Ep 307: When Do I Need to See a Fertility Doctor?

 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. This episode of Fertility Docs Uncensored tackles one of the most common fertility questions patients ask: When should I seek care for infertility? We answer key questions including: When do I need to see a reproductive endocrinologist? In general, patients under 35 should seek fertility care after one year of unprotected intercourse without conception, while patients age 35 and older should seek care after six months. What conditions should prompt earlier evaluation by a fertility specialist? These include irregular menstrual cycles, blocked fallopian tubes, male factor infertility, such as low sperm count, and medical conditions like autoimmune disease or endometriosis, all of which may have an impact on infertility. We also discuss when to see a fertility doctor if additional factors are involved, such as the need for donor eggs, donor sperm, or a gestational carrier. These situations vary in complexity, with gestational carrier arrangements typically requiring earlier and more specialized planning, while donor eggs or sperm may be more straightforward. This episode helps patients understand when waiting is reasonable—and when seeing a fertility specialist sooner rather than later can make a critical difference. 

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 lovely vivacious co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Carrie Bedient from the Fertility Center of Las Vegas. How are y'all doing today?

Abby Eblen MD (00:35)

Hey everybody.

Carrie Bedient MD (00:39)

Hi.

Abby Eblen MD (00:43)

Hanging in there. How about you, Carrie? How are you doing today?

Carrie Bedient MD (00:47)

I am what I would deem as vaguely more chaotic than normal. I mean, I'm not normally chaotic, but normally I'm doing 25 million things at any given time. And today it's probably 25 million and one.

Susan Hudson MD (01:06)

What, what, are you, are you planning on something big today?

Carrie Bedient MD (01:11)

So our clinic sees a ton of international patients like we have talked about before. And we have French coordinators and Spanish coordinators and Chinese coordinators and all those things. And so we take international trips. And today we're going to Tahiti.

Abby Eblen MD (01:27)

Okay, so let me get straight. You're going on a work trip to Tahiti, right? Is there really such a thing?

Carrie Bedient MD (01:31)

Damn straight. There is really such a thing and I am so thrilled about it and that actually reminds me I need to stick the podcast flyers in my suitcase.

Abby Eblen MD (01:44)

There you go. We need some Tahitian listeners.

Susan Hudson MD (01:45)

Very good.

Carrie Bedient MD (01:47)

Yes.

Susan Hudson MD (01:47)

You also should bring a copy of our book, The IVF Blueprint, so people can look through it and maybe we can get some readers on the other side of the world.

Carrie Bedient MD (01:59)

Yes.

Abby Eblen MD (01:59)

Does Amazon deliver in Tahiti?

Carrie Bedient MD (02:01)

I mean Amazon's gotta deliver everywhere, right?

Abby Eblen MD (02:03)

Well, not in your, there's places in... That's true.

Susan Hudson MD (02:04)

There are other book sellers. You've got bookstop.com and you got Barnes and Noble and I'm sure there's, yep.

Abby Eblen MD (02:10)

Bookshop.org.

Carrie Bedient MD (02:13)

Yep, yep. Okay, while I'm thinking about it right now.

Abby Eblen MD (02:16)

Then we've added 1,025 plus two things.

Carrie Bedient MD (02:19)

Okay, grab the book and I'll put it right here so that when I'm packing up the copy goes in.

Susan Hudson MD (02:26)

Carrie, I know you've been working on learning French lately. Do you think you're going to improve your acumen over the next couple of weeks?

Carrie Bedient MD (02:35)

Well, I certainly can't get worse.

Abby Eblen MD (02:38)

That is a good point.

Carrie Bedient MD (02:39)

I have logged 612 days straight on Duolingo and…

Abby Eblen MD (02:44)

612 days, really, seriously?

Carrie Bedient MD (02:46)

Uh-huh, I have the little icon to prove it. Yeah.

Abby Eblen MD (02:51)

When do you do all that stuff, Carrie? And you do that? You post on Insta or on TikTok every day? Good Lord. When you sleep?

Carrie Bedient MD (02:59)

Probably don't get as much sleep as is healthy for me. Also, somebody described it as knowing which balls you are juggling that are glass and which ones are plastic. And I'm pretty good about knowing which balls are plastic and versus glass and which ones I really cannot drop. Like patients, 100 % taken care of. Picking up other human beings in my life from their things, 100 % taken care of. Showing up when I need to be there.

Abby Eblen MD (03:29)

Bonjour, ça va? Comme ci, comme ça.

Carrie Bedient MD (03:33)

Yeah, like having packed for a trip that I leave for in six hours, not yet done. Yeah.

