You're listening to the fertility docs, uncensored podcast, featuring insight on all things, fertility from some of the top rated doctors around America, whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.
Speaker 2Hello, this is Dr. Carrie BDN with fertility docs uncensored for our next episode. And I am joined by Dr. Susan Hudson of Texas fertility center and Dr. Abby Ablin of Nashville fertility center. Hi everybody. All right . So do we have a question this week?
Speaker 3We do have a question. Um, let's see here. Sorry. It's on the wrong page.
Speaker 2So while you're looking that up, Susan , um, we were talking about interesting encounters with other , uh, other species of creatures, both moveable and non-moving . Um, and so Susan, what did you encounter?
Speaker 3So I live in Texas and in Texas, we have it, especially if you live kind of in the country , um, we have scorpions and , um, I don't know if any of y'all have seen that, like a Facebook meme thing going on. That's like the nest of scorpions. That is one of my two nightmares. Oh, my end . When I'm at home, I I'm always wearing some sort of footwear.
Speaker 2I think you just gave me another reason to never go on Facebook again. I might accidentally see a nest of scorpions and that sounds,
Speaker 3It's so disturbing. It's so disturbing. And the thing is you never know when they're going to pop up. I mean, my, my son actually , um, he got stung by a scorpion one time he was , um, going to like turn on a light switch and he saw something moving. And so he touched it, which didn't make sense. And of course, God is hand stung, but about two weeks ago. So I wear glasses and I literally, if something is more than six inches in front of my face, it's blurry that you do, you do wear your glasses all the time when you take care of patients, right? Yes. All the time, all the time. However, not exceptionally convenient for showers. So, because I'm paranoid about this scorpion situation. I always, when I go and turn my shower on, I have my glasses on so I can examine the shower. It makes sure that there's nothing there. Well, I have one of those walk-in showers and literally the other day I'm finishing up my shower and I see movement on the floor and it was a scorpion. I , I screamed, my husband came and killed it for me, fortunately. Um , but yeah, I was like that, that is something I could live my life without. So for
Speaker 4Those of us who are not from a part of the country that have scorpions , what happens when you get stunned? Does it feel like a basting or is it like really hurt like a steam racing or
Speaker 3It hurts like hell does it okay? Yeah. It's I mean, and they're mean, and the interesting thing or me , they , they, they are mean they are not like, they're not the tech . I mean, they really are aggressive types of insects and they , um, you might be want
Speaker 4To move to Texas, Susan,
Speaker 3But you can even get stung if they're dead, because it's, the stinger still works. And so you don't want to step on a dead scorpion. And so at my house, like, I actually
Speaker 4Live in love though.
Speaker 3I , yes, better dead than alive, but I pay my kids to kill scorpion . So they get paid a dollar, a scorpion.
Speaker 2I think I may have to take that up. My, so we have a black light around our house, like a little light black light. And so the kids love playing with it. And so every so often we'll go around the house and make sure that there's no scorpions, but , um, that the money that we spend on having the pest control guy come around every however often is well worth it and is not an optional type of thing is it is a necessity type of thing. Cause those little buggers are hard to kill.
Speaker 3They are, they are, it says little exoskeletons. They're like resistant to so many things you can get rid of almost anything easier than he can scorpions.
Speaker 4I will say in Tennessee, kind of the only things sorta like that, that we have are brown recluse fighters . So they're kind of gross and creepy too .
