Ep 292: High Hopes, Low Reserve: Making Tough Choices with Decreased Ovarian Reserve

 Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, the Fertility Docs dive into the complexities of decreased ovarian reserve and the tough decisions that come with it. What happens when only a few eggs are retrieved? When is it best to fertilize, and when might it be time to stop treatment? Our docs unpack the emotional and financial weight of multiple cycles with low yields and explain why sometimes looking at sperm health—including DNA fragmentation testing may be important. They discuss the role of growth hormone in supporting egg quality, the difficult but potentially life-changing choice of donor eggs, and strategies for dealing with dominant follicles, from luteal starts to estrogen priming. You’ll also hear insights on high AMH at age 41, unexplained infertility that turned out to be diminished reserve, chemotherapy’s impact on fertility, and alternative paths when IVF isn’t financially possible—from IUI and intratubal insemination to fertility grants. This is a must-listen episode for anyone navigating the challenging reality of decreased ovarian reserve. This podcast was sponsored by Shady Grove Fertility. 

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.

Abby Eblen MD (00:22)

Hi, everyone. We're back with another episode of Fertility Docs Uncensored. I'm one of your hosts, Dr. Abby Eblen for Nashville Fertility. Today, I'm joined by Susan Hudson of Texas Fertility Center and Carrie Bedient from the Fertility Center of Las Vegas.

Susan Hudson MD (00:34)

Hello.

Carrie Bedient MD (00:38)

Hey

Abby Eblen MD (00:40)

And I forgot to add that they're quintessential queens. I forgot my adjectives, but we were talking about that before and I think we all fit the bill for that.

Susan Hudson MD (00:48)

Absolutely.

Carrie Bedient MD (00:48)

Oh, one hundred percent.

I think the quirky, quintessentially quirky, I think I got that one nailed.

Abby Eblen MD (00:56)

That's even better, even better. Well, we were just talking about childhood memories as it's hot outside and we were thinking, what brings us back? What dessert brings us back to our childhood? So, Carrie, what dessert brings you back to your childhood?

Carrie Bedient MD (01:08)

I don't know that it's so much as a dessert as a sweet treat because the thought of classifying this as a dessert now somewhat horrifies me. But the one that pops into my mind are Otter Pops.

Abby Eblen MD (01:19)

What are those?

Susan Hudson MD (01:20)

What are Otter pops?

Carrie Bedient MD (01:21)

You don't know what Otter Pops are? I am shocked and appalled. Maybe. They're Freezy Pops. It's the long, skinny plastic tube, yeah, with the brightly colored liquid in them that you freeze and then you cut off the top of them and you squeeze them out. We used to have to pay a dime for them in summer camp, which, my God, I...

Susan Hudson MD (01:31)

I know what they are! Yes!

Abby Eblen MD (01:34)

I've never called them that.

Susan Hudson MD (01:42)

Yes, flavor-ice.

Abby Eblen MD (01:43)

Yes.

Carrie Bedient MD (01:49)

I'm old. But we would pay for them and it was the best thing ever because it was so freaking hot and they were just icy cold. I like the red ones.

Susan Hudson MD (01:57)

I remember those.

I know what you're talking about now. Absolutely. loved those when I was a kid too. Mine, mine are orange push-up pops.

That flavor is like, so good. And I have to say the new orange cokes taste just like it. So they're so yummy.

Abby Eblen MD (02:17)

I've never had orange coke yet. Oh, I'm gonna have to go get one of those. I didn't either.

Carrie Bedient MD (02:20)

I didn't even know that that existed.

Susan Hudson MD (02:23)

It's new.

Carrie Bedient MD (02:24)

Do you, is that like a dreamsicle type flavor? Or is that different?

Susan Hudson MD (02:30)

I don't know. It was just the ones that were at Sac-N-Pac with they're in the little cylinder and you push them up and you eat it as you push it up and then get the little plastic thing at the bottom and you lick that with your tongue. It was like a whole event for me.

Carrie Bedient MD (02:43)

So, so there, do you, you know those ice cold, beer steins is what I think about them for, but I always used to use them for like orange soda, where it's, it's a big mug and it's just ice all the way down. If you put an orange Coke in there, you'll get the icy component of it as well. If you put it in the freezer for half an hour to an hour and all the ice crystals on the side and then you can take a spoon and take it off.

Carrie Bedient MD (03:10)

That will get you more of your push poppety greatness.

