Ep 277: Not Just a Numbers Game: Understanding Male Factor Challenges

In this Q&A episode 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 tackle male factor infertility—an often overlooked but critical part of the fertility equation. They break down the role of sperm morphology in fertilization and explain how it’s assessed and why, even with IVF, poor morphology can make a difference. The discussion also covers what happens when there’s no sperm motility and how testing and treatments, like the use of pentoxyphylline, can help. The docs explore the influence of varicocele, a common condition, and how it can impact sperm health and fertility outcomes. Plus, they dig into how female age and conditions like endometriosis can further complicate fertilization and pregnancy. Whether you’re just starting your fertility journey or deep into treatment, this episode is full of practical insights and clarity on a topic that deserves more attention.

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)

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Abby Eblen MD (00:54)

Hi everyone, we're back with another episode of Fertility Docs Uncensored. I'm one of your hosts, Dr. Abby Eblen from Nashville Fertility Center. And today I'm joined by my colorful and creative co-host, Dr. Susan Hudson from Texas Fertility Center.

Susan Hudson MD (01:08)

Hello.

Abby Eblen MD (01:09)

and Dr. Carrie Bedient for the Fertility Center of Las Vegas. How you guys doing?

Susan Hudson MD (01:13)

We're doing great!

Abby Eblen MD (01:14)

Well good, even you, it's really funny. We started out today and we hadn't seen each other in while and we were talking about national parks and somehow our conversation went to skiing for some reason, even though it's really not the season for that. And Carrie, tell everybody kind of what you were saying to Susan and Susan was like, what?

Carrie Bedient MD (01:29)

So I thought that Susan was a big skier because the last time we were at one of our conferences, we were talking about in Utah, in Park City, which is a fantastic skiing place if you're into that kind of thing. She was talking to me about the beauty of ski in and ski out places. And so I internalized that to think that she really liked skiing because I I don't know why I happen to black out the fact that you hated living in Minnesota because of the cold. I mean, not for any other reason, but just because of the cold. ⁓ And then Abby, you thought that I was a big skier because I had sent you guys a picture of me in my super big fuzzy coat ⁓ when in reality I spent that entire trip parked next to the fireplace in the lodge with a Cadbury chai thing that they had at the coffee bar and that was absolutely delicious, combing through three books. So yeah, so that's my opinion of skiing.

Susan Hudson MD (02:25)

Yeah.

I have tried skiing and it was really, really hard on my knees. And then I tried snowboarding and I broke my tailbone. And I think it took about two or three years before I did not have a reminder of that incident every time I went to a movie theater. And so I love going to ski destinations with my family, but I do not partake. I do other things, relaxing, reading books, doing shopping, just enjoying life and taking things a little bit slower. I always have the fear of what happens if I break my arm or my hands? Best case scenario is you break a leg, at least you can still work that way. I mean, it's terrible. But I too much enjoy what I do every day to have to take off like six weeks for something to heal. That just doesn't make sense. Abby, are you much of a skier or snowboarder?

Abby Eblen MD (03:22)

Big scaredy cat when it comes to all that stuff. When my husband and I were just newly together and we went to Heavenly to go skiing and he's actually really good skier, doesn't ski as much anymore, but he would ski the black slopes and so he could not wait to take me to the point at Heavenly where you could look over and on one side you see the desert and on the other side you see the lake and it was beautiful once we got there but I was so mad at him by the time I got there because I had to go through the slope that had moguls on it. I couldn't ski hardly at all. So after that, I was like, I don't think skiing's for me. That's not my activity. I like a stationary bike. It's hard to hurt yourself on a stationary bike.

Susan Hudson MD (03:57)

I'd like to say, Carrie, like this picture you sent of us with you in your little ski jacket was the cutest picture I think I have ever seen. It was really, really awesome. I love that.

Abby Eblen MD (04:08)

You looked the part.

