Ep 256: Beyond the Diagnosis: Tackling Unexplained Infertility

 In this episode of Fertility Docs Uncensored, your hosts Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center, and Dr. Susan Hudson from Texas Fertility Center dive into the complex world of unexplained infertility, which affects about 15% of couples.

In this episode, we'll explore the critical factors that can impact fertility, including age and its significant influence on egg quality. We’ll discuss the importance of testing for egg and sperm quality and quantity, as well as how lifestyle factors can shape fertility outcomes. Our experts will also explain how IUI cycles and IVF can offer deeper insights into cases of unexplained infertility and how genetic testing might uncover hidden issues.

Tune in for a thorough discussion filled with expert advice and valuable information to help you better understand the complexities of unexplained infertility. Let's dive in!

Have questions about infertility?  Visit FertilityDocsUncensored.com to ask our docs. Selected questions will be answered anonymously in future episodes.

Today's episode is brought to you by Theralogix

Transcript

Susan Hudson MD (00:01.552)

Hello everyone, this is Dr. Susan Hudson with Texas Fertility Center and another episode of Fertility Docs Uncensored. I have my amazing, fantabulous co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Carrie Bedient from Fertility Center of Las Vegas.

Abby Eblen MD (00:15.558)

Hi everybody.

Carrie Bedient MD (00:19.861)

Hey!

Susan Hudson MD (00:21.654)

Hey, what have y'all been up to?

Carrie Bedient MD (00:25.516)

All the things all the time, not having any ability to say no to anything that I should. You know, The usual.

Abby Eblen MD (00:32.968)

But other than that, more importantly, we were chatting about ice cream flavors. So Carrie, tell us what's your favorite ice cream flavor or brand? 

Carrie Bedient MD (00:48.562)

I realized after I posed that we should talk about this, it was an entirely self-serving question, because I'm looking for things that you know that I don't about ice cream. It's self-serve. Bud-ump-ching, I'll be here all night with the waitresses. But I was realizing this is entirely self-serving because I want to know what you know that I don't know that I should know about ice cream. So there's different categories to this answer. If it's grocery store ice cream, Tillamook is my default, in part because we went up to Oregon and saw the factory. And it's the best. And then there is a place called Handel's, which is a chain, but it started in Ohio. And I have decided that all of the best ice creams, oftentimes like two thirds of them emerge out of Ohio.

Abby Eblen MD (01:29.66)

Never heard that.

Carrie Bedient MD (01:49.418)

Because there's Mitchell's and there's Graeter's and there's all of these places that are delicious. And the place that I really wanna go back to is Mitchell's, which is in Cleveland, but it's kind of a long flight just for an ice cream. 

Abby Eblen MD (02:01.52)

A long drive from Las Vegas.

Susan Hudson MD (02:05.35)

What about you, Abby?

Abby Eblen MD (02:07.592)

So I would say grocery store ice cream, Ben and Jerry's. And I have a personal story. When I interviewed for fellowship in Vermont, I had to stay over a Saturday. So I interviewed on Friday at the fellowship or University of Vermont fellowship program. And then Saturday I had to find something to do. At that time, and I don't think Ben and Jerry's does it anymore, but they had tours. And you got to go through the Ben and Jerry's plant, and the best part of it at the very end, they would take ice cream off the conveyor belt, bring it out and they slice it up. And then every single day, it's their quality control. Depending on what the ice cream is, they have to have so many chunks of chocolate per part that they cut up. And so anyway, we got to eat some of the ice cream. And of course, Chunky Monkey's my favorite. So I love Ben and Jerry's. And then local ice cream, we have a place called Jeni's Ice Cream. 

Carrie Bedient MD (02:59.082)

Yes, out of Ohio 

Abby Eblen MD (03:02.448)

I didn't know that. So it's really cool and they have lavender ice cream and they have Brown butter. It's delicious. It's great. So that's probably my one that I that's not grocery store type ice cream. What about you, Susan?

Susan Hudson MD (03:21.55)

As a Texas girl, I have to say my long time favorite, of course, is Blue Bell. That is out of Brenham, Texas. I can't have most Blue Bell anymore because most of it is not gluten free. So of my favorite gluten free versions, in Minnesota, there is a brand of ice cream called Kemp's. It's their local thing and they had a chocolate with peanut butter chunks that was just absolutely to die for. The peanut butter was super salty, and it was the perfect match between chocolate and peanut butter together. I'm obviously a big chocolate and nut fan. As my mouth is now watering, I have to say that that's probably my two favorites other than gelato, which is just amazing. And I love coffee gelato. So those are my weaknesses.