Abby Eblen MD (03:13)

That sounds like a head freeze to me, you to that slowly.

Carrie Bedient MD (03:16)

What about you Abby? What's your favorite?

Abby Eblen MD (03:19)

I can't say exactly, but when you said, okay, we should talk about what we remember as a child. So I lived in the quintessential small town, 5,000 people. In the summertime, there wasn't a lot to do. We'd play softball down at the creek or go over and play in somebody's yard or ride our bicycles. And so we would have the ice cream man that would come around and it would be maybe once every few weeks.

And, because you could hear it miles away, they jack up the sound so that all the kids would know. And we'd come running out and usually we'd get to pick. There was like a picture of all the different ice creams that they had. And I use I remember the red, white and blue one, the best that was kind of shaped like a rocket. Was that a rocket pop? Yeah, yeah, yeah, yeah, yeah. That was my favorite thing to get when the when the ice cream man came around. But it was just a good memory because it was always fun, laid back summer, hanging out with your buddies, just doing fun things.

Carrie Bedient MD (03:54)

Rocket Pops. It's a Rocket Pops.

I definitely have friends whose parents told them that, when the ice cream truck is playing their music, they're out of ice cream.

Abby Eblen MD (04:15)

That was kind of mean. We didn't buy that back in my day though. We knew that he had ice cream.

Susan Hudson MD (04:17)

That's mean!

Susan Hudson (04:24)

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Abby Eblen MD (05:30)

All right, well very good. So today we are going to talk about decreased ovarian reserve. We're to take questions.

Susan Hudson MD (05:36)

Here's our first one. Hello and thank you so much for your podcast. Thank you for listening I'm a 36 year old trying to conceive with my partner for a year AMH 0.5, AFC 9, FSH 2.3 Estradiol 1,407, healthy weight. I had frozen 26 eggs at age 34 through four egg retrievals, two of them were duo stim. It was on 12 of Rekovelle 300 of Menopur and three months of Androgel pre-stimulation. This year we unfroze 13 eggs which resulted in one embryo, did not implant. We then did another IVF cycle with fresh eggs and meds and raised to 15 of Rekovelle and 375 of Menopur. Androgel again. This resulted in one egg, no embryo. Eggs fertilized but things go down day three to five according to my doc.

Full DOR testing complete, no causes found. My partner's spermogram is good and DNA fragmentation is okay. We want two kids, what should we do from here? So for our listeners, first of all, this is someone who is listening to us from overseas. That's why the medications are a little bit different than what we normally talk about, but the concepts of what we're looking at here are very similar.

Carrie Bedient MD (06:57)

So, Androgel is a testosterone pretreatment. I personally haven't found a whole lot of use for this. I haven't found a negative impact, but don't see it as being super helpful. And so that's something that may or may not make an impact. At this point, it's how much physical and emotional effort are you wanting to put into this? And at what point, do you or do you not want to consider egg donation? Because it sounds like you still have half the eggs that are frozen that may or may not turn into an embryo. Going to get more eggs is not necessarily something that's going to be particularly easy. There are differences in the way that other countries do stims and their embryology labs and what they put focus on. And so, that's something that may or may not play into your decision making. And there's also a lot of differences in how other countries view egg donation. And the counseling you may be getting at home might be very different than what we would give here just because the laws are very different and the access is very different. If the goal and the ability is to keep going for your own eggs, I think you may do that. I don't know that the really high doses of meds make a difference for you. We typically go for that first because the goal is let's max out what we have, give absolute support to everything. But if you only made one egg this last time, you may be able to get by with just Clomid and a little bit of the Rekovelle or FSH or a little bit of Menopur or both rather than doing these really high doses. So that's something to consider if you have access. If you know that you've got a bunch more cycles that are covered, then maybe better to go with a real low stim because the higher ones aren't making a difference anyway. So that's something to think about.

