Ep 294: The IVF Blueprint Part 2: Making it through transfer and beyond

 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 second installment of our two-part series, the Fertility Docs continue their deep dive into the topics covered in our upcoming book. This episode explores the “in-between” stage after egg retrieval and before embryo transfer—a time that can feel both exciting and uncertain. We’ll walk you through the concerns patients face, such as ovarian hyperstimulation syndrome, and explain how to prepare for a frozen embryo transfer. We also compare fresh transfers with frozen transfers, so you’ll know what to expect in both scenarios. But the IVF journey doesn’t end there. We’ll discuss the range of emotions that come with a positive pregnancy test—and the difficult moments when the outcome isn’t what you hoped for. Beyond infertility, IVF can serve many purposes, from egg freezing for future family building to using a gestational carrier. We’ll also explore when donor eggs, sperm, or embryos may be needed, and how IVF supports LGBTQIA+ family building. Finally, we’ll highlight the importance of genetic testing to prevent inherited conditions. This podcast was sponsored by 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)

Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I am here with my cute, crazy, and creative co-hosts, Dr. Abby Eblen from Nashville Fertility Center.

Abby Eblen MD (00:37)

Hi, everybody.

Susan Hudson MD (00:39)

and Dr. Carrie Bedient from Fertility Center of Las Vegas. How are y'all doing?

Carrie Bedient MD (00:42)

Hi! How's it going?

Abby Eblen MD (00:45)

Doing great. Seems like it's been a while since we've sat down and chatted.

Susan Hudson MD (00:50)

Little bit, little bit.

Have y'all seen any movies?

Abby Eblen MD (00:51)

What you been up to?

Susan Hudson MD (00:53)

I just saw the last Downton Abbey movie and it is so amazing. Do y'all watch Downton Abbey?

Abby Eblen MD (00:59)

I love it. It's great.

Carrie Bedient MD (01:01)

I have a lot of people around me who love it, but I am fifth in my house to get control of the remote control. And that includes being after the dog who sits on it, touches it, and accidentally turns the TV off more than I get any kind of control. I do love stories though. So I'm more than happy to listen to stories about what it is and what happens, because I know the general premise. You can tell me everything. And my mom got Downton Abbey earrings that she gave to me that are like giant chandeliers. So it's somebody from the upper house that got it. So I have Dowton Abbey earrings that I've inherited.

Abby Eblen MD (01:35)

So I have to tell my side story Downton Abbey real quick. I watched it when I was locked up in my basement in 2020. My friends had already watched it, my mom, my sister, and I thought this is a great time to watch it, because I was in my basement for 10 days before I found out that my test was negative. I watched it, and if you remember one of the episodes, they have somebody in there that gets the Spanish flu in 1918.

That night I'm like, okay, I'm turning this off. I'm going to bed. I don't have COVID. I don't have the Spanish flu. I don't want to think about it. I'm going to bed.

Susan Hudson MD (02:04)

It was, the movie was amazing. It really did bring it all together. And I mean, I was, I'm a movie crier. I admit it. I cry at movies all the time. And I was just at the end, the water works for going, but it was good water works.

Carrie Bedient MD (02:05)

So how was the movie?

Abby Eblen MD (02:12)

It's actually on the big screen, Real movie theater and everything.

Susan Hudson MD (02:25)

Yeah, yeah. Every time a movie has come out, my husband and I have rewatched the series. And so when I heard this movie was coming out.

Carrie Bedient MD (02:33)

Wait, there are multiple, there are multiple Downton Abbey movies?

Susan Hudson MD (02:37)

Three.

Abby Eblen MD (02:37)

There's three of them, yeah.

Carrie Bedient MD (02:39)

Huh, are they with the same cast as the TV show?

Susan Hudson MD (02:42)

Yes. Yes.

Abby Eblen MD (02:43)

Well, with the exception of.

Carrie Bedient MD (02:45)

Dowager.