Speaker 3Ooh , but scorpion sting though, I
Speaker 4Choose not to focus on brown recluse because I want to tell you about cool fauna story. So our floor, I don't know if you call it flora or fauna, but when I was a camper or counselor , um , in basically towns in Tennessee at foothills of the smoky mountains, I was just telling you guys earlier about running across Fox fire F O X F I R E. And it's basically this fungus that grows in you . We probably, in the course of the summer, we might see it three or four times when we're kind of in the higher elevations of the camp. And you'd be hacking down from somewhere. It'd be pitch black except for your flashlights. And you'd look way over and there'd be this green glow and it was so cool. And so you go trot never there, and it's this fluorescent fungus. And it's like a blue , green fluorescence that you see. And so, you know, whatever it was growing on, usually you'd take it with you and it'd be so cool. And then, you know, you'd save it. And then the next morning you wake up and you look at it and you think, oh, this is going to be so cool. And it just looked like a stick or something. It didn't glow obviously the next morning, but it was, it was a really cool natural phenomenon to see this fluorescent fun guy that grew kind of only in a certain part of the country. So
Speaker 2People used to think that they were being like chased by ghosts when they would see it out in the distance. When it wasn't, wasn't so close that you could tell it's a fungus that's growing on a stick or a , or
Speaker 4I'd be like, you know, like those neon glowsticks , the kids have those green neon close to exceed and you just see it glowing over in a distance. And you'd be like, what in the world is that? And you start walking over and as she got closer, you could tell that that's, you know, just be something glow and green. And we, of course we knew it was FOXFIRE . You know, we saw it. It's hard to be .
Speaker 3That's cool. I've seen pictures of like this like pools of water that have stuff like that. I would like to see that that would be a bucket list thing. I think,
Speaker 4I think Puerto Rico may have something like that. So if anybody's from Puerto Rico and listen, listen to us, fill us , fill us in about the fluorescent funk on the water. But I think it's, I think it's in Puerto Rico. I've heard that before.
Speaker 3Cool, cool. Well, I have found our podcast question submission. That was alluding me. Um, and so our question for this week is what is the difference between long protocol and short protocol IVF ? How do you decide which is best for your patient ?
Speaker 2That's a good question. That's a more technical question than we usually get. So long protocol versus short protocol typically refers to what kind of suppression you're using. And whenever you're doing an IVF cycle, the goal is to grow as many eggs as possible , um, as are available on the , the ovary and then to have them all release at the same time. So that when you go in for a retrieval, you can capture them all. Well, in order to evade the , the brain's natural release function, you have to have some sort of controller medication so that while you are growing the eggs, the release doesn't trigger early and give premature ovulation. And so we use one of two types of medications. The general class of Kwan is a GnRH agonist. And the general class of other is a GnRH antagonist, and which class of medication you're using shows whether or not you're using a long protocol or a short protocol. So the long protocol tends to be with Lupron, which is a GnRH agonist. And that takes a little bit of time. And that's why it's called a long protocol because when you give an agonist, what happens is that drug goes into the system and it binds all these receptors and it says, Hey, I'm here. And it triggers those receptors to kick out all of their hormone. Now that is very helpful in many cases, but when you're trying to suppress all those hormones, you want to do that at a time when it's not going to do damage to your ultimate goal. And so you typically have them start the Lupron early before they start their stem meds. And so it means that they've released all that medication or released all that hormone. They then start the medication and their brain is no longer releasing the stimulatory hormone. So that is a really useful cycle in cases where, for example, you're worried about hyper stem and you really want to shut them down. Um , at least that's what it was used for more often in the past.
Speaker 4And I would say to , just, to , to pop in for a second, that probably more people use the agonist cycle or do the agonist cycle now than, than using the Longwood Pran cycle, mainly because of what Carrie was just saying, that it really, really reduces the number of people that have the side effect of hyperstimulation , which is where the ovaries get really big and fluid can sometimes collect in the body cavity and just can cause lots of discomfort and lots of issues. And so I would say probably most people now use that, do the agonist cycle. And so an agonist would be something like central Tod or Ghana relics were sort of the trade names of those. So,
Speaker 3So our question of the day for this week is what is the difference between long protocol and short protocol IVF? How do you decide, which is the best for your patient ?
