Ep 341: Failed IVF Cycle: How we Debrief & Adjust

What does a realistic IVF journey actually look like—and how do you know when to keep going, pause, or consider a different path? In this episode, Dr. Susan Hudson and Dr. Carrie Bedient take a candid look at the realities of fertility treatment, from understanding IVF success rates to interpreting what happens during an individual cycle. They explore why statistics don’t tell the whole story, what factors can shape a patient’s prognosis, and the moments when it may be worth stepping back and reassessing the plan. But fertility treatment isn’t just about numbers and test results. The conversation also addresses the emotional toll of IVF, the importance of having the right support system, and how asking better questions—or getting a second opinion—can help patients feel more informed and confident in their decisions. Whether you’re considering IVF, in the middle of treatment, or trying to understand what comes next, this episode offers an honest and reassuring conversation about navigating the medical, emotional, and deeply personal decisions that come with a fertility journey.

Transcript

Copy Transcript Copied

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Susan Hudson MD (00:22)

This episode is brought to you by Receptiva DX. What if unexplained infertility isn't actually unexplained? For many women, hidden inflammation associated with endometriosis and other uterine conditions can go undetected for years, even when everything else appears normal. For more than a decade, fertility specialists have trusted Receptiva DX to provide deeper insight into the uterine environment.

Helping women and their physicians uncover answers and make more informed treatment decisions.

Susan Hudson MD (00:52)

Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. We are here with my amazing, audacious co-host, Dr. Carrie Bediant from Fertility Center of Las Vegas.

Carrie Bedient MD (01:05)

Hello, how are you doing?

Susan Hudson MD (01:07)

I am doing great. I I just got back from our family vacation and I'm readjusting to time and everything like that. So other than kind of being tired and awake, but that type of thing, I'm good.

Carrie Bedient MD (01:21)

You look remarkably put together for someone who's been back in the country for maybe thirty six hours at this point.

Susan Hudson MD (01:28)

Yeah, I'm doing all right. I'm doing all right. You just keep on trugging through. It's just like when you're in residency or fellowship and your time sensor got off whack because of night shift or whatever.

You kinda click back into those old habits, but doing good. We had an amazing time, but I'm glad to be home and I'm glad to be sleeping in my own room, in my own bed with air conditioning and a fan above me.

Carrie Bedient MD (01:51)

I was gonna ask, did you have any mishaps while you were traveling?

Susan Hudson MD (01:53)

We really didn't have any major mishaps. We went to Germany and Austria and it's pretty darn hot there right now. And of course, most places do not have air conditioning. So two of the three places we stayed at didn't have AC and it was it was pretty hot during the day. So in the evenings it did eventually cool down, but I still would not say that it's my normal sixty eight degrees that I like to sleep in.

Carrie Bedient MD (02:23)

Mm-hmm.

Yeah. But everybody all the luggage got there, all of the people got there, you didn't lose anybody along the way or as you were traveling, everyone was intact.

Susan Hudson MD (02:34)

Relatively speaking, we are kind of synonymous with almost missing flights just because we tend to like tight connections.

Carrie Bedient MD (02:41)

You? No.

Susan Hudson MD (02:43)

It's not because we get there late, it's because my family doesn't like having really, really long layovers. So we don't add a lot of extra wiggle room time in there. And if we can help it, sometimes you just do what you do because it's the right price to the right location.

But we don't have a lot of extra time at connections. If planes are running late or things like that, we have actually one time we were the last people to walk on a plane, and that was a really weird feeling because you have hundreds of people seated, buckled up, all the suitcases are up. I'm talking about like they are ready to go.

And you walk on the plane and you're like, Yes, we are those people. Like I said, it wasn't because we were late intentionally, it was just because our connection and we had to go all the way across an airport and you do what you have to do.

Carrie Bedient MD (03:34)

Yep. Yep. Well I am glad that you are back here 'cause now I can text you without worrying that I am going to disrupt whatever sleep schedule you are or are not on at that given time.

Susan Hudson MD (03:45)

And vice versa. There were multiple times that I was sitting there having to connect a seven hour time difference from home to where we were and then adding two hours for you and I'm like, whoa, can't do that.

Carrie Bedient MD (03:57)

Yep, yep.

