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, and welcome to another episode of fertility docs. Uncensored. This is Dr. Carrie Beaton from the fertility center of Las Vegas joined by my two , uh , delightful and cool and refreshing looking parents . Dr. Abby , Evelyn from Nashville fertility center. Hi everybody and Dr. Susan Hudson from Texas fertility center. Hello, how are you both doing and how come you look? So cool and lovely and just delightful in this really fricking hot summer.
Speaker 3It is crazy half this year. I got to go a little north this week, so that was fun . Where'd you go? I went to Chicago. Was it cooler ? It wasn't cool. I mean, like it was in the high, like in the heat of the day, it was in the high eighties, low nineties, but in the evening it was nice blue then Texas though. Oh yeah. Texas is hot right now. I'm sure it's not as hot as Vegas says , but it's, I, I think it feels more like mid to late July than late June, unfortunately. So, you know ,
Speaker 2Chicago in the summer time is , I mean, it's awesome. Can be, it can be lovely, but it can also be brutally humid. And as a desert rat, I cannot handle that humidity. And it is the fastest thing to make me start whining on the ,
Speaker 4Anything to you. Carrie is human because Las Vegas is like sets the bar for everybody else as far as humidity. So to me, when I go up there, I'm like, huh , this was a great,
Speaker 3Yeah, it was, it was interesting. I learned, I didn't know that Chicago was actually built on a swamp. Did you know this? I knew that .
Speaker 4Yeah. Yeah. A bunch of garbage. Yeah. I knew that
Speaker 3I did not know that we went on , um, the , uh, one of the river boat tour, things that , uh , the architecture tour. Oh, that's a
Speaker 4Good tour.
Speaker 3I learned so much about, you know, it being built on swamp and about the fire and how tall these skyscrapers are. And it's hilarious because like now that I've come back, like I look at every tall building and I'm like categorizing them according to era. I'm like, I am such the architecture officiant auto after one.
Speaker 4Well, as an art history monitor , one of the things we studied was buildings and how they looked and the style. So I love that architectural boat tour . It was awesome.
Speaker 3It was fun. It was fun. We had a good time. It was, it was a quick trip, flew up like Tuesday evening and flew back on Thursday. But , um, to do a lot of shopping, we did a little shopping. We went and turned in our paperwork to try to get our Lithuanian dual citizenship thing. Oh. So it was a first big step. They have to get the paperwork and then they send it, we went to the consulate and it was hilarious because my, my mom was with me cause she's applying as well. And you know, we, we go and do this thing for, it took us a couple of hours and we gave him all the paperwork and then the paperwork gets sent to Lithuania and then they officially see a fit . That's all the categorize that has to and everything like that. And then we left and so she was good . She was like, he know this kind of really like ruined my entire like vision of what I expected this to be like, because first of all, this is a consulate, not an embassy.
Speaker 2Oh. So this is like a tiny office, not some place .
Speaker 3This is an office in the Chicago NBC building. Okay. And so, you know, I mean, it was still kind of cool, but she is expecting, you know, like the iron gates and the guards. And you know, when you run away from the bad guys in the mirror ,
Speaker 2She had like the Bourne identity in mind as for what she was expecting.
Speaker 3Yeah . I was like, you know, this works. I was like, maybe we can go to the actual embassy in guessing that's in DC and you can experience the full embassy thing.
Speaker 4That'd be cool.
Speaker 2That'd be great. And maybe as a special treat for your mom, you can hire some kind of fake Hitman to come change you so that you can go running into the embassy and make it a full, full experience. Like I'm sure there's a lot of actors out there who need , uh , a side gig for a day to , um, to chase you down and you can be action movie stars.
Speaker 3It would be funny. It would be funny, but she's in her mid seventies. I wouldn't want her to have a heart attack cause be chased by bad guy . So probably won't do that. But , um, it is a funny thought. It was a funny thought
Speaker 2Once you do this weekend, anything fun.