Abby Eblen MD (04:20.594)

When we come down to San Antonio next year for our American Society for Reproductive Medicine meeting, you're gonna have to take us to Kemp's, right? Is that the ice cream? That's the Minnesota one. Okay, so you're gonna have to take us to the one in Texas, Blue Bell.

Susan Hudson MD (04:35.45)

We'll have to eat at Blue Bell.

Carrie Bedient MD (04:38.31)

Mmm, ice cream. I like this plan.

Susan Hudson MD (04:41.318)

It's a good one. All right, well let's do a question today. Here's our question. I've been having brownish discharge daily ever since ovulation. Is this cause for concern? There's some minor cramping, but not sure if this is a PMS symptom. I usually only notice such a brown discharge a few days before my period. This cycle comes after two IUIs with letrozole and oral progesterone. I've planned for IVF five months later due to travel plans and will be trying unassisted in the meantime. I'm afraid that this is something that will impact my chances of conceiving and affect IVF success. So what are the things that you're worried about when somebody has brown spotting?

Abby Eblen MD (05:22.536)

Sometimes we worry about lower progesterone levels. Sometimes taking hormone or taking medications like letrozole or Clomid, sometimes it will kind of help your progesterone production. But for some reason, maybe it's interfering in some way, but it suggests that the dominant hormone in the second half of the cycle is progesterone. And if your body stops really making the amount that it needs, then what happens is your lining starts breaking off and you start having spotting. So I would agree, we don't really like it very much.

Sometimes I'll treat patients with progesterone in the second half of the cycle, right after ovulation help that problem. And usually that's pretty effective, and there's a lot of different ways you can get progesterone. A lot of times if it's part of an ovulation induction cycle with oral medicines, I'll use oral progesterone for usually about 14 days or so. And then ultimately, I usually tell my patients if you're not pregnant by about day 34, check a pregnancy test and if it's negative, then you can just stop it. Because sometimes it will make your cycle a little bit longer. The downside to that is it makes people excited that they're pregnant when they're really not. It's just from the progesterone. What about you, Carrie?

Carrie Bedient MD (06:24.072)

I always think about if you're having spotting and a period is funky at all, take a pregnancy test. Because first and foremost, you want to make sure that there's not something growing in there in a weird place that shouldn't be growing. And also, women don't get periods while they're pregnant, but you can get bleeding in early pregnancy. And sometimes it can be really inconveniently in the exact timing of your period. And so nobody wants to get faked out with that. So always double check a pregnancy test. If there's any doubt, go to the docs, get a quantitative HCG level so that you actually have a number. So if it is high, you can follow it up, down, sideways, whatever it's gonna do so you are covered. So that's another thing that I always think of is just make sure that there hasn't been something that has happened that may throw off your plans.

Susan Hudson MD (07:16.4)

A couple of things that I think about are one, making sure there's not something structurally that's disrupting the integrity of your endometrium or lining of the uterus. If I have a patient that has that history, I often recommend a saline ultrasound to take a close look at the lining, make sure you don't have any polyps, little overgrowth of the lining of the uterus that may be creating not quite as great of an environment as you would want. 

I'm also not a fan of oral progesterone. I think that a lot of progesterone gets broken down by the liver if we take it orally. Especially in this type of situation, I might recommend you using vaginal progesterone instead and see if that might help kind of maintain the integrity of that endometrium.

Carrie Bedient MD (08:05.26)

I would agree with that. And one other thing, make sure your pap smear is up to date.

Susan Hudson MD (08:11.812)

Yes. All good. Today we are going to talk about the enigma, unexplained infertility. We get a lot of questions about unexplained infertility, and that's the reason we're having this discussion today to really take away a little bit of the mystery about what is unexplained infertility. So let's start off, we're gonna talk about the diagnosis of unexplained infertility. What are some things that if somebody's thinking about unexplained infertility, do we need to test?

Abby Eblen MD (08:50.578)

Egg count is one. Sometimes we'll see really young patients that have a lower egg count. And a lot of times if you're trying to get pregnant just sort of the good old fashioned way or with ovulation induction, it probably doesn't dramatically impact your fertility. But yet, if you're in your early 30s and your egg counts considered as abnormal, that's unusual. To me that suggests that it's not entirely unexplained in fertility. We know that there's a lower egg pool there. So that would be one of the things I would check. What about you, Carrie?