Susan Hudson MD (02:46)

Yes. Yeah. Yeah. But it is.

Abby Eblen MD (02:46)

Yes, she's not there anymore.

You need to watch it, Carrie. It's cool. It's good.

Carrie Bedient MD (02:54)

Okay, I'll put it on my list for when I retire.

Abby Eblen MD (02:58)

That might be a while though, right?

Carrie Bedient MD (03:00)

Hopefully, hopefully I would like to not have to retire for quite some time unless it's my choice, but I'm not really planning on going anywhere because I'm kind of a workaholic.

Abby Eblen MD (03:01)

You are.

Carrie Bedient MD (03:11)

Little bit.

Susan Hudson MD (03:12)

Here at Docs Uncensored, we've spent years answering your toughest fertility questions and walking alongside you on the IVF journey. And now we've taken everything we've learned from helping thousands of patients and from the thoughtful questions you've sent in for us to answer and put it all in one resource, our brand new book, The IVF Blueprint. This book is your step-by-step guide through the entire IVF process written in the same conversational, down-to-earth style come to know from us. Whether you're just starting to explore IVF or you're already in the middle of treatment, the IVF Blueprint is designed to give you the clarity, confidence, and support you need. You can find the IVF Blueprint in print, as an ebook, and as an audiobook with a special conversation from us at the end, wherever books are sold. Links to purchase are also available on our website at fertilitydocsuncensored.com.

So if you've been wanting an easy to understand, compassionate guide to IVF, pick up the IVF Blueprint today and let's take this journey together.

Susan Hudson MD (04:15)

Let's do a question for today. This question is near and dear to my heart. So, hi all, I am 28 and trying to conceive for 11 months, semen analysis, HSG and all tests are normal. I have celiac and my TSH is 3.08. RE is not concerned, but wondering if there's something we are missing.

Set to start IUI soon, but just wondering if there's any concern that my TSH should be lower or if my celiac is causing a delay. Thanks in advance.

Carrie Bedient MD (04:45)

Take it away, Susan.

Abby Eblen MD (04:46)

Thanks, that's your Susan.

Susan Hudson MD (04:48)

Hahaha.

Abby Eblen MD (04:50)

Takes one to know one.

Susan Hudson MD (04:51)

It does take one to know one. So for our listeners, I both have celiac and I do have Graves' disease, which is a thyroid condition. So when I saw this one, I was like, aw, I've been there. I get it. So when it comes to the celiac, really the biggest thing is that you need to make sure your celiac is controlled. So if you haven't had recent celiac enzymes done, I always recommend that being done usually once a year for listeners who aren't familiar with celiac.

These are the people that have to actually really eat gluten free all the time. And you have to know what's in your medicine and what's in your toothpaste and what's in your lipstick. And it's a bit of a challenge at times. Yes, Abby.

Abby Eblen MD (05:34)

What kind of enzymes do they do? Since I'm not a primary care doctor, I don't know what those are.

Susan Hudson MD (05:40)

So there's transglutaminases and some other endomycele enzymes. Most of the time for the physicians, you can order a celiac panel and it'll be the panel of labs that you should get. And the reason why it's important to get those checked is because sometimes you have been eating something that has been completely safe and the manufacturer changes it without your knowledge and you end up glutening yourself and you don't know it. So make sure your celiac is under really good control. Carrie?

Carrie Bedient MD (06:10)

When doctors order the celiac panel, because we don't have much cause to do this, is this one of those things where you order it and it gives you a very clear cut, yes you are, no you're not, or is this like lupus where it's any one of 25 different things that may or may not be related to whether or not you have lupus, if the sun is in mercury, which is in retrograde, on a blue moon on a Tuesday?

Susan Hudson MD (06:34)

So yes, these are directly related to celiac and it's usually a platform of about five different antibodies and enzymes. And so if any of them are abnormal, there is room for improvement in the diet control of the celiac.