Advanced advanced math on no sleep, right? 

Susan Hudson MD (04:00)

Absolutely.

Carrie Bedient MD (04:01)

Seven plus two is complicated.

Susan Hudson MD (04:02)

Yes, yes. So it was good. It was good. All right. Well, let's do a question for the day. Our question today is, Hi, I've been diving into several fertility podcasts lately. And yours has been the most help.

Thank you for all the information and help. My question is, I had a tubal ligation with the ring in 2020 and I recently got it reversed in April. I had an HSG show that my right tube is open and my left is blocked.

My partner's count is six million, morphology three percent, motility seventy percent, and he's been taking supplements since April. With me having one tube open and his count potentially still being low, would IUI be a good bet for us or straight to IVF?

Carrie Bedient MD (04:43)

She didn't give us an age, right?

Susan Hudson MD (04:44)

She did not give us an age, but we're talking about six million, morphology three percent, motility, seventy percent.

Carrie Bedient MD (04:51)

Yeah, I would be inclined to go straight to IVF with those kind of numbers and with the tubal damage. I think if you really wanted to try ITI, you probably could, but I would not do that more than once, maybe, maybe twice. And I would be really scared about an ectopic pregnancy in there. And so at this point, I think I would just go straight to IVF because those sperm numbers, independent of your tubes, those sperm numbers are much more aligned with IVF. Now, part of the reason why I asked your age is because a woman who's 32.

Has a little bit more leeway than a woman who's 42. So for example, if you guys are not in a position to do IVF and he wants to go see a reproductive urologist, get on meds like HCG and enclomophene, and wait the three to six month minimum to bump up a sperm count, then that is a more viable option for someone who's in her early 30s compared to someone who is older. But even then, you've got the tubal factor on top of it. And so this tends to be the kind of case where I just say go straight to IVF and cut your losses and and just go in that direction. What do you think?

Susan Hudson MD (06:01)

I agree. I think intra-tubal insemination is a reasonable choice if you are at a center that offers it. But realize anytime we're using tubes after they've been operated once or twice or three times, you are at increased risk of ectopic pregnancy or pregnancy in the wrong place, and that could be a life-threatening condition for you. And with us having these low sperm numbers, chances are you're probably going to need more aggressive treatment.

Now you've had your tubes tied, so I'm gonna read between the lines that you've already had maybe one, two, three children, and that that was things that happened when you were younger. There's some definitely good things going for you, but we need millions of sperm, and those little guys do not stop and ask for directions. If you want to avoid frustration and potentially three to six months waiting for sperm parameters to improve.

Then I think IVF is the right thing. But if you're young and you still want to spend some time doing more conservative options, going and seeing a reproductive urologist for your husband should be a really good consideration. But make sure that they're actually a reproductive urologist. These are guys who or gals who have been trained.

specifically in urology and then also in fertility urology, just like Carrie and I have been trained in OBGYN and then reproductive endocrinology. So they have additional training and additional time and knowledge to dedicate to your fertility care.

Carrie Bedient MD (07:27)

Mm-hmm. And considering the reason why his sperm count is low is also important because it might be low from a prior vasectomy and reversal, or it might just be low. And for the ones that are just low, that brings up more of a question of can you increase those counts? What is exactly going on? And you've got a a decent shot at at improving it, but also, there are some reasons that will never improve, it doesn't matter what you do. And thinking about those types of things, thinking about if he has had a vasectomy or prior procedures, what does that sperm look like? What is the mobility actually looking like? Because especially after vasectomy and reversal, those sperm are not moving the same way that completely unencumbered, unhindered sperm is. So looking at the big picture here is also important.

Your age, the reason for his low sperm, known tubal damage, all of those things play together will will factor into what you do, how many kids you want is another important part of this.

Susan Hudson MD (08:23)

Another thing to consider is perhaps having him do a special test called SpermQT. Sperm QT looks at genes within the sperm that determine how well a sperm can bind to penetrate and actually fertilize the egg. And if he has an abnormal SpermQT, regardless of numbers, chances of getting pregnant with IUI or timed intercourse are pretty darn low. If you have low sperm count, block tube, and an abnormal SpermQT.

I would cut your losses and go straight to IVF, whereas if it was a normal SpermQT, I do think that there probably is some more wiggle room in there too.

