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 2Hi everyone. We're back with another episode of fertility Dawson sensor . I'm one of your hosts, Dr. Abby Evelyn from Nashville fertility center. And today I'm joined by my co-host and good friends. Dr. Susan Hudson from Texas fertility center and Dr. Carrie obedient from the fertility center of Las Vegas. Hello. Hey guys, what have you guys been up to lately? Haven't talked to you in awhile .
Speaker 3We have been going to basketball games, basketball games and more basketball games.
Speaker 2It's already basketball season.
Speaker 3It's like pre pre-season kind of middle school, high school. So I have a junior this year and that is, that has definitely, it is exciting. He's on varsity and it's wonderful, but yeah, we're already, we did, we're doing Tuesday night games. We had Saturday tournament, three games in one day and it's funny, like, you know, we all do long days, you know, we , uh , not unusually do you know, 10, 12 hour days, but that's just exhausting sometimes .
Speaker 2Yeah, absolutely . Good grief. What have you been up to Abby since I last saw you guys? I guess I went to San Francisco for a little kind of four day kind of like adventure. And it was actually really cold in San Francisco. I hadn't been there in a long time and they had like, these microclimates where like, if you're 10 miles from the coast, it's like 10 degrees different than if you're on the coast. And just like every 10 miles you go away from San Francisco, it gets warmer and warmer. And so San Francisco was freezing. I mean , the whole time we had jackets on, I felt like it was fall early winter almost. And then we ended up going driving a little bit west to Davis, California, and , um, or in that area of UC Davis and it was like a hundred degrees. So it was like, we went from like 70 degrees that felt more like 60 degrees to like a hundred degrees in just a really fairly short, maybe hour, hour and a half drive or so
Speaker 3Can be an average day in Texas Abby .
Speaker 2Oh really? Well it probably the Arizona too. I bet.
Speaker 3Yeah. What am I missing ? Favorite things when we lived in Minnesota was like, whatever temperature, it was higher, low that you woke up to. That's what you would have all day long. Whereas in Texas, you can live . It is not unusual to have 30, sometimes 40 degree temperature swings and a day.
Speaker 2Really. Wow.
Speaker 3Oh, those are rough. Like, you know, can't climate control your house. You're in there . You're wearing one thing when you get up in the morning. And then by the afternoon, you're like shedding layers. I like predictability
Speaker 2Cool thing too. Was we actually met up with somebody that I know that's actually a nurse midwife in San Francisco and she was so nice to like drive us all around and shows all these parts of the city that I'd never seen before. And we ended up going to this vegetarian restaurant called grains , which apparently has been around for a long, long time in San Francisco. And so we get there and we walk in and the lady that was going to see this said, okay, as soon as I can see your COVID cards, I'll let you sit down. And I was like, what? And I asked my friend if that, you know, cause I'd heard out in California, they were kind of doing that. And she said, well, I don't think they do it widespread. I think every, you know, here and there they do it and I've completely had forgotten to bring my card with me. So I had to like look through a bunch of emails. And finally I found an email from January where the hospital had emailed me and said, you need to come back for your second COVID vaccine. And so they were nice enough to accept that, but everybody else that I was with could show proof of their COVID card and I'd just completely forgotten mine. Didn't take a picture of it since I returned. However, I have now taken a picture of my COVID card. So that will happen again. But , um, it was just kind of funny. The world has changed.
Speaker 4That's a really good idea to have that on a photograph. Like I just have a copy of it in my wallet, but no , but that's a really good idea to just toss it on your phone so that you've got it in case you need it,
Speaker 2Because my worry is if you lose that card, I'm kind of what happened. How do you replace that? You know, I don't know that there's a great system to figure out how to replace it. So , um, at least most of the places around there would accept the picture on your phone. That's good. So that was kind of interesting. What have you been up to carry?
Speaker 4Not a whole lot at anything. I mean, I, the most exciting thing that I've done is that I made a , an apple pie bread recipe earlier today, which is delicious. And other than that, like we've just been hanging out and the weather here is finally turning nice. So you can go to a park and sit down on a bench and not immediately burst into flames.
Speaker 3What is Las Vegas? Nice.
Speaker 2That's what I was going to say. What is , what is nice for Las Vegas?