Carrie Bedient MD (04:10)

Aw, thanks. I relegated myself to the lodge after the very first time I went skiing in Montana, which was absolutely gorgeous. I ended up with a new ACL, and so I'm like...

Abby Eblen MD (04:12)

You so you're one of those people that had an injury on the slope.

Carrie Bedient MD (04:26)

Yeah, yeah, turns out you need to know how to stop better than I knew how to stop. To be fair, I did stop, but I stopped with one ski probably 10 feet away from me and my foot or my knee at an angle that God did not intend that hinge to bend that way. And so I, yeah, so I've got a new ACL as a result of that and I decided I don't need to do this again.

Abby Eblen MD (04:42)

Yeah.

You don't get second new ACL, right?

Carrie Bedient MD (04:53)

Yeah, yeah. And one of the instructors was kind of making fun of me of like, go out and take a lesson as I was sitting there and I'm like, no, I'm good. Thanks.

Susan Hudson MD (05:00)

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Abby Eblen MD (05:34)

Well, very good. So today we're going to have a question episode and we're going to talk about male factor in our question episode. And Susan's got some questions I think queued up for us, quite a few actually.

Susan Hudson MD (05:43)

I do. Okay, our first question is, I am 38, husband's 42. We have a four-year-old conceived first time, but have been trying for the second for two years with no success. Failed IUI and failed IVF with ICSI. 11 eggs, eight mature, eight fertilized. Only two blasts. Both came back PGT-A abnormal. AMH is 8.1, AFC 13.

Husband's morphology is 1 % but I am told that it is not the cause of his infertility because his count is high and would counter that. Is that true? He also has a three millimeter varicocele which isn't treated even though the urologist says greater than three millimeters is abnormal. In the IVF cycle, they also found two cysts on my ovary saying it might be an endometrioma. Could this be causing poor egg quality? I don't know how to proceed as removing the cyst damages ovarian tissue, but leaving them causes poor egg quality. Advice? So little male factor, little female factor in there.

Abby Eblen MD (06:42)

Yeah.

Carrie Bedient MD (06:42)

What do you guys think about the varicocele? And this is a true question because I have heard such mixed advice about that over the years. What would you guys do with that?

Susan Hudson MD (06:53)

I think the recent advice, at least what I've really been hearing over the last five years is that one, unless it's really causing pain, that they generally leave them alone. I think the one caveat is if they're actually having testicular failure and they're trying to do a last stitch effort to prevent any further failure, but those are relatively few and far in between. So I would say a three millimeter varicocele seems very small and not something I would be too concerned about.

Carrie Bedient MD (07:31)

I wonder if they meant 3 cm?

Like, a millimeter is really quite, quite small.

Susan Hudson MD (07:37)

Right. Either way, if it's not causing pain and they're not having the impending testicular failure, I don't think that most urologists would recommend it being removed at this point.

Abby Eblen MD (07:48)

Yeah, I don't think so either. And I think with IVF, not that it negates the effect of the sperm, because I'm sure there's factors that we don't understand, but generally we feel like if we can take one single sperm and put it inside the egg, then that really kind of negates the negativity in terms of the sperm not being able to bind to and penetrate the egg. For a long time, we thought the abnormal morphology, and maybe it still does, but we don't really know, could have any impact on the ability of the sperm to actually get into the egg. But if we can now do it through IVF, we don't feel like that it has such the negative impact that perhaps it had in the past.

Carrie Bedient MD (08:20)

I wonder if a sperm fragmentation might actually be helpful on this one to see if it's really bad, maybe it is worth going after the varicocele, plus looking at all the other lifestyle things.

Susan Hudson MD (08:33)

And even if you didn't want to have surgery for the varicocele, if you have DNA fragmentation being present, the options of things like Zymot, which is a little sperm sorting device that helps the sperm that essentially go through a little maze have lesser degrees of fragmentation or even having a sperm aspiration where essentially sperm that are further upstream and potentially less fragmented can be accessed.

I still think that would probably be an easier recovery than having a varicocele repair.