Carrie Bedient MD (06:50)

Got it. Okay, so about this patient, what does she do? Besides making sure her celiac is really under control, is that just it?

Susan Hudson MD (06:56)

So for the celiac part, yes. So if your celiac is not in control, waiting until you do get it under good control and your antibodies are negative. When it comes to your thyroid, I would probably recommend anybody who has a TSH greater than 2.5 to about 4.1. I usually do TPO antibodies to see if...we are starting to get any Hashimoto's or anything going on that direction. Realize that the gene that can turn celiac on or not, that particular HLA type is related to both Graves and Hashimoto's two different thyroid conditions. And so you're at a genetic predisposition to have a problem.

If you have positive thyroid antibodies, then generally we do start you on thyroid medication like Synthroid or Tirosint, which the brand names of both of those are both gluten free currently at the making of this episode in 2025. And we want your TSH level ideally to be less than 2.0 in that situation. So anything else you guys were to add?

Abby Eblen MD (08:17)

I think you covered it. That's great.

Carrie Bedient MD (08:18)

So we call you when we have all these questions, so we're good.

Abby Eblen MD (08:22)

I  know. You're the celiac expert.

Susan Hudson MD (08:24)

Well, I wish I was a celiac expert for another reason. ⁓ Of the autoimmune diseases to have, I will stick with my celiac and my Graves and hopefully none others pop up.

Abby Eblen MD (08:28)

Yeah.

Carrie Bedient MD (08:37)

Yeah, don't be greedy. Leave some for the rest of us.

Abby Eblen MD (08:39)

Yeah, only two. Yeah, only two for you.

Susan Hudson MD (08:42)

That's enough, that's enough.

Susan Hudson MD (08:44)

Every adventure begins with a dream, and for many, that dream is growing a family. At IVF Florida, we understand the road to parenthood can take unexpected turns. Our team is here to guide you with expert care and advanced fertility treatments designed to support you at every milestone. With convenient locations across Jacksonville and South Florida and flexible monthly payment plans, IVF Florida makes it easier to move forward with confidence.

Visit ivfflorida.com to schedule your consultation because every great adventure deserves a trusted guide. Start yours with IVF Florida.

Susan Hudson MD (09:23)

Okay, well today we are going to talk about the second half of our book, The IVF Blueprint.

Carrie Bedient MD (09:32)

Yeehaw!

Abby Eblen MD (09:33)

Yee-haw!

Carrie Bedient MD (09:34)

It's really interesting that for anybody who's watching the YouTube, all of our covers look totally different color, even though...

Abby Eblen MD (09:39)

That is so funny! We go from red to yellow to orange. That is odd. Really odd. Huh.

Carrie Bedient MD (09:44)

Yeah. Huh. Interesting.

Okay. So last episode, we had talked about the first two sections, which are about everything to prime for IVF and how you get ready and what meds and what supplements and lifestyle changes and some of the testing you need and all of those things. And then we had started to talk about the IVF process and look at the egg retrieval and the meds and the retrieval day and all of those things. So now we're on to the third part of our book of essentially what happens after the retrieval.

Abby Eblen MD (10:21)

I feel like we're at a book club. I'm holding my book and I'm looking at it.

Carrie Bedient MD (10:25)

And this one, everybody on this has read the book. All three of us know the story very well.

Abby Eblen MD (10:28)

Yeah, ⁓ multiple times and listen to it.

Susan Hudson MD (10:33)

Have you ever been to a book club where everybody in attendance has actually read the book?

Carrie Bedient MD (10:38)

I think the very first one of the current book club that I'm in, everybody read the book because we were all feeling each other out and trying to make sure that we were all worthy to be in this book club. And then I'm pretty sure ever since then, there's always been at least one person who hasn't, but it's not the same person, which is what matters.

Abby Eblen MD (10:56)

I bet somebody was bluffing and I bet her name was Carrie probably.