Susan Hudson MD (08:42)

Suggest some repeat ovarian reserve testing because essentially your FSH was low and your Estradiol was high, which means I can't trust that FSH level. Essentially, the brain and the ovary work on a feedback loop. So when one is talking loudly, the other one is generally quiet. So if you have a functional follicle or cyst on your ovary, which looks like probably happened when you had your labs drawn. You have a high estrogen level, which means I really can't tell you what your FSH level is. Now, FSH is not as in vogue as AMH, but what I can say is I don't think most people make any absolutes based on an AMH that gives us an idea of quantity and that time is important and those types of things. However, we know with very, very high FSH levels, and if that's where you actually are, that your chances of taking home a baby may be much, much less than what you're visualizing at this point in time based on a lab value that is really not giving you any valuable information. And so I agree with Carrie. I would take advantage of the remaining eggs that you have cryopreserved. Number one. Number two, is you didn't mention how your eggs were inseminated if it was ICSI versus standard insemination. And there's a possibility, although we know you have diminished ovarian reserve and based on a basic semen analysis and DNA fragmentation, that there does not appear to be anything wrong with the function of the sperm. However, I don't think you've probably had a SpermQT, because I don't think SpermQT is available outside of the United States at this point. SpermQT is a test that looks at the genes within sperm that can become dysregulated or abnormally turned on or off. And if there's a high number of dysregulated genes, then you could have millions of sperm and they essentially get to the door and don't know how to press the doorbell. So they don't know how to get in. So if you've done these cycles and you've been using conventional insemination, ICSI might be something to consider just because the treatment for these abnormal genes is doing ICSI and it's something that you can change from cycle to cycle.

Abby Eblen MD (11:10)

Okay, guys did a very thorough job of covering about every aspect of this. The only thing I would add in, because I was thinking about the sperm as well, sometimes, and this is something that you may or may not want to do, but sometimes if we think that there is a sperm issue, which again there may not be, but sometimes you can actually use donor sperm for half of the eggs and use husband sperm for other half, so that would be something to consider. Most likely it's your egg though, not the sperm. There is a test called PGT-A+ where we can get a sense for if poor fertilization is related to the egg or the sperm. But you probably did not do that, but that's a potential option if you were to do another cycle. Looking at your numbers, it looks like on average you got about six or seven eggs per cycle to get to that 26. Clearly when you went through IVF again and you only got the one egg, regardless of what your FSH, your AMH, all those numbers say, clearly there's something different now in you that wasn't the case when you did those retrievals before.

I would echo what Carrie said. Your best chance, probably of a pregnancy, is using donor egg. You spend a lot of time and lot of money and you want a baby and you're probably pretty tired of doing what you're doing. So I would seriously consider doing that.

Susan Hudson MD (12:17)

Try to use your frozen eggs first.

Abby Eblen MD (12:19)

Yeah, absolutely. Yeah, try and use your frozen eggs first, sure.

Carrie Bedient MD (12:22)

And if you do end up having to go the donor egg route, make sure you know what all of your options are, not just in your home country, but everywhere else, because that may change your opinion of what you want to do and how you want to do it.

Susan Hudson MD (12:33)

On that note, our upcoming book, the IVF Blueprint, we have a whole chapter dedicated to things like donor eggs and donor embryos. That might be something for you to check out.

Susan Hudson MD (12:47)

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Susan Hudson MD (13:24)

All right. Our next question, Hi, doctors. Great podcast. Thanks for doing it. I have a question for you about unexpected poor responders and dominant follicles.

I am a recently turned 41 year old. My wife and I are using donor sperm and went straight to IVF given my age. At my initial appointment, my AMH was 3 and AFC was 15. My doctor told me I was lucky. I recently attempted my first egg retrieval cycle, which my doctor suggested I cancel seven days in. At baseline, cycle day 3, I had an AFC of 10, but only six follicles ended up growing. Worse, I had a dominant follicle that was huge right from the first monitoring appointment. I think 16 millimeters after five days, with everything else under 10 millimeters. I primed with estrogen before the cycle. My doctor told me she was perplexed. Thoughts on dominant follicles.

Abby Eblen MD (14:14)

I think you'd just ignore it if you've got a whole bunch of other small follicles and I think she said she had six total and maybe one dominant is that what she said? One approach would be and it may not be a perfect cycle but you could just continue to stimulate it will be a longer cycle for you may take more medicine but a lot of times if you have a group of eggs that do seem to be grouped together just ignore the dominant follicle continue to stimulate and see if you can get something from those four or five that you have that are close to the same size ultimately.

