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Speaker 2Hello everyone. This is Dr. Carrie Beadon with the fertility center of Las Vegas here with my two lovely, delightful, beautiful, charming stunningly, vivacious, incredible co-hosts .
Speaker 3Wow.
Speaker 2Not have it. The soreness in front of me, this is just from looking at your two beautiful faces . Um , Dr. Abby , Evelyn from Nashville fertility center. Hey and Dr. Susan Hudson from Texas fertility center. How are you ladies? Both doing today.
Speaker 3We are doing wonderful. And even better since we're talking together. Yes, but now that
Speaker 4It's summer, it's just slapped . Just feels good.
Speaker 3What's your favorite season is summer your favorite? Yeah ,
Speaker 4Like some , a lot, actually I'm in Tennessee. I'll have to met out really like fall. Ball's probably my favorite season. That's the season I chose to get married in because of the leaves are just so pretty here. So probably falls my favorite, but I really liked summer light too.
Speaker 3What about you, Carrie ?
Speaker 2We had a fall wedding too. Um, but I think it's probably a tie between summer and fall because I mean, I grew up in the desert, so I'm a desert rat. So the heat is no big thing. And in Vegas it's actually a lot cooler comparatively than it is in Phoenix. And it's about 10 degrees, but it is the most important 10 degrees ever go. So someone who's pretty high up there. I mean , I would say it's a solid number two . Cause spring here is just a tease . Like it's a , here's about two weeks in cool, but really sunny temperatures. And then, and then it hits summer. And so spring, I don't understand the concept of, so I think summer is pretty high. What about you, Susan?
Speaker 3I like early summer. Well, in Texas, like may, June early July is , is nice. I mean like it right now, we're in our rainy season, but it's, you know, you can get set on your patio, enjoy outside and things are green and pretty August sucks. Okay. Like there is no other way to say it. Everything turns brown, it all dies. It's icky and everybody, we always have a drought and then we all ended up on water restriction and all you hear is people griping about water restriction and what you can and can't do. And who's cheating
Speaker 4And cheating on their partners, but cheating on their lawns
Speaker 3Amazingly every year, September always happens. And what happens in September? It's kind of like me , it rains, it rains every year. My birthday's in September. And like as a child, like I remember like it was almost a guaranteed that it was going to rain some the week, weekend of my birthday. Like it just rains in September and then the droughts break and we kind of go into our like crazy circle. But I do like I like early summer when things are pretty and not a hundred degrees yet and not scorched
Speaker 2With these giant yellow bell bushes in my backyard. And because spring only vaguely exists here. I always know that it's summer when my yellow bells start to bloom and this last year we didn't cut them back to look like tiny little stick bushes. So they started off really tall and they're pretty fabulous. Cause it's just this huge burst of yellow and green. And I love it.
Speaker 4Yeah, that's kind of my, my thought that summer's here is first, the Azalea start to come out in spring, which are really beautiful around here. And then finally, when my hydrangeas start to bloom, they have big, you know , white and blue and pink flowers. And when they finally start to blame, that's when I really know it's summertime and I dislike , I just like the heat. It's just not , I mean, not hot, hot heat, but nice enough that you can go sit down on your porch or sit down on your deck and eat dinner. And that, to me, that's just the funnest part about summer is coming home and still it's still being daylight outside when I get home and being able to spend time outside, you know, with my family.
Speaker 3That's awesome. I live , we're where we are. We have lots of white tail deer. And so right now all the mamas are very pregnant and they're going to start having their funds in and the baby funds are so cute and they're, they're just, they're just darling . They're just darling. And then they eventually became teenage deer. Teenage deer are not very smart. It's just like regular teenagers. They, you have to keep up like the baby fond stick near the moms and the grown-up deer. Like they know like people in cars and I'm in kind of a acreage communities. So it's like, we all have some land, but we, you still have neighbors and stuff like that. But our deer had us all very well-trained. We know they were here first. Um, but yeah, baby deer season. I love it. I love it.