Susan Hudson MD (11:00)

We're we're at chapter 12 where we're going to talk about after the egg retrieval but before embryo transfer. So what are some of the things that we touched on in this chapter?

Abby Eblen MD (11:00)

Well we talked about ovarian hyperstimulation syndrome. And that's something that typically most of our patients don't have to worry as much about. And that's because we tend to trigger now with Lupron. Probably 10 or 15 years ago, we would trigger with HCG. And if your estrogen level is over about 3,000 or 4,000, you're at minimum risk for it, minimum to moderate. If your estrogen level is seven, eight, nine thousand and beyond, you're at pretty significant risk for having symptoms that may require some sort of treatment. And so it talks a little bit about that in case, and hopefully it'll be more for historical interest than anything else. Hopefully you won't get hyperstimulation syndrome. But now because of that, we don't have to worry about it so much.

Susan Hudson MD (11:54)

And that's fortunately a pretty short chapter because we really talk about some of the other complications and that type of thing. But that leads into one of our favorite chapters all about frozen embryo transfer.

Carrie Bedient MD (12:08)

This is going through everything that you might imagine about frozen embryo transfer. So it talks about, of course, transfer day itself and what you go through when you get there and what's going to happen and in general how the process works. But we also go through in quite a lot of detail all of the medications and different protocols. And this is something that varies quite a lot from clinic to clinic.

There's typically not really one right answer to it, but it really explains some of the differences and some of the rationale behind what we're doing and why we are doing it so that patients have a really good idea as they're going into it. Okay, this is kind of what I can expect. These are what these medications are for. This is why I'm doing this.

Abby Eblen MD (12:51)

And we also have some really cool tips and tricks and things that we add in as a side note. One of them specifically for progesterone injections, there's several tips and tricks that you may want to think about, like medicine that can numb the injection site, other things you can do, massaging the area after you give the injection to help decrease the discomfort from intramuscular progesterone.

Carrie Bedient MD (13:13)

It also looks at some of the data about adjunctive medications. So other medications besides the straight-up hormones that we give that may or may not be helpful as you're going through this because one of our most popular questions is what else should I be doing to help this stick?

Susan Hudson MD (13:25)

All right and talking about sticking that leads to chapter 14 where we talk all about both a positive pregnancy test or if we haven't been successful. This is a chapter that I wrote and actually it was one of my favorite ones that I wrote because really I wanted to be able to give a light at the end of the tunnel with with either of the situations because obviously if we're pregnant, we go on to have more blood tests and ultrasounds and then eventually go on to a see our OB. But if it's negative, for a lot of people that doesn't mean that everything stops at that point. We talk about what additional testing you might want to do. What are things that maybe your doctor...didn't do at the very beginning for testing because it wasn't indicated at that point in time, but whether you weren't successful because you had an embryo transfer and that transfer wasn't successful or if you didn't get any eggs or embryos, what are things that you can do from here? So it really helps bridge that gap to where do I go?

Carrie Bedient MD (14:37)

Definitely.

Susan Hudson MD (14:38)

All right, and then.

Carrie Bedient MD (14:40)

From there, we start going into the fourth section of our book, which is all of the other stuff that surrounds IVF. It's the other reasons you might do IVF. It's all the unique family journeys and how someone might find themselves in a position where IVF is the best treatment for them. And the first part of this is looking at egg freezing and how that works. It goes through what is egg freezing? How is it different than embryo freezing?

What is the process like? What are the numbers that you need? And how do you think about the long-term planning of this? And so not just the getting the eggs frozen, but also once you have something frozen, whether it's eggs, embryos, sperm, what do you do with it? And what do you do with it long-term? And so think about some of the really long-term planning components of this, not just with freezing your eggs, but once you're done with the process, what happens next?