Carrie Bedient MD (08:59)

Mm-hmm. Agree with all of that.

Susan Hudson MD (09:01)

All right, good stuff.

Susan Hudson MD (09:04)

Let's play a game.

How many tabs do you have open right now about IVF? One says your chances are great, another says they're terrible. Reddit has one opinion, TikTok has another. Facebook is full of horror stories. And somehow, after two hours of searching, you have more questions than answers. Sound familiar? That's exactly why we wrote The IVF Blueprint. This isn't another fertility book filled with opinions or miracle cures. It's an evidence-based guide that walks you through every

stage of IVF, from understanding your fertility evaluation and choosing a treatment plan to medications, egg retrieval, embryos, genetic testing, transfers, and the two-week wait and beyond. Because the last thing you need during IVF is more noise. Close the tabs, put down your phone, open The IVF blueprint instead. Available now wherever books are sold.

Susan Hudson MD (10:03)

Well, today we are going to talk about kind of a difficult topic, and but it's something that Carrie and I deal with every single day, unfortunately. And what we're going to talk about is how to debrief and regroup after you have had a failed IVF cycle. Now, IVF is a very successful way to achieve pregnancy. So Carrie how successful on average is IVF in the United States?

Carrie Bedient MD (10:32)

IVF in the United States for someone who's under the age of 35, and that's for the female partner, is typically really exceptionally successful. 60 to 70% of the time, usually those numbers are on the higher end once you've gotten further into the process and actually have that tested embryo.

They are fantastic success rates, but they are not 100%. And anyone who tells you, you've got 100% or anything even close to that in an IVF cycle should probably run away from because if any of us had that kind of certainty, we would be running our immaculately run house of psychic advice and also would have won a Nobel Prize in the process. And so those numbers are going to be adjusted based on whether or not you are over or under the age of 35.

There's age parameters based off of what the female partner's age is, and we kind of have approximate ideas of what success rates will be that we can adjust up or down based on the testing results that we get. But success rates are phenomenal. And unfortunately, they're still not perfect.

Susan Hudson MD (11:36)

Absolutely. I think one thing to keep in mind is knowing what your success rates are for your individual situation. So if you're under 35 or you're 40 or you're 45, those success rates are going to vary some. Also whether or not you're using donor egg or donor embryo and whether you're using PGT or genetic testing or not using PGT or genetic testing.

Those are all going to play into that. Really having an idea before you go into your IVF cycle of what are my chances of taking home a baby. That's something important to prepare yourself because if you know going into this, hey,

We only have a five percent chance of success versus hey, we have a 60 to 70% chance of success that you go into IVF with a different mindset, or at least I think you should go into IVF with a different mindset. We want everybody to be hopeful, but we also want people to be appropriately hopeful as well.

Carrie Bedient MD (12:38)

Being realistic for what the expectations are is a very fine line to walk because the people who come in doom and gloom, this is never gonna work, they they seem to suffer more.

During the process, mentally and emotionally, more than they necessarily have to. But also the people who blindly think this will absolutely work also are unfortunately in many cases setting themselves up for a disappointment because even if it does go beautifully, it's not gonna go that perfectly. You're never going to get the same number of embryos as you did eggs coming out. And that's an important thing to know. But even that math changes. If we get one egg out, well, all of us have stories about one egg, one embryo, one baby. And there's a lot of room for maneuvering and changes, and and it's very helpful to be aware of that as you're going in and to as much as possible separate yourself from having a preconceived notion of what is going to happen and how it is going to happen.

Susan Hudson MD (13:40)

So, one thing that I think would be good to talk about are where are points within the IVF process that you may need to pause and regroup? And so these of touch points, and they're all going to be a little bit different. But as we go through the IVF process, so we're going to say everybody's already been through their testing and their doctor has talked to you and given you an idea of how successful.

You may be with this type of treatment. You have somebody who is going through stimulation. We're gonna kind of beginning to end, we have somebody who's going through stimulation. There are going to be some people who either don't stimulate at all, they stimulate way too quickly, or they aren't stimulating to where your doctor thinks you should be. So that's one area that could result in things not going the way that we expect. What's another section.