Speaker 2This is going to sound like a dumb question, but I've never lived anywhere where there's deer frequently in the area. Really . Can you look at , uh , you know , I mean I'm a desert rat always happen . Um, can you look at a pregnant deer and know that she's pregnant,
Speaker 3You can towards the end, like right now you can see them in. It's like they are definitely fuller. It's kind of like when you look at a horse and it kinda goes up where upward towards the rear end, like you're kind of are like that. And like right now they , they look pretty chunky. And actually when it comes to white tail deer, I read an article from our HOA recently that like the percentage of twinning is like over 50%, which is crazy, but that's just proofing of how much they are prey and um, how much they have to do to survive. But they have a huge rate of twinning because you do see a lot of them. And I've actually, until I read that, I was really curious as to do deer , um, kind of adopt other, you know, deer cause you see multiple baby ones with a single mama a lot. Um, and it was interesting because so the baby, the little boy deer get to hang around mama for a year, little girl deer get to hang around with mama for two years.
Speaker 4Oh,
Speaker 3Interesting. So I, I thought that was another little interesting tidbit for Texas, Texas lore .
Speaker 2All right. Well on from baby dear to our question of the day. So this question's about school careers and fertility treatment . So while we all hear about people delaying pregnancy well into their thirties and forties to focus on school and careers, what about those who decide to go for it anyway, college often takes place in your prime fertility years, especially if you go to school a little bit later or pursue a more advanced degree. So I assume that women have babies including planned or fertility treatment babies in college fairly often, but you never really hear about it. Can you talk about your experiences with this? So what, what are your guys's experiences with younger women needing fertility treatment in terms of like, this kind of sounds like the 25 years old patients and younger , um, or even maybe a little bit later in their twenties, what are your guys' experiences?
Speaker 4I think regardless of what you're doing, otherwise, whether you're working or in college or whatever. I mean, I think there's a few people that we see in the early twenties and those are usually people who don't ovulate at all. So, you know , unless we give them something to make them make an egg, they have trouble getting pregnant or who have blocked fallopian tubes or who have partners that have a really low sperm count or don't have any sperm. And all those are generally the ones that we tend to see early on. Um, it's pretty rare to see anybody for true infertility . Um, I just think as you get older, you know, like everything else, more problems arise, you have more exposures potentially to sexually transmitted diseases that can block your tubes. Um , more reasons why your husband may have low sperm count. And so I think just older women just have more potential issues in addition to the aging of the , the eggs. But we definitely do see younger women, just not as many
Speaker 3Completely agree with Abby. I think I've had a pretty enlightening experience getting to be in Texas for most of my career, but I went, I did my fellowship training up in Minnesota as a little background for me. I got married when I was 22 after my first year of medical school. And then,
Speaker 4Oh , I didn't know you were that young when you got married, you were a baby.
Speaker 3I was a baby. And um, my first child we had when we had been married for like five or six years, it was in my third year of residency. So , um, you know, I was still in my kind of mid to late twenties , um, and where I'm from, that was not unusual. And so, you know, I have, I don't have a whole lot of patients that are less than 25, but I have some, I think I probably have more patients in that 25 to 30 group than I necessarily experienced when I was in Minnesota. But when I was in Minnesota, like everybody thought I was afraid because I had gotten married at 22, which was like unheard of because all of them were like not even married yet. And , um, I was having my second child and fellowship. And so , um, it was much more of a, we put it off type of thing and it, it , I do think there's definitely regional differences that you can experience, but there within all regions, you're going to have people, you know, we have people, I , I have patients who come in who are 20. Okay. And then I have patients who come in at 50. And so , um, most reproductive endocrinologists I think, are going to see, you know, the entire gamut. And also unfortunately for a lot of people, you know, when it comes to actual fertility treatment, a lot of it is still cash based. Insurance doesn't necessarily cover it. Granted there are some mandated states and insurance coverage is increasing in that type of thing, but most people still don't have access to insurance paid fertility care. And so if you're looking at something that even costing a few thousand dollars or $2,000 a month for, you know, an IUI treatment, or if you need to go to IVF and you're looking at something with a much, much bigger price tag, those dollar amounts are, they're harder to swallow when you're younger. Cause you've had less time to, you know, grow your earning potential. What do you, what do you think Carrie ? So