Susan Hudson MD (03:39)

That's okay. That's okay. You have lists and lists are important. Lists get us where we need to be.

Abby Eblen MD (03:41)

You know, what do you need? What do you need there anyway? Like just a bathing suit anyway to see patients in?

Carrie Bedient MD (03:43)

Yes.

It'll be a nice bathing suit to see patients in. Yeah, little sarong and yeah. I actually spent a long time because I can't wear my normal stuff that I would wear even here in Vegas. Now part of the reason for that is my office in Vegas because it is 100 degrees outside. My office is about 62 degrees inside. And so I can wear warm stuff all year long because otherwise I...

Abby Eblen MD (03:50)

Okay, maybe a cover-up or something.

Yeah. Yeah, I know.

Carrie Bedient MD (04:13)

get frozen out by my other partner who has, he's got the control of the AC in his office. I freeze my little butt off every day. I have multiple blankets in my office. I spent a long time thinking about like, I've got some nice light long dresses and we'll wear those and I'm excited.

Abby Eblen MD (04:14)

Yeah. Well, they have they have air conditioning there too, or do they just let the ocean

breeze flow through?

Carrie Bedient MD (04:37)

It's a little bit of everything. Like I know where we're seeing, where we're talking to people, it's outside. mm-hmm. Mm-hmm. Yeah, I'm not a doctor there. It's just conversations. Yeah, just conversations. it's, yeah.

Abby Eblen MD (04:44)

Really? You see patients outside? Really?

I see. Okay. Wow. That is really cool. No wonder you

have to take sunscreen if you're going to be seeing patients outdoors. We didn't even see patients outdoors when I was in Florida, much less Tahiti. Wow. That's crazy.

Carrie Bedient MD (05:03)

Yeah, well you remember how when ASRM was in Hawaii a few years ago and the conference center was all outdoors.

Abby Eblen MD (05:11)

Hmm, yeah. I didn't go to that one either, but I can take it.

Susan Hudson MD (05:11)

I didn't go to that one.

Carrie Bedient MD (05:13)

Yeah, I was a senior fellow and so excited because I got to present at that one, which meant I got to go out of all my co-fellows.

Susan Hudson MD (05:21)

Wasn't there a hurricane that happened right beforehand?

Abby Eblen MD (05:24)

There was, like the day before or something.

Carrie Bedient MD (05:27)

Yes, there was. Beach time was left something to be desired.

Yes, mostly because there wasn't any in the time leading up to the conference. Then, yeah, everybody else that I was traveling with, they got plenty of times, but I was focused on presenting and getting a job. Yeah.

Susan Hudson MD (05:42)

Absolutely.

Susan Hudson (05:48)

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Susan Hudson MD (06:51)

Let's do a question for today. Our question today is, thank you so much for the invaluable information you provide us. My question is, after two FETs and one embryo each time, one biological and one from a donor, should I be pushing my clinic to do more testing like a hysteroscopy? I am 44, I've been trying with this clinic for four years doing many tests, many stimulation rounds, and ultimately, with insurance funding running out, was guided to use donor eggs. I had four day five embryos created with my husband's DNA and now have three left. We were not allowed to do PGT testing on the donor eggs, but told that they look great. I also have Hashimoto's thyroid disease, so could there be more that my clinic is missing to help with implantation issues? Thank you so much for your help.

Carrie Bedient MD (07:38)

That's an awesome question on like six different levels.

Abby Eblen MD (07:41)

Yeah, I was gonna say, which one of those things, there's a of things to talk about.

Carrie Bedient MD (07:43)

Yeah.

Susan Hudson MD (07:44)

Let's start off with her primary question. Is after two embryo transfers a reasonable time to get a hysteroscopy?

Abby Eblen MD (07:52)

Sure, absolutely.

Susan Hudson MD (07:55)

There's actually a published study specifically on that subject that states even with previous imaging like a saline ultrasound or HSG, in the case that you've had two failed embryo transfers, and that study did look, it was at the time that we were not doing much PGT, so it was untested embryos after two of those transfers that 30 % of people have some sort of pathology or something wrong inside the uterus that could be identified and fixed with with a hysteroscopy. I think it's a great time to be considering a hysteroscopy.

Carrie Bedient MD (08:29)

Yeah, it's low hanging fruit. It's easy to do. You can go in and out. You can do it with or without anesthesia, depending on what your clinic allows. There's pros and cons to each of those, but well worth doing. I don't know that I would necessarily consider the embryo transfer that you did using a 44-year-old egg the same as I would consider an embryo transfer from a donor egg just because, untested especially, because there's the better part of 90 % chance that that embryo was abnormal.