Speaker 2So long protocol versus short protocol IVF refers to what type of oscillation suppression you're using. So anytime we do an IVF cycle, the goal is to have you ovulate when we want you to ovulate, but not a moment before. And there's two ways of doing that. One is with what's called a GnRH agonist. And the other is with a GnRH, antagonist, and both serve to shut down the body's production of the hormones that cause oblation, but they do it in slightly different ways. So when you're using an agonist protocol, that's typically with Lupron, what happens is it's a longer protocol because it takes longer for the medication to work in, get to the point where you want it to, because when you take the Lupron, what happens is that medication binds all the receptors in your brain that tell the FSH and LH to fire, and they all get released in high amounts. Now that is helpful when you want someone to ovulate, but in this case you don't want someone to ovulate. So what you do is you give it to them before they really get into the cycle and their supplies of FSH and LH go down and then their brain has kind of a , an empty reserve. And so everything is shut down and then you start your cycle and go in through the IVF.
Speaker 4So caring , when would you use one versus the other?
Speaker 2So that is a cycle that a type of cycle that used to be used very commonly , um, because it was a medication that was more readily available and it was a better control of as you're going through the cycle, making sure that someone did an articulate early, and it was one of the, the earlier medications that , that people would use. And it's, it's a very different type of cycle than an antagonist protocol. And one antagonist protocol does is once someone starts taking the medication as her hormone levels increase and as her egg size increases, once it gets to the point of getting closer to ovulation, we give the antagonist and the antagonist goes in and it just flat out blocks those receptors. So there's no firing of the ovulation hormonal signals until you take that medication away and you give the signal. And so it means that we're running on track with more of a normal ovulatory cycle. And so that's considered more of a short protocol.
Speaker 4And one last question about that, what would you say is the biggest advantage of that cycle as opposed to the older cycle that we used ?
Speaker 3I think the biggest advantage in using an antagonist cycle is that we help re significantly reduce the risk of ovarian hyperstimulation syndrome or OHSS OHSS is a condition that women can get fluid in their lungs, fluid in their abdomen, blood clots, and salt abnormalities. People can end up in the hospital. People can even die from it. It's very, very rare that something like that would happen. Um, but , um, OHSS is one of the things that we worry about. And so when we , um , use that antagonist cycle, we are able to use actually that Lupron that we were talking about in the, in the long cycle to create our trigger and that trigger after that happens, everything shuts down really quickly. And so people, their ovaries start getting smaller, faster, their hormone levels drop faster, and we kind of get back to normal a little bit more expeditiously. And so , um, there's an advantage to that. You know, some people, some people aren't candidates for a , um , Lupron trigger , um, and people who aren't candidates or people who have recently used flu prawn because there's this receptor turnover that has to happen. Um, or if they naturally just don't produce L H out of their brain as well as they normally should. So
Speaker 2That was a very good question.
Speaker 4The point that quite well, I must say good job girls, ladies.
Speaker 3So what's on the docket today.
Speaker 2So today we are talking about IVF after the age of 40 and how you go about it. Lastly,
Speaker 4Fertility after the age of 14 .
Speaker 2Oh , that's true. Fertility after the age of 40. Um, and I would even say that I was giving things away, but I'm not really giving anything away. Cause it's IVF after the age of 40 is not always a given. Um, so, so fertility after the age of 40, when your patients come to you and they say, okay, my birthday puts me in the , the over 40 crowd. What do you do? What testing and how do you start? So
Speaker 3The first thing I do is I really try to educate my patients on what, what, what makes it so hard to get pregnant at 40. And so basically when, where , when women were in their mom's tummies, we had about 3 million eggs. By the time you're born, you're down to a million. And by the time you go through puberty, you're down to about 300,000, you obviate or release about 450 eggs in a lifetime. And the rest of them undergo something called a treasurer program, cell death. They just kind of disappear the rate at which they disappear significantly increases in the upper thirties and early forties. In addition to that, not only do we have a quantity issue, we also have a quality issue because those eggs have been with you for a year longer than you've been on. You get to count your presence on earth, they're they become fragile. And so when all those little divisions have to happen to create little embryos and essentially little babies, mistakes happen, and in humans, mistakes happen all the time. And the fact that they're even more fragile, the percentage of those chromosomal errors significantly starts increasing. And so that's kind of the nuts and bolts of what makes it harder. But then we have to add in the entire fertility picture, because as we all know, getting pregnant is more than just eggs.