Speaker 4So the temperature today is right around 89. That's great. That feels like downright chilly . I mean, we were, we had stepped outside for a little bit last night and , and I shivered and my husband just looks at me like I was kind of an alien. He's like, you know, the temperature is 78 degrees right now. Right. And I'm like, and I maintain every right to my shivering that I have because it has been, you know, God awful hot for,
Speaker 3Yeah. We're still in the high nineties and almost a hundred every day. So we have a cold front coming in in like three days. So I was so excited. I think Wednesday we're supposed to be in the high eighties and I'm like, oh , I've got some stuff in my yard I have to do. And as y'all know, I am not the yard person. So the excuse of it's like the humidity is high and it's almost a hundred degrees. I'm like, eh , my neighbors can just complain for a few more days.
Speaker 4Yeah .
Speaker 2We kind of started to feel a little fallish around here. It's rain the whole weekend and it's, I'm looking right now. It's 71 degrees. So it's a little on the chilly side here a little bit.
Speaker 3That's almost winter.
Speaker 4That is almost
Speaker 2Winter. I keep forgetting when I, you know, I feel like where I live is hot, but I keep forgetting when I talked to you guys that you live in much hotter climates than I do. You know,
Speaker 4I'm on 59 degrees is practically Arctic. And like I have documented , um , friends from years ago where they all know full well that if it, if it breaks under 60, that it is full scar, full hat, full coat, kind of weather with zero shame.
Speaker 2Well, and I do think there's something to it. If you're used to it being really, really hot and it drops by 20 or 30 grand , I mean, you feel it, you know, it really does. It's all relative. You know,
Speaker 3It does, it takes a while to reacclimate to those different temperatures. So, but our question of the day, it's a little bit long, so it just kind of hang with me. So first of all, thank you so much for the work you're all doing with the fertility docs and censored podcast. I have taken so much comfort in the consistently positive outlook and trusted by shared for such a heartbreaking journey. My partner and I are one year into trying to conceive. Naturally, we recently had several tests run. We received the results of his semen analysis, which should 0% of his from morphology to be normal, other than morphology, his results were normal. He leads a very healthy lifestyle, but our doctor recommended high doses of vitamins. Um , ISI filled-in zinc for three months in an attempt to improve as far morphology and remit recommended another semen analysis. At the end of this time period, my lab work results also fell within the normal range, FSH and LH 4.1 progesterone 8.5 on six days, post ovulation prolactin, normal AMH 1.76 , um , despite falling within normal ranges. I am concerned about the quality of my ovulation since some of my labs seem borderline parentheses. Thanks Dr. Google in front of it . And I failed to produce a positive result on an ovulation test kit. Despite consistently morning test days, 10 to 20 of my cycle. I have a history of hypothyroidism, which is treated by Levi rock scene and recently received a normal TSH lab based on both male and potential female fertility concerns. Our doctor proposed both IUI and IVF as potential options. Assuming we don't see a significant improvement in sperm morphology at the end of this period, she did mention that the chances of IUI maybe poor with the 0% normal sperm morphology, I am 30 and my partner's 34, but we had hoped to have three children. So we do not want to go down past . They provide little to no chance of conceiving though. The price tag of IVF also seems challenging to stomach. How detrimental is a 0% for morphology? Should I be concerned by my lab results? Or should we factor these into our decision to go with IUI or IVF? Do you think IUI is worth our time? I would also appreciate your expert advice on this. And again, thank you so much for all you do. That's a lot. It is a lot. So
Speaker 4It sounds like we've some male factor questions, some female factor questions
Speaker 2And some just general life logistics. Yes . That's a good way. Then we'll get it in.
Speaker 4All of those things are very different. Like when I see a zero morphology, there's a couple things that come to my mind first is where that semen analysis has done is important because , um, I don't know about you guys. I send my guys for a semen analysis at the standard insurance covered lab most of the time, because that means that they're going to have that particular test paid for, and they're not going to have to pay out of pocket because if they come to the lab that, that works with us, that's, it's oftentimes not covered by insurance. And so when you're working with those big contract labs, the semen analyses are kind of the ugly stepchild of the labs that they do. They do them, they report out on them. It's reliable information, but it's not the level of a fertility doc. And so one of the first things I would say is if you just had zero morphology done at one of those contract labs, you may want to see if your fertility doc has the ability to analyze it in her own lab. Because when you're looking at a sample as a whole, for example, if there's a whole bunch of white cells in there, they may be read as abnormal morphology. When in reality they're not really abnormal, you know , they can also zoom in on the scope and take a look and see, oh yeah, there's, there's some normal here. Now that can give you a little bit of peace of mind as to how you approach things. Because certainly, you know, all right, if there's some normals in here, even if it's just a couple, we can do IVF with exi intracytoplasmic sperm injection, where they're going to cherry pick the best looking sperm. And we got something to work with. If there is really truly zero morphology, then where you go is going to depend on your overall life decisions. And , and let's talk about the female factor and then we'll kind of go into the well, crap, what do I do now?