Speaker 2With where I am in Vegas, I have two, two populations of younger women who come to see me. And , um, one, one set of the population is the, the female couples and our LGBTQ , um, population. Um, and they're women who they've met their partner. They know they're ready to start the family. They have what I call a permanent lack of male factor. And so they know that they're going to need some kind of assistance in terms of getting pregnant. So that's one subset of women and those patients are simultaneously easier and harder. You know, they're easier because they're young and they're healthy. They are harder because 15% of women have unexplained infertility. And that, that number doesn't really care whether or not you partner with men or women or whomever. And so , um, so it's easier because a lot of times they're easier to get pregnant. It is more challenging because there's going to be a subset that don't where you have to work harder to do it well. And kind of, you know, talking about what Susan was, Susan was talking about cost . I was just thinking about a same-sex couple that I saw last
Speaker 4And finances were their big issue. They really wanted to start a family, but , but like you said, Susan, they, they had no coverage, which most people don't, and they're really young and they just don't have a lot of money saved up. So that's something, you know, that they're going to have to work with to try and be able to afford to do it. So, yeah, I think for young couples, that's, that's a big issue if you're same-sex
Speaker 2And then there's also , um, a couple of , um, subsets of the population were getting married at age 18, 19 20 is, is very common. It's just what you do. And so with a subset of the population, they have started to try at a much earlier age than I think many other women do. And so they're coming in at age 21, 22, 23 , um, because they have been trying for a couple of years and it hasn't happened, you know, again, they're limited by the financial because of just the impact that , that, that has. And they may or may not be in a really stable, good insurance providing jobs that can help them at least get the diagnostic treatment. Um, but for those couples and for a lot of our younger couples in general, I tend to work a lot more with their regular OB GYN where we know insurance is going to cover that. And so I'll work with the OB GYN and say, okay, tweak it this way, order this ultrasound here, things were coming out of my office insurance, isn't gonna pay for it, but coming out of their general OB GYN, they might get it covered. And so there's, there's some tandem working there with the docs in the community to help, help get our younger patients taken care of, but their overall success rates tend to be really quite good because they are know . And so that's, that's phenomenal. It's just in general, we see them proportionately less than our ladies who are in , in their , you know, probably I'd say 28, 29 years and older.
Speaker 4Yeah . One other group too , that I was thinking about as well is younger patients that have a condition like endometriosis. Sometimes you see really young patients that can have really bad endometriosis that can make it more difficult for them to get pregnant. So , um, but yeah, we definitely see young people, but just proportionately. We see a lot more people that are late twenties, early thirties.
Speaker 2All right. So going on to our topic of the day, which it kind of segues nicely from our question is what is IUI and how does that work? Because oftentimes a lot of our younger patients are going straight into that because they've got the time and they can work with so Abby, can you tell us what our UI is?
Speaker 4You asked stands for intrauterine insemination. So that's basically , um , taking sperm , um , from either partner or donor sperm. Um , it's prepared so that we remove the seminal plasma and we concentrate the sperm into a really small volume. And the benefit of doing entry uterine insemination potentially is that we bypass the city gage of the vagina, which can cause the sperm to die sometimes, or some of it to die. We bypass the cervical mucus sperm can get kind of tangled up in that sometimes, and just basically get the sperm closer to the uterine cavity so that it has a better chance of getting to the, to the egg that's been ovulated
Speaker 2And Susan, who are the patients that make the most sense to
Speaker 4Do this kind of ,
Speaker 3As we kind of mentioned earlier, people who have, as Carrie says permanent lack of spark , lack of sperm. So anybody, anybody who , um, you know, obviously is going to need to use donors from would be , uh , you know, those are, those are the most obvious. Um, but a lot of times we use it in conjunction with , um, oscillation action where we give the woman medicines like Clomid or Femara or injectable medications. And we use the insemination to maximize that egg and sperm interaction sometimes with male factors sometimes without male factor , um, you know, for insemination to work. Um, we like to see over 10 million total modal sperm. Um , we can see it work with less, but we know that the odds are going to decrease. Um, I, you know, I've seen it with very, very low numbers, but those are the exceptions in the rules. Um, and so, like I said, it maximizing that egg and sperm interaction, the sperm that ends up into the uterus then I say is, it can stay there for two, three days and survive. And so it really kind of boosts the amount of sperm that have exposure to that day .
