Ep 269: To Do List for IVF

Getting ready for your first appointment at the fertility clinic? Join Dr. Carrie Bedient at the Fertility Center of Las Vegas, Dr. Abby Eblen  at Nashville Fertility Center, and Dr. Susan Hudson at Texas Fertility Center for an informative episode reviewing the best way to prepare for your first visit at the fertility clinic. The docs review records and items to gather prior to your appointment. They discuss questions to review with your primary care physician. Tune in to get firsthand advice on preparing for your appointment!

This episode was brought to you from ReceptivaDx and IVF Florida.

Transcript

Susan Hudson (00:01)

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.

Susan Hudson MD (00:22)

This podcast is sponsored by ReceptivaDx. ReceptivaDx is a powerful test used to help detect inflammatory conditions on the uterine lining, most commonly associated with endometriosis and may be the cause of failed implantation or recurrent pregnancy loss. Take advantage by learning more about this condition at receptivadx.com and how you can get tested and treated, providing a new pathway to achieving a successful pregnancy. ReceptivaDx, because the journey is worth it.

Carrie Bedient  MD (00:53)

Hello and welcome to the latest episode of Fertility Docs Uncensored. I am one of your hosts, Dr. Carrie Bedient from the Fertility Center of Las Vegas. And I am joined by my two incredible, industrious and impressive co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (01:09)

Hi everybody.

Susan Hudson MD (01:13)

Hello everyone

Carrie Bedient  MD (01:15)

How's it going?

Susan Hudson MD (01:17)

It's good!

Abby Eblen MD (01:18)

Going well.

Carrie Bedient  MD (01:20)

So what's new? What have you guys been up to recently that is new and exciting or at least entertaining?

Susan Hudson MD (01:29)

So I just got to see Les Mis again this weekend and I loved it. I've seen it five times, but I have to say, the thing that I love about Les Mis is I've seen it over a very long timeframe and the way they've changed the stage production from the very first time I've seen it over the years, it's almost like watching a new production each time. So you know the story, you know the music, but how they deliver it, it keeps on changing and evolving. And I don't think that happens in a lot of productions. Granted, most productions don't have the lifespan of Les Mis. But I mean, it was really neat to see. They did a good job.

Carrie Bedient  MD (02:08)

Yeah. Tried to see Les Mis on multiple occasions. I have yet to ever get tickets. So I know all the music because I have been a theater junkie since I was like I started when I was six and got really heavily involved and I was I don't know 11, 12 somewhere in there. So I know all the music. I have never actually seen the stage show nor have I seen the movie because I haven't seen the stage show and I wanted to see the stage show before I saw the movie.

Susan Hudson MD (02:39)

So actually, no, no, no, no. So what I do recommend is watch the movie first, okay? The movie adds in some stuff. I mean, it's a longer story than what the actual stage production is and watch it with subtitles on so that you get all of the words and so you get all of the meaning completely and then you see the play. But don't y'all have like Broadway Across America in Vegas?

Carrie Bedient  MD (02:51)

Mm-hmm. Okay. Yeah. I know they have come. I have tried to get tickets. I have not been able to get the tickets. Like this is with sitting in line from the very beginning.

Abby Eblen MD (03:15)

That's because you live in Las Vegas.

Carrie Bedient  MD (03:17)

I don't know what that means.

Abby Eblen MD (03:20)

There's lots of people that come to Las Vegas that want to see shows.

Susan Hudson MD (03:22)

Yeah. You have the local people who want to go see a show. You people coming in to see a show. Whereas when I go see something at the Majestic in San Antonio, which is an amazing place to go see it because it feels like a New York theater, that, you know, it's people from central Texas going to see it, not people flying in from all over the US or the world to see something.

Carrie Bedient  MD (03:24)

That's true.

Yeah, yeah, yeah.

Abby Eblen MD (03:47)

Yeah, we have a Tennessee Performing Arts Center that has Broadway shows that come through too, so not quite as difficult to get as probably yours in Las Vegas.

Carrie Bedient  MD (03:47)

Yeah.  have, I've read the book, so does the movie hold true to the book?

Susan Hudson MD (03:58)

Have not read the book.

Carrie Bedient  MD (04:00)

I am shocked and appalled, Susan Hudson. Shocked and appalled.

Susan Hudson MD (04:04)

I will need to look at it on Audible. How about that?