Speaker 2Morphology, let me just make a comment about morphology. I think really what this person's asking is if a 0% morphology, does it mean this for I'm not going to get to the egg? And the answer is nobody knows. I mean, the problem is we really don't have a good test to look and see if the shape of the sperm head, the neck or the tail really makes a difference in terms of sperm penetration into the egg. We used to do a test called the sperm penetration essay. We don't do that anymore because we realized it didn't really tell us what we wanted to know. And so if you're just looking at that issue, not all the other issues that were mentioned, but if somebody comes to me and , and of course, 0% I will agree is that's low, but the answer is we really don't know for sure that the sperm can't get to the egg . We don't know that may just be a red herring. There may be some other issues that are bigger issues. And so in my practice, if somebody is young and healthy, female partners, young and healthy tubes, Roquet , um , she's ovulating regularly. I mean, my thought would be, why not try you off for three or four tries? And if it doesn't work, then yeah, we can certainly move on to IVF because in some of those patients, they do get pregnant. And so , uh , you know, my feeling would be, it would be reasonable to consider that, you know, now if you're, you know, 40 or something like that, and there's other issues, then the more problems we have the more quickly I'd go to IVF. But in the whole scheme of things, try and get you off for three or four months. If that's the only issue, then it may be reasonable to do that. What do you think?
Speaker 3I agree with that. I mean, we we've talked about before that the issue of how important morphology truly is comes and goes. I mean, just in my career, I know there have been multiple times that it's like, should morphology just be taken off of the semen analysis completely. So just the fact that we keep on twing with the subject of how important is morphology, it's something to be aware of. And I would say most people when it comes to infertility issues, it's a little of this, a little of that, a little of this put all those things together. You end up needing people like that . And so what I say, what I feel more warm and fuzzy about somebody who had more normal sperm, of course I would, but I wouldn't use it as a definitive. You have to go to IVF and, you know, for, for a lot of people, I mean, even if you tried two or three IUI cycles, if you were able to be successful, you've just saved yourself 15,000 plus dollars, depending on where you're doing your IVF cycle. So, you know, I wouldn't use it as an absolute, I would say, yes, I'm more concerned, but not, I would not try it now, as Carrie was talking about, you know, it sounds like your labs are relatively normal FSH of nine being 30. I do think that's probably on the upper end of normal, but probably not related to the fact that you aren't picking up observation . And just another reason why, you know, doing some, you know, super ovulation or ovulation induction in combination with the IUI is probably going to give you a reasonable chance of success. Especially if you're a cash pay patient. I mean, sometimes patients have insurance policies that kind of drive us in one direction or the other based on what coverage is available. But if you're in the, you know, we're purely making the decision based on the clinical factors. I think doing a few IUI cycles with superovulation or ovulation induction taking medicines like Clomid or Letrozole or combinations of those medicines, maybe with some injectables would be very reasonable course of action.
Speaker 4No, and I think the other thing to think about is , uh , particularly when you're coming back for a second child, like, let's, let's play the, what if game? What if you do IUI and it works and you get a baby and then you try for your second baby. After that saying that you knowing you want three kiddos, I would not hesitate to go back into your fertility doc, if once you start trying for baby number two, if you're, you know, six months to a year into it and you have not gotten baby number two, I would probably jump pretty quickly going straight back to your fertility doc , because we don't want to waste any time. I mean, I know for us about six months after a vaginal delivery a year after a C-section, we'll, we'll dive straightened to try and for the second baby. And even though once you have one kiddo, it does make it a little bit easier of , okay, at least I have have one child, but that doesn't negate or diminish the desire for a second child at all. And so I would say B be kind of aggressive as you're going through this, because if you get to the second child, if the first one is relatively easy in the fertility world and you get to the second one and it's difficult, I would, I would go straight towards getting help, not just assuming it's going to happen because mostly because you want to make sure that you're leaving enough space age-wise to get your third pregnancy that you want .