That is a little bit more explainable and understandable than perhaps a donor embryo. But even in the best case scenarios, if you've got a tested embryo made from a donor egg, that's like a 70 % success rate, which is phenomenal, but not the same as 100%. That's a 30 % chance, like three people out of 10, that we're going to call you with bad news at the end of the day. And so don't despair, because these numbers are all real.

That means that there will be some that just don't go the way that we want them to. And it doesn't mean that you need to lose hope. Hang on to every little shred that you have because you have three embryos made from donor eggs left to go and you've got space here for sure.

Abby Eblen MD (09:41)

The other thing I would add in too is the Hashimoto's. Probably at this point, if it's known Hashimoto's, you're being treated or it could be, but there is some data to show that even if you just have antibodies and you really have normal thyroid function, that you should be treated with some low-dose synthroid or levothorax. And so if that's not being addressed, you may want to think about that as well.

Susan Hudson MD (10:01)

Well, we are at the end of 2025 going into 2026. And one thing that we know a lot of people do is they create New Year's resolutions. And for our listeners today, we're really going to target when should I call and ask for help? When should I seek a fertility evaluation? We know from the questions we get, there's lots of people who have been through lots and lots of cycles, but there are also lots of people who've listened to us who've never gone to see a physician for their fertility challenges. Let's start off with one of the basics. What is the definition or definitions, because there are a couple of them out there, of infertility?

Abby Eblen MD (10:49)

The definition of infertility if you are 35 or younger is if you've tried for a year or more and not been able to get pregnant. Now trying is very important because we find often that people go, oh no, I've been just trying for six months. And then when we really ask patients, we say, how long have you had unprotected intercourse? Meaning sex with your partner fairly regularly and not gotten pregnant because that counts even though you don't feel like you're trying to get pregnant. Your body doesn't know the difference. If you've had unprotected intercourse for a year or more, if you're 35 or younger, that's the best time to seek treatment. If you're over the age of 35, then we say six months is the window. So if you've tried with unprotected intercourse for six months or more, then you need to seek treatment if you're over the age of 35.

Carrie Bedient MD (11:36)

If you have a known barrier to fertility. The easiest low-hanging fruit one to describe here is if you don't have regular periods, it doesn't matter if you just started to try yesterday. If you know that you do not have regular periods, that is a reason to go in much sooner rather than later because it means that you may not be ovulating regularly. And we most often see this with patients who have PCOS, for example, where they get periods every 40 days, every 60 days, every year. And so those are reasons to go get help sooner rather than later, because you can save yourself a lot of frustration and drama by going in and get evaluated early. Now, the flip side to that is that patients with PCOS, even who have screwball periods, can also get pregnant without necessarily realizing it. And so the first thing that we're going to do when we're analyzing, can we give you progesterone to bring on a period? Can we not? We're going to throw an HCG level in there because sometimes we will patients who are pregnant and they had absolutely no idea because their periods just do not have the decency to show up on a schedule.

Abby Eblen MD (12:46)

Carrie, how would somebody know if they're ovulating with their periods or not? If you're having periods every couple months, are you making an egg? Are you ovulating usually, you think?

Carrie Bedient MD (12:55)

It totally varies. And if you're having a period every couple of months, you can be ovulating, and that can be what's triggering it. Or your uterus could just be at a point where it's like, shop's full, got to evict some of the tenants, some of the shoppers here. And your lining has built up and built up and built up, and it's become unstable, and you get bleeding. People see this show up in different ways. Sometimes they'll see just a little bit of light spotting periodically where just enough came off to stabilize what's going on inside. There will be other people who it seems like Niagara Falls has opened up and everything in between. And then sometimes people will have that overflow bleeding and they'll have the real light spotting and then they will get an ovulation and they will get those very coherent signals of it's time to have a period and then they'll bleed for a month or longer at a time.

While you can get pregnant in there, it also causes a lot of drama in your life from heavy bleeding, from pain, from anemia, potentially needing blood transfusions, all of those things, needing medications to control it. If you're in that pattern of really wild and crazy periods, come see us sooner rather than later so we can help figure out what's going on and help control it in the direction that we need to.

Abby Eblen MD (13:56)

Yeah.

Susan Hudson MD (14:10)

Does everyone who has irregular periods have PCOS or are there other conditions, either health conditions or specifically fertility related conditions that we would need to check out because we have a lot of people who come in, they're like, my doctor said I have PCOS because I have irregular periods. What are some of the other things that we might uncover?

Abby Eblen MD (14:35)

when people have very irregular periods, not often, but small percentage, most people that see us have PCOS when they have irregular cycles, but if you have irregular cycles, it doesn't mean you have PCOS. And one of the things that we can see is patients who exercise a lot. They are running excessively, they're swimming, they're biking, they're doing all sorts of things. Those things are all good, but everything in life is good, but only in moderation.