Speaker 4So you're saying there's a shelf life on our eggs in other words, right? No matter how fertile we've been, there's a shelf life. Unfortunately
Speaker 3There is, there is. And, you know, you can look at charts that , you know, the chances of getting spontaneously pregnant, even in late forties. And I , I always say, I never say never, okay. There's always that person who they had a aunt or grandma or a mom who had a child that in advanced 40 age. And it does occasionally, but rarely happen . Um, you know,
Speaker 4When you, when you look sorry to interrupt, but when you look at the women who are able to get pregnant over 40 and the ones who are actually successful first , there's really no way to do that. But it's very, very small percentage of women who are able to get pregnant and stay pregnant and ultimately, you know , deliver a lot for baby . It's just a channel .
Speaker 3Yeah. And I think this is one thing where I'm kind of celebrities and the media create a false illusion , um, to how easy it is because you see these people getting pregnant at 50 55 and it's like, oh my goodness. And I'm like, yes, they're pregnant, but I can tell you, they're probably not telling you the whole part of the story. Okay. Can you get pregnant at those ages? Yes. But you don't, you don't know all the nitty-gritty and it's probably not the same situation. You know, a lot of these people are probably eating either using donor eggs or they may have cryo-preserved eggs or embryos, you know, years before. That's probably a much smaller proportion. Cause I don't think a lot of people think that that , um, but it's one of those it's if you take the very small chance of getting successfully pregnant and multiply that times, the chance of becoming that famous those odds are, are really low.
Speaker 4So one thing I think is important to point out too, that, you know, unfortunately as Susan has illustrated really well, you're kind of on a time table, if you're 40, you know, unfortunately as much as I hate to say this, the clock is kind of ticking. And so you have to really think you have to be aggressive. You can't just sort of lay back and say, okay, well let me see what happens down the road. You really have to be kind of aggressive. And I think part of that is knowing the scope of the problem. You really want to make sure that, you know, you've been tested with, with blood tests, things like anti-Mullerian hormone to kind of get an idea of where you sit on the reproductive spectrum. Uh, you want to probably check your fallopian tubes pretty soon, early on to make sure they're open check your uterine cavity to make sure there's not , um , you know, something like a fibroid growth was in the cavity that would cause a problem. And also you want to check your partner too, cause you just never know, you know, what his count is going to be. So I think it's really important that you very early on know the scope of the problem and kind of know what you're dealing with before you then start with other treatments,
Speaker 3Kind of what Abby's talking about. I think it's really important if you're just now thinking about having a baby and you're in your forties, you don't need to sit there and wait six months to a year to go get things, checked out, get things checked out now just because you get things checked out, doesn't mean you have to actually do something. Okay. But I think it's real important to have that knowledge because at 40, you know, the difference between 40 and 41 and 42 and 43 , um, those are, those are very, very different case scenarios. And so if somebody comes into me and they're 40, I'm concerned, but my level of concern at 40 is not nearly what it is. If somebody comes to me at 43,
Speaker 4But you know, even the ASR and American society for reproductive medicine would say, if you're 35 or older, you don't need to wait more than six months if you're trying to get pregnant. And I would say, if you're late thirties, early forties, as soon as you make the decision that you want to get pregnant, like Susan said, it's probably a good idea to see somebody really early on, because it's better to know on the front end. You know, if there's some sort of problem. And
Speaker 2Then when you get the test results back and they are reassuring, and this is something that I see , um, somewhat frequently that someone will get tested and they'll say, oh, my results for age 40 are great. So I should be able to do this. No problem. It's , it's both a quantity and a quality issue. The testing that we're able to do is better able to measure quantity. It doesn't have as great of a , a bead on quality. And so the main way that we measure quality is by the birthday test . How old are you? Because we know that the longer those things have been sitting there, the more faulty the mechanisms and the mechanics behind the chromosomal separation is, and that is really, truly the end all be all of our success because it's not just the getting pregnant, it's also the staying pregnant. And so what I tell my ladies who are in their forties is okay. If you, if you came to me saying, you're going to go off birth control and you're going to start trying next month and you get testing and it's all really reassuring then, okay, go ahead and start trying next month. But I'd like to have a plan in place so that if you're pregnant, phenomenal, we're going to follow it . We're going to support it. We're going to move forward. But if you are not pregnant, you're going to come right back in and we're going to start moving forward because as Susan said, the difference between age 40 and age 41 and 42 is much, much different. You know, nobody's going to think twice about a 20 versus 21 versus 22 year old. But success rates are significantly different between a 40 year old and a 42 year old. And we, all we want is the cute baby picture that you send us at the end of the day and to help you get there. So, Susan, what does Kerry mean by moving forward more aggressively? What does that mean?