Speaker 4It's interesting. Some people are really hesitant to do IUI and it may be the cost of IUI. Um , but you know, we kind of just feel like it's, it's just gives this firm a better chance to get there. You know, it , it obviously you may not get pregnant with the natural act in your bedroom, and that may be sort of a , you know, another reason why people don't want to do it, but, you know, I think a lot of times I'll see people and they'll be like, well, we, we don't really want to do very aggressive or we, you know, we want to do minimally aggressive treatment. And I don't know about you guys, but you know , for the most part, we don't think about IUI as being a really aggressive treatment, but because it's a fairly monitor office procedure, you don't have to be put to sleep for it. And it's not, you know , exceedingly expensive in the way IVF is. So for people that are sort of thinking about it, I mean, it's , it's something we commonly do when you agree. We commonly see a lot of people that do value-wise in our office.
Speaker 3I mean, it's probably the most common fertility treatment that a reproductive endocrinologist does. I mean, there's a lot of people who start with IUI. It may or may not work for them. I mean, IOI success rates kind of under the best of circumstances are going to range somewhere between 10 to 20%, depending on age and other factors. But, you know, if you can get pregnant by using IUI with, or without other medications, if we can save you 20 grand and you don't have to do IVF, that's , that's well worth the effort and realize that, you know, a lot of the things that people who are wanting to do minimally invasive types of things, we're not causing fertilization to happen, egg and sperm still have to come together in the tube. The little embryo has to, you know, it's created on its own. It has to go from the fallopian tube and implant into the uterus. Um, your, your body is really, I mean, like have you said, we're kind of giving it a , a nudge in the right direction. It is not a push.
Speaker 2Yeah. The way that I describe it to my patients is, is when we're talking about just doing, you know , um , making a baby in the bedroom, doing insemination versus doing IVF, particularly IVF with ECC , which is intracytoplasmic sperm injection. It's the difference between setting up a blind date, where they have to figure out how to get to the restaurant on their own, which is what natural conception is versus an IUI where you drop them both off at the entrance to the restaurant versus IVF with ECC where you both put them in bed together. None of those things guarantees that what will happen in bed is going to be good, productive, and continue on, but the odds are a lot higher the further on down that list you get. Um, and so, so, so you were mentioning total modal count earlier. So how can you break that down for us, Abby , can you say, when you're looking at a semen analysis that your patient has that he went and had that really romantic experience in the lab and you get that report back, what are you looking at to say? Yeah, it's reasonable for us to try IUI versus no, we really got to go to IVF. Like where's the line.
Speaker 4So we want to have a really good concentration. That's what most people think of when they think of the count . We also want the guy to have a good volume. Cause if he doesn't have much, that's kind of a problem, even though the concentration of the sperm may be really good. We also want the movement to be there. So if you had your husband had lots and lots of sperm, but none of it moved, that would be a problem. So the total modal can't really take all three of those things into the picture. So you multiply the count times of volume, times and motility to come up with that number. And so when I look at a sperm, count my eyes, go to that. The very first thing, because really to me, that sort of a summary of kind of everything that's important, or at least I think it's important for the IUI. So typically we want that number to be around 10 million . That means 10 million moving sperm, absolute number that we think that we're going to be able to put up inside the female reproductive tract.
Speaker 3And an important thing to know also is that when we're sitting there and talking about 10 million, realize that not all sperm are going to survive the processing to become an IUI specimen. And so whatever you have on your baseline, semen analysis is not going to be what we actually put into the female recipient. Okay. Those numbers are going to decrease. And so that's, you know, if you come in and your baseline semen analysis shows us 10 million total modal sperm, we may be like, Hmm , it's 10 million. But after it gets processed and goes through the things that we do to it in the lab, we're not going to have 10 million.
Speaker 4What are the things in the lab, Susan, just in general, there are
Speaker 3Different ways to prepare a IUI. Sometimes they do. What's called a swim-up prep where essentially there's a separation of media and that type of thing. Um, like, like you said, we, we separate eight , the sperm out in have , cause the other stuff is going to be very uncomfortable. If we directly injected it into a woman's uterus and should have lots of cramping and not like this anymore, that doesn't do us any good.
Speaker 4So we get the best and the brightest sperm is what we do. Right?