Carrie Bedient  MD (04:11)

All right, fine, fine. That is an acceptable alternative because it is a long ass book. But it's good, so it's fine. Okay, Abby, I notice you haven't jumped in about your favorites.

Abby Eblen MD (04:22)

Yeah, I haven't seen the book or read the book or seen the performance or so don't know anything about Les Mis. I'm not a huge fan of musical theater, so I hope I don't offend anybody out there. I like visual arts, not performing arts as much. I will say we had TPAC tickets for a while, which is our performing arts group, because my husband loves me. Tennessee Performing Arts Center. So, no.

Carrie Bedient  MD (04:42)

T-Pak, not Tupac, right?

Got it. No, no rappers. No rappers.

Abby Eblen MD (04:49)

So I will say we saw Jersey Boys and I'm not a huge fan of that music, but then having it performed on stage was really cool. I really liked it. And the guy that, one of the guys that was one of the initial, original Four Seasons guy actually popped in and made a guest appearance. And so he was the one that wrote a of the songs like, What a Night. Like was the night he lost his virginity. And he talked about that when he was at TPAC, which was...A little weird, yeah, I little awkward, but it was kind of interesting to get the backstory on that. but I really did enjoy Jersey Boys a lot.

Carrie Bedient  MD (05:25)

And you guys give me crap for living in Las Vegas. I have never been to a show where somebody's talked about losing their virginity. I just want to point that out.

Abby Eblen MD (05:30)

Yeah, so when you listen to Oh What A Night late December back in 63, well, there you go. Now you know the best. Yeah, yeah. Well, it was a true story, actually.

Susan Hudson MD (05:35)

Hmm.

Carrie Bedient  MD (05:35)

I mean, I was kind of assumed that's what it was, but...

Excellent, I think. All right, Susan, do we have questions?

Susan Hudson MD (05:46)

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Susan Hudson MD (06:18)

We do. We do. Okay. So hi there. I recently was going to start my first round of IVF when the doctor saw a 5.2 centimeter cyst blocking my left ovary on the ultrasound. They canceled my stims and are starting me on birth control, aygestin to try to shrink the cyst. Have you seen this work? If it doesn't, would removal or drainage be an option? As background, I've had the cyst for over a year diagnosed as a simple cyst and it started out at 2 cm. I'm 30 years old, have two partially blocked tubes and AMH of 3.12. Thanks for all you do.

Carrie Bedient  MD (06:52)

Okay. Abby, what do you think?

Abby Eblen MD (06:54)

So cysts can definitely go away, particularly simple cysts. And we do treat them either with birth control or aygestin to suppress the function of the ovary because a lot of times, and I'm not sure in your situation if this is true or not, but a lot of times it's a physiologic cyst, meaning it's just, it's a cyst that forms around the egg, because remember the egg is in the cyst. And so as the cyst sac grows, usually it pops open and the egg comes out, the sac closes and usually over the course of a couple of weeks, if you don't get pregnant, that cyst just involutes and goes away. Sometimes they can be a little onry and they'll keep growing or getting bigger. The fact that yours has been there for some time makes me worry a little bit that it's not that type of cyst. Simple cysts we tend to worry about less in terms of cancer risk and things like that. But if yours has remained, sometimes it can be a para-ovarian cyst and sometimes those have to actually be physically removed. Sometimes it can be a blocked tube can be mistaken for a cyst as well.

So the fact that you've had yours for quite some time makes me think it may not go away. And I'm a little surprised it's gotten bigger though. A lot of times they stay about the same size and just never change. What are your thoughts, Carrie?

Carrie Bedient  MD (08:02)

So the ones that I worry about are endometriomas that are masquerading as simple cysts. Because most of the time an endometrioma, a collection of usually bloody fluid from endometriosis, sometimes they appear as though they are simple cysts.

Most of the time we associate them with a very specific appearance that shows up on ultrasound. But every so often, all of us have had the experience of we go in to do a retrieval, everything looks beautiful and follicular, and then you enter in one and you just get this thick, brownish, reddish material back, and it clogs your lines, and it takes five minutes to get the stupid things unplugged so you can aspirate every other egg that you're looking for. And so...That's the one thing that I worry about because if you've got an endometrioma, you wanna avoid puncturing it if you can. It just leads to problems. It's not necessarily gonna harm you if they drain it. It's not gonna go away with aygestin or any other OCP. Really the only way to truly make it go away is with surgery, but that's its own ball of wax of you don't wanna go in and operate on an ovary and remove a cyst if you don't have to because you don't want to damage your egg supply and further decrease it. And so, I think it's worth trying the aygestin. I think it's worth seeing what happens. I would not lose a lot of sleep if it doesn't go down. I think it's just, you have to try that. Cause if it does go down, you want that benefit. If it doesn't go down, you want that information because they may amp up your stim a little bit. If they think, Hey, maybe this is an enemy trioma. need to, we need to juice up your, your stim a little bit.

