endTime":1880.714,"body":"so I remind people that"},{"startTime":1880.89,"endTime":1883.446,"body":"you can try, but the chances are lower."},{"startTime":1884.626,"endTime":1886.446,"body":"However, when you're younger"},{"startTime":1887.506,"endTime":1889.526,"body":"and you're making one or two eggs,"},{"startTime":1890.426,"endTime":1893.114,"body":"I feel you can keep going ahead"},{"startTime":1893.21,"endTime":1896.182,"body":"because of the fact that most of your eggs are"},{"startTime":1896.214,"endTime":1899.086,"body":"good. So only getting 12 eggs at"},{"startTime":1899.086,"endTime":1901.934,"body":"a time obviously has a"},{"startTime":1901.99,"endTime":1904.606,"body":"small chance compared to your peers,"},{"startTime":1904.766,"endTime":1907.758,"body":"but still much higher than someone who's at 42"},{"startTime":1907.822,"endTime":1909.026,"body":"trying the same thing."},{"startTime":1911.126,"endTime":1914.106,"body":"Additionally, I think you can't look at IVF"},{"startTime":1914.446,"endTime":1916.986,"body":"as ah cycles when you're trying to determine"},{"startTime":1917.806,"endTime":1920.646,"body":"if you should do another cycle. If you're only getting"},{"startTime":1920.726,"endTime":1923.456,"body":"one or two EGs per month, then"},{"startTime":1923.576,"endTime":1926.328,"body":"six cycles really isn't that much when you're"},{"startTime":1926.352,"endTime":1927.916,"body":"talking about egg number."},{"startTime":1930.136,"endTime":1932.656,"body":"If someone goes through IVF and gets"},{"startTime":1932.736,"endTime":1935.408,"body":"22 eggs and"},{"startTime":1935.552,"endTime":1937.952,"body":"out of those 22 eggs only one makes it to a"},{"startTime":1937.984,"endTime":1940.984,"body":"blastocys and the other person who's"},{"startTime":1941.0,"endTime":1943.956,"body":"getting one or two eggs makes the blastys every time,"},{"startTime":1944.936,"endTime":1947.696,"body":"I would say the person going six"},{"startTime":1947.736,"endTime":1950.606,"body":"times making one to two eggs has more justification"},{"startTime":1950.646,"endTime":1953.646,"body":"to keep moving forward because at least when they go through things go"},{"startTime":1953.686,"endTime":1956.518,"body":"well, they can't help it that they make fewer"},{"startTime":1956.542,"endTime":1959.542,"body":"eggs. Whereas the person who is making 20"},{"startTime":1959.614,"endTime":1962.266,"body":"something eggs and still only getting one embryo,"},{"startTime":1963.006,"endTime":1965.266,"body":"their chances are actually lower"},{"startTime":1965.926,"endTime":1968.862,"body":"because it's not going as well. So, in"},{"startTime":1968.894,"endTime":1971.846,"body":"summary, if someone ever told"},{"startTime":1971.886,"endTime":1974.666,"body":"you you have diminished ovarian reserve,"},{"startTime":1975.786,"endTime":1977.366,"body":"take a look at the numbers,"},{"startTime":1978.586,"endTime":1981.366,"body":"take it all and whole. And remember,"},{"startTime":1981.986,"endTime":1984.226,"body":"diminish ovarian reserve is like saying"},{"startTime":1984.266,"endTime":1987.146,"body":"automobile. You cannot compare"},{"startTime":1987.186,"endTime":1989.946,"body":"yourself to everyone else. So if you hear"},{"startTime":1989.986,"endTime":1992.926,"body":"that someone did something, they got pregnant,"},{"startTime":1993.306,"endTime":1996.218,"body":"keep in mind that may not"},{"startTime":1996.242,"endTime":1998.842,"body":"be you. And just because you have the"},{"startTime":1998.874,"endTime":2001.63,"body":"same word diminished ovarian reserve"},{"startTime":2001.678,"endTime":2004.586,"body":"doesn't mean you have the same thing, just like"},{"startTime":2005.206,"endTime":2008.11,"body":"automobile doesn't mean the same thing in"},{"startTime":2008.158,"endTime":2009.626,"body":"every situation."