Speaker 3Exactly. Exactly. But in , you're going to have variability from man to man, how I've seen people who have had a hundred million total modal sperm and come in for IUI and it drops down to 10 million. Whereas I've had people who had 14 million and then it went down to 10 million. It's going to vary from person to person. And so it's something we're aware of and our treatment modalities are also diagnostic modalities. There, there are things that we are going to learn about you as an individual about you as a couple , um, that until we're in it, you know, we're, we're not necessarily going to know exactly how it's going to turn out. We know how it's going to turn out most of the time and if it's not going in the right direction, that's when we're going to have honest conversations with you.
Speaker 2So what about, what do you, how do you guys counsel, when you have someone comes in, let's say it's a woman. Who's had her two, one tube root removed for whatever reason, ectopic, pregnancy, endometriosis, whatever it may be. And she's got the other two that is open when the HSG or tubal testing is done. So she knows she's got at least one tube and an IUI is , uh , is on the table as a method of getting her pregnant. How do you counsel those patients let's assume that his sperm count is, is adequate to do IUI reasonably.
Speaker 4So in general, what I tell the patient, if she only has one tube and she's obligated on that side, I think it's a good idea, obviously, to do IUI. It's certainly possible that sperm can swim up to that Philippian tube, go over to the other side, fertilize the egg. And you know, if she didn't obviate on the, on the side where there was a good egg, but generally you generally, I don't advise people routinely to have an IUI, spend the money for that. If they don't have a good egg on the side, that they have an open toolbox .
Speaker 3I differ from you a little bit, Abby , on that, I I've had a number of pregnancies with people who have gotten pregnant on the contralateral side. I mean, I'm, I granted the chances are less, but compared to the, I mean, you've already spent, you know, two to $400 on ultrasounds, monitoring your cycle and, and those types of things, if we do get pregnant, you know, the other option is going straight to IVF and that's, you know, probably five to 10 times as much.
Speaker 4Well, I mean, I wouldn't after one trial , I mean, you know, hopefully you're going to have three or four trials on the good side, but yeah, you're right though. If you don't get printed that way, then you're thinking probably more in the realm of IVF.
Speaker 3I don't cancel IUs because you're ovulating on the wrong side. Cause I've seen it happen plenty of times. It's not going to happen as often, but you know, there's going to be different ways. People manage that.
Speaker 4Usually I give him three to four months and if they haven't gotten pregnant, then we regroup and talk.
Speaker 2I tend to tell people with just one tube that we're going to watch them like a Hawk, because I'm more worried about whatever caused that tube to come out, could have damaged the other side. So even if it's open, there's all these little hairs on the inside that still have to function because it's not just the passageway being open. It's the passageway being open and clear and facilitating egg and sperm coming together. And then the resulting embryo moving down to the uterus. So I always tell people, we are going to watch you like a Hawk because I expect, like I know when that egg and sperm should have come together. And when we should be seeing something in the uterus and if I'm not seeing something in the uterus at that early stage, then all the little hairs on the back of my neck go up and I, you know, you are now on my radar screen, big time
Speaker 3Clarify what Carrie's talking about is she's worried about an ectopic pregnancy or a pregnancy in the wrong place, which can be a life-threatening condition for a woman. And so , um, I , I totally agree. I, those, those are the people that I have a little, I have ectopic risk as my first alert that comes up on, on their , um, the EMR portal that I use. So that I'm like, okay, I need to make sure that we're making sure that, you know , we'll make sure on everybody, but those are people that you, you definitely are on heightened alert because you know, whatever made that other tube not work, the , the one that is theoretically working, you know, definitely was exposed to it. And this is definitely an area of fertility testing that we're lacking. We , we have the ability to test structure of fallopian tubes, but we have no tests to test the function of fallopian tubes.
Speaker 4So on a different note, but similar to what we're talking about as far as ways to give people a better chance, I have a lot of patients that will come in sometimes and the female partner will be oscillating regularly. And maybe there is a male issue. Maybe there's not. Would you start with medicine first? Would you start with IUI first or would you recommend doing both of those together? What do you think carry ?