Carrie Bedient MD (09:04)

Yeah.

Susan Hudson MD (09:04)

What are y'all's thoughts about the possible endometriomas in a 38-year-old as compared to just age-related decline in ovarian function?

Carrie Bedient MD (09:19)

Those endometriomas were fairly small, right? Like one to two centimeters?

Susan Hudson MD (09:22)

She just said that two cysts were possibly endometriomas. She didn't put measurements on those.

Carrie Bedient MD (09:28)

Okay, so when she says possibly to me that indicates that they're probably not that big. And they could be hemorrhagic cysts, they could be, just leftover, they could just be empty, fluid filled sacs, just your plain simple cyst. Unless they're big, unless they're causing pain at this point, I would probably leave them alone. I would be worried if there's not another reason to go in and get them that that you do more damage by trying to get them out. That's without any of the relevant information, like how big are they? Are they getting in the way of accessing other eggs? Is she requiring atypically high doses to get the eggs that she does have? Her AMH of 8.1 is stellar, especially at 38.

Abby Eblen MD (10:13)

Yeah, and I would add in too that two blasts at 38 is not all that bad.

Susan, you got another question for us?

Susan Hudson MD (10:20)

I do. My husband has 0 % sperm motility, but the doctors did a test that said that 6 % are alive. Is ICSI a good possibility of having a successful pregnancy? Should we look at surgically removing sperm? My husband's urologist is saying, look toward ICSI, but at my appointment with my fertility doctor, they did not seem to think it would be successful. They recommend a sperm donor.

That's a pretty big jump to go from having sperm, we can make some of them motile, but you shouldn't use them and go straight to a sperm donor.

Abby Eblen MD (10:45)

So. Well, did she say, so they said 6 % were viable, is that what she said? So I'm not a urologist, but the tricky part from the lab perspective is even if they're viable, whether or not they're gonna move with pentoxifylline. So I know in our lab they mix with that chemical, and if they can see that there's any quivering sperm, they know they're not dead sperm. And so I think it's certainly worth a test with your partner's sperm first just to see if they can mix it with this pentoxifylline in the lab if they can see any signs of life and if they can, I would, I think it's reasonable to see if, they can use it. If they can't see any movement, that's where it gets kind of tricky because if you only have, if he only has 6 % that are viable, that means just by random chance, they may pick all sperm that are all dead and not ones that would fertilize and there's no way that they would know it because the way they understand that the sperm is alive is if they see movement from the sperm.

Carrie Bedient MD (11:46)

There's also the thought of doing like a hyperosmotic swelling test. I know sometimes they've done that in our lab to help figure them out because there's no stain involved in that. Because a lot of the times the way that they get the viability is through a stain and you can't stain the sperm and then use it. So that's how they know that it's viable, but then that information is not specifically useful on that particular cycle. So I've had people who've done that in the past. The other thing to consider is whether or not, and part of this depends on your age and egg number, whether you want to do a 50-50 cycle where you have the donor sperm there and you divide the eggs and that way you've got potential backup so you don't have to go through two cycles. That doesn't work quite as well if you're 42 with three eggs, but depending on the rest of your circumstances, that's a thought.

Susan Hudson MD (12:35)

I would also say this is definitely one of those cases that I think involving a fellowship trained fertility urologist is very helpful. As much as we know about IVF and helping create pregnancies and things like that, the question of is a biopsy in this particular clinical situation going to be helpful? That's really the type of person that you need to ask. Now, there aren't a lot of those folks out there.

I mean, I think in Texas, there's probably less than 10 for the entire state and considering the size of Texas, that's pretty, significant. But a lot of them nowadays do telemedicine visits, that type of thing. And so I would ask your clinic, who is the fertility urologist or urologists that they typically work with? Sometimes your insurance actually has a voice in this.

Abby Eblen MD (13:05)

Yeah.

Susan Hudson MD (13:24)

Go talk to one of those folks to see if biopsy would be good thing.

Abby Eblen MD (13:29)

All right.