Carrie Bedient MD (14:44)

Another approach would be to use a different priming technique. So instead of just Estradiol, add in Cetrotide or one of the GnRH antagonists to it. Or instead you can use Orilissa, and this is what I do in a lot of my patients who are over 40 because it's a stronger med, use Orilissa in the five days leading up to your cycle and try and knock out anything that is growing prematurely. Another way to think about it is by doing a luteal start so that your body doesn't have the time to select that dominant follicle. Your progesterone is still going to be high, but nobody cares because you're probably not doing a fresh transfer. And that way you can get in on the early phase too. So there's a bunch of different protocol variations that you can do here that, especially cause it sounds like you just turned 41 and tis the season for follicles to grow prematurely, you just make some alterations either with pretreatment, with the cycle type, with start time, all of those things.

Susan Hudson MD (15:42)

All right, our next one. I'm 40 and my wife 41 and I went to have a couple of kids. 10 years ago, she did one successful IUI before we moved. Then we each did several ICI cycles with frozen donor sperm before putting family building on the back burner. Now we're back in the US. We have no health lifestyle issues besides age. My wife has lower numbers, so we started with IUIs for her, but all three were unsuccessful, so switching to my womb. My periods are regular with LH peak 12 days before bleeding. My AMH is 7.5 was 8.5 to 12.5 10 years ago. Antial follicle count is 30 on the right, 10 on the left, and she does have an endometrioma on the left. Plan to start clomid at 50 milligrams if the fluid sac they saw on ultrasound is not estrogen producing. How many IUIs should I try before cutting our losses for IVF or reciprocal IVF.

Carrie Bedient MD (16:42)

And this is the wife that is 41 or 40.

Abby Eblen MD (16:42)

I mean, I think.

Yes, I think 41. I think the 40-year-old didn't get pregnant with IUIs.

Susan Hudson MD (16:50)

She's 40. No, this is the 40 year old.

Abby Eblen MD (16:53)

Okay.

Carrie Bedient MD (16:53)

I don't think I would do very many cycles of IUI before cutting your losses. I would do maybe two.

Abby Eblen MD (16:58)

Would you say that in a 41-year-old or 40-year-old?

Carrie Bedient MD (17:02)

Because right now her egg reserve is freaking amazing. And at some point that will drop and we don't get any advanced notice reliably as to when it's going to drop. And so this would be someone where I want them to be able to make the transition from IUI to IVF easily and quickly. This is not someone where I want you to do six cycles of IUI and then hem and haw for another five months.

Thinking about whether or not you wanna do IVF, this is someone where if you wanna do IUI, totally fine, let's do it. But let's do a cycle, another cycle, and let's go straight into IVF if it doesn't work because we wanna maximize the time because your ovaries are giving you a huge gift right now in those numbers. And it doesn't necessarily mean you're gonna get pregnant, but we got a good chance, so let's take it.

Abby Eblen MD (17:52)

Well, we don't know for sure how many eggs you're gonna get, but what Carrie is saying is you have a really, really good egg count. So we would think, we would presume that even with a moderate stimulation, you'd have a lot of eggs, and eggs are like lottery tickets. The more eggs you have, the better chances you have of finding a genetically normal one. Even though at 40 or 41, depending on where you are in that spectrum, your chances are much lower of having a genetically normal embryo. It's pretty likely that with that many eggs, if we get quite a few, 10 to 15 maybe, or maybe even more, that we would have one that's normal. Whereas if you do IUI, you're just banking on that one egg that you happen to ovulate that particular month is genetically normal and statistically probably is not. So you're spinning your wheels, doing some things that are not as successful when you could be jumping right into an IVF and you have a much better chance if we were able to find a genetically normal embryo.

Susan Hudson MD (18:43)

Also, if you're going to be doing some IUI cycles, I would probably recommend using letrozole instead of Clomid. I mean, it sounds like you're on the PCOS spectrum. Very good evidence to say that letrozole is superior to Clomid in that situation. Also, you have an endometrioma. Letrozole has an anti-endometriosis effect. And so anything we can do to squelch any of those negative hormones or chemicals that being secreted by the endometriosis can be beneficial.

Carrie Bedient MD (19:14)

The other thing to consider with endometriosis, and I don't know if you ladies find the same thing, I'm more than happy to start my patients with endometriosis in an IUI cycle, especially if we know that their tubes are open, but I find far more often we end up in IVF for endo patients.

It's because of the hormonal environment that they're in. It's because of a higher likelihood of structural issues. And so that's another reason why I would not do very many IUIs before jumping to IVF because you not only have the age component, the egg component, but you've got an endometrioma there. And so that right there is going to automatically A, decrease the number of eggs that you're available to get and B, does make it more difficult to conceive with an IUI just based on experience.