Speaker 2I tend to do both together primarily because by the time someone hits my office, they wanted to be pregnant yesterday. And, and so if someone feels very strongly and this is assuming there's no male factor that mandates, we gotta do IUI or IVF, or what have you. Um, you know, I tended to go straight to a combination of medication to make sure that the egg is being grown up to be a mature egg. So that's either Clomid or Letrozole clomiphene or Femara. And then I give a trigger shot, a typically an HCG trigger shot of some sort. Um, I think oblation predictor kits drive everybody nuts. And so by the time they get to me, I'm less inclined to want to use them because I just want to know that it's happened. And when you give the trigger shot, you know, that that happens. And then we do the IUI to make sure there's from there. So that tends to be my preferred starting treatment because as, as the specialist, I want to know that I am looking at every factor and I'm checking off every box and being thorough. Now , some people are gonna want to start with less than that, and that's totally fine. We go through for the people where that is and is not appropriate, but that's kind of my default. What's your Susan .
Speaker 3Yeah. I pretty much do that. I mean, I, I, you know, I think there's relatively decent evidence that says that in the absence of male factor, just doing IUI, actually doesn't improve chances of pregnancy and it just makes you spend more money and it makes you spend more time. And as Carrie said, you want to be pregnant yesterday. And so I do a lot. I don't eat as much Clomid in my practice. I do a lot of Letrozole. I do a lot of Letrozole plus like a single gonadotropin injection. We call it a mini stem cycle , um, and use that in combination with insemination. And we have, we have good success rates and, and, you know, and like Harry said, we, we offer lesser things because we want to do what's right for that individual couple. Um, but if it's, you know, Hey doc, what's going to give me the best chances of getting pregnant and it's, you know, clinically appropriate. And you know, we're not wanting to go to IVF. I think, you know, oblation induction or super ovulation , um, with IUI is , is really kind of my main stage . What about you, Abby?
Speaker 4I agree with everything you guys said, I would definitely say, you know, so we do have a male indication and there's a male factor. I would definitely add medicine to that, even though the female partner may be ovulating regularly because there's data to show that if you do both of those together, they work better than either one of them separately. So certainly if you're going to do IUI, definitely do medicine medicine probably doesn't have a great impact. Excuse me, particularly for women over the age of probably 35 40, somewhere in that range. So I, I try and get patients to do both of those together, but sometimes I find that some of , particularly some of my younger patients are a little more hesitant to immediately start out with IUI. They feel it that's a pretty big step for them. So, you know, sometimes I start people on medicine first with the thought that, well, if this doesn't work after three or four months, they're young, three months in the whole scheme of things is probably not. Won't have a negative impact on their fertility. If it doesn't work at that point, then we'll add an IUI after that.
Speaker 2So if you have looking at looking at all comers, if you get one shot, one cycle of whatever you want to do to get someone pregnant, what do you, what do you choose? Do you do medication alone? Like your kilometer for Mara , a medication plus IUI or IVF? What if you get that one shot and that is all you have, what do you do?
Speaker 3I have one shot and money's no object. That's a
Speaker 4Loaded question. Carry
Speaker 2One shot. And money is not on the table. Like you have someone who comes like I need to be pregnant or have the ability to get pregnant as soon as possible. I can do this once. And then I am moving to the middle of the ocean on, you know, a tiny little floating island and
Speaker 3IVF. I mean, th the success rates are, they're just not comparable with IUI. Like I said, your 10 to 20% versus at a quality lab, you know, you're going to have success rates, 60 plus percent dip , depending on your age and your individual factors and things like this. But if you give me, if you give me the option and there's no dollar sign attached, why would I not go to something that has the best success ? Right.
Speaker 4And Carrie , you may be kind of speaking to the point that I think, because both of those start with the eye , people get those really confused and it's busy. Sometimes we're even saying IUI and we mean IVF, but I ask again, stands for intrauterine insemination, five, maybe 10% chance at best, and a really young patient IVF , much higher success rate, but also much higher costs , which is limiting for a lot of people. So, yeah, definitely. If I have the choice of IUI or IVF, I'm definitely going to choose IVF for the patient because it has a much better success rate as a general rule. Yeah .