Speaker 4So I took a few days off at the end of the week and I liked to paint. And so this woman who's like the rock star of watercolor painters, portrait painters was in Huntsville, Alabama. So I spent three days in Huntsville, Alabama, and she also is unique because she's, it took her seven years to do it. But she painted a veteran in all 50 states and did like a wa watercolor portrait of all 50 veterans in 50 different states. And like what , whatever their job was like, there was a guy that was like a falconer. So she painted a picture of him with the birds. And there was a woman that was a truck driver. It was this great picture of her next to her rig. And there was a guy that was a coal miner and these pictures are humongous. And just, I mean, they were just breathtakingly. Beautiful. So the Huntsville art museum has those currently and we'll have them for another month or so. And then they go to DC and hopefully we'll be permanently somewhere. So it was really a fun to get some of her tips and take her class and then see her, her watercolors that she did that were breathtaking. So it was fun.
Speaker 2That's really cool. You guys do such fancy things. I made a new cookie recipe this weekend.
Speaker 3How do
Speaker 4You come up with the new cookie recipe? How do you
Speaker 2Do that? Uh , oh, I didn't come up with it. I just went like looking for
Speaker 3Something that looks yummy ,
Speaker 2Something that looked yummy and I made , um, red raspberry, frozen yogurt and uh , dark chocolate ice cream. And so I wanted something to go with them and I figured, okay. Almond is a good supplemental flavor. Oh yeah . All
Speaker 4The cookies
Speaker 2Always good. So I found this really chewy recipe that it's kind of based on macrons . Um, I don't think I'm saying that right, but it's that same, like Marangu and almond flour and it's really jewel . You let it sit out for a couple hours to get that crust and then you get the crackle and you roll it in sugar. So it's got these it's perfectly white. And then it's got these deep kind of light yellow clefts where the almond flour is making it yellow. And it's there a little crispy on the outside and really chewy on the inside. There were really good, full dessert with the raspberry yogurt and the chocolate ice cream.
Speaker 4Oh, that sounds delicious. One time I out, because I really liked almond cookies too. And I bought this almond paste with the intention. There's some cookie that you can make with the almond paste in the middle. And I bought the almond paste, but I never got around to making the cookie, but it sounded really
Speaker 2Almond paste is good enough. You don't need to make the cookie , just eat the almond paste ,
Speaker 3Just buy this thing.
Speaker 2Do you have our question for the day?
Speaker 3I do have our question of the days . So our listener , um, has been undergoing fertility care for a number of years that started around August, 2017 and they got a semen analysis that looked essentially normal. They decided that their path was going to be essentially three IUI and then an IVF cycles. So they did two IUI and then decided to go on to IVF. Um, when they did IVF, they didn't quite get the results . Didn't have quite the stimulation they were expecting to get and did end up with a couple of embryos , um, transferred those embryos and did get pregnant, but baby stopped developing and ended up having to have a DNI . And , um, then went through some blood testing, looking for blood clotting disorders and, and this type of thing. And so essentially kind of after about two years of treatment, she decided to kind of step away from her job and they were going to , um, do some, some more treatments. And I'm gonna kind of , from this part, kind of read what she says. My husband convinced me to try again in spring of 2019. So we started to try again, the doctor said she was going to throw the kitchen sink at me. I was taking more meds at this time. I was taking you 10 avoiding receipts, perfume, plastics, nail salons started to feel good again. And when they started to see how many eggs were growing, there were only two and there was only one to retrieve. They said maybe it was a bad month and they should convert to IUI patient agreed. My husband was not there. And he was upset with that decision. I think just upset with the outcome. And when I pushed, he told me he was done with fertility treatments. He has been my biggest cheerleader and I knew I could not move forward. Knowing I did not have his 110% support. He left it up to me. So he did the IUI and stopped fertility treatments altogether. It was the hardest decision I ever made. She basically begged me not to give up and that she would waive the fees, but he already had his mind made that we said we would foster or adopt. And I cannot seem to pull the trigger. I only think about doing fertility again, but if we do it again and is not successful, we would not be able to afford adoption. We went to foster classes at the end of 2019, but I'm not sure if it is for me. Of course, 2020 was a wash due to COVID. I still wonder if that was the right decision. And if we would ever be able to have a child of our own, I've been thinking about it a lot lately. I never felt good about how we stopped and now I'm wanting to try again, but time has passed and I'm now 35. I am not sure if it is a waste of my money and happiness to go down that road again, any and all advice appreciated. Wow. Yeah. Wow. Lots of information. What do you think Gary ?