Susan Hudson MD (09:33)

And I would say that the fact that it's been there for a year makes it more highly unlikely that I think, I mean, I'm a big fan of aygestin and birth control pills to fix this. But I would actually be pretty surprised if that does result in what we're hoping for. And once you start getting over five centimeters, that is the time that really considering decompression or removal of that cyst does become more reasonable just because of the risk of potential ovarian torsion down the road. Ovarian torsion is the ovary turning on itself, which can cut off its blood supply, cause you to have to have emergency surgery and all kinds of things that we don't want to happen in the middle of the night. And so it's something to keep an eye on.

Abby Eblen MD (10:05)

Yeah, one other thing to add to that, I agree with Carrie, most of the time we don't want to operate on the ovary and really our thinking's changed over the past decade or so. We used to operate on even small collections of endometriosis. Now we don't do that so much. But personally, if you were my patient with a five centimeter potential endometrioma, that's what we really thought it was and didn't respond to aygestin. I would be a little worried about going in to do an egg retrieval because good chance we may not be able to get to your eggs. We certainly don't want to go through the endometrioma. So it's worth a discussion with your doctor about do we keep it in or do we take this out and, wait and do IVF a few months after that.

Susan Hudson MD (10:54)

Also for our listeners know there's other types of ovarian cysts. There's serous cystadenomas, there's teratomas, there's all kinds of things with OMA after them. Most of those things are not going to go away with birth control pills. And so there are other things that can cause cystic structures. A lot of them are not harmful. A very, very small percentage of them are.

But again, we start needing to weigh the risks of doing surgery on your ovary, removing the cyst, potentially losing some eggs versus not being able to access the follicles that you are ideally going to grow from that ovary as well. We've all seen people who, they go through their IVF stimulation, one ovary responds way better than the other one. And we're like, well, you got more on your right than your left. And that's very common. They're always like, Yeah, the left one's the one that I had that cyst removed, 10 years ago. And so we hear that quite a bit. So it is something that is real that we have to weigh those pros and cons.

Carrie Bedient  MD (11:56)

Mm-hmm. All right. So in the spirit of spring cleaning, in the spirit of being somewhat compulsive physicians who love our to-do lists and love checking things off them even more, today's episode is focusing on the to-do list to take care of before your first fertility visit. And so in looking at all of this, what are the things that you think patients should have on their to-do list before their first visit?

Susan Hudson MD (12:22)

There are so many things that come popping into my head.

Abby Eblen MD (12:24)

I know it's like where to begin. So one I would say that really confounds and frustrates patients when I see them as a new patient and sometimes so much so that they can't get their mind on the new patient visit is make sure that when you order your medical records, you follow up with your doctor's office and make sure that they get the records. Now I will admit sometimes those records are really valuable like if you've had a surgery and I'm not sure what you've had done.

A lot of times you can just tell me what I need to know and I'm happy to get the records later on. And it's really not that big of a deal most of the time, but a lot of times people just really get upset about it. So if you really want to be absolutely certain before you get to your doctor's office that they have your records, go by your doctor's office, get that copy and bring them, them to the doctor when you come in for the visit. Because that way you know that you've handed it to them and they have a copy of them.

Susan Hudson MD (13:12)

Realize if you're requesting medical records, I'm assuming all states have these rules in Texas, the office has up to a month to get those records to wherever they're needing to be sent. So just because you request your records today and just because you pay for your records today does not mean that they have to provide them today. And so, if you're contacting whoever you're trying to get records from and you're like, my goodness, I have an appointment in 48 hours. There's a reasonable chance you're not going to be able to get them in that timeframe, you'll eventually be able to get them. But just realize that they do have a window that they have to that they should be fulfilling that request. Getting medical records from most places is not exceptionally hard. There are some challenging things, especially if you're trying to get records from certain types of institutions and things like that.