Susan Hudson MD (19:57)

Agreed. Our next one. Hello, I'm 39, AMH 1.59, diagnosed with unexplained infertility. My husband's semen analysis was normal. We had four egg retrievals and haven't been able to get a euploid embryo. The numbers for cycles vary, but it's been anywhere from two to eight eggs. I've been labeled a poor responder to meds and tried various protocols. And at most one blastocyst per cycle, but all blastocysts have had chromosome abnormalities when we've done PGT testing. My question is, would you recommend any additional testing for either myself or my husband? Example, DNA fragmentation tests, sperm aneuploidy test, et cetera. My doctor's telling me it's just luck of the draw and it's almost certainly an issue with my eggs versus the sperm chalking it up to advanced maternal age.

Carrie Bedient MD (20:46)

What do you guys think about that unexplained infertility diagnosis?

Susan Hudson MD (20:49)

So you have diminished ovarian reserve. It is explained. Unexplained means there is no identifiable factor. At this point, understand that IVF is not only therapeutic in that we're helping you try to achieve pregnancy, but it's also diagnostic. So it is a diagnosis tool. And based on your response, you have diminished ovarian reserve. Now, this isn't necessarily testing I would do, but if you haven't tried any growth hormone or Omnitrope during your stimulation, I would probably recommend that. It's not a miracle cure, but I have had people who have had poor responses. I don't tend to get more eggs or embryos, but I tend to get better quality eggs and embryos and more chromosomally normal embryos if it's going to have an impact.

It's not 100%. I definitely have had people that I thought were going to respond that didn't, but I've also had some amazing success rates with it as well.

Carrie Bedient MD (21:48)

Agree to all of the above.

Susan Hudson MD (21:50)

Okay. Our next question is, what can I do besides IVF to get pregnant after chemotherapy? I am 40, nearly 41. My husband is 44. I was diagnosed with diminished ovarian reserve and my husband was diagnosed with teratozoospermia, which means abnormally shaped sperm. IUI was unsuccessful.

I responded well to letrozole but no pregnancy. Unfortunately, my insurance does not cover fertility preservation and cover zero fertility treatments now. REI has recommended IVF, but we cannot afford it. The reality for most people in the US is that cost is a true barrier to fertility treatments. Are there any other low cost options? We've been trying for three years and infertility is more heartbreaking than enduring cancer. Thank you. I'm so sorry you go through this.

Abby Eblen MD (22:37)

I think, yeah, that's, and she's exactly right. Insurance is the big barrier for lots and lots of people. And we see that all the time in our practice. It's really upsetting. I think the one thing I would think about, cause you, I think you said you're continuing to do IUIs. I would do a SpermQT test. Susan and Carrie, I think both mentioned that earlier, basically that would just tell us if the sperm is capable of binding to and penetrating the egg.

If you're ovulating every month, you're making an egg every month. And granted at 40, it's less likely that you would get pregnant every month as opposed to somebody that's 35 or younger. But still, I would check the sperm out just to see if this is a reasonable option for you guys to continue. Because if his sperm can't bind to and penetrate the egg well, then you may just say you don't want to do this anymore. And even consider something like donor egg or donor embryo at some point. Or probably not donor egg, but donor embryo would be less expensive than donor egg.

Carrie Bedient MD (23:30)

That's actually what I was thinking too, is that donor embryo. So one thought is if the SpermQT is good considering an ITI, which is definitely more expensive than an IUI, because that catheter is. An ITI is an intra-tubal insemination, which is instead of an intrauterine insemination that places the sperm in the center of the uterus to let it swim and find the tubal opening on its own,

Abby Eblen MD (23:42)

That is, what's an ITI Carrie?

Carrie Bedient MD (23:56)

the ITI goes up higher, goes much closer to the opening and blocks the sperm in that corner. And so it's got a higher likelihood of at least getting into the tube. Now, whether it inseminates and embryo grows and implants is up to the body, but it at least opens that up. So that's one option. Another option is, like Abby said, embryo donation. And that's actually what popped into my head first, because oftentimes you can get an embryo donated at much, much lower prices so that the cost is less of a barrier there. Now, embryo donation is, that's a full episode in and of itself because of the nuances of that, but that may be a plan that you guys find beneficial.