Speaker 3Another thing I'd like to mention kind of, of what Carrie was saying is, you know, one question we're often asked is, well, if I need fertility care for my first baby, am I going to need it for my second baby? Chances are, yes, there's always the exception to the rule. Everybody knows somebody who needed fertility or IVF even. And then they ended up having spontaneous pregnancies. That is not what I would necessarily expect. And I always think it's very reasonable. You know, if you want to try on your own a little bit for number two, that's fine, but I'm also fine with, Hey, we're ready for baby. Number two, we want to get back on, you know , treatments and let's just kind of pet to the chase. I don't think any of us would, would hesitate in saying that's a good idea.
Speaker 2All right. Well, so today we're going to talk a little bit about fertility imaging. And I think probably two of the most common things that we do in terms of imaging are doing vaginal probe ultrasound . So ultrasounds, and we can also look abdominal , but we usually use a probe in the vagina to do those con the ultrasounds that we typically prefer. Cause we can see better with those. We also do historicist Pinga grams. So why don't we start out by kind of defining what those are. So Susan, tell me what a hysterosalpingogram is.
Speaker 3Well, a history salpingo gram, blah, blah, blah, chief for short , also known as an HSG from here on out, because I'm going to get tongue tied today. Um , an HSG is essentially what we call a dye test of the fallopian tubes. So what the procedure is most of the time you will , um, sometimes you'll go to your doctor's office. I would say most of the time you probably go to a radiology center or a hospital that has an imaging center and they will usually do a pregnancy test on you beforehand, just to make sure that you aren't pregnant. Cause the last thing we would want to do is disturb obviously a very wanted pregnancy and you will lay on a little table and you'll kind of get your legs up in a frog leg position and they will place a speculum just like when you get your pap smear done. Now it tends to be a little bit, in my opinion, it to be a little bit more awkward because the radiology tables don't have stirrups and stuff like that. So kind of the logistics of this is , is a little bit cumbersome at times, but they placed the speculum so they can see your cervix just like they normally do. And usually they'll apply a little cleaning solution to your cervix and then they'll place a tiny little catheter inside the uterus. And when they place that little catheter inside the uterus, usually they'll blow up a little balloon and then they will have a little imaging device above and below you. And they will inject dye, which is actually clear, but you can see it on the image and it will fill up the uterus and then go through your fallopian tubes and ideally spill out into your pelvis. And by doing that, we're able to see number one is the general shape of your uterus. Normal are your tubes open? Are your tubes healthy appearing? And sometimes do you even have two tubes? And so there's quite a bit of information that , that we can get from that type of procedure. So Carrie , tell me that
Speaker 2A little bit about the timing of it and what if you do only have one too .
Speaker 4So timing wise, we want to make sure that you're not in the middle of your period. Um, and so typically what they do is they try and schedule it for as soon as you are done bleeding, because the concern is always, if you have a big blood clot in there, it will get read as an abnormality inside the uterus and we'll prompt more testing imaging procedures, those types of things. So it's right after you're done with your period, that has the additional advantage of knowing that you are highly unlikely to be pregnant at that time. Because like Susan said, we really don't want to dislodge any very desired pregnancy. So that's kind of how the timing works. And most radiology centers are built to accommodate that in the same way that your fertility docs are gonna accommodate. If this is day one of your period and you've got procedures schedule and they X your period, they're gonna take it and run, talk a little bit
Speaker 2At about the risk of it. And also along with that radiation exposure, cause people are always kind of worried about what am I going to be zapped with a lot of radiation .
Speaker 4So no fertility doc is going to send you to something where we think there's going to be detrimental amounts of radiation, Greece , because our careers live and die by the ovaries. And so yes, there is radiation exposure. It's very minimal amount of fluoro time, which is the radiation. Um, it's typically, you know, 15 seconds to 30 seconds. Maybe if there's something really challenging, let's say double that. And it's all of a minute. Like it's , it's not that much. Um, the, the dye is of course non-toxic , it's not going to do anything. And there's potential advantage if, when they're pushing it through it, it clears out any mucus. So there , there are some studies of just very slight bumps in fertility afterwards, let's say you don't have a tube-like let's say, you know, that you had an ectopic pregnancy and they had to pull out one of those tubes because it was damaged beyond repair and they needed to do that to save, save you injury or , or mortal harm there . What they'll do is they'll just, they'll put the die through and we'll know that it's not going to go through that one side. We would still expect it to go through the other side, if that other side is normal. So when you have two tubes, we expect it to go through on both sides. One to just the side it's open or in some cases, if you don't have either tube, what it will do is we will see the outline of the uterus and then almost these two little nubbins little alien ears coming out. That, that show us, okay, it's starting to travel down that path, but it doesn't go.