Sometimes when people are doing these things, they don't realize how much exercise they're actually doing. They don't realize how many calories are actually burning. It's really a calorie deficit. If you're not eating to keep up with that calorie deficit or that stress on your body, then a lot of times what happens, your body just goes, okay, would I rather expend these calories, these few calories that she's getting on making her heartbeat and her lungs breathe, or would I rather make eggs? And the body's like, I'd rather keep her alive and keep her brain going.

Therefore, a lot of times your body just says, okay, now's not a great time for you to be pregnant if your body thinks you're in starvation, it's not a great time to be pregnant. Therefore, you typically don't ovulate very often or at all. The other condition that we see, and there's several, but the other one I think that we see in that same category in terms of irregular cycles, occasionally we see even young women that don't have a good pool of eggs and have a low amount of eggs and actually have decreased ovarian reserve.

It's a gradual process and it's generally somebody that has regular cycles and then all of a sudden their periods start getting longer, they start having intermittent bleeding and then stop having bleeding a lot of times altogether. That's the other thing that we worry about is that the egg count is really low and they have decreased ovarian reserve.

Susan Hudson MD (16:10)

Another thing to keep in mind is if you are a person that has an autoimmune disease, whether it's Hashimoto's with the thyroid or scleroderma or lupus or any of the myriad of autoimmune diseases that are out there is that people who have autoimmune diseases tend to get other autoimmune diseases and your body can fight off your ovaries and that's that's a hard battle for us to fight. We fight it every day though. ⁓ But it's one of those things that, you may be, hey, we're gonna just now start trying. I may have these couple of other autoimmune conditions going on and they're quote, under control. But I would recommend people with autoimmune disease seek help sooner than later. So if you've tried for six months and you may be under 35. You're probably somebody I would recommend go seek a little bit of investigation and help sooner than later. Figuring out if there is an issue isn't going to be an impediment to you trying. We're more than happy for people to get spontaneously pregnant when they see us. I'm like, I just want you to have a baby. However, safely and effectively we can get to there. But...sometimes it's good because we can uncover something that you may not realize is a challenge.

Abby Eblen MD (17:36)

And if that immune condition is not under good control, it needs to be under good control before you get pregnant. We don't want to do that after the pregnancy.

Susan Hudson MD (17:47)

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Carrie Bedient MD (18:25)

If you have a known complex medical history, especially if it includes chemotherapy in either direction, whether it's you or your partner, I would lean towards coming to see us sooner rather than later. Now, if you have everything is stone cold normal, you are ovulating regularly, you're in perfect health, your oncologist has cleared you, dah, dah, dah, dah, dah, dah, dah, all those things, then maybe you get a little bit more of a pass rate if you are female. If you are male and you seem totally fine, you're completely recovered, I would still tend to get checked out with a semen analysis sooner rather than later because chemotherapy is absolutely amazing. It keeps people alive, it saves lives, it is just phenomenal. And the advancements that have been made in it for people's survival are just phenomenally cool. And they're what keeps the oncologist colleagues among us going because they really can make huge impacts in people's lives.

But an impact that chemotherapy can have is it can cause a decrease in quantity and quality or an absolute absence of sperm and or of eggs. Particularly if you've got a male partner who's had chemo, whether it is for cancer or a bone marrow transplant from sickle cell anemia or any number of other reasons that chemo agents are used, get that semen analysis sooner rather than later so that we can take a look at it or get your eggs evaluated sooner rather than later so we can make sure that we're kind of in the position where we think we are for your age rather than something considerably more dire.

Susan Hudson MD (20:04)

I call this the positive port placement sign. And what I mean by this is I don't know how many times, I mean, this happens multiple times a year that when somebody comes to me as a new patient, male or female, and it'll be medical conditions, none, surgeries, port placement. If you have had a medical condition, whether it is sepsis, or cancer or any number of things that have required you to have a port surgically implanted for some point in time, this is a medical condition your fertility doctors need to know about. Doesn't it happen to you guys? I can't be the only one.

Abby Eblen MD (20:41)

It counts. Yeah.

Yeah, when you said that, I shouldn't laugh about this, but when you said that, I'm like, I can count three or four times when that it's exactly like medical conditions, none. And then you're like, wait a minute, why'd you get an infusaport? There's gotta be something there.

Carrie Bedient MD (20:58)

I tend to see this more with surgical scars where surgical history, none, medical history, none. And I'm doing the physical exam and there is a huge surgical incision on their chest or on their abdomen. And I'm like, somebody either attacked you in the middle of the night and drugged you really well or had a medically sanctioned attack where they drugged you really well and did something important. So what's the story here?