But that's something to be aware of, that it's not a spin on a dime type of thing. And realistically, even if you show up at the doctor's office and say, I want a copy of my records, they don't have to give it to you that day because you're standing there.

Carrie Bedient  MD (14:17)

When you're looking at records to go after in particular, op notes are particularly valuable to us. Lab results.

Susan Hudson MD (14:23)

Operative notes

Carrie Bedient  MD (14:26)

Yep, Surgery notes, lab values are particularly helpful. If they are hormonal lab values, knowing where they fall in your period is helpful. If you can go back through, let's say, your menstrual tracker app and say, OK, my FSH on this date was drawn on day three. The one that I had here was drawn at some random point in your cycle. If you happen to have that information, it's really helpful.

Things like imaging results, ultrasounds, MRIs, CTs, all of those things are helpful. HSG, not just for you, but for your significant other as well, if they're relevant. We don't necessarily care so much about your ACL repair when you were 21. We care very much about the laparoscopies that you had done when you were 16 and 24 and whatever because of possible endometriosis. So those are the things that are higher yield.

Abby Eblen MD (14:53)

HSG.

Carrie Bedient  MD (15:14)

A lot of times, semen analysis, a lot of times just seeing the last note that your doctor wrote, that's not usually as important to us because our general principle is trust but verify. And so we appreciate their opinion. We are going to make our own based on the original documentation of labs, ultrasounds, imaging, op notes, all of those things that you give us.

Susan Hudson MD (15:14)

Semen analysis.

Abby Eblen MD (15:37)

And just as a rule of thumb, within two years is a reasonable timeframe. Sometimes for younger patients, I've actually gotten records from pediatricians from when they were 15 or 16. Those are not so important. So within two years, because, and I'm sure Carrie and Susan can verify this as well, sometimes we'll get 200 pages of medical records. Probably some things are gonna be missed that maybe are important. Whereas if we have just two years worth of records, that's a lot less to look through and those are things that are really probably gonna be much more relevant to your ongoing care.

Carrie Bedient  MD (16:07)

Having those records in our hands in advance of the visit is also, in some ways, really helpful. In other ways, it's not at all. So if you get to your first visit and that doc has not gone through all 150 pages of your medical records, don't get bent out of shape. We are, if we have them in front of us, we are very good at picking out just the things that we need because frankly, we don't really care about your cholesterol unless it is crazy ridiculously high.

We are going to gloss right over that and we're going to zero in on the things that are important to our job with you. And so that's actually where having directed records is really helpful because I don't really want to look through 150 pages of prior docs. I am much more interested in the 12 pages of labs that you've had because that will tell me a lot more of what I need to know about where do we go next.

Susan Hudson MD (16:58)

Exactly.

Carrie Bedient  MD (17:00)

Okay, so records is one, what else?

Susan Hudson MD (17:03)

So start your prenatal vitamins. Oh my goodness. We know you are tired and frustrated of those prenatal vitamins. Okay. We get it. You've been taking them for years and you stopped because you're frustrated, but now you're turning over a new leaf. You're coming to see a reproductive endocrinologist. We're going to be actively figuring out what the problem is and ideally getting you to your goal. And we really want you on prenatals for three months prior to conception. So start that now. There may be other things we want to add on to later like coQ10 or ovasitol or different things like that. But just start a good quality prenatal vitamin now. Build up those folic acid levels because as much as we know you want a baby, we also know you want a healthy baby. And that's the best way for us to prevent things called neural tube defects.

Carrie Bedient  MD (17:54)

Neural tube defects.

Susan Hudson MD (17:56)

Totally lost my words there. Yeah, exactly. And so that's a really important thing to do prior to your appointment.

Abby Eblen MD (17:56)

Incomplete fusion of this spinal column. Yeah.

Carrie Bedient  MD (17:59)

Yep.

Abby Eblen MD (18:05)

And to tack onto that, if you're supposed to be taking a medicine, take it. Like, Synthroid or levothyroxine, which is a thyroid medicine. Sometimes patients will say, well, they started me on it, but then I ran out of it I never got a refill. Well, those are medicines that are really important. And there's some medicines on the flip side that maybe someone's told you, when you want to get pregnant, go off these medicines. So I've seen a lot of patients lately on spironolactone, and that's a medicine that people take, for acne.