Carrie Bedient MD (09:18.678)

So going into sperm, figuring out A, what your basic semen analysis shows, concentration, movement, and motility. There's a couple additional sperm tests that may or may not be helpful depending on what the overall situation is. SpermQT looks at the functionality of the sperm breaking into the egg. Sometimes a DNA fragmentation, especially if there's pregnancy loss, can be helpful. And making sure that all of those things check out. Susan, what do you go for?

Susan Hudson MD (09:46.31)

Also looking at the structure of the uterus and the fallopian tubes. We wanna make sure that your tubes are open and healthy appearing. And I usually do that through an HSG. Some people use other tubal patency tests where they put saline or foam or different types of dye through your fallopian tubes. And then also, as I said, the uterus itself. Really not quite as concerned about things interfering with the muscle of the uterus, but really focusing on the endometrium or the lining of the uterus. That's where an embryo would implant, and if you're not pregnant, that's what you shed every month with your period. If you don't have any history of certain things that make us worried about things like polyps or fibroids, sometimes just a basic pelvic ultrasound with a vaginal ultrasound will give you good images. But if we're concerned, sometimes we put some fluid in there and do a saline ultrasound or even do a hysteroscopy, which is an outpatient procedure where we put a little telescope inside the uterus to make sure it's a perfect place for a baby.

Carrie Bedient MD (10:54.784)

The other thing you need to check on is overall lifestyle factors. Some of these are the obvious ones, drugs, sex and rock and roll. Others are things that you may or may not

actively think of because you may think of them as well managed. Aand that can be, blood pressure, that can be diabetes, that can be kidney problems, for example. If somebody's had a kidney transplant and their kidneys aren't functioning super well, that can drive up their prolactin, which stops them from ovulating and then you have a difficult time. Some people with autoimmune conditions, even when they're fairly well controlled, they can have difficulties. And so looking at your overall medical picture and what medications you're on and how any conditions you have may be managed plays into that as well. Now, please do not read that as an advertisement to stop every medication you are on. That is absolutely not what I am saying, but making sure those conditions are well managed with pregnancy safe medications because you need to make sure that what you need to have managed is, but not in a way that's gonna jeopardize you in either direction from being on it or off of it.

Abby Eblen MD (12:01.746)

Couple other hormonal things that we didn't mention too is thyroid. We wanna make sure your thyroid's under good control. It's unusual for somebody to have really significant hypo underactive thyroid or hyper overactive thyroid, but that can certainly impact things. And the other thing that a lot of times goes along with that is prolactin. Unless I ask patients specifically, do you have breast discharge…no one volunteers that usually. In fact, I just had a patient the other day and she's like, well, I think if I really tried I could get some breast discharge and sure enough she did. And so that makes us worry that the hormone prolactin's elevated. That's a hormone that should be only elevated kind of right around the time that you've had a baby when you're breastfeeding. And if that hormone is elevated, a lot of times it can change your endometrium in a way that can make it difficult for you to get pregnant. Sometimes it even prevents you from having periods at all. So some people will come to us and not have periods at all, and it's related to that hormone.

Carrie Bedient MD (12:55.952)

I'm just curious when you asked her if she had nipple discharge in the middle of your consultation, did she stick a hand up her blouse and look?

Abby Eblen MD (13:02.024)

She did, she did. I was like, we can just do an exam. She goes, no, let me just check. And she did. And then I said, well, so you got it out of the right side. What about the left side? She's like, well, let me check. And she did.

Carrie Bedient MD (13:12.524)

Yep, I don't know if you guys have had this experience. I don't know how many of my staff members over the years have come in and just like dropped trou in my office to ask me about something. Patients do it too when you ask them a specific question, and they want nothing more than to help you out and to give you answers.

Abby Eblen MD (13:21.266)

Yeah. We got an immediate answer right there. We knew.

Carrie Bedient MD (13:30.752)

Yeah, whip it out. It's great.