Abby Eblen MD (15:33)

One other thing I was gonna add in too, because when I opened up to this chapter, I was right on the part where it says egg versus embryo freezing, and I literally had a patient last week that was in this situation. She unfortunately has a diagnosis of cancer. We talked about freezing eggs, but she also is married and has a partner, and they've never tried to get pregnant before, but we talked about, if you have a partner, you may wanna even consider creating embryos because we can give you more...more information about what your chances are if we have an embryo, because it's just further down the pike, further down development. And for somebody like that, it might be more reassuring if she knows she has an embryo there instead of just eggs.

Susan Hudson MD (16:09)

Another important part of this chapter is this is where we address what we call egg, sperm and embryo disposition. So what are all of the options that you can choose if you decide not to use your biologic material in the future? And so that's really important. It's not something that a lot of people dedicate a whole lot of thought to. Some people do, as to what they want to do immediately, what if something were to happen to somebody and we have leftover eggs, sperm or embryos, but it's actually a very important conversation for everybody going through the IVF process to discuss and really do a little soul searching over.

Abby Eblen MD (16:56)

And it's actually important to put that in your will. If you have embryos and they're kind of hanging out, you may want to put that in your will because that's a stronger legal document even than the one that you signed at the fertility center. So just keep that in mind.

Carrie Bedient MD (17:10)

That's the best thing to make sure that what you want to have happen to your embryos, happens to them.

Susan Hudson MD (17:17)

Absolutely. Okay, and then we get into one of Carrie's favorite sections, eggs, sperm and embryo donors.

Carrie Bedient MD (17:27)

This is looking at all of the background information about where do you find donors and what kind of screening goes into them and how do you figure out some of the legal aspects. And this is a chapter where it wasn't just us writing it, but it was the lawyers going over it as well to make sure that some of the legal components that we were bringing up made sense because that weighs in a lot here.

And we talk a lot about what's a known donation, where you know the identity of whoever is donating their eggs or sperm versus a non-identified donation. And non-identified is a very deliberate term. It's not anonymous because nothing in this world is anonymous anymore. And so we talk about how those two things differ, how you can get through one or the other.

We talk about FDA testing whenever we're getting eggs or sperm and how that plays in and what some of the regulatory things are. So it's a pretty in-depth chapter with a lot of, yeah, I mean, it's a lot of how-to, it's a lot of this is why, it's a lot of these are the considerations to think about.

Abby Eblen MD (18:25)

Yeah, and let me just say, we try and make you laugh a little bit along the way. So every time I look at the title of this chapter, it's called An Oven for the Bun, Gestational Carrier. So hopefully that puts a little smile on your face when you read that.

Carrie Bedient MD (18:45)

The next chapter is all about gestational carriers. And this is very similar in the scope of what the egg and sperm freezing chapter is, because again, we got the lawyers involved on these to make sure that everything was correct. And we talk about how do you find the GC? What are the important things about a person that you're considering to be your gestational carrier? And how do we do the medical clearance, and a lot of the contracts, legal, all of these things that play in. It's also a very, very detailed, very in-depth chapter for the folks who need it because there's really not any other great resources that put it all in one place. And that's what we're trying to do. And so you can just pick this up and read it and at least have a pretty good starting idea.

Susan Hudson MD (19:26)

I'm impressed that we were able to get this much knowledge in about 15 pages. That's pretty fantastic. I mean, really a straight to like, what is the nitty gritty you need to know about gestational carriers? There's a reason gestational carriers that doing that type of cycle is so expensive because there's so much involved and to have

Abby Eblen MD (19:32)

Yeah, it was a lot.

Susan Hudson MD (19:47)

A quick reference to go over the nitty-gritty. It's it's really great.

Abby Eblen MD (19:52)

And I bet there's probably no other place that I can think of that has a really good source for it like this book does. I mean it's a lot of information and it's important information.

Susan Hudson MD (20:01)

Absolutely. And so our next chapter is all about LGBTQIA plus family building. And we understand that this is very, very complex. And so we dedicated an entire chapter to this.