Speaker 2So Susan, talk about the risk of infection with this. What's the likelihood of that?
Speaker 3The risk of infection with this type of procedure is actually very, very, very low. Now with that being said, if there are specific abnormalities such as you have, what's called hydrosalpinx or swollen fallopian tubes, that is an exception where if we see abnormalities in tubes, we'll generally prescribed some antibiotics to prevent any infection from happening.
Speaker 2And I would say too , if I usually find know that patients have had a history of like a pelvic inflammatory condition or something, or , um , I think it's highly likely that they have a blocked tube. I like to start it before they ever do their HSG couple of days before, and then continue it throughout because unfortunately every now and then, although it's very uncommon, but every now and then I've seen some pretty nasty infections with that type of procedure, but it's very rare and it's kind of one of those things we've got to know about the tubes . So it's an important test to have done. So Carrie , tell me about the other way that we can evaluate the uterus and the fallopian tubes.
Speaker 4So the other way that we can do the uterus and the fallopian tubes , um, there's actually probably a couple of , depending on what you're talking about, but looking at
Speaker 2You, tell me what you
Speaker 4Think specifically. There's a procedure called a high COSI, which is pudding . Essentially. The concept is the same as putting dye through. It's just instead of doing radiation based imaging to , to watch the dye go through, it's done with an ultrasound. And so you put the catheter in the uterus, just like you do with an HSG you push the fluid through, which is not a contract and not a dye it's , um, it's more of a saline and air bubble mixture. Um, and then you watch the ultrasound to make sure that you're able to follow it along and see that the fluid comes out on both tubes. And so you follow out on one side and you do it, you follow it out on the other side. The advantage of that test is that there's no radiation there. The disadvantage of that test is that you don't necessarily get the same kind of imaging of a hydrosalpinx perhaps as you would with an HSG. Um, you also don't necessarily get the same kind of imaging within the uterus as you do with an HSG now , um, depending on what practice you're at, usually people have thought that out and there's a method to the madness of why they do what they do. Um, I will say the biggest advantage with the high COSIes . It is a heck of a lot less painful than an HSG because HSGs are, they are known for being uncomfortable and for causing cramping. You know, I would say with any of these tubal evaluation procedures, it's worth your while to take ibuprofen, a legit dose of ibuprofen before you go about an hour and plan heat and plan, all the things you would do for just an ugly period is very helpful for the discomfort. But I do think the high Coasties are much better tolerated by patients.
Speaker 2So we call them a saline sonogram. So if any of my patients are listening, we call them saline sonograms. And one of the things I would say that I think is an advantage, and sometimes the reason why I would choose that test over an HSG is we tend to get a better image of the uterine cavity. So if I see a patient that has maybe a polyp that I'm worried about just with a regular ultrasound, if I want to image that better , sometimes it really is beneficial to put water in, open the cavity up and see that at the same time, you can also check the fallopian tube . So it's, if there's a uterine problem or something that I'm worried about, I'm leaning more toward that task versus if it's mainly just tubes and I don't know about your all's experience, but we don't, a lot of times get great images if it's a radiologist that does, HSG not, not to make the radiologist feel bad, but they don't use the same technique. I think that gynecologists use. And so it's harder for them to be able to pull the uterus down so that we can see the cavity in the way that we want to. So Susan, tell me a little bit more about our ultrasounds that we do for our patients, as opposed to just, if you're going to have somebody look at your kidneys or something like that, who gallbladder.