Carrie Bedient MD (13:30)

What else we got?

Susan Hudson MD (13:31)

Okay, husband 45 and I, 38, just finished two rounds of IVF, neither resulting in usable embryos. Previously diagnosed with severe male factor. Her hormone levels were normal with the antral follicle count of 15. No health issues and healthy-ish lifestyle. First IVF, traditionally antagonist with ICSI, 11 eggs, nine mature, six fertilized, no blasts Four arrested on day three, so doc believed that the sperm was the problem. The second cycle, husband went on clomid for three months. They added a microlupron flare, 13 retrieved, seven mature, seven fertilized. On day three, five eggs were graded, one or two. On day five, one blast, three AA. Day seven, two blasts, four CD, four DD. This diagnosis of egg quality is also a large factor.

They recommended a micro stim but less than 10 % chance and quote "pointless". Is there anything else we can do or is this it?

Abby Eblen MD (14:31)

With PGT-A +, which some platforms have, they can get an inkling of if it's an egg problem or a sperm problem. And so, if you guys would be open to either an egg donor or a sperm donor, depending on where the problem is, the benefit of that would be at least, one of you could be a biologic parent. And, that is if you would...be willing to accept donor eggs if it was an egg issue or sperm if it's a sperm issue. So that's something that you may want to think about doing. Unfortunately, you'd have to go through another IVF cycle to kind of figure that out though.

Carrie Bedient MD (15:01)

Yeah, I would be reluctant to rely on those two day sevens because individually, they're day sevens which have lower success rates. Then independent of that, they've got poor morphology grading. And so that's a poor indicator as well. I hadn't thought about the PGT-A plus or the PGT link. That's a good idea.

I think some of this just comes down to what are your resources? Financially, what can you do? Mentally and emotionally, what can you do? Physically, what can you do? And what are the scenarios that are possible in your mind versus not possible, keeping in mind that that may change over time. What you thought two months ago may not be what you think today, it may not be what you think six months from now with respect to donor egg, donor sperm, donor embryo, adoption, all of those things.

And so all of us have stories of people where we thought there's no way that this is gonna work. Then we get cute baby pictures from them. And so a lot of this is, do you fully understand what you're doing as you're going into it? Because there are some docs who say, this is less than 10%, I won't do it. There are other docs who say, look, this is 1%.

It's not impossible, but it is extraordinarily unlikely. And what's your intent for doing this? Because yes, the intent is always to get a baby, but there are some people who need to go through that for a closure cycle. There are some people who need to do that so that five years from now, regardless of what happens, they can sleep at night because they know they did everything that they needed to do. And so that's one of those things where you're doc style is gonna play a role, you knowing yourself is going to play a role because if you're doing this blindly and you're just like, it's gonna work, it's gonna work, it's gonna work. That's a very helpful mindset in some respects, but also no doc wants to take advantage of somebody who thinks, this is gonna be the time that it works. Like that's not a good way to sleep at night. None of us wanna do that. And so there's this fine balance of why are you doing what you're doing?

Do you truly understand that this may be throwing time and money and effort into a very, very unlikely pond or where are you at all?

Susan Hudson MD (17:16)

Yeah, I mean, I would say if you're at the point where you're still wanting to try to use what we call autologous or from your own body, eggs and sperm, it's the time to do everything you can possibly imagine. I mean, you've been through two cycles, things that you can do for egg, making sure you're taking CoQ10, possibly maybe using some Omnitrope during your cycles. Your simulation numbers look good.

Okay. 11 and 13 eggs, if we had 11 and 13 eggs on everybody we did egg retrievals on our lives would be a lot simpler. Now there is more than just quantity with their, like I said, is quality and kind of CoQ 10 and growth hormone or Omnitrope for probably some of the bigger, more accepted things that we think may have an impact. And then again, thinking of other things for dealing with the sperm, should maybe we use biopsied sperm, fresh biopsied sperm for this particular case instead of using ejaculated sperm. Ejaculated sperm have literally sometimes been through the wringer and your partner is older, he's in his mid 40s and had more life exposures. And so if you're looking for a no holds barred type of cycle, those are things that I would consider doing.