Speaker 3Uh , I would say that as I mentioned earlier, you don't necessarily have to wait for treatment if you don't want to you, if you wanted to go try on your own for a little while, that's okay. But you know, if you go and try for three months and you're not pregnant, what we know in humans, regardless of the age, most people who are going to get pregnant, it's going to happen relatively quickly. Okay. And for younger people, we generally say, we know that in the first six months of trying, you have a much higher success rate than your second six months. And then once you pass a year, chances go way, way down. Well, I think we have to kind of speed up that process if we have somebody who's in their forties. So like I said, if you want to get a, try 2, 3, 4 months and you haven't tried at all beforehand , um, then I think that's fine, but then we need to start talking about, you know, what types of treatments may be the most appropriate for you. And they go from relatively non-invasive to , um, things that some of you may have never even thought about. So , um , kind of starting off , uh , on the, on the simpler Fox side, people think about, you know, taking medication, using that in combination with inseminations, I can say in my practice, I generally don't encourage oral medications in my 40 clusters. Um, there was a pretty good study done probably about 10 to 15 years ago. Now that looked at gonadotropins , which is the injectable medications with [inaudible] and ladies who are 38 and above. And in that 40 and above age group, the take home baby rate is about 4%. And that's that's whether you do one cycle or five cycles. And so to me that means doing something less aggressive than that is going to give us less of a chance of success. And so that's generally my kind of launching point if somebody said , oh, I absolutely, we're not going to do that because of cost or anything. We can try something less as long as they understand the risks and benefits of it. Um, but that's where I kind of start on the conservative side, but some people want to go onto things like IVF more directly. And that's very, very reasonable. Um, when we're looking at somebody who's in their forties,
Speaker 4How I always say to that, it's always talk about cost and success because unfortunately the more aggressive we get, the more successful the therapy, unfortunately, the more invasive or the more expensive. And, you know, I never liked to tell patients they only have one option and I never really do that. Um, but I think most of us probably would agree and I'll be interested to hear what hearing Susan say about it. The older the patient gets, the more we worry about time and the more we really feel like we need to move more aggressively. And I think most fertility physicians would agree that hands down IVF is the quickest route to pregnancy and the most successful. And so I usually joke and say, if I could send every one of my patients that walked through my door, no matter what their age is to IVF, I would. But I really think that that's a very true statement and women over 40, because Tom is not on your side. And, you know, if you choose to do IVF within three or four months, potentially we could retrieve eggs, making embryos, transfer the embryos and you could be pregnant and, you know, is provided, we find genetically normal embryos and you, I mean, you have a really high success rate with IVF. So , um, I think it's something that you really need to strongly consider when you embark on pregnancy over the age of 40, or at least think about that as a potential option sooner rather than later,
Speaker 3What would you describe as some of the , the biggest benefits and somebody who's over 40, if they're going to pursue IVF
Speaker 2Biggest benefits of doing IVF, I would say hands down, it's the ability to get more eggs than just doing a , uh, a mild stimulation protocol with kilometer Letrozole or one of the oral medications or, or even the injectable gonadotropins. Um, and with getting more eggs, you get the ability to create more embryos and IVF is at heart, a numbers game. I tell my patients this all the time, everyone thinks the gambling in Las Vegas happens on the strip. It doesn't, it happens in the fertility clinics because with our patients over 40, you know, you're, you're trying to get as many eggs as possible so that you get as many embryos as possible because you know that that many of them are not going to be normal. And people always ask for percentages. And it's very difficult to give percentages because when you're only getting two, maybe three