Susan Hudson MD (13:33.444)

Another thing, when you go see your fertility doctor, they may offer some genetic testing, and that testing is often looking at things that kind of hide in the family tree until the right person meets the right person. When you do that testing, there is a condition called Fragile X Syndrome and sometimes people who may not have Fragile X Syndrome but may have some of the precursors to it, we know that that can make it more challenging. And even knowing your family history and knowing about things like breast, ovarian, prostate, pancreatic cancer, those things can all be related to something called BRCA or B-R-C-A. And we know that even being a carrier of BRCA can make it a bit more challenging to conceive. So that's something else I think about. Now, one big thing that we face every day, and that's because the population is putting off childbearing, sometimes people have a normal evaluation but there may be something else glaring that can have a negative impact. What might be that?

Abby Eblen MD (14:44.104)

Age, over 35, but truly over 40, we see the biggest impact with age. And you're right, we see people like that all the time that are really healthy, exercise, eat correctly, have good lifestyle habits, but just unfortunately, at a certain point, you just can't outlast the biological clock. Starting after 40, it's really difficult for women to conceive, even if they're making eggs every month, even if they're ovulating every month. It's just a challenge because genetically the egg is just not the same over the age of 40 as it is when you're under 35 basically.

Susan Hudson MD (15:17.638)

Let's dive into that a little more deeply just because I want to make sure everybody understands why is egg age a big deal.

Carrie Bedient MD (15:24.588)

So within the eggs, you have 46 chromosomes. And those chromosomes are all paired off, so you have 23 pairs. What happens when the egg gets released is those pairs break up again. And so you've got a set of 23 and a set of 23. Well, there's no mechanic that is putting WD-40 on hinges that hold those chromosomes together. And as a result, they get rusty. And some of them are going to stick together. And as a result, you're going to get too many chromosomes on one side or too few on the other. And it doesn't mean you're necessarily gonna have an entirely duplicated set. It may just be one or two that stick and don't go in the direction they should. But as a result, you end up with too many or too few chromosomes in the resulting embryo. And for the most part, that is not compatible with a healthy pregnancy. You can get some pregnancies, Down syndrome is probably the most well-known of this, that result in a live birth. But those children are still affected to some degree by the chromosomes that are there. And for the most part, when you have too many or too few chromosomes, those don't result in live births. And that's true no matter how young you are. Because it's one of those laws of nature. And pretty much everybody, especially in our patient population, is very law abiding. You can bend the rules of nature, but you can't break the rules of nature. And so even though you're young and healthy, you can't break the law of nature. So by the time people get to 40 and especially 44, 45, those rusty hinges cause all kinds of problems.

Susan Hudson MD (16:59.408)

So guys make new sperm about every 72 days. When do women make new eggs?

Abby Eblen MD (17:05.69)

Once in a lifetime. And that's it. And you start out and we've said this before, but you start out with a large number of eggs, around six million. Then by the time you're born, about two million. By the time you reach puberty, about 500,000. By the time you reach late 30s, about 25,000. And then around 40, it's about thousand eggs. But at that point, it's what Carrie just talked about, the genetics of egg that probably has the biggest impact, plus the fact that the eggs are left over are eggs that have not been ovulated for the last 40 years. So they're at the bottom of the barrel and probably not the best eggs.

Carrie Bedient MD (17:39.126)

Have you guys ever thought about the fact that when your grandma was pregnant with your mother that you were in her body too?

Abby Eblen MD (17:46.95)

No, but I tell you what I have thought about is that my mitochondria from my mother and my great, my grandmother and my great grandmother are all passed down to me. That's the other interesting genetic factoid for women.

Susan Hudson MD (17:57.83)

That's pretty darn cool. So at the heart of what we're talking about is if we have discussed any of these things and any of these things actually relate to your diagnosis, do you have unexplained infertility?

Carrie Bedient MD (18:15.324)

No. And that's true even if, and this is especially why Susan brought up the age thing, even if all of your testing is absolutely stellar and beautiful and people tell you, you've got the egg supply of a 20 year old, you may have the numbers of a 20 year old. We do see that on occasion, but you don't have the mechanics of a 20 year old. And we're really trying not to be assholes when we bring that up because it is just a touchy subject and we know it's a touchy subject and we don't want to insult anyone, but it's a very real impact on what we do and how we get to where we need to be. And the people who fight us saying, well, I'm really healthy and my numbers are all correct. Yeah, we totally get that. That's why we're still working going forward with everything we can. But it really has a huge impact on what we do just based on the sheer statistics of it all. You can bend the rules, but don't break the rules.