And a lot of times what it does is it impairs the ability for a male fetus to form testosterone. So that's a problem. If you got pregnant and you came to see me at six weeks and you were on spironolactone, that's a big deal. So if there's anything that you think or you've been told that could be a problem, certainly talk to your doctor first. Use protection though until you know for sure. And if it's problematic, then go off of it. And there's some blood pressure medicines that are in that category. Not a ton of things that jump out at me, but there's certainly some things that are important. So just make sure you have a powwow with your primary care doctor and just let them know, just let everybody know that you're trying to get pregnant and that way they can plan your medication accordingly.

Susan Hudson MD (19:10)

When you're going in for that first appointment, having the names of all of your medications, telling us you're taking that little green pill for your cholesterol is not going to help us. Have the names for all of your medications and the medications your partner is taking. Because each of those, we will go through those also and help you figure out, hey, these look okay.

Abby Eblen MD (19:19)

Yeah.

Carrie Bedient  MD (19:27)

Yes.

Susan Hudson MD (19:34)

These are ones that you need to talk to your prescribing doctor about perhaps moving to something a little more pregnancy friendly, that type of thing. But really being on top of what you're taking and understanding why you're taking those medications is an important thing as well.

Carrie Bedient  MD (19:49)

There are a lot of things like antibiotics that might be given for acne or blood pressure medications that might be given for headaches or things like that. So knowing the underlying reason why is really helpful when we're thinking about alternatives and how critical is it that you stay on that medication.

Abby Eblen MD (20:05)

And there's one really important medication that we always want to really ask your partner about because that may make us look like rocket scientists if we figure this out. So if your partner is on any type of testosterone, that's bad usually, not always. But a lot of times it really prevents him from producing testosterone. And in that same process, his body thinks he's already getting enough testosterone. And in that same process, he stops producing sperm. A lot of times I'll see a really shocked look on a guy's face when I'm like, well, if you've been on this for a year, you probably don't have any sperm. Couple may have been trying for a while, they had no idea. So make sure that he's very honest about the medicines he's on because his medicines are important too.

Susan Hudson MD (20:46)

Along the note of testosterone on the female side, especially over the past two or three years, I've had more patients who are taking continuous progesterone every single day of the month, not just after they've ovulated. So if you are listening to this and you are on progesterone every single day, I am letting you know that is acting like a birth control pill. The number one medication that's in birth control is a progesterone.

Abby Eblen MD (20:57)

Yeah.

Susan Hudson MD (21:14)

And so that is something that we will help you get off of it and take it in the appropriate fashion if you really need it. But sometimes that is really one of those like, what do you mean you need me to stop my progesterone? It's like, my goodness, this is probably one of the major reasons you haven't gotten pregnant. So that's something important to know and know that every hot thing that's in the news and in the magazine that's on the shelf, especially those GLP-1 agonists that's helping everybody lose weight and get their blood sugars under control. Those are medications that you're going to likely be advised to stop because we need those out of your system for two months before trying to conceive. They're really good at helping improving our chances, especially if you have obesity and we need to get your weight down.

These are neuroendocrine modulators. So they affect your endocrine system, which essentially is your hormone system. And we need to make sure we're doing things safely.

Carrie Bedient  MD (22:15)

Along with all of the medications and getting those optimized, you want to make sure you have seen all of your routine docs to get regular preventative care done. This means pap smears. This means mammograms. This means colonoscopies. This means general routine labs looking at your blood sugar, checking your blood pressure, things like that. All of that stuff is ideally going to be done before you come see us because that means that it's not gonna hold us up as we're progressing through your treatment. Because if you're 40 and you haven't had your mammogram yet, we need you to do that before we get you knocked up because nobody wants to find breast cancer during a pregnancy. That is a bad day for everybody who that impacts.

Susan Hudson MD (22:59)

Same thing for your pap smear.

We don't want to find cervical cancer and you be pregnant either.

Carrie Bedient  MD (23:04)

Yeah, yeah. And so make sure you have gotten all of those routine things because those visits often take lead time to set up, a couple months to get in to see that doctor. And so if you're even contemplating on the edge of your brain coming to see us, make sure you've done all the regular groundwork because we want you to have your regular docs order that so that you can be clear to run as soon as you come see us.

Abby Eblen MD (23:28)

And the other kind of corollary to that too is another reason that you want to have your mammogram done is because if you're approaching 40 and pretty close to that age, by the time you get pregnant, you have your baby, and particularly if you're going to breastfeed sometime after that, you're not going to probably get a mammogram for another couple years until your breasts really kind of get back down to normal again after breastfeeding. It's really important. And I tell my patients, even if you're close to age 40, it's reasonable to go ahead and just get that done preemptively because of that time span you're gonna have to wait to have it done after you have the baby.