Susan Hudson MD (21:27)

Pediatric heart conditions too.

Abby Eblen MD (21:28)

That is, yeah, that's what I was just thinking. I've seen a couple of people with omphalocele repairs when they were babies. There's a lot of times it's stuff that happens to the baby and that's part of them. They're just used to that scar and don't think about that as being something that we need to know about. The one other condition that we should talk about in our field is endometriosis. And so sometimes people don't know if they have endometriosis or not, but they'll come and go, well, I pain once a month, it's severe pain, it keeps me home from work, or I've had this cyst on my ovary that people think could be endometriosis, those are probably situations where you probably do wanna have that checked out in some way, particularly if you have a really large cyst, or if you're having a lot of pain and you're staying home from work every month, that's a reason to have a surgical evaluation to look for endometriosis. And I just saw a woman this week who was very young, but she'd already had two surgeries for endometriosis. When I was talking to she and her partner, we were talking about, well, I'm not so much worried about your age because you're in your early thirties, but I'm worried about your endometriosis time clock because endometriosis can come back even as early as six months. Sometimes if you have really bad endometriosis, even if you've had a surgical treatment and they've removed it. That's something that you need to think about too. Even if you're a young person, sometimes endometriosis can damage the eggs in your ovaries. Sometimes people do fine even if they've had severe endometriosis, but still you really need to seek a reproductive endocrinologist at that point to at least discuss, because every situation's different with every patient that has had endometriosis.

Susan Hudson MD (22:55)

I just wanted to mention though, not everybody with endometriosis has pain and vice versa. Okay. Not everybody with pain has endometriosis. Just for our listeners, knowing there's not always a correlation there. I do think that anybody who's had surgery on their ovaries should seek an earlier evaluation, whether it was an endometriosis, a dermoid, some other type of cyst on your ovaries.

Every time you have surgery on your ovaries, you are going to lose eggs. And sometimes we lose more eggs than other times. Sometimes it has to do with just how big the cyst was or the situation at hand. Sometimes somebody may have a huge cyst that happens in the middle of the night and for safety reasons, bleeding reasons or whatever, the ovary may be removed.

We were given two ovaries for a reason, but if you've had one of your ovaries operated on, it doesn't mean you have to rush in, but again, I would say whatever we gave you as a timeframe, whether it was six months or 12 months at the beginning of this podcast, I would split that in half. We want you to come in at an appropriate time, but I have to tell you the appropriate time is the point where your heart and your mind are like, I think I need help, before you get into a challenging psychological situation.

Carrie Bedient MD (24:21)

We would much rather see you and reassure you of, yes, you may have problems, but you're still in a good place to keep trying on your own. The advantage of going, even if you don't necessarily need us yet, is that you will already be established with our office. Let's say you come see us at three months and you really don't need to see us or we don't need to start testing for another until six months, nine months, 12 months, whatever it is. If you're already established with our office, we can write in our note, start eval at x time and if you're not pregnant you just call and you rock and roll and you get going.

Abby Eblen MD (24:57)

Kind of that same end to, you we didn't talk about tubes, but I think it's intuitive for most people that if your fallopian tubes are blocked, that's the tunnel that connects the egg and the sperm and the egg and the sperm can't get together. If one of your tubes are blocked, I mean, I've had many people that have gotten pregnant with one blocked tube, but again, that's one of those situations where, if you've tried for a while and you hadn't been able to get pregnant, maybe sooner rather than later, like what Susan said, whatever we said at the beginning, cut that in half if you have a blocked tube because...sometimes not only can that tube be blocked, but sometimes whatever affected that tube and made that tube get blocked, like pelvic inflammatory disease or endometriosis, could now have blocked the other tube. Even if you had an assessment a few years ago and you're like, my tube, I have one open tube, well, maybe you do and maybe you don't. It may be time to reassess that again.

Susan Hudson MD (25:41)

When we're looking at someone just based on age, I would like to say what we're about to say here is based on no official guidelines. This is Carrie, Abby and Susan's opinion of things. Exactly. Is there an age that you in your heart you're like, if you are blank age and want three children, two children or one child, you should…You should come right away. What are your thoughts on that?

Abby Eblen MD (26:10)

I would say that the more children you want, the sooner you need to come because, even if things go perfectly, you may not get pregnant, you may have a miscarriage that may extend the time, may take a while for you to get back into trying again. So I would say, 30ish, if you want to have three or more kids, I think you need to at least see somebody at 30 if you've been trying for a little bit just to talk about planning. Maybe I'll try my own, try and have a baby. If I want three, maybe then at some point I'll do IVF or I'll freeze eggs. I think it's worth a planning visit anyway.