Speaker 2Um, I mean, it sounds like the crux of the question is what do I do? And my partner and I are not on the same page. Yeah , that's right. That is something that we see very commonly. And what I hear in all of this is that she's been through a crap ton of treatment, had won at least one that made it to the point of miscarriage, meaning eggs from came together, they implanted, but something wasn't going gone . Right? And so the pregnancy stopped, which is in general, although it sucks to high heaven for the patient is usually the right thing for the pregnancy. And so now they're at this crossroads where he's done and she's not. And I think at this point there they're just tests to be some ongoing discussion about it. Um, therapists are really great when, when it comes to something like this, because going to a therapist doesn't mean that there's something wrong therapists are to help communicate. And sometimes they can help bring things out and both acknowledge and accept the emotion as well as separate from it. Because anytime you bring up fertility, it is super emotional. And that means tears happen and angry words happen and feelings of despair and all of those things at the same time. And so , um, what I would say at this point for you is probably sit down with a therapist and you probably need two different types of therapy. One is with him. The other is just for you because whatever decision you come to is going to be difficult either because you know, he's not totally on board or he is, or you're not on board or you don't feel comfortable with it , whatever. And so , um, sometimes there's a lot of value in therapy to help you make a decision and to feel comfortable with it and to cut through the crap that's going through your brain that is just bogging you down. So I would, I kind of tend to think that, and, and the other thing that strikes me about that is that the fertility doc said, you know, I will help you get through this. That means she thinks that you got a chance. I mean, that those offers are never made lightly ever. And , um, because it, you know, as expensive as fertility treatment is there's, there's so many man hours and equipment and all the things that go into it, that if she is, if she's offering that, you know, that there's a chance there. So I don't know, that's kinda my blurb of ideas.
Speaker 4I mean, my take on it is I think there's an emotional aspect to it that you touched upon and that's obviously gotta be addressed. Was she and her husband, we can't ignore the fact that for most of our patients, it's a financial decision too . I mean, there's only, you only have so much money and if you have X amount of dollars and you're thinking, well, gosh, maybe I'll adopt, but if I do this other fertility treatment, I may not have the money to adopt. I mean, it's certainly a gamble. And I guess my concern is, yeah, I agree. The doctor said she would be willing to kind of help, but, you know, I don't know, based on the way our patients or our listeners stimulated, you know, I think unfortunately the reality of it is, you know, that's for 35 year old getting only one or two eggs is not normal. I mean, typically I would think we get, we planned to see more like 10 or 15 eggs.
Speaker 3So I think that's what she got for embryos wise at the blastocyst stage. So she had a couple of blasts.
Speaker 4Okay.
Speaker 2At the end , she said that they converted from, they only got two eggs.
Speaker 4Right? Yeah. So I think there's an issue with poor stimulation. And I think it's, you know, I've been through fertility too, and it's a tough decision to know what to do next, but you know, the reality of it is, you know, our listeners just not stimulating the way you'd expect. And you know, if you only have X number of dollars, you know, maybe if you really want to adopt and you've got to use that money to adopt. I mean, I think I would probably, you know , talk to the therapist about it, but I think, you know, looking at it objectively and not emotionally, which is really hard to do, you know, I think that sounds like that might be the better decision. Yeah .