Speaker 3So, I mean, and please correct me if I'm not speaking for, for all of us, because you know, sometimes we do things and we don't even realize that we're doing things different than somebody else. So when I think about especially ultrasound imaging, I kind of, we have our saline ultrasounds that I, I definitely agree with Abby. I don't ever use Salian ultrasounds to evaluate tubes. I've seen so many people who've come to me, had a high Kocide and then I ended up doing an HSG and there's something like blaringly wrong. And so I, I, it's just not my test of choice, but I love saline ultrasounds for checking out the lining of the uterus, really looking at those fine polyps , adhesions, those types of things that are commonly missed elsewhere. So the first ultrasound that I think most of our patients get is we call it a full gynae ultrasound. It is like the pelvic ultrasound where we're looking at your uterus, we're looking at your ovaries and all of our offices get the same phone call. I already had a pelvic ultrasound at my OB gen or at the hospital. Do I have to have one? The answer is yes. And the answer is yes, because there are certain things that when you go get your ultrasound done at your fertility doctor that we are looking at and documenting that no one else has really paid attention to the most notable things are number one, antral follicle count. So counting the number of little follicles on your ovary, really looking at the structure of the ovary , kind of like little, tiny eggs, and we're counting kinda right. The houses of , I call them the houses of the eggs. And so, you know, looking at the structure of the ovaries , um, looking at the uterus, making sure that there aren't any abnormalities, especially in the lining of the uterus. I mean, I've had lots of people who have had multiple ultrasounds and I'll be like , um, I think there's probably a polyp. We probably need to do a saline to make sure, but I think, you know, I think there's something there. And also looking at , um , what we call Mullerian anomalies or anomalies that are kind of their birth defects. They're how you were born. But the uterus is a pretty complicated organ. When you were in your mama's tummy, your uterus actually started off as two pieces that had to come together fuse and the inside had to dissolve. So that's kind of a complicated process. So it doesn't always happen the way that we expect it to. And so quite frequently, we might see maybe an arcuate uterus, a heart-shaped uterus or a septate uterus, a uterus that has a division through the middle that maybe fibrous and impairing good, healthy implantation, potentially increasing miscarriage. More rarely, we may see what's called a by corn unit uterus or a uterus where kind of the inside and the outside of the uterus both look heart shaped . And there are some other things that are even more significant embryology that w we can notice, but we're really, really paying attention to those things. Whereas quite honestly, I I've, I've picked up a lot of things that weren't picked up elsewhere. So that's, that's why we want to do our own ultrasound. The other major ultrasound, the ones we do all the time are the ones where we are monitoring your cycles. We're checking out the lining of the uterus, making sure it's. Then at the time it's supposed to be thin, making sure it's thick at the time it's supposed to be thick, making sure it has the right architecture at the right time. There are times that we want your lighting to have what we call a trilaminar appearance, where you can actually see three distinct lines. There's certain parts of your cycle that we should see everything white and fuzzy and hazy together. These are all normal things when they're at the right time and then monitoring the size and number of follicles that are growing. That's really important in what we do, because one, we don't want to just be giving you medicine and just throwing it at you. You're here to see us for a reason you want to be pregnant yesterday. So we want you, we want to get you pregnant today. So we're going to do everything we can to maximize, you know, the timing. And when is the exact right time for your personal body? Not just based on necessarily a test strip or a when theoretically the fertile window should be. We're trying to find your fertile window. And we want to make sure if you're doing things like IUI, that you don't have too many follicles, as much as we want you to be pregnant, we do not want you to be pregnant with the litter of babies. And on the other side of that , if you're doing an IVF cycle, and if you're one of those people who should have a robust response, we want to make sure you're not having a poor response and that we need to change things up because we want to give you your best chance when you're going through, you know, such a big, important treatment.
Speaker 2So Carrie leak , we can look at ovaries on ultrasound. We can look at sometimes tubes. If we put dark and water through, we can look at the shape of the uterus. Like Susan was saying, what's something in the wall of the uterus that we also look for that could be problematic for some people that are trying to get pregnant.
Speaker 4So we look for fibroids and we look for Adnan meiosis . Those are probably the two biggest things that you can see in the wall of the cavity. Um, fibroids come in in general, one of two flavors, they're either one or two of them,
Speaker 2Chocolate or vanilla.
Speaker 4I'm thinking like Rocky road and the chocolate chip mint chocolate versions of , um , you know, we're looking for, is there one really big one or a couple of really big ones? Or sometimes we see that it's really mint chocolate chip ice cream, where they're just everywhere. And every so often you get the really big goombas that are in there , uh, for the technical term or, or you have just a bunch of really little ones. And so we're going to approach those two things differently. We're also going to want to know where, where are their relative positions, real
Speaker 3Estate, real estate, real estate location,
Speaker 2Location, location.