Carrie Bedient MD (26:40)

If someone wants more than one kid and they are 35, I'd like to see them sooner rather than later, if only to have the embryo banking or egg banking discussion to see.

Abby Eblen MD (26:53)

So would you wait till 35, you're saying?

Carrie Bedient MD (26:56)

If more than one, if more than one. If somebody wants, three or more, yes, I would rather see them sometime between 30 and 35. But a lot of people don't really actively start thinking about that and contemplating it and putting it in a very real, this is what I want. Up until that point, it's oftentimes much more nebulous. But then they hit 35 and everyone has heard, that's advanced maternal age forever and ever and your fertility drops off and you drop off this fertility cliff completely, which by the way, 35th birthday, it's not like you are fine and then you fall off Niagara Falls. It does not work that way. It is a gradual decline that does get a little bit steeper around 35, but it's not like it is a make or break point. And at 11:59 on this day, you're fine. And at 12:01 on the next day, you are never going to get pregnant. This is not how it works. But if someone is...approaching that age, a lot of times that's what turns the biological clock or awareness, whatever it may be. And that's when people really start thinking, oh crap, I got to do something. That's why I say at 35, if you want more than one kid, come see us. Because if we want to have the discussion about embryo banking, we want to do it now so that when you're 39, looking at your second or third or whatever child, you've got backup.

Susan Hudson MD (28:24)

Is there an age that you're like, if y'all are just now starting to try, you should probably come in like yesterday.

Abby Eblen MD (28:33)

Over 35.

Carrie Bedient MD (28:34)

I would say over 40.

Susan Hudson MD (28:34)

I mean, I would say 40 and up. If you're just now starting to try, you need to know, you may not need to do something, but I would say you need to have an evaluation because you need to be informed about what your options are and what your prognosis is.

Carrie Bedient MD (28:47)

And even if it's just the simplest tests like sperm and tubes, those are very worthwhile to have. Because if he doesn't have as much sperm or if your tubes are damaged, you are not someone who wants to wait six months to get that evaluation. And then it takes another couple of months to get it. And it takes another couple of months beyond that to think about things. It can take a little while to get all this together. If you are in that age range and there's an issue, the sooner we know about it, the sooner we can start having discussions about how do we make this so works with the life that you are envisioning.

Abby Eblen MD (29:26)

I would argue that I would wanna do it sooner though because kind of 40 and like Carrie said, nobody flips a switch at 40, but 40 a lot of times you're at that brink where it may be too, I mean you may not have good eggs left. So I would argue, I would wanna see somebody more 36, 37 to plan. Doesn't mean you have to initiate anything or do anything, but at least you become educated about what's it gonna look like after I turn 40 or what's it gonna look like if I'm 38 or 37.

And I think at those ages, we tell you what the genetic outcome would be, for example, if you did IVF or froze eggs or something like that, you might go, I think I'm just gonna freeze eggs now and then I'll start worrying about getting pregnant at 40. But I just worry when I see somebody at 40. It's not to say that you can't get pregnant, but boy, you're awfully close to that brink where it's gonna be really, really hard. Even if you're like, okay, I'm ready to have my two kids now, it's gonna be tough at 40.

Carrie Bedient MD (30:18)

When do you like to see patients who are thinking about egg freezing? I someone who doesn't have a partner, who knows what they want, they want kids, but hasn't actually started trying yet. When do you want to see your potential egg freezers?

Susan Hudson MD (30:32)

Ideally, probably between ages 32 to 34 would be my favorite age group. That's the age where I think there's the most evidence that you're more likely to going to use eggs. So there's some people who are going to come freeze eggs at 25, which is great. Okay. So nothing wrong with that, but statistically chances are you're not going to need to use them. Whereas at 32 to 34, you're more likely going to need to use them, if not for the first baby, maybe for baby number two or baby number three. And we still have good quality and quantity usually. Our prognosis tends to be much better. I think that's kind of the sweet spot. What do y'all think?

Abby Eblen MD (31:19)

I think so too. Yeah, I think under 35 is definitely the sweet spot. And I think you're right. You're more likely to use them then. I've had quite a few people now that have come back when they've frozen eggs at that age and now have a partner or whatever ready to use to donor-sperm and want to get pregnant. I think that's the sweet spot.

Susan Hudson MD (31:34)

So what would you advise to people who are listening who are missing a component, meaning missing eggs, sperm, uterus, going to need to use any type of third party reproduction, when would you advise them to start talking with a reproductive endocrinologist?