},{"startTime":2011.446,"endTime":2014.23,"body":"If you are young, regardless of your"},{"startTime":2014.278,"endTime":2016.466,"body":"FSH and regardless of your amh,"},{"startTime":2017.086,"endTime":2020.067,"body":"you have the best chance of overcoming it. Now, clearly there are"},{"startTime":2020.099,"endTime":2022.831,"body":"examples that are severe, such as"},{"startTime":2023.131,"endTime":2026.131,"body":"ovarian insufficiency, that can make it"},{"startTime":2026.171,"endTime":2028.931,"body":"very difficult to get pregnant. On the same"},{"startTime":2028.971,"endTime":2030.951,"body":"token, if you are more mature"},{"startTime":2031.691,"endTime":2034.395,"body":"and your FSH levels are good and"},{"startTime":2034.443,"endTime":2037.123,"body":"AMH is good, your chances are higher of"},{"startTime":2037.147,"endTime":2039.931,"body":"having success, even though you have dimish OARI reserve"},{"startTime":2039.971,"endTime":2042.963,"body":"based off of age, because you make enough eggs to get"},{"startTime":2042.987,"endTime":2045.831,"body":"a big enough handful to get that green M and M."},{"startTime":2048.211,"endTime":2050.891,"body":"Today we check in the mailbag. Today's"},{"startTime":2050.931,"endTime":2053.355,"body":"question comes from Lauren. Her question"},{"startTime":2053.403,"endTime":2055.871,"body":"is, what are my thoughts on"},{"startTime":2055.911,"endTime":2058.407,"body":"transferring two embryos over"},{"startTime":2058.439,"endTime":2061.271,"body":"one? Lauren is aware that there are"},{"startTime":2061.311,"endTime":2064.143,"body":"risks with having twins. This is a"},{"startTime":2064.167,"endTime":2067.031,"body":"great question because I would have answered"},{"startTime":2067.071,"endTime":2069.591,"body":"this question different in the past than I would"},{"startTime":2069.631,"endTime":2072.484,"body":"now. As everyone, or, most people know,"},{"startTime":2072.612,"endTime":2075.34,"body":"I have two sets of twins, and both"},{"startTime":2075.38,"endTime":2077.772,"body":"times I put back two embryos in"},{"startTime":2077.796,"endTime":2080.535,"body":"ivf. I have never"},{"startTime":2080.567,"endTime":2083.567,"body":"been against putting back two embryos, and to this day,"},{"startTime":2083.743,"endTime":2086.215,"body":"I still am not against putting back two"},{"startTime":2086.247,"endTime":2088.895,"body":"embryos. I know there is a lot of"},{"startTime":2088.927,"endTime":2091.383,"body":"push to go to single embryo"},{"startTime":2091.431,"endTime":2094.099,"body":"transfer. However,"},{"startTime":2095.079,"endTime":2097.863,"body":"if you have never been infertile, I don't"},{"startTime":2097.911,"endTime":2100.279,"body":"believe you can understand the"},{"startTime":2100.319,"endTime":2103.191,"body":"mindset of an infertility patient. When it"},{"startTime":2103.215,"endTime":2106.092,"body":"comes to twint, it's not"},{"startTime":2106.116,"endTime":2108.84,"body":"just a financial decision. Although"},{"startTime":2109.46,"endTime":2112.116,"body":"getting 2 for 1 is quite nice when the cost"},{"startTime":2112.148,"endTime":2113.52,"body":"is exortbantt."},{"startTime":2114.46,"endTime":2117.036,"body":"But even the fact of having"},{"startTime":2117.188,"endTime":2120.012,"body":"two children, you would then know"},{"startTime":2120.156,"endTime":2123.11,"body":"that, you never have to worry about having another child and you"},{"startTime":2123.126,"endTime":2124.882,"body":"won't only have a single child."},{"startTime":2126.142,"endTime":2128.958,"body":"So I have never been against putting"},{"startTime":2128.99,"endTime":2131.562,"body":"back two embryos. And when I first"},{"startTime":2131.642,"endTime":2134.154,"body":"started, honestly, I think I"},{"startTime":2134.178,"endTime":2137.082,"body":"would tell people put back two embryos because they would give them their"},{"startTime":2137.122,"endTime":2139.382,"body":"best chance. And that's still true."},{"startTime":2140.162,"endTime":2142.978,"body":"No one can ever tell you that putting"},{"startTime":2143.01,"endTime":2145.73,"body":"back two embryos will not give you a better"},{"startTime":2145.786,"endTime":2148.314,"body":"chance than putting back one embryo. That's just"},{"startTime":2148.378,"endTime":2151.17,"body":"mathematically always true. And"},{"startTime":2151.226,"endTime":2154.13,"body":"anyone who Says otherwise is honestly"},{"startTime":2154.186,"endTime":2156.87,"body":"not understanding it or"},{"startTime":2157.046,"endTime":2157.962,"body":"is lying."