Susan Hudson MD (23:58)

And realize that pregnancy is the time that your estrogen and progesterone levels are the highest and the most sustained that they are in your entire life. And if you have a breast cancer that's itty-bitty and receptive to those hormones, that can make things grow a lot faster and go from something that is relatively minor for it to get taken care of to something becoming a much bigger deal.

Carrie Bedient  MD (24:22)

All right, what else do want our patients to know before they come in and see us?

I always appreciate it when patients have talked to their families ahead of time and they know what their family history is. If it turns out that your maternal aunt and your maternal grandmother and two cousins on that side have all had breast cancer, knowing when they got diagnosed, knowing if they had genetic testing, knowing what kind of treatment they had. All of those things can be relevant to what kind of testing we order on you because just saying, my mom had some sort of female cancer really encompasses a very wide variety of things. And if you just say, yeah, my mom and my aunt on her side, they both had this type of cancer. Well, if one had cervical cancer and one had breast cancer, that's two very different things than if they both had breast cancer or one had breast and the other had ovarian. And so getting a little bit more of those details is helpful. Assuming that you can text ex-relative during the visit to get that answer is not a great use of time for anybody and you're unlikely.

Abby Eblen MD (25:17)

Yeah, exactly. Or text anybody.

Carrie Bedient  MD (25:21)

Or text anybody because we're going over so much stuff. You want to be able to pay attention and you don't want to have to be trying to toggle that information. So calling the relatives who know what everybody's history is and know everybody's business can be really helpful because you can start to get that information ahead of time, which is very clear in helping us to know, we need to order this advanced genetic testing on you that we might otherwise not have needed or not have thought about. And your partner doing that, also helpful.

Abby Eblen MD (25:46)

And kind of the same lines, if you can get this information, and sometimes you can, and sometimes you can't, but if you know your mom had two miscarriages or three miscarriages and her mom had some miscarriages, going back pretty far, you're not gonna be able to find out a bunch of information, but that sort of makes us worry a little bit. Is there some genetic problem in the family? Is there some uterine malformation issue in the family? Is there, or if your mom had a hysterectomy when she was 25, why did she have that? Was it cancer? Was it a big fibroid? Was it endometriosis? So sometimes you can get that information, sometimes you can't, but it's helpful if you can, and I would say it that way.

Susan Hudson MD (26:23)

So another thing to know and think about as you're going into your first appointment is that there are exceptions to this rule, but in generally fertility is a team sport. Realize that if you are in a relationship that we actually do need information from both of you. is...

Carrie Bedient  MD (26:45)

That applies to both female-female and male-male couples as well, because if we're using

Abby Eblen MD (26:48)

Yes, yes, yes.

Susan Hudson MD (26:49)

But if they're single, then that's fine. But we need information from all parties that are participating in any way, shape or form, because it really does color what tests we order, how invasive we are. It's good for you guys to start having a few conversations about the basics of fertility. And if you're listening to our podcast, you're already learning the basics of fertility and starting to have those conversations of, how aggressive or not aggressive are we wanting to start out? Are we just wanting to do testing and see where things are or do we have in our minds what direction we want to be going in? Those are very helpful things. We have some patients who come in and they're like, we just want information and then we'll come to a decision later together, which is completely fine. But if you come in and you're like, we know we really want to do blank, that can help us not only make sure you have the right testing to lead into whatever you're wanting, but it also helps us get the right testing to make sure that's still a wise decision.

Abby Eblen MD (28:05)

One other different topic, and Susan actually brought this up earlier, so take credit for this, but insurance. It's always good if you can know about your insurance, your carrier, if you have diagnostic testing. So diagnostic testing would be things like office ultrasounds, blood draws, things like that. Fertility treatment insurance would be literally if they pay for your procedure, like an intrauterine insemination or the things that you would need to try and get pregnant or IVF in some situations.

And you may not know a whole bunch about that, but the more you can educate yourself, the better. Because a lot of our practices really try and take it upon themselves to give you as much information as possible. But just know that we don't know a lot about your insurance, and even within a plan or with an insurer, there can be different plans. So really, it's not, really the onus is not on the fertility center to find that out for you. It's really the onus is on you to know what your coverage is.