Speaker 3I agree with both of you. Um, I do want to say that also knew that sometimes this might be a good time to get a second opinion. I mean, we've all seen people who went through stimulations with one set of doctors and then they come to see us and we're like, Hey, we could do something a little bit different. So sometimes a fresh set of eyes and sometimes partners are more open to a fresh set of eyes, you know, at least to say, Hey, is everything my other doctor did like in line with what you would expect, because just because you get a second opinion, doesn't mean you have to actually change doctors. It's just exactly that getting a second opinion. The other thing to consider is if you know, your tie is not necessarily a biological child, but that you want to have pregnancy and things like that, that perhaps, maybe considering something like donor egg or donor embryo, especially if you're thinking about adoption. Sometimes I have patients who find, especially donor embryo, a nice bridge. It's not quite adoption, but because you get to control the pregnancy part of it, but you still have that adoptive kind of feel component that maybe it might be time to kind of, you know, you're not necessarily in line with his path that he's thinking he's not in line with the path that you're thinking. Maybe y'all need to find a new path that kind of bridges the , the desires and, and comfort level of both of you. And again, that's where the therapist can really help out. Um, and maybe just sitting down and having a conversation of, Hey, you know, I, I'm not really comfortable with what you're thinking. You're not really comfortable with what I'm thinking. Let's think outside the box. And maybe one of these other ideas might be something that's going to give us a better chance of having a baby and having a child in our lives that we can kind of move forward in that direction. So just some ideas. Yeah.
Speaker 2Excellent. All right. So what we were talking about today is kind of feels like a weird topic in some respects ,
Speaker 4But it's a great topic because we get these questions all the time.
Speaker 2It is a great topic, but when , when I think about all the things we do, which are okay, this is the testing we are going to do this episode is this is the testing. We're not going to do
Speaker 4The testing that's obsolete.
Speaker 2And so we're just going to go through some of the most common ones that we see that are , um, that pop up a little bit more frequently because they were used in the not so distant past, or they were used in the distant past, but they have managed to maintain a life of their own. And they just will not go away in the life of the internet after,
Speaker 4And Google things never die on the internet that they never died on the internet. So be, be wary when you read something about a test on the internet,
Speaker 2Dr . Google went to a question , well , medical school first test is the ever popular post-coital tests . So Susan, can you, can you describe how this really delightful? I mean, there's a lot of delightful tests that we do in our office.
Speaker 3I'm going to punch this one. I'm tending to Abby because I have personally never done.
Speaker 4Oh man. So the post-coital tab , the idea may kind of make sense. It's like, is the sperm, can it get through the cervical mucus? And so what you do is the patient and her partner would have intercourse during the fertile window when the mucus was supposed to be thin and stringy. And so the patient would come in, I think it was , uh , within 24 to 36 hours of intercourse, or no , I'm sorry. About 12 hours of intercourse they'd come in. And then basically you would take them back to the room and you would try, which was really challenging to get cervical mucus . So sometimes you'd use forceps or sometimes you'd use a little instrument to kind of , or like a little syringe to kind of suck up the mucus. And then the idea would be you would count how many sperm you saw per high powered field. And depending on the number, you'd say, yes, the sperms getting through or no, it's not. Well, the , the thing about that though, is you're looking at the cervical mucus. And so how do you know if the sperm that you're seeing there gets any further than where they were, you know, when you looked at them and, you know, obviously for all kinds of reasoning , sampling was not very good. And you know, it was not, there's no standardized way of looking at the mucus or getting the mucus . And so anyway, it was a test that probably was done. Gosh, I dunno . It hadn't been done for a long time. I can't remember. I mean, probably for 20 years, we've not done a post-coital test. I would say probably cause I don't. Yeah. I think it's been at least 20 years.
Speaker 3I think that's a fair estimate.
Speaker 2It just sounds like such a great way to kill sex.
Speaker 4Yes
Speaker 2Ma'am. Can you please do this and then come to our office? Um, all right , so next test clomiphene challenge test.