},{"startTime":2159.502,"endTime":2161.998,"body":"However, where"},{"startTime":2162.03,"endTime":2164.974,"body":"I differ now is"},{"startTime":2164.998,"endTime":2167.566,"body":"that the rate of success is so"},{"startTime":2167.614,"endTime":2170.07,"body":"high when you do PGS."},{"startTime":2170.206,"endTime":2172.966,"body":"PGS pre genetic screening, also called"},{"startTime":2173.134,"endTime":2175.602,"body":"PGD A,"},{"startTime":2177.622,"endTime":2180.39,"body":"is 60% per embryo and"},{"startTime":2180.446,"endTime":2183.396,"body":"slightly higher at some clinics. When"},{"startTime":2183.404,"endTime":2185.996,"body":"you take that into account, two embryos"},{"startTime":2186.164,"endTime":2188.956,"body":"without testing have approximately a 60 to"},{"startTime":2189.004,"endTime":2191.312,"body":"70% chance of pregnancy."},{"startTime":2191.612,"endTime":2194.332,"body":"So one embryo with"},{"startTime":2194.372,"endTime":2197.22,"body":"testing has almost the same pregnancy rate"},{"startTime":2197.236,"endTime":2200.18,"body":"as two embryos untested. And so"},{"startTime":2200.196,"endTime":2202.992,"body":"I think this is part of what should play in someone's decision."},{"startTime":2203.692,"endTime":2206.58,"body":"If you have PGS"},{"startTime":2206.636,"endTime":2209.518,"body":"tested embryos, I think you can feel comfortable pulling"},{"startTime":2209.55,"endTime":2212.374,"body":"back one embryo without the"},{"startTime":2212.398,"endTime":2215.273,"body":"risk of, twins. Now, your twin risk would"},{"startTime":2215.321,"endTime":2217.029,"body":"only be 1 in 240,"},{"startTime":2218.689,"endTime":2221.309,"body":"whereas if you put back two embryos,"},{"startTime":2221.609,"endTime":2224.309,"body":"your twin risk would be 60% with testing."},{"startTime":2225.209,"endTime":2227.969,"body":"If you put back two embryos without"},{"startTime":2228.009,"endTime":2230.937,"body":"testing, your chances are 60, 70%"},{"startTime":2230.993,"endTime":2233.91,"body":"and about a, 40% chance of twins. Keep in mind, these"},{"startTime":2233.942,"endTime":2236.674,"body":"statistics is at our clinic."},{"startTime":2237.054,"endTime":2239.558,"body":"However, what I take into"},{"startTime":2239.606,"endTime":2242.502,"body":"consideration now is how many embryos you"},{"startTime":2242.518,"endTime":2245.334,"body":"have. If you only"},{"startTime":2245.374,"endTime":2248.246,"body":"have two embryos and you"},{"startTime":2248.27,"endTime":2250.91,"body":"want the best chance at becoming"},{"startTime":2250.982,"endTime":2253.878,"body":"pregnant, you actually have a higher chance"},{"startTime":2253.926,"endTime":2256.838,"body":"putting one embryo back at a time. Now,"},{"startTime":2256.846,"endTime":2259.526,"body":"I know this seems weird because I just got done saying two"},{"startTime":2259.55,"endTime":2262.396,"body":"embryos always gives you a better chance than one. And that"},{"startTime":2262.42,"endTime":2265.364,"body":"is still true. But if you only"},{"startTime":2265.404,"endTime":2268.188,"body":"have two embryos and anything"},{"startTime":2268.236,"endTime":2271.196,"body":"happens at the transfer, you lose both"},{"startTime":2271.22,"endTime":2273.704,"body":"your embryos. So"},{"startTime":2274.844,"endTime":2277.668,"body":"your chances per transfer are always"},{"startTime":2277.716,"endTime":2280.5,"body":"higher with two embryos, but"},{"startTime":2280.532,"endTime":2282.744,"body":"the cumulative pregnancy rate"},{"startTime":2283.044,"endTime":2285.904,"body":"between individual transfers is actually higher"},{"startTime":2286.484,"endTime":2289.28,"body":"than putting two back at the same time. So for"},{"startTime":2289.312,"endTime":2291.76,"body":"example, if you put back two"},{"startTime":2291.792,"endTime":2294.564,"body":"embryos and let's say"},{"startTime":2295.104,"endTime":2297.904,"body":"during the transfer you started moving or coughing"},{"startTime":2297.944,"endTime":2300.504,"body":"or whatever reason something went wrong,"},{"startTime":2300.664,"endTime":2302.924,"body":"that's it, you're done."