Speaker 4If you have a fibroid that is ginormous, but it is almost completely outside the uterus, you know, yes, we care about it, but we don't care about it in the same way that we care about a even relatively much smaller fibroid that is hanging out, dangling into the cavity that is obstructing where that embryo is going to try and land, or is obstructing the sperm, getting up into the tube. We're going to care about those low
Speaker 2Irritation up in the cavity that can make those
Speaker 4Problems, irritation, bleeding, all of those types of things. So that's one of the other things that a vaginal ultrasound is very good at at looking at. And we tend to prefer vaginal ultrasounds just because they can get much closer to where we need to look. Now there's exceptions to every rule. Sometimes an abdominal ultrasound is going to get you a better picture. Um, certainly an abdominal ultrasound is not putting a , uh , you know, a long wand up inside your lady bits that some people find highly objection. Um , I would say that most people tolerate having vaginal ultrasounds really well because once you get used to like, oh, there's something in there it's really not like it, it kind of feels like someone is just taking a gentle spoon and stirring very lightly. It's not poking, it's not prodding. It's not intended to be painful ever, but it does allow us to get much closer to the uterus and to the ovaries. So we can really clearly see what we're going after.
Speaker 2So Susan, for patients that are in the midst of IVF, a lot of times when we do embryo transfers, we don't do vaginal ultrasounds. Now, some people do, but explain why we, most people would usually prefer do an abdominal scan. And what do we have to get the patient to do when they're about to have a transfer in that situation.
Speaker 3And one time we do lots of abdominal ultrasounds. So when we are doing an embryo transfer, we like to see where we're going. Just like everything else. We , we , we are not as fertility doctors. We don't like to do things blindly. And when it comes to putting your precious little embryo into your uterus, this is one time we, especially nowadays don't do it blindly most of the time. And so what we're able to do is with your ability to fill up your bladder nice and full, which is honestly the worst part of your embryo transfer is having to have a full bladder. We're then able to do an abdominal ultrasound while we're doing the embryo transfer. So we can see exactly where the catheter is. See all the little curves of your cervix and the position of everything, and , and be able to put that embryo just in the sweet spot where it's going to have the best chances of implanting. So, like I said, that involves you filling up your bladder. That can be pretty uncomfortable. I remember my embryo transfer. I remember my bladder. I remember pinging afterwards.
Speaker 2Why does fill in the bladder make a difference? How does that help us see better?
Speaker 3We have to have a medium between the ultrasound and what we're actually ultrasounding that that helps with the ultrasound waves to be able to give us the best picture. Number one, number two, having a full bladder when you're having procedures like that can actually straighten up the curve of the uterus and the cervix and make it easier for us to get the embryo into the uterus as well. All right .
Speaker 2Well, I think that about covers ultrasound 1 0 1 and HSG one-on-one anything that we, that I didn't ask about that our listeners should hear about, or that you guys can think about that we didn't cover.
Speaker 4So sometimes I'll ask for an MRI when, okay ,
Speaker 2Carrie, that's not part of this HSG ultrasound, but yes, we do ask for MRI sometimes just kidding,
Speaker 4Managing that we do. Um, we work with what is usually less expensive. What's easier to order and get done quickly, but every so often you've got to pull out the big guns. And so MRI tends to be what we pull for when you have an abnormality of the shape of the uterus, when you have something that just isn't clear that before, maybe before you go in for surgery or anything like that, we get the MRI
Speaker 2Are really large fibroid or something like that. Yeah. Or Mo or multiple fibroids. Sometimes it can be helpful to get an a ,
Speaker 4For an anomaly where you're also worried about the kidneys and the spine. Like things like that. Sometime an MRI will, will be the final arbiter of what do we do next, but , um, but yeah ,
Speaker 2Well to our audience, thanks for listening and tune in next week for more also be sure to subscribe and leave a review for us in iTunes. We'd really love to hear from you.
Speaker 4You can also visit us@fertilitydocsonsensor.com to submit specific questions. All questions will be answered on the podcast anonymously for our ask the doc segment . So don't hold back. Um , we also love episode ideas. So let us know what you're thinking and what you want to hear as
Speaker 3Is this podcast is intended for entertainment and is not a substitute for medical advice from your own position . All right . We'll
Speaker 2Talk to y'all soon.