embryos, if you have three embryos and you have one versus abnormal versus two verses that are abnormal, you have gone from 33% to 66% just like that. And in one embryo can swing hugely. And so the more eggs you have to work with, the more embryos you have to work with the higher likelihood, you're going to get a genetically normal one. And that's true, whether you decide to do the genetic testing or not. And the genetic testing is a huge benefit of doing IVF in your forties, because you can avoid transferring an embryo that is going to vary , obviously not implant . I mean, if you have to multiple too many or too few chromosomes in that embryo, you know, it's not going to stick. Um, but also is going to avoid some of the survivable abnormalities things like down syndrome. Some of the lesser known ones like trisomy 13 or 18, which are really devastating conditions where the children don't live past one to two years of age, if they even make it that far. And in one of the things that many of my patients, when they come in, a lot of people will say, well, we want to try the most natural way possible. And they'll either opt for time dinner course, or they'll want to do oral medications with insemination. And, and they will be able to get pregnant, but the pregnancy won't stick and people really underestimate just how devastating and traumatic and time-consuming miscarriages are because not, excuse me, not only are you in the process of growing and then losing that baby, but oftentimes it is not an overnight thing. It takes a while for that process to work its way through. And while it is working through, we are not actively trying to get you pregnant again. And so, so we're losing months and end each month matters. And so when you're going straight to IVF, you're bypassing a lot of that by getting more eggs at the outside, getting more embryos, doing more testing and, and heading straight for your end goal, much more directly. One of the other things that I think is really helpful is if I have someone who comes to me, who says, you know, I met my partner much later in life. We really want two kids, three kids, you know, more than just that first one. If we have any hope of that, we need to do IVF because we've got to get those eggs out now, because by the time you've got someone who's 40, by the time we get her pregnant and she delivers, and then she gets her head out from underwater of having a newborn she's 42, by that point. And , and that starts to cut down on our chances of baby number two,
Speaker 4Say, for example, you're 40 and you come in and we find out that you have a really low egg number. Um, and we try some things and they don't work and you even do IVF and it doesn't work. What are the other ones
Speaker 3You have said? The other options that people consider are we can think about using donor egg. We can think about using dinner. Embryo, people can think about adoption and people can think about child-free living. And all of those are, are very reasonable options and things that we , um , kind of help our patients work through to figure out what's going to be their best option. Um, a little bit about donor egg and donor embryo, donor egg. Um, there's a couple of different ways that that is done. Um, you can have either what we call a known donor. So somebody that you actually know have interacted with, sometimes people have a sister, cousin, friends , you know, somebody in their life that they're going to essentially use one of their eggs , um, or most commonly in the United States, we use anonymous donor eggs. So , um, women have gone either are willing to go through or have gone through IVF cycles to harvest their eggs. And those eggs can be used with your partner's sperm to create embryos. And , um, so those are a couple of ways that we can help , um, at least maintain lineage of one partner. However, one thing I've been seeing happen more and more often in the U S and I'm sure this is across the world. We are ending up with a , a true surplus of embryos that are cryopreserved , that people have completed their families, and they're , they're not wanting to use those embryos. And so , um, there are programs where you can either adopt slash purchase embryos from people who have completed their families, but they want to give their little embryos a chance at life, and you still have the chance to carry the pregnancy through delivery, breastfeeding, all of those parts. And, and it's really kind of a really special gift. And , and I'm , I'm excited that that's, that's becoming more, more acceptable and more popular. At least in my region.