But just like Carrie and Abby said, everyone has their point of when do we need to change tacts to something else that is going to help us focus on having another little human in our life, not necessarily having that biological component. And that's the right thing for some people and it's not the right thing for others. And the two of you are the only ones who can really decide when and if one of those options is gonna be the best thing for you.

Abby Eblen MD (19:05)

Very good.

Susan Hudson MD (19:06)

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Susan Hudson MD (19:20)

All right, here is another one. Hi docs, I love your podcast. I've been listening for over six months now. Thank you for listening. I can't thank you enough for the education and information you have given me. Secondary infertility. I am starting my IVF journey and my blood work and ultrasounds have been normal. However, my husband's sperm analysis says that while he has a high sperm count, 40 million, and motility is good, 90%, his morphology for normal forms is 1%. His morphology was 7 % last year. What does that mean for our chances for IVF? Does this mean that ICSI is more effective for us? Can he do anything to improve this? Thanks so much.

Carrie Bedient MD (20:01)

So the first question of can he do anything to improve this is what's he doing right now that might be ⁓ not improving it? Is he smoking? Is he drinking?

Susan Hudson MD (20:09)

So what are some of the things that we wanna have for healthy lifestyle for guys?

Carrie Bedient MD (20:15)

So no smoking, no tobacco, no nicotine, no vaping, none of those variations, no marijuana, normal body weight.

Susan Hudson MD (20:24)

No hot tubs, no saunas.

Carrie Bedient MD (20:27)

No long bike rides.

Abby Eblen MD (20:29)

Yeah, no excessive exercise, I was thinking that. On either end, too little exercise, too much exercise, stress, lots of stress.

Carrie Bedient MD (20:34)

Yeah, sleep. Testosterone, don't do testosterone. Never do testosterone. Testosterone is the anti-fertility med. I mean, those are kind of the big things.

Susan Hudson MD (20:47)

Yeah. So what could, if somebody's going to make lifestyle changes, how long do they need to have those lifestyle changes to potentially have an impact?

Abby Eblen MD (20:57)

Probably about three months because it takes about three months for him to make new sperm. So generally, from the time he makes the change, he's got to go through that whole process to really see if it makes a difference. And one of the tests out there now that we, think all three of our clinics do quite frequently is called the Sperm QT test. And that test, at least in some smaller studies, they've shown that men sometimes can have sperm that bind to and penetrate the egg really nicely. And other times they don't.

And so, they haven't done a lot of ongoing studies. They haven't extrapolated it, I don't think, to morphology and all that necessarily. But I do think that demonstrates there may be some benefit to changes in lifestyle. And so I would think about, three months from now, maybe having him do that test too, just to see if his sperm functions better.

Susan Hudson MD (21:42)

In the grand scheme of things, and I'm being a little sarcastic here, but in the grand scheme of things, when we look at sperm parameters that are in a semen analysis, how much are we super worried about morphology as compared to other things like concentration and motility?

Abby Eblen MD (22:00)

Not so much. We don't really care too much. And part of that's those, because we've never really had a test to really see if morphology really makes a difference with fertility. And so there's not been a great test to look at that. And still there's really not. But the Sperm QT test at least is better information about function of the sperm.

Susan Hudson MD (22:18)

Just to kind put it in perspective, I would say probably about every seven to 10 years, there's a discussion on whether or not we should even keep on grading morphology. So the fact that I think that's the only parameter that we're always like, do we actually still want to include it? Again, kind of a grain of salt.

Abby Eblen MD (22:24)

Yep.

Carrie Bedient MD (22:37)

And especially once you've made the decision to go to IVF, at that point, if there is a morphology question, even if it's up in the air, it great last year, it's not this year, maybe it's better the day that you do it, I would still say you're not losing a whole lot in that scenario by doing ICSI because it has been abnormal and that's something that's worth, all right, let's cherry pick the best looking ones that we can in this scenario and see if that's helpful.