Speaker 3All right . So I'll , I'll take this one. Cause I , I did do Clomid challenge tests when I was early in my career. Yeah .
Speaker 4You guys are making me feel really old. Let me just point out for, for coldest and TCS . I never did one of those. Those are on the internet too. Those are for ectopic pregnancies.
Speaker 3Uh , Carrie , have you done, did you ever do Clomid challenge test , like in fellowship or anything?
Speaker 2I read about them a lot.
Speaker 4Yeah. You know ? Oh , okay. Now if a really old period , you never did a Clomid challenge test . No kidding .
Speaker 2I know I've never actually done one. Like I think maybe once in residency, but even then, I don't think so. I'm not that much younger than you guys, but I think I, yeah, you are point in here where I actually don't know what I mean. I know what they are. I just have never done most of these guys.
Speaker 3Like when I first got into practice for the first couple years. Um, and , and around that time is when like AMH testing kind of came out to help support FSH, nester dial testing. So first of all, before I get into it, it's part of an ovarian reserve testing profile. So none of the ovarian reserve testing is perfect. And so most of us do multiple tests and put them all together and be like, okay, we're looking at quality and quantity and this is giving us kind of a big picture. Okay. And so that's kind of where the Clomid challenge test came from. So it started out as that day three FSH and estradiol level. Okay. To see how the brain and ovaries are talking to each other. Well, after you would do that, you would do five days of Clomid. I think it was a hundred milligrams. If I remember correctly, like I said, I haven't done this in a number of years. And then you would repeat the FSH and estradiol around a 10, if I remember correctly. And essentially you should have relatively similar findings in both of those numbers. But like I said, it didn't really have a lot of strength beyond your day three FSH and estradiol. And when AMH came along, I think we kind of switched to FSH and estradiol. It gives us a little more information about quality AMH gives us more information about quantity. You can throw in an antral follicle count, which is the ultrasound where we're looking at the number of follicles on the ovaries between those three tests. You have something pretty good and you avoid having to have somebody take Clomid, which a lot of people don't tolerate well, and you avoided another blood draw and he really wants another blood draw. So
Speaker 4Yeah, I mean , we, we kind of said back in the day, it was kind of like a stress test for your heart. You do an FSH kind of baseline, and then you stress your ovaries with the Clomid and then repeat the number and see if it was basically the same, like you were saying, Susan. And, you know, it did pick up people that had really bad FSH levels, but it was kinda like that's kinda like catching somebody robbed before they have a heart attack or something. If you had, if you had a really bad FSA, you were, I mean, it was kind of beyond the point where, you know, our treatments would be helpful. It was more like a situation where that patient probably needed to go to donor egg or Dunmurry embryo and Hey , and like you said, sometimes you do it on younger patients and they get really stimulated on Clomid . So it was, it didn't work very well. AMH is much better now because we can do it at a time when you're not stimulated at all. We just draw your blood. When you come to the office,
Speaker 2I have seen some practices, use it as , um, exclusionary criteria. If a patient has X value, they won't take them. But I don't know that that really adds a whole heck of a lot. And it , at least for the three of us, we don't, I don't think any of the three of us have exclusion criteria where if you have X value, we just will flat out refuse .
Speaker 3There used to be insurance policies that required a Clomid challenge test. And I think most insurances have, especially for probably the last five years I do some insurance reviews. So I kind of see what's coming through and what gets, you know, through the appeals process. And I think those criteria are pretty much going by the wayside because the data just really doesn't support that. It's, it's a very valuable tool ,
Speaker 4But I know in our patients though , they need day three value. I tell the patients didn't really help us, but there again, if you have a day three FSH and it's really high, that's not good news. I mean, probably not many of the treatments that we have are going to be very helpful if you have a really abnormal FSH on day three.
Speaker 3Exactly. Who
Speaker 2Wants to take sperm,
Speaker 3Penetration, go for it, Abby.