Carrie Bedient MD (31:53)

I think this in part depends on what it is you're missing. So if you are missing a uterus, I would have the initial conversation as soon as you know that you want to have kids. Not because you're necessarily going to do something at that moment, but because you want to have an idea of what you're in for. Because many people think like, I know I'm just going to need an egg donor or to get my own eggs. And then I'm going to find someone to carry and it's going to go really quickly and those journeys can take a long time. And they can take a long time for any number of dozens of reasons, but it's it is a longer and more involved process when you are working with someone else's uterus in order to achieve your family because there's higher levels of regulations that we have to follow. There's just a level of complexity in finding the right people for you because the right surrogate for one couple is not the right surrogate for another couple and people have their own ideas of what they want and who they want and how they want this to go and sometimes those ideas are realistic and very achievable and other times those ideas are not and they need some time to adjust to what is the reality of that. What I would say is if you know that you're going to need to use a surrogate of any variety, have the conversation early so that you have an idea of what's going on. And if there's a long time passing between, you know at 22 you're going to need a surrogate, but you're not actually thinking about having kids so you're 31, go in early, have the conversation, but know that everything is gonna change between age 22 and age 31, and that it may be worthwhile to have another conversation somewhere along the line, because you wanna be prepared for the mental, the physical, the emotional, and the financial going into this.

Susan Hudson MD (33:42)

And speaking to the financial, when you're looking at using a gestational carrier, that is really probably the most expensive thing in the fertility world for you to face. And though you can do it maybe a little bit less expensively, if you do it without an agency, you're going to have to do a lot of legwork and legal work on your own.

But if you go to an agency, that's going to average probably $150,000 or more, depending on all kinds of different things. If you need to be financially preparing for that journey, I mean, I know I would, if I needed to lay out $150,000 to do something that important to me.

Abby Eblen MD (34:27)

Yeah.

Carrie Bedient MD (34:29)

It'll take a minute.

Susan Hudson MD (34:30)

It's going to take a minute. It's going to take a lot of minutes. And you want to be able to set yourself up for success. If you know, Hey, I don't have a uterus. I know I want to have kids, but that may be five years down the road. It's a whole lot easier to save $30,000 a year for five years.

Carrie Bedient MD (34:49)

Than it is to save $150,000 in one year. That's true even if you know someone who is going to be your surrogate, even if you have a sister, a best friend, somebody in your life who's willing to be your surrogate.

Abby Eblen MD (34:52)

Yeah, that's right.

Susan Hudson MD (34:53)

Exactly.

Carrie Bedient MD (35:03)

Sure, you don't necessarily have to pay the $30,000 to $50,000 surrogacy compensation, but you still have to pay for the visits, the logistics, the IVF, the insurance, the ⁓ life insurance policy, the medical insurance, the hospital fees, all of those things. It's still a much more expensive process. And that's worth knowing about, even if you do have your own surrogate who you can bring with you to this process.

Susan Hudson MD (35:32)

Okay, so we've talked about missing a uterus. What about missing eggs?

Abby Eblen MD (35:37)

I think eggs and sperm are a little bit easier process because you could have a known donor, sister, friend, she'd still have to be tested and there still would be some financial issues there. But it's not nearly as expensive. You could also use a donor bank and pretty quickly, it's just really a matter of selecting your donor, figure out who you want to use. You do need to have counseling and things like that. There is some expense, but like Carrie and Susan said, it's not nearly as costly as it would be to use a carrier.

Same thing for donor sperm. I mean, that's probably even less expensive to use donor sperm because the banks have already screened the donor, you order the sperm, and then really it's almost like you have a partner and you use their sperm. It's not that expensive to do, not that much more expensive to do it than it would be if you were doing IVF with a partner.

Susan Hudson MD (36:23)

What are your thoughts about reaching out to non-bank sources? And when I say that, I am not including friends and family members, but I'm talking about non-bank sources available on the internet for looking into things like donor eggs and donor sperm. What are your words of advice regarding those directions?

Carrie Bedient MD (36:45)

Proceed with caution.

Susan Hudson MD (36:46)

Why?

Carrie Bedient MD (36:47)

People do find donors on Facebook groups. I'm not gonna say Craigslist because even though I have had patients who have found donors on Craigslist, they found them, but ⁓ I have very, very rarely seen a good situation arise from that. But there's more and more Facebook groups. There's more and more...social media forms of connection where you can find people. Proceed with caution. And this applies to sperm donors, egg donors, and surrogates. The reason for that is when someone has already gone through a bank, they have been vetted. That means that a lot of the people who just don't qualify are already out.