Carrie Bedient MD (14:38)

Another section occurs at the time of retrieval, where your doctor goes in and they don't get any eggs. Maybe you've ovulated prematurely. Or they get fewer than expected. Or they get a reasonable number that's been expected, but the percent of mature eggs or fertilized eggs is not what we had hoped. And every clinic is going to have ideas of what are normal for them. And that's an important. Asterisk because when you look on the internet, thank you, Dr. ChatGPT, it's going to give you all these preset numbers. But those preset numbers are an average of an entire nation worth of thousands of clinics, and that's not helpful in relation to the clinic that you are talking to. Getting that perspective of is this normal for this clinic? Is this what you expected? Is helpful because when a doctor says, yes, I anticipate this to be successful. That may be different than what a patient says they anticipate success as. And ideally those two things are the same, but we've got more nuance as we're looking at it. And something that doesn't read as success to you may actually read success to us in the context of what you are going through.

Susan Hudson MD (15:53)

Absolutely.

Carrie Bedient MD (15:54)

What's the next last point where we worry?

Susan Hudson MD (15:56)

The next place that we are concerned are what happens in the lab. So we have eggs, we know if they're mature or not, and then we really have to deal with whether or not we have fertilization. So have the eggs been able to accept sperm? And then what happens over the next three, five, six, seven days? And there is going to be attrition. So you are not going to, in most cases, get the same number of embryos as you had eggs? So not all eggs are going to fertilize, not all of those fertilized embryos are going to result in expanded blastocyst, so the advanced stage embryo where we can tell what part's going to become the baby and what part's going to become the placenta. And not all of those embryos that maybe even get to that stage are going to be of good enough quality to either transfer biopsy or cryopreserve. So you may have embryos that get to that point, but they may not be good enough to result in a baby and thus probably be discarded. Where from there?

Carrie Bedient MD (17:04)

From there, we start to talk about PGT results if you were doing PGT. And this is a situation where we are looking to see: do we have 46 chromosomes, no more, no less? And if we have some number other than 46 in general, we tend not to transfer those. There are exceptions, potentially for mosaics. That is an entirely different episode. So we're not going to dive into that today. But it is entirely possible that someone will get their PGT results back and they will be unexpected.

And that can be unexpected in both directions, either good or bad. But of course nobody remembers the unexpectedly good results. It's the unexpectedly bad results where let's say no embryos came back, PGT normal and All of a sudden you're looking at going back to the beginning of a retrieval again because you have to get more embryos. That is a very challenging spot. And this is something where when we look at success as defined by the different people involved, if we've got a 42-year-old patient who's going through, and let's say we get three embryos from her, but they are all abnormal. In the eyes of the fertility doc, three embryos and a 42-year-old that were good enough to get biopsied? Hell yeah. That's amazing. Now they weren't normal, so we don't have the ability to go forward with them. But that is a much better place to be in than the alternative, where maybe the reason you don't have the ability to do a transfer is because no eggs came out or no eggs grew. Those are two very, very different stories. That's an example of a case where the patient will see failure because they don't have the baby that they're going for. But maybe the medical team that they're working with says, hey, let's let's pump the brakes here. This is not the failure you think it is.

Susan Hudson MD (18:48)

Absolutely, absolutely.

Susan Hudson MD (18:50)

RMA of New York is a global leader in state-of-the-art reproductive medicine, serving as Division of Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai. Led by an integrated team of physicians and scientists, RMA of New York is renowned for its pioneering research in the field and for delivering high IVF success rates. With locations across Manhattan, Brooklyn, Westchester, and Long Island, RMA of New York has helped thousands to build the families of their dreams for more than two decades and counting.

Susan Hudson MD (19:21)

From there, we're looking at if you're going to go to a frozen embryo transfer. Sometimes embryos do not survive the freeze and thaw process. Or you actually go through your transfer, or you're prepping for your transfer and your prep is not going as well as we expect, and your lining's not getting thick enough to make your doctor have that warm, fuzzy feeling. And then going into whether or not the transfer results into a positive pregnancy test and subsequently ideally rising HCG levels, pregnancy hormone levels, normal ultrasound, and you ideally getting discharged to your OBGYN for continued obstetrical care.