Speaker 4We we've done that the whole time. Really I've been in medicine, we've had a program for donor embryos, and you know, what I usually say about donor embryos is there are a few people that will come to me and say, I really want to get pregnant with the donor embryo, most people, however, it's a process. And most people unfortunately kind of go through the process of trying to have a baby with your own eggs and owns from , and it didn't work out. And, you know, a lot of times there'll be really sad, which is understandable. They'll leave for awhile . And then after a year or two or whatever, they'll come back. And, you know, I will say over the course of several years, I have several happy stories of patients who, you know, it was really tough for them to make that decision. Um, it was really something that they really, it took a while for them to come to , but almost variably every time I call my patients when they've had their babies. And I talked to him, the first words out of their bowels are Dr. Evelyn. I don't know why I didn't do this sooner. I'm so thrilled. You know, the genetics don't matter to me when I'm looking at my little boy and my little girl's eyes, it really does matter. And I'll see that time and time and time again. So for anybody out there that sort of listening to this and has really gotten really bad news, and you don't think you're going to be able to have your own child genetically there's, there's a lot of different ways you can become a parent. And , and there's lots of happy people that have done the same thing that you've done and gone through the same thing you have, but ultimately they had a happy outcome using donated embryo .
Speaker 3And I think it's important for our listeners to know that fertility truly is a journey and it's okay to change your mind. I mean, very few people walk into any of our offices and say, I want to get pregnant using donor egg donor embryo. I do have a few, but that's the exception and not the rule. And so, you know, what may not have been a realistic option for you and your particular situation last year, or even a couple of years ago at this point in time, it's okay to change your mind. And if that happens, then, then that's great. And we're we're we want to do, what's the right thing for you. And you're the only one who's going to be able to make that decision. Yeah .
Speaker 4I'll echo that. It's okay to change your mind. This is a tough thing to go through and it's okay if you know, I've had many people go, oh, there's no way I'd ever do that. And then a year or two later, they changed their minds and that's okay. We won't make fun of you or anything
Speaker 2Without a doubt. It is a
Speaker 3Journey. Absolutely. Absolutely.
Speaker 2So one of the other things that we, we always get, and we'll , we have talked about this in other episodes, but just to make sure we touch on it in this episode as well is we always have people who say, what can I do to improve my egg quality after 40? What do you tell your patients?
Speaker 3I don't smoke. If you smoke, quit
Speaker 4Smoking hands down is one of the worst things you can do for your eggs . It's amazing. When I see people, even in their mid thirties, sometimes it had been smokers and they had a really pregnant verse. So definitely don't smell
Speaker 2But supplements. Anything else? Is there anything that you guys have seen really solid data on that can change the course of someone's biology? Once that course has been set aside from smoking and other toxic ingestions, you know, big doses of radiation growing up next to Chernobyl actually have a disproportionately large patient population where that is the case required IVF like five or six patients. Um, but is there anything else that you guys know that a woman can do to change the quality of her eggs once that quality has been set?
Speaker 3I don't think that there's anything that's going to truly change the quality of your eggs. Now, I think there is reasonable, not exceptionally strong, but reasonable evidence that DHA and cocuten do improve pregnancy outcomes in people with diminished ovarian reserve. So more likely to have a successful pregnancy and people whose ovaries aren't functioning as well as we would like them to. Um, but it's , they aren't miracle pills. Um, unfortunately there's, there's nothing that we have in my opinion, that reverses the course of time for women.
Speaker 2Yeah . I would agree with that, Abby , anything that you have come across, that's a miracle drug. No,
Speaker 4No miracle drugs out there. I mean, we put our patients on coenzyme Q 10, it , in theory, it may help a little bit with cell division. Um, you know, I wish it was under more of our control, both our patient's control and as a physician, I wish it was more under my control, but unfortunately by the time you get to be 40, 41 42 it's it's nature has taken over, unfortunately for many people and it's just really difficult to get pregnant.
Speaker 2All right. Okay. Well, so to our audience, thanks so much for listening and be sure to tune in next week for more also be sure to subscribe and leave us a review in iTunes. We would love to hear from you .
Speaker 3You can also visit fertility docs and sensor.com to schedule an appointment with any of us or submit questions that you have about your fertility situation. All questions will be answered and honest on anonymously on the podcast, in our asset ox segment. And please let us know anything you have questions about. All right,
Speaker 4Guys, we'll talk to you soon.
Speaker 3Bye
Speaker 5[inaudible] .