Carrie Bedient MD (20:16)

And so this is going over as many variations as we could think of of how you might need to do this and the things that are of particular consideration for someone who's in this position to build their family and how they go through, not just the egg donation, sperm donation or GC part, but how it all fits together and what they might wanna be thinking about and where the FDA does and does not come in.

And really tries to go through in great detail what might be special for this group of patients as they're building their family.

And then beyond that, our next chapter is looking at all of the other medical reasons, especially the genetic ones, that people have when they're pursuing IVF. And so this goes into a lot of genetic testing detail in particular.

Abby Eblen MD (21:05)

In one of the groups that early on when we first started doing pre-implantation genetic testing, aneuploid or PGT-A, was women with recurrent pregnancy loss. And it's, many times when I'm talking to couples with recurrent pregnancy loss, I'll mention something about IVF and they kind of look at you like you have three heads because, wait a minute, I don't have trouble getting pregnant. I just have trouble staying pregnant. But the advantage of doing IVF if you have recurrent pregnancy loss, particularly if you've had a complete workup and, still unfortunately you're not able to continue with a pregnancy, the advantage is we can genetically test embryos and really just try and change the tipping point and give you a better chance of getting pregnant because oftentimes when people have miscarriages at least half the time, it's due to some sort of genetic abnormality. So this chapter talks about that and why you might want to consider it if you have recurrent pregnancy loss.

Susan Hudson MD (21:54)

We also go into some specifics about PGT-A or pre-implantation genetic testing for aneuploidy that directly plays into recurrent pregnancy loss, but also PGT-M if you have a single gene defect like cystic fibrosis or spinal muscular atrophy or one of the hundreds of recessive or X-linked genes or sometimes even dominant genes that we test for that can have significant disability for either children or adults.

Carrie Bedient MD (22:25)

Definitely. And then of course there's trying to build a family faster, talking about family balancing, some of the other reasons that people have as they're going through this. So in a nutshell, that's what the book is. And so if you haven't tuned into last week's episode yet, that's talking about all of the first part of it, which is also a, that is a very juicy part of the book because it goes through so much detail of how people decide to get to IVF and what's the initial part. But really the biggest goal that we had in the entire book from start to finish is to make a user friendly way for patients to know what they're gonna go through because the uncertainty is so craptacular as you're going through that one way to help alleviate that is to at least have an idea of what's going on and why it's happening. And so this is not designed to give you every answer under the free world, although heaven knows we certainly try to think of every question that we get asked and have the answer in the book somewhere. But the goal is to give you enough confidence and knowledge that you can just waltz through this process and take the bumps and know what's coming and know that for every bump there's a solution and that you are not the first person who's gone through it and that we've got a way to help you.

Abby Eblen MD (23:39)

I'll just throw into our editor after we had written the book and had really felt like we were putting the finishing touches on it. Our editor came back and she was like, is there anything else you can put in, any other tips you can put in? So we all started racking our brains. We're like, okay, what else can we put in this book? So even though we may not have everything in there, I think we have a lot of stuff. In fact, there's not much more that I could think of that we possibly could put in there about IVF that's not in there now, but maybe you'll find something. If you do, let us know. We'll put it in the next edition.

Susan Hudson MD (24:10)

Absolutely fantastic. Well, thank you so much for joining us today and thank you for listening and subscribe to Apple Podcast to have your next Tuesday's episode pop up automatically for you. Also be sure to subscribe to YouTube that really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (24:28)

And visit fertilitydocsuncensored.com to submit specific questions, sign up for our email list. Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Carrie Bedient MD (24:39)

And as always, this podcast is intended for entertainment, not a substitute for medical advice from your own physician. So subscribe, sign up for emails, go get the copy of the book, and we will talk to you soon.

Abby Eblen MD (24:48)

Bye.