Susan Hudson MD (23:05)

What are, just to kind of go off on a little bit of a tangent, what are some of the pros of doing ICSI and what are potentially some of the pros of doing standard insemination in the right patient?

Abby Eblen MD (23:16)

I think we probably all, our labs, I think we've talked about this before, mostly do ICSI because you may only have to make this phone call a few times a year, but after one or two of these phone calls, it sort of gives us a little bit of post-traumatic stress disorder. And what I mean is within a certain amount of time, about 18 hours, the sperm and the egg have to fuse, their DNA has to get together, the embryo has to become a zygote, and if the sperm and the egg are put together, and that doesn't happen, meaning if the sperm is just in the petri dish swimming around it, it never gets into the egg. The following morning when the embryologists come in the day after the egg retrieval to look for fertilization, if they don't see fertilization, there's no going back. So if you've paid all this money and been through all these monitoring visits and taken all this medicine, everything's riding on the expectation that you're gonna have normal fertilization. With ICSI, we think that we have a pretty good chance of getting good fertilization. So ICSI stands for intracytoplasmic sperm injection. It's where we take one single sperm, or the embryologists do, put it inside the egg to bring about fertilization. And so with conventional insemination, where we just put it in a Petri dish and let the sperm swim around and hope that it gets to the egg, a lot of times that goes just fine, but when it doesn't, you've lost a lot of time and money and people are very upset and frustrated when fertilization doesn't go well. And ICSI helps prevent that from happening, I think.

Susan Hudson MD (24:34)

Carrie, what's the other side of that really kind of relating to blast formation for conventional insemination?

Carrie Bedient MD (24:40)

So the thought is that ICSI may actually be less helpful in getting those ultimate numbers of blasts and getting good embryos. And it's something that I think a lot of this depends on the lab that you are working with. When you look at a lab that's got really high blast rates and they're doing ICSI all the time, maybe there's some really subtle something that they're doing that's helpful. And so there are a lot of labs that will do this all the time, but they've got the success rates to back it up.

But when you look at some of these general studies, the thought is that ICSI is maybe not as helpful and that when you do conventional insemination where you just dump them in together and say, here you go, that may be a better natural selection process where the sperm that can't make it don't make it. Whereas with ICSI, we are helping the sperm that might not otherwise make it make it. And so it is a very difficult back and forth because like Abby said, when it doesn't work, it is catastrophic. You potentially lose the entire cycle. And so it's kind of the difference between you'll get in a car every day knowing that you could potentially have a crash and that there is a high likelihood of that relative to say getting in a plane. But there's also a much higher likelihood that you're to walk away from a car crash. Whereas with an airplane crash, the likelihood you're going to walk away is lot lower. And so you tend to take more precautions in that scenario, even though the risk of that bad outcome is very, very low, but when it happens, it's a huge deal.

Susan Hudson MD (26:03)

I do think that we are going through a little bit of a pendulum shift when it comes to ICSI and standard insemination. Used to we had so much standard insemination, then we went to almost all ICSI, and I think we're kind of switching back a little bit where we're doing more and more standard insemination and things that we used to not even consider options for standard insemination. Used to in our lab, we would consider using donor sperm because they had been frozen, that had to be ICSI. And that's not necessarily the case anymore. And it's more on a case-by-case basis when it comes to that.

Abby Eblen MD (26:35)

Yeah, and I know kind of in between conventional insemination and almost exclusively ICSI for a while there in a different practice I was in, we would do 50-50. We would do 50 % conventional insemination, 50 % ICSI. And so.