Abby Eblen MD (19:11.304)

One other thing too, Susan, and you may have touched upon this, but just I want to emphasize, one of the things that we used to look for quite frequently is endometriosis. So from time to time, I'll get patients that'll say, well, should we do a test to look for endometriosis? And we're not as likely to do that so much anymore because if you have fairly mild endometriosis, then it probably doesn't really have a big impact, at least not on your egg retrieval part. There's the transfer, maybe yes, the jury's out on that. But for the egg retrieval we typically, even if we think you have endometriosis, we know that, and again, you fall into the explained category, not the unexplained if you have that, but we typically don't go and look for that unless you're having a lot of symptoms from that, like pain or severe menstrual cramps. The other thing is fibroids too. Many people have fibroids, and it's the size and location that really make a big difference. So if you have lots of fibroids and the fibroids are growing into your cavity and distort your cavity, then those probably do have an impact. And again, you're not in the unexplained category, you're in the explained category, if we find those.

Susan Hudson MD (20:15.054)

Absolutely. Shifting gears here. Going into treatments. We're gonna start off with our less invasive treatments. The nice thing is a few years ago, the American Society of Reproductive Medicine published this fantastic article about unexplained infertility and really kind of opened the door to what we in fact were doing a lot of time in our practices because not everybody can or wants to go straight to IVF. If we're not going straight to IVF and we have unexplained infertility, which means you have normal sperm, you're ovulating, your tubes are open, you're a relatively young age, and all of those stars are aligning, what is a reasonable treatment for someone in this situation?

Carrie Bedient MD (21:04.972)

Typically we start with an IUI cycle, and that's combination of medication to help her ovulate, medication to ovulate at time certain, and then the insemination itself to put the sperm there. And this is what I think of as a gentle nudge to everything. A little bit of a nudge to the eggs to grow, a nudge to kick them out, a nudge to get the sperm closer to where it needs to be, keeping an eye on the endometrium or the lining to make sure it's thick enough. But you're still really pretty heavily relying on the body to do a lot of the work itself because you're putting the sperm closer, you're not directly putting the sperm into the egg, for example. And there's still quite a lot that has to happen on its own for an IUI cycle to work. With unexplained, we don't know the specific reason why it's not happening on your own. And so we're totally willing to try, but it's with that knowledge of it's a nudge.

Abby Eblen MD (22:06.844)

You're trying to change the tipping point is what I tell my patients a lot. And you can still have sex after that. We tell you to abstain or partners to abstain somewhere between two to five days. So a little bit before we do the IUI, ideally we want you to abstain. But after we do the IUI, you can have sex as much as you want to, doesn't matter.

Susan Hudson MD (22:24.558)

An important thing that I think a lot of us see also in our practices is people will mention you have unexplained infertility and patients are like, great, there's nothing wrong with me. And that's not the case because if that was the case, you would not have been having unprotected intercourse for six to 12 months, and you would not be in our offices. So realize that when we do fertility testing, there's a limited amount that we can test at this point in time as compared to all the things we know that can possibly go wrong. And so when we're suggesting things like ovulation induction with inseminations, like Abby and Carrie said, we're gently nudging things in the right direction. But what you also need to know is a lot of times when we mention these things, they're like, can we just do some of that medicine and have timed intercourse? What does the the data, what does the published research show us about just doing medications for the woman and not doing insemination?

Abby Eblen MD (23:24.36)

Well, like Carrie said, it's probably just about as good as having a martini and having sex at when you think is the right time. We used to think that doing that by itself was helpful. Now we say if you're baseline, if you're an infertile patient, your baseline chances of pregnancy in a month are probably one to 2%. With oral medicine, maybe 5%, but statistically there's probably not a big difference there. So generally we tend to lean toward, and I think all doctors do now, toward doing ovulation induction with IUI and not either one of them separately. Now, in reality, if you show up to my office and you say, you know, I really don't wanna do both of those together. Can I just do ovulation induction? I'll say, sure, we can do it. But I always like to let people know that, the chances are not all that great. It's not a whole lot better than just having time intercourse at home if you just do ovulation induction.

Susan Hudson MD (24:13.164)

Absolutely. If we do some of these IUI cycles, generally we would recommend probably not doing more than three or four of them, because at that point you end up not really gaining any momentum any longer. Or sometimes people have other reasons why they might want to go to another treatment like IVF. How does IVF affect unexplained infertility?