The place with the best statistics and track record because they've been around the longest are the sperm banks. For every hundred people who say, want to be a sperm donor, maybe one gets through. And there's a reason for that. Because of their medical history, because of their current financial situation, because of their medical situation, because of their psychological situation, the list goes on and on. When you find somebody who has not been previously vetted, you need to be medically and emotionally prepared and financially prepared, for the fact that they may not make it through screening. And I see this a lot with surrogates, for example, where somebody will find a potential surrogate on one of these groups and we'll ask for records and we look at their initial intake form and we can already say, no, she doesn't qualify. And people get their hopes up very high only to get them dashed. It doesn't mean that you can't do it. It means that you need to be prepared for additional steps and additional work that probably you are going to have to do. And it means that you may have to go through several in order to get somebody who is medically cleared and approved. I think they're better than what they were five to 10 years ago. But I also would say most of the time when we get people who are coming through a non-medically mediated or agency mediated match, it takes longer because there's a lot more, there's a lot higher likelihood that something is gonna be there that's like, this isn't safe for her to do. We're gonna say no because it's not safe for her or for you or for the baby or whatever.

Susan Hudson MD (38:55)

I think it's really hard to be the person involved saying no, no, no, because you want to say yes, yes, yes. And having the choices from, and granted, like if it's a friend or family member, that's a whole different ball game. But if it's somebody that is unknown to you, that you're trying to match up online, it's like online dating. There's a lot of people you need to swipe in the other direction. If it seems like, I just started this journey and I just found the perfect person. Realize you might want to take that with a little bit of a grain of salt until they start visiting with the people who do have to make sure that this is a safe, good idea for you and your fertility journey.

Carrie Bedient MD (39:37)

And even when you are working with an agency, whether it's for egg donor, sperm donors or GCs, gestational carriers, keep in mind your clinic still may say no and not all agencies are created equal, not all surrogates are created equal, not all donors are created equal. And so we may find someone who on paper looks perfect and we get in a medical screening and it just doesn't work. Or we may, we dive through people's medical records.

Depending on what the situation is and we find things and it doesn't mean that anybody's doing anything bad or dishonest or anything. It's just, we went through the better part of 15 years of training to get here. And that means that we have a very specific set of things that we're looking for and that set off red flags. And when this is a, it's not elective because nobody really chooses to do this for fun, but when this is a semi elective procedure, we have to be very cognizant of the risk that we are putting everybody through the process. And we take that very seriously because we need to return everybody home to their loved ones at the end of the day in excellent condition. And that's a big deal for all of us.

Susan Hudson MD (40:48)

Very good, very good. One last piece of advice is if you're thinking about making an appointment, call sooner than later. It often takes two, four, six weeks to get in to see a reproductive endocrinologist. There's more and more of us, but there still aren't a lot of us out there. It's not something that you can call and make an appointment and probably going to get in this week.

Having that in mind is important. If there's things that you're needing to work around in your life and you're like, I would ideally like to be seen and evaluated now so that blank can happen in this type of timeframe.

The more flexibility you can give us, the better. One of the hardest things for us to do is I think of people who are educators and they come in, in May, and they're like, I need to be pregnant by July. That's a really, really hard turnaround in the reality of fertility care. If you're thinking, I really want to...ideally conceive within a certain window, the window in which you first see us needs to give us some lead time.

Carrie Bedient MD (41:58)

I'm gonna add one more explicit thing and we touched on this earlier with the potential surgical history, but more than once, sometimes more than once a month, I will have somebody comes in who come in who we go through absolutely everything. And then the very last thing I call it the doorknob moment or actually Susan calls it the doorknob moment and I have adopted that is they say, yeah, I had a vasectomy or yeah, I had my tubes tied or whatever it may be, that is a very definitive, we cut off ability to spontaneously have children. And again, it doesn't mean the decision is wrong, but lead with that, please, because yes, yes. And don't assume that those things can be reversed quickly, either surgically or by IVF, because there's...

It is more likely that they can be worked around, but it takes an awful lot of technology expertise, staff, and hours to do it. If you know that that applies to you, please let us know and come see us sooner rather than later so that you're prepared, whatever you are ready. We appreciate that. And ultimately you do too, because it means your experience is a little bit smoother.

Susan Hudson MD (43:08)

All right, good stuff, good stuff. To our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday's episode pop up automatically for you. And be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (43:25)

You can also visit us on fertilitydocsuncensored.com to ask questions for our Ask the Doc segment. Also check out our new book, The IVF Blueprint. It will help you understand IVF in more detail. You can find it on Amazon, Barnes & Noble, bookshop.org. We'd love for you to subscribe and also leave a review for us. We'd really love to hear from you.

Carrie Bedient MD (43:45)

Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes. And 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 will talk to you soon.