Abby Eblen MD (24:39)

Hey Carrie, what's the cost of intratubal insemination? I know we talked about that a while ago, but I can't remember what the cost, because it's not cheap either though. I mean, it's not thousands of dollars like egg donation, but it's not entirely cheap.

Carrie Bedient MD (24:51)

It's still at least a couple thousand dollars because it takes more time to do and the catheter is much more involved than just a basic IUI catheter. And so one thing is that they only recommend doing one or two because if you're going to be successful, you hit it in the first one or two. So that does offset it a little bit because I think it trades some of the timing and the frustration with shortening that down and it makes the total amount you spend maybe more of the same, it narrows it down.

Something to think about.

Susan Hudson MD (25:21)

Another thing to think about is applying for some grants and make sure you tell your whole story. We had an episode probably about six months ago all about how to apply for grants. I would go and listen to that episode and really tell your story about your journey with cancer and where your struggles are now because I think that your story is one that resonates with a lot of grant foundations and If you consider doing something like embryo donation and tried getting a grant, there's a reasonable chance you might get the majority of that covered.

Carrie Bedient MD (25:56)

Agreed.

Susan Hudson MD (25:58)

Okay, one more?

Carrie Bedient MD (26:00)

Let's do it.

Susan Hudson MD (26:01)

I'm 41 and diagnosed with DOR and no cycle for a year after getting off hormonal birth control. Was on it for 15 years. I went to two fertility specialists and they both said I wouldn't be able to conceive with my own eggs. Even if I tried IVF to ovulate, the percentage is 5 % of working. Looking for guidance on changes I need to make. I started acupuncture back in October and have already noticed a difference.

Don't want to lose hope, but would love to conceive naturally.

Abby Eblen MD (26:36)

We're all quiet because we don't want to give you bad news. It's going to be hard to conceive naturally. If you've not had it, and I'd be interested to see what you guys say, but if you've not had a period for over a year after stopping birth control, birth control doesn't have a lasting impact. So typically within a couple of months after stopping birth control, you go back to what your normal cycling is. And if you're not having a period, that suggests that you're not ovulating every month. It suggests that you may even be in menopause, if not perimenopause.

Certainly hormonally there's some things the doctors can look at, but we just know if somebody's perimenopausal or postmenopausal, they're probably not gonna be successful using their own eggs.

Carrie Bedient MD (27:15)

And just to be clear, the birth control pills didn't cause this. If you had been on them or had not been on them, it would not have made a difference. This would have happened in the timing that it would have happened regardless of that. There is that really low, less than 5 % chance that you could conceive on your own. That typically has not significantly changed whether or not you do IVF. And so this is a case where potentially just letting it ride on your own may be helpful. Sometimes we'll give patients just a little bit of low dose estrogen continuously. Number one, that fights off some of the symptoms of menopause and helps you get through the day a little bit better without having nasty hot flashes. But also it can suppress your FSH levels. And so it gives them a better opportunity to... show the follicles the changes that they need to see in order to get them to grow. And so sometimes by putting people on estrogen therapy with appropriately timed progesterone, not all the time, just intervals throughout the month, cyclic, that can help somebody to ovulate. And so that's a thought as well that may be helpful for you.

Susan Hudson MD (28:18)

I totally agree with Abby and Carrie. We're all concerned about your chances of success. We never say never because we see never happen. OK. We don't know when or where it's going to happen. And I think including acupuncture in your regimen is great. Adding some CoQ10. We recently had a guest who talked about Primeadine, which is a commercial product of a chemical called Spermidine, can potentially improve function of ovaries and sperm. These are all things that may help. Nothing's a guarantee, but those are the words of advice that we would offer at this point.

Carrie Bedient MD (28:59)

Definitely.

Abby Eblen MD (29:00)

All right, well this has been a great episode. Any final thoughts that you guys have?

Carrie Bedient MD (29:04)

Keep the faith, get emotional support if you need it. This stuff's big.

Abby Eblen MD (29:08)

It is. All right, well to our audience, thanks for listening and subscribe to Apple Podcasts to have next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information so that we can help as many people as possible.

Carrie Bedient MD (29:23)

Visit fertilitydocsunsensored.com to submit questions and sign up for our email list. Keep an eye out for our book being released September 23rd. It's coming up. Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Susan Hudson MD (29:39)

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 (29:47)

Bye!

Abby Eblen MD (29:48)

Bye.