Speaker 3Yeah. But with that being said, because we all live in the real world, at least most of us live in the real world. That the important thing for our listeners though, is realize that starting with some sort of IUI for most people is a reasonable thing to do under reasonable circumstances. Should you go do a year of IUI? No, not at all. I don't, I don't care if you have permanent male factor 12 , I mean, 12 months. I mean, you've spent a butt-load on donor sperm by the time you get to that point, like, it just, it just doesn't make sense. And what we know in our fertility treatments is that if it's going to work, it should work quickly. I think I had two patients last week that no kidding had been on Clomid or Femara , um, with their general OB OB-GYN for 18 to 24 months. And I'm like, obviously that's not working. I mean, like I would never ever prescribe that for that long because it's not working.
Speaker 2One of the things that I tell my IUI patients, cause I would say the vast majority of the time we start with at least a couple of cycles of IUI. And then we sit down and re re reevaluate and say, okay, these are what your success rates are. This is what we saw with the IUI cycle. And we go from there. But I would say the thing that I worry most about in IUI cycles is the frustration factor. Because if someone has gone through, usually you see it emerge somewhere between about cycle number three and cycle number six of doc , my eggs are there. My lining is thick. We know that this farm is the right place in the right place. Why haven't I gotten pregnant? And then the thinking, cause , cause you can see it in their faces and hear it in their voices and see it in their eyes is all this is here and ready to go, but I'm not getting pregnant. Therefore I will never get pregnant. Therefore I'm going to stop treatment now. And I can't tell you the number of times I've seen people come back after taking a two year five year, 10 year hiatus from treatment where before, if they just kept going, we were like, it had a very high chance of working, whether that is continuing on with IUI or, you know, accelerating to IVF, but because they got frustrated and so down and depressed and sad about it, they walked away and then they came back and now they have to use donor egg. And now they've got to use donor egg or go through multiple, multiple cycles of IVF , um, to even have a chance of getting pregnant. And that is a very different story. So one of the things that I worry most about is that frustration factor. Cause I've seen that in even my most resilient patients and that's what I worry about.
Speaker 4Well, and I think sometimes too patients get really frustrated at us. They're like, listen, doc, you said, if we do this IUI and the count's good and my lining's good and I have an egg I'm going to get pregnant. Why has it happened? And you know , I sorta tell patients, you know, even if you're not in the medical field, think back to what you learned in high school biology. There's so many steps in this process that we don't have tests for and we don't have treatments for. And there's so many things that have to happen just in the first 24 hours that, you know, unfortunately we just don't have a way to test for, to treat. And so we just try and get the sperm and the egg and the closest proximity is that we can at the right time , um, to enhance the success. So, but there's definitely a lot more aggressive therapies that we can do beyond just IUI.
Speaker 3So I have a question for you guys just to kind of gain perspective of how our practices are the same or different. Um, I love this part of our podcast is, you know, seeing, what's seeing what everybody else does, these little intricacies. So generally my rule of them is I usually give IUI about three cycles and at that point is my, Hey, let's sit down and talk. We may do some more or we may change tracks, but this is the point where I like to sit down and talk what
Speaker 2You guys do. Mine is two to between two and four cycles. If I have someone who I can tell is really anxious. Sometimes I'll do it after one cycle. But I would say between two, two to four with two and three being my most common touchpoints . That's , that's where I want to make sure that we're
Speaker 4Yeah. Yeah. I usually say about three cycles. I think patients get really frustrated after a while . And even though, you know, three months in the whole scheme of things, if you went to your primary care doctor, you don't expect to see them every three months. But I think in our field, if you know, if they're coming in, you know, several times for ultrasound monitoring insemination and they haven't gotten printed out for three months, I feel like that's a really good time to catch them before they just get really frustrated or like really, you know, just angry and just ready to move on. Absolutely.
Speaker 2Yeah. All right. Well thank you ladies for such a wonderful episode and going through everything , um, to our audience. Thank you for listening. Be sure to tune in next week for more and leave us a review on iTunes. Let us know you're listening. Um , we'd love to hear from you.
Speaker 3You can also visit us@fertilitydocsendsensor.com to schedule an appointment with any of us or submit specific questions you have about infertility. All questions will be answered on the podcast anonymously for our ask the doc segment. We'd love your ideas. We love your , your comments and just keep sending them in. We love, we love all the feedback.
Speaker 4Keep them coming by.