},{"startTime":2303.904,"endTime":2306.8,"body":"Even if the transfer was off for timing purposes, or whatever"},{"startTime":2306.832,"endTime":2308.684,"body":"reason, you're done."},{"startTime":2310.104,"endTime":2312.484,"body":"But if you are doing individual transfers,"},{"startTime":2312.904,"endTime":2315.8,"body":"each transfer might have a lower chance than that"},{"startTime":2315.832,"endTime":2318.816,"body":"one transfer with two embryos. But because"},{"startTime":2318.84,"endTime":2321.608,"body":"you're getting two chances, if anything goes wrong,"},{"startTime":2321.656,"endTime":2324.496,"body":"you still have another chance, increasing your then"},{"startTime":2324.64,"endTime":2326.964,"body":"cumulative pregnancy rate."},{"startTime":2328.464,"endTime":2331.216,"body":"So how would I summarize things? I think there's a"},{"startTime":2331.24,"endTime":2333.944,"body":"couple things to take into consideration when choosing"},{"startTime":2334.104,"endTime":2337.016,"body":"how many embryos to put back. Now, I think"},{"startTime":2337.04,"endTime":2339.928,"body":"I should point out that your clinic may have"},{"startTime":2339.976,"endTime":2342.496,"body":"guidelines, and I recommend you following your clinic's"},{"startTime":2342.52,"endTime":2345.47,"body":"guidelines, since each clinic has their own"},{"startTime":2345.542,"endTime":2348.534,"body":"guidelines. However, at my clinic,"},{"startTime":2348.694,"endTime":2351.694,"body":"or if yours has a choice, I first"},{"startTime":2351.734,"endTime":2354.206,"body":"would look into how many embryos you"},{"startTime":2354.23,"endTime":2356.714,"body":"have. If you have"},{"startTime":2357.014,"endTime":2359.71,"body":"multiple embryos, then"},{"startTime":2359.822,"endTime":2362.806,"body":"if you want the risk of twins, I think it's fine to"},{"startTime":2362.83,"endTime":2365.518,"body":"put back too because of the fact that you have"},{"startTime":2365.566,"endTime":2368.35,"body":"multiple chances. Now there"},{"startTime":2368.382,"endTime":2371.366,"body":"are risks with twins. ###br it can split. You can"},{"startTime":2371.39,"endTime":2373.966,"body":"get triplet. However"},{"startTime":2374.15,"endTime":2376.634,"body":"that is something you should discuss with your doctor"},{"startTime":2377.454,"endTime":2380.158,"body":"and not every person is safe to have"},{"startTime":2380.206,"endTime":2383.182,"body":"twins. If you don't have a lot of"},{"startTime":2383.198,"endTime":2386.114,"body":"embryos such as only having two"},{"startTime":2386.774,"endTime":2389.262,"body":"or if it's very difficult to get embryos for"},{"startTime":2389.278,"endTime":2391.99,"body":"you, then I would recommend"},{"startTime":2392.022,"endTime":2394.91,"body":"putting one back at a time because that will give you the highest"},{"startTime":2394.982,"endTime":2397.614,"body":"chance at success"},{"startTime":2398.034,"endTime":2400.174,"body":"from a cumulative pregnancy rate."},{"startTime":2402.394,"endTime":2405.134,"body":"Remember there is no wrong or right."},{"startTime":2405.714,"endTime":2408.706,"body":"This is a personal choice that needs to be made between"},{"startTime":2408.73,"endTime":2410.614,"body":"you and your doctor."},{"startTime":2413.114,"endTime":2415.53,"body":"To keep this episode from getting too"},{"startTime":2415.562,"endTime":2418.413,"body":"long, I created the second part to"},{"startTime":2418.437,"endTime":2420.997,"body":"diminish ovarian reserve. Would you would like to hear"},{"startTime":2421.029,"endTime":2423.809,"body":"that? I've created a second podcast"},{"startTime":2423.945,"endTime":2426.745,"body":"that you can listen to. Have a great week"},{"startTime":2426.873,"endTime":2429.761,"body":"and I'll see you next week for Talkaco about"},{"startTime":2429.881,"endTime":2430.841,"body":"fertility Tuesdays."}]}