Carrie Bedient MD (20:04)

How do you approach when a cycle has not gone to plan? Like if you were a patient, Susan, what questions are the ones that are helpful and important to ask?

Susan Hudson MD (20:18)

Well, my first piece of advice is if you have something that stops or fails or does go wrong, don't disappear. Make an appointment with your doctor to go in and have a face-to-face or telemedicine visit if that's the best way you can do it, but have a conversation about what did your doctor like about the cycle and what did your doctor not like about the cycle.

Be able to talk about the things that you liked as well and disliked in the same respect. Because really as you can go through those things, IVF is not only therapeutic in that we're helping you get pregnant, but it's also diagnostic. There are things throughout this entire process that most REIs are going to be like, ooh, maybe we could do this. Ooh, maybe we could do this. And tweaking and changing and manipulating is what we do and that's how we end up being successful a lot of times is because we take that knowledge from the IVF cycle and be able to put it forward into something that's going to give us better results.

Carrie Bedient MD (21:28)

Mm-hmm. And when you come into that appointment, I would highly suggest you try to schedule it at least a week out from getting whatever bad news you have gotten. And even a little bit more than that, if you reasonably can. And the reason for that is you want to get some of the emotional component of this, the first pass of it, out. Because while nobody really expects you to have, perfect emotional control, nor do we really want you to? That's a lot of energy to a place that could be used elsewhere. But we want to be able to have a full conversation with you and be able to explain things and be able to get your input and help you to understand what's going on. And if you're still dealing with that first pass of, my God, this didn't work. I'm crushed, I'm devastated, I'm angry, I feel all of the feelings. It's really hard to have a productive conversation. We will oftentimes have people who really do want to have conversations very quickly. And I don't know about you, Susan, but I automatically assume that they will not remember a single thing that I have said and just automatically say, okay, let's plan a follow-up in a week or two. Because at that point I know that they will remember enough of I remember you said we could do something different, but tell me that again because the expectation is that you are grieving a loss. And even though it's not a concrete loss in the form of losing a child that other people have had the opportunity to meet, it is still losing something that is incredibly important to you. And giving yourself the time to grieve that is important. And it's this fine line between we want you to work through the emotions, we want you to process it, but we also don't want you to disappear because that's going to have a negative impact on our ability to move forward just for aging purposes and efficiency purposes of how do we get you there quickly.

Susan Hudson MD (23:16)

I also recommend if you have questions or if you and your partner have had a little bit of time to sit down and come up with questions, write them down because we're gonna talk about so many things at this visit. And probably as your doctor goes through everything, you're gonna get a lot of your questions answered. But we wanna fill in the blanks for the nuances that are important to you specifically. And it's really hard, especially in this type of situation to remember all the things that you want to know. And we would much rather tell you the answers to your questions than you go on Chat GPT or Dr. Google or whatever. And us having to reinvent kind of the mindset of truth. These are all great resources, but also understand that they do not number one, they did not go to medical school.

Okay. And number two, they don't know the entirety of the situation. We want to make sure that you have all of that information. Write down your questions so that after y'all have your conversations, you can be like, okay, let me go through my list, make sure I have everything that we wanted to have known, discussed and addressed.

Carrie Bedient MD (24:31)

One of the things that I think is helpful to keep in mind when you're comparing what has happened to you to what ChatGPT or whatever AI model is, is that there is a difference between reading a recipe word for word and following it immaculately. And the person who's doing that never having done it in real life before versus the person who has done it 4,000 times before. Because when you come to that person, you're not coming to them for the recipe. Everybody has the recipe. What you're coming to them for is the hands-on experience of the prior 10,000 cycles that they've done and the ability to look at something and go, that's not quite right.

And and it's the same way you look at a cake in the oven and go, that needs to come out 60 seconds earlier than I was gonna take it out. And it's very subtle things that have to be learned, not necessarily taught. And that's a very important distinction between AI and the people who are doing this for real.

Susan Hudson MD (25:28)

Another thing to keep in mind for this discussion is that you may not get answers to everything.

Carrie Bedient MD (25:36)

Can we amend that to you will not get answers to everything? Because if we all had those answers, again, Nobel Prize, psychic hotlines, all of those things.