Susan Hudson MD (26:49)

There's all kinds of ways to do this. How about one more question, which I think is a really great one because it's one of those, is this a myth or is this real? All right. So our question is, Hi docs. I have some really exciting news that has left me with many questions. We struggled with male factor infertility for two years before moving on to IVF in 2022. It took us three FETs, but my baby girl finally stuck and was born perfectly happy and healthy in early 2024. She’s now 11 months and surprise, I just found out I'm pregnant. We conceived naturally this time around after being told from a few doctors in the past that it was extremely unlikely we would ever due to low sperm count and motility. I've heard a few people say that sometimes IVF meds can quote "flip a switch" in your body or cause you to ovulate later on. And that's why we were able to conceive naturally. Is there any truth to this or is this a myth? This is such a great question.

Carrie Bedient MD (27:48)

All right, what do you guys think?

Abby Eblen MD (27:49)

It's pretty much a myth.

Susan Hudson MD (27:50)

I mean, especially in this situation. Now, in this situation where it sounds like they primarily had male factor, no matter what you're doing to her body, IVF didn't change anything that was happening in his. And the reality is you only need one good sperm. And sometimes you have that little one that kept on going and going and you get pregnant and it happens. And we do see people even with...female factor infertility that they do IVF and they get pregnant and then sometimes they spontaneously get pregnant thereafter. Now, if you have somebody who gets pregnant relatively quickly after they've delivered, realize that pregnancy does have a suppressive effect on things like endometriosis. So it's probably more the fact that you were pregnant than necessarily that you did IVF. And there's, those things can happen.

But in general, if you have struggled for pregnancy number one, the likelihood of you having not needing any help for pregnancy number two is not high, it is not impossible. We hear and see these all the time, but it is something that we don't necessarily want you to expect. It's a happy occurrence when it happens. I would not say, I just need to do IVF for my first pregnancy and I'll be fine thereafter.

Abby Eblen MD (29:08)

One other thing you mentioned about hormones too is another kind of reset is sometimes people that have polycystic ovary syndrome, they have elevated male hormone levels and their hormones are kind of out of balance. I have definitely seen people stop birth control pills and a month or two later they ovulate and get pregnant and that's mainly because of the suppressive effect of the birth control pills are still there on the other hormones but they're able to ovulate. So yeah, there's definitely stories like that but your best odds are to do whatever you did before to get pregnant usually.

Carrie Bedient MD (29:37)

So pulling out of the archives of memory and of fertility articles, there is, it's approximately 15 to 20 % higher chance of conceiving after IVF within the first two years of a spontaneous. 15 to 20%, when you're thinking about something as important as this, is not something you're necessarily gonna rely on. I wouldn't take it as a holy grail you're gonna get pregnant, but it is just a touch more likely, again, for all of the reasons that we've mentioned of suppressive hormones that may be beneficial and showing your body what to do.

Abby Eblen MD (30:11)

So what over what period of time are you saying lifetime 15 to 20 percent chance or are saying per month or say that again? Within two years. Okay. Gotcha.

Carrie Bedient MD (30:17)

Within two years, there's a slightly higher chance of conceiving. And this was in couples who had had long-term infertility prior to their conceiving their first child with ART, and then the second child just came on their own.

Abby Eblen MD (30:37)

All right, more questions or are we? All right, well, very good.

Susan Hudson MD (30:40)

I think we're good.

Abby Eblen MD (30:43)

Well, to our audience, thanks for listening and some subscribe to Apple Podcasts to have next Tuesday's fertility episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information.

Carrie Bedient MD (30:55)

Visit fertilitydocsuncensored.com to submit questions and sign up for our email list and get notifications about our book as we get closer.

Susan Hudson MD (31:03)

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.

Carrie Bedient  MD (31:11)

This podcast is sponsored by ReceptivaDx. ReceptivaDx is a powerful test that can help detect inflammatory conditions on the uterine lining that might be preventing you from becoming pregnant or staying pregnant. If you have experienced implantation failure or recurrent pregnancy loss, ask your doctor about ReceptivaDx testing. If found, uterine inflammation can be treated, providing a new pathway to achieving a successful pregnancy. ReceptivaDx because the journey is worth it.