Carrie Bedient MD (24:37.868)

The way that I think about this is as blind dates, and I think I've given this example before. If you're timed, just timed intercourse with nothing else, that's like giving each part of the blind date the phone numbers. If you're doing an insemination cycle where you've got the medication and the insemination to put everything closer together, that's dropping both sides of the date at the door of the restaurant together. When you're doing IVF, you are dropping both of them into bed at the same time. And if you're doing ICSI, you're dropping them both into bed at the same time with no clothes on. And so it doesn't guarantee that anything good is gonna happen or that anybody's gonna like it, but it makes it a hell of a lot more likely that something's gonna happen because you're setting the stage in a much more direct way. 

Abby Eblen MD (25:11.449)

Hahaha

Susan Hudson MD (25:34.544)

That's a great way to compare it. I also think of it as combining 12 months of trying into a single cycle? Because you're getting more eggs, you're getting more good sperm, and you're also letting, one of the challenges, as I mentioned about unexplained infertility, is our testing is limited. There's some things that we just don't know about your egg, sperm, embryos until we see them interacting in a dish. I consider IVF not only therapeutic, but it's also diagnostic. How many times have we done IVF and we actually do have an egg issue, we actually do have a sperm issue or embryos just aren't doing what they need to do. It really can be so, so insightful to see what's happening in that little incubator.

Abby Eblen MD (26:13.159)

Yeah. Well, and to that end, what you were saying about unexplained earlier, I thought about how just recently, and we have all started doing this test recently, used to we'd say, your husband has, or partner has a good count volume motility, that's great, he's fertile, he's great. Well, now we've learned there's a test called the SpermQT test that we've talked about several times before, and it looks to see how well the sperm can actually bind to and penetrate the egg. It looks at the DNA of the sperm, and what we've learned from that is that even guys who have great count, volume, motility just don't have what it takes for their sperm to bind to and penetrate the egg. And so that's a great example of how, you we used to say, well, gosh, we don't know. Your partner has a great count. Everything's fine. Well, little did we know that, you know, there is a subset of men, even with a good count, that still their sperm doesn't work correctly. So Unexplained may not stay unexplained depending on the tests that we get in the future basically.

Susan Hudson MD (27:21.666)

And that's an important thing to remember is what's available now may not be available a few years from now. We all have patients that we may have seen four or five years ago and they come in now and we're offering them something like SpermQT where we're like, well, this might actually offer an explanation. So not having an explanation, one, is not necessarily a bad thing. And I know it's really hard sometimes as people who are struggling with infertility to grasp that because we're used to Googling why is the sky blue. okay? But when we tell people, hey, we definitely have a problem with this, this or that, sometimes those things are not easily fixable or amenable to a workaround. And that's what I think of when I think of unexplained infertility is that we know that we don't have some of the big and ugly things that we sometimes have to deal with. And often, sometimes we just need a little nudge, sometimes it's a bigger nudge than others, but we're very often successful in these situations. That's the important part is keeping your eye on the prize and not where you are at this moment.

Carrie Bedient MD (28:36.588)

It's very important for especially the patients who would clock themselves or their significant others as super type A. Engineers, I am looking at you. And accountants. Yep. College professors, they're another group. But it's really important for you guys to know that this is a real diagnosis. There are papers written about this. There are practice bulletins about this. This is very, very real. This is not just a…my doc doesn't know what they're talking about and they gave me some BS about unexplained infertility. Just means that they didn't know the test to run. No, no, we're working hard. We would much rather be able to give you a specific reason most of the time, but it's a very real entity that hits approximately 15 % of couples with fertility issues. And that's why we have these algorithms, and that's why we approach it in the way that we do.

Susan Hudson MD (29:29.07)

Any other thoughts today?

Abby Eblen MD (29:33.032)

Think we've hit it.

Susan Hudson MD (29:34.432)

All right. Well, hopefully we've given you a lot of information and dispelled some disinformation about unexplained infertility. So to our audience, thank you so much for listening and be sure to tune in next week for more. Be sure to subscribe and leave us a review in Apple podcasts or on YouTube. We'd love to hear from you. We're on Instagram, Facebook, YouTube. Follow us and subscribe and stay updated on all things fertility.

Abby Eblen MD (30:00.688)

And you can also visit us on fertilitydocsuncensensored.com to submit questions. We'll answer all of our questions anonymously on our Ask the Docs segment. We would love to hear from you.

Carrie Bedient MD (30:10.078)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. All right, we'll talk to you soon. See you next week.

Abby Eblen MD (30:18.674)

Bye.

Susan Hudson MD (30:18.832)

Bye.