But most centers are pretty good about having people in the office that can work with you and try and find out information, particularly before you're to do something really expensive like IVF.

Carrie Bedient  MD (29:10)

All right, I think all of those are the big things. Can you guys think of anything else that you have come across over the years that is really helpful for your patients to know about ahead of time?

Susan Hudson MD (29:21)

This is a big one, you are probably not going to get the answer to all of your questions at that first visit. Write your questions down. I would say that probably 30 to 40 % of your questions are things that we can answer at a new patient appointment. But a lot of the questions that most people have in their heart are having to do with treatment. And until we get testing,  we really can't give you information and without it being super general. And honestly, I think that just kind of adds angst and frustration because it's like, well, you said this was going to work. And it's like, well, but now we find out that we don't have sperm or our tubes aren't working or our ovaries aren't working as well as we hope. Going into that first appointment, knowing I'm going to get some answers to my questions, but this is a journey, and these are the people I'm entering the journey with and they will get me my answers, but I may not get them on that first visit.

Abby Eblen MD (30:24)

So one of really important thing, and I don't get this often, but a lot of times patients will come and I'll be like, okay, now, you we've talked, we've talked about our plans. Now let's do an exam and ultrasound. Well, I just had an exam by my doctor last week. The problem with that is we all like to do our own exams and there's different things that we may be looking at that your doctor wasn't looking at. And we really like to get our own ultrasounds ideally. It doesn't happen to be that way all the time, but if it's been a few months, we probably want to get an ultrasound.

We also probably want to do an exam too. So be prepared for that because a lot of people are caught off guard. They're like, I didn't shave or I didn't, don't worry about that. We're women too. We don't do that stuff all the time either. So don't worry about that. But some people are really that really throws them off and they're really anxious about that. The other thing is take several hours off from work. The appointment may be scheduled for 45 minutes or an hour, but it depends a lot on your questions. It depends on a lot of the information we have to give you.

Honestly, it's gonna drag out probably for maybe an hour and a half or maybe two hours depending on if you're having blood drawn and having an ultrasound and all that. So it's not gonna be quick. So just be prepared for that.

Carrie Bedient  MD (31:28)

Although that depends on the practice. Like for us, we start out primarily talking. And so the half an hour, maybe 45 minutes that we have scheduled tends to be pretty true to course.

Susan Hudson MD (31:38)

How long are they talking to your nurses after you finish talking to help them get set up for things too?

Carrie Bedient  MD (31:44)

Set up at a different time by appointment so that they can plan that.

Abby Eblen MD (31:47)

Yeah, we usually do exam, I mean, I talk to the patient, do exam and ultrasound and blood all on the new visits. So it takes a while.

Carrie Bedient  MD (31:55)

Yeah, a lot of what you're going through also is really helpful if you have another set of ears with you. So having, if not your partner, a good friend, a family member, I feel like I do an awful lot of appointments with people's moms listening because they're listening at a different level. They are hearing things that you are not gonna hear because you are in the thick of it and they are watching from the sidelines and that can be very helpful. And so that's important at the first visit. I would say it's probably even more important at later visits as we're really talking about results and next steps. But that is a helpful thing to know even if you don't have somebody with you at that first visit, who you can talk to about it afterwards because they're gonna pick up different things than you are and that can be very helpful.

Susan Hudson MD (32:42)

Totally agree with that.

Carrie Bedient  MD (32:44)

All right, so we've got our to-do list. So get your records, particularly the operative notes, the labs, and the imaging that you may have had done already. Get your medication list, all teed up of the names, the doses, and why you're taking them. Get your preventative care done, your pap smears, your mammograms, general labs, all of those things. Know what your family history is. Know what your partner's info is. Get your insurance information all lined up so you have at least a little bit of an idea and then know what your questions are and maybe have another person with you. So that's your to-do list as you're going into this appointment. And the more of that you have done, the more prepared you're going to be and the more information you're going to be able to absorb as you're going through this. All right. Well, thank you so much to our audience for listening. Please subscribe to Apple Podcast to have next Tuesday's episode pop up automatically for you.

Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (33:41)

And visit fertilitydocsuncensored.com to submit specific questions that you have and also sign up for our email list.

Susan Hudson MD (33:49)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we'll talk to you soon. Bye!

Abby Eblen MD (33:59)

Bye.

Carrie Bedient  MD (33:59)

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