Speaker 4All right . So this kind of goes back to, you know, the idea that if the sperm isn't perfectly shaped, so if the head's too big or the tails true crooked, the concern is can this perm swim to the egg, can the sperm bond to and penetrate the egg? And so we still, you there's are still potentially factors, you know, cause we know that there's receptors on the sperm head and on that, on the egg, but clinically we don't have a great test for them . So the idea behind this berm penetration essay was can we mimic a situation in the lab? That's similar to what the sperm would go through when they were in the, you know, in the woman's body. And so we would take hamster eggs because hamsters have the same sort of construction of the egg. They have the same sort of like barrier that the human egg has. So you would mix sperm , um, in a lab with hamster eggs and see how well the sperm penetrated. And so the idea was if they penetrated well that even if the shape of the sperm or the morphology was not very good, it probably was not significant. And so now we know it's a pretty much useless test. It doesn't really tell us a whole lot because I'll tell you more than one time. I would call somebody to tell him that the spa sperm penetration essay was abnormal and they'd be like, oh, I just got a positive pregnancy test today. So it wasn't the most useful test. And so therefore no one uses it anymore. So
Speaker 2Order these from like a lab and have them shipped in and ho how exactly do we go about getting hamstrings? I want to know who's doing hamster IVF. That's what I want to know.
Speaker 4People there at, believe it or not. When I interviewed for fellowship, there are places that literally had their own hamsters and they would harvest the hamster eggs and use them. But you could order them. You could order them from labs. And I think he probably still can somewhere. Can you imagine,
Speaker 2And in that tiny little ultrasound pro to get whether it's an abdominal ultrasound or, I mean, I assume hamsters have vaginas. Why w they're mammals? Why wouldn't they? But like you imagine that probe,
Speaker 4Those eggs husbands would also laugh when, if they had a good spa tests , they'd be like, well, at least I can knock a hamster up. So that's
Speaker 2All right. So next one , uh , we talked about sperm, penetration and sperm antibodies next one's ovarian antibodies. Um, this is one that it's, you know, it's a blood test. It's easy to get, but again, there's not a whole lot we're going to do about it.
Speaker 4Why would you get it, Carrie ? Why would anybody want an ovarian antibody test ?
Speaker 2This one tends to come up more with premature ovarian insufficiency or failure. Um , and the thought is that there's an automobile condition. Cause we do see women who are more, have more auto-immune conditions are , are a bit more likely to have these ovarian insufficiency syndromes. And, and it's one of those things where you can get it, but it doesn't change anything. Like there's no steroids that we can give that change anything. There's nothing different that we're going to do. And in many physicians, particularly in insurance era and , and even just good clinical medicine is you don't order the test . That's not going to ch that's not going to have any impact on what you're doing. And so with ovarian antibodies, it just, it doesn't change anything. And so getting it doesn't really make a whole lot of difference. And I think sometimes patients may, may feel a little bit better, but , um, just knowing all my antibody levels are high, but we can't even necessarily say, oh, they're high. Therefore, that is the reason why you have ovarian insufficiency. So next up on the list is testing for blood clotting disorders in recurrent pregnancy loss in particular , um, MTHFR methyltetrahydrofolic reductase deficiency also falls in this category. So who wants to jump on, on this monster?
Speaker 3Um , I'll kind of talk about this a little bit. So this is one of those kind of gray zones that not everybody practices the same way. Okay. Um, but realize that first of all, the blood clotting disorder that has the strongest evidence in first trimester, miscarriages, which are most of the miscarriages that people experience is going to be a condition called anti-fossil lipid antibody syndrome. And that's an acquired blood clotting condition. Um, we do a blood test. See if you have some positive markers, if it is positive, because some of these markers can be transiently positive. We repeat those labs in 12 weeks to make sure they're truly real, because if they are truly real, we are essentially sentencing you to being on injectable, blood thinners and aspirin throughout your entire pregnancy and six weeks postpartum. So this is, it's a big deal. We , we don't want to just toss these medications around to just anybody. Now, the strongest evidence says that the other blood clotting disorders, if there's a role in pregnancy, they are more likely to have a role in probably second and third trimester miscarriages. And so even I know amongst the three of us, some of us do some of these blood clotting tests in first trimester losses, some of us don't, but as patients, you should probably realize that if you get them for first trimester losses, sometimes your insurance company may not cover them because there isn't a lot of strong evidence. It doesn't mean we can't order it. It's just, there's not a lot of strong evidence, you know, but if you have a family history of somebody with a blood clot or especially a personal history of a blood clot, but I'm assuming usually if you've already had a personal history, somebody has already run these labs on you or they should have. And so that's kind of where blood clotting disorders kind of fall into. Do y'all have any other kind of words about that?
Speaker 2Say that the one that, that I probably see the most often , um, if someone comes in and says, oh, I have MTHFR and there's two different variants of , of MTHFR. And the important thing to know about that is it's a deficiency in how the body processes fully . And so we always tell people, take, you know, take a more bioavailable folic
Speaker 4Acid, which would be who I carry.
Speaker 2I knew you were going to ask me that. And it just flew out of my head , the M L Foley. Yeah. And so, you know, cheap, easy intervention, you got to take folic acid anyway, pregnancy . So no big deal there. Um , but about 40% of the world walks around with an MTHFR mutation and 40% of the world is not having problems
Speaker 4And definitely not needed to treat those patients with Lovenox. For sure. Yes.
Speaker 2Yes. And so, like Susan said, these are big, big medications that are powerful and they're wonderful when used in the right population. But we want to make sure we are not giving them out. Willy-nilly because there's some, some potentially very significant side effects that you can have from them. So we want to be judicious in who we're using them in . So, all right . And then the last test on our list is coldest and TCIs and Abby , this is all yours.
Speaker 4Just the reason I threw that in there. Even I haven't done this one, but this was a test a long time ago. If somebody had a ruptured ectopic pregnancy, you could actually put a needle in the back of the vagina and that little opening there and ask if you aspirated blood , um, then that made you worry that they had a ruptured ectopic pregnancy. Now the good news is we have ultrasound. That's pretty good at looking for those sorts of things. So, but that's just something still that comes up every now and then I've had patients ask about that, particularly a patient that we're worried about an ectopic pregnancy. So , um, I would say the, the longer I stay in this field, the less tests there are, there are a lot more tests when I started out than there are right now.
Speaker 2And things seem to cycle every so often. Like I know for awhile , just a couple of years ago, I was hearing about , um, intralipid and IVG all the time. And when I went back to look at the data, I was like, oh, this is all from the nineties. And they didn't have any data for it then. And they don't really, I haven't seen any great data for it now. I don't know if you guys have now things seem to cycle. And so every so often you'll be like, oh, I read about that in, in the history section of my REI textbook and just announced .
Speaker 4And I , I just thought of one other things you're talking Carrie , um, for , uh, luteal phase defect now, which means that you don't make enough progesterone in the second half of your cycle. Now we know that it's probably reasonable to check your progesterone, probably just once. But if you , you know, when the first paper came out and looked at checking progesterone three or four times in the same luteal phase in average in it, but now we know probably checking it once is okay, but there are tests where there were times where we would actually do a biopsy of the endometrium at that time and look at it and date the endometrium based on how it looks. So we take a sampling of the lining, but now we know that it's probably not that helpful. And it's probably just as easy just to give you some extra progesterone. It's like , like curious, is it's like dumping water in the ocean to get a little extra progesterone if we're worried about it. Yeah.
Speaker 2So, all right . Well, lovely. Well, I am so glad that I get to see you ladies today and to our audience. Thank you so much for listening. We are always grateful that you are here with us, hanging out with us. Be sure to subscribe, leave us a review in iTunes. We would love to hear from you.
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