Susan Hudson MD (25:44)

Yes. So there's a lot of things that we may not be able to say this happened because of blank. But that doesn't necessarily mean that there aren't tweaks that in our experience may help prevent something bad from happening as well. But also realize that those things, there's nothing that's a hundred percent. I'm gonna give you an example. So if I have somebody who comes to me and we don't have a cycle that ended up as well as we expected, whether it be embryo quality or whether they're euploid embryos or something like this, and I'm like, hmm, there's kind of an egg thing going on. I think we need to add in growth hormone or omnitrope. Can I tell you why growth hormone or omnitrope may improve the situation for quite a few people? No, we don't have that information yet.

But I know that sometimes, not always, that can have a positive impact. There's things like that that are nuanced that we can address, but also know that sometimes your doctor has at the first time given you the kitchen sink. So if you come in and you're 42 and you have all these other things going on and you're like, well, what else can you do?

There's a possibility that they may say, We can try something different, but we really don't know if it's gonna have any impact because they've probably given you the whole kit and caboodle of all the things that they think are going to put you in that direction. Our goal always is for you to get pregnant the first time. No one ever, as a physician, goes into, hey, we're gonna do IVF and just kind of, test this out and see if it works or not. And if not, we'll just, plan on another cycle. That that's never what our intention is. Our intention ideally is to be one and done. But unfortunately, when we're looking at statistics, best case scenario, probably somewhere 60, 70, maybe a little higher chances of success. There's a lot of times that these things may not be as successful as we expect.

Carrie Bedient MD (27:46)

Exactly. And this is a time where as you are going through the searches and looking for absolutely everything that can help and improve it, this is where people tend to fall prey to everything that's out there. And that's supplements, that's practices, that's courses, that's alternative medicine, that's typical Western medicine used in different atypical fashions. It really runs the gamut. And while we're happy to answer questions about those things, do you think that this will improve it?

Most of the time, those are considered alternative or secondary or not prime, not the initial things that we do is because there's not a whole lot of data about it. And there's a whole lot of things that make sense in this world that don't actually help, where the theory behind it absolutely follows, but the execution doesn't make a difference.

And we are very acutely aware of supplement overload, of treatment overload, where you are spending all of your time dedicated to this between your taking your supplements and doing the yoga mindfulness practice and then going to acupuncture and then coming to your clinic visits and getting blood work and giving yourself shots later in the day, it can very quickly become life-consuming. Having the ability to focus in a little bit rather than look at the entire world worth of possibilities is is really helpful.

Susan Hudson MD (29:14)

Absolutely, absolutely. There's a lot of things out there. I also like to warn people at this point in time you're pretty vulnerable. And especially if you're on blogs, blogs and internet group interactions are are great for a sense of community and creating an information space and a safe space, but also realize that there is not necessarily balance in all of that information and the people that are participating in that. I just want you to be cautious if something seems too good to be true. Really think hard before considering it as a way to get to your goal.

Carrie Bedient MD (30:00)

I think that's a very very good way of saying that.

Susan Hudson MD (30:02)

What are some other things that you think about, Carrie, when when somebody comes in for this type of visit?

Carrie Bedient MD (30:08)

I want to make sure that their mental health is being taken care of and in addition to partners knowing if they've got somebody else in their corner.

family member, friend, work wife, whomever it may be, therapist, any other sort of mental health professional, making sure that they've got somebody else who can go through that with them. And even if you feel like, well, they're not gonna give me anything, they're not gonna give me any additional tools, sometimes it's just having someone who can listen and be objective about it because that many people will want to keep talking about whatever happened. And there's only so many times, often, that your friends and family can listen to that same story. Sometimes having a therapist go with you through it can really help you to process it. And many of our patients are exceptionally smart. They know how to process these things in terms of looking at it logically, but it's the intersection of logic and emotion that makes it challenging. And the professionals are oftentimes really good at helping.

You sort that out and maybe pointing out the thing that your family member doesn't want to say of insert obvious fact here that maybe is painful for you to think about. And and those those points in time can be very valuable. Paying attention to your mental health is huge in all of this.

Susan Hudson MD (31:26)

Another thing to think about before you go into this visit is trying to go in and say, I'm going to gather information. I don't necessarily have to make decisions this day, because this visit oftentimes is, hey, we can do this again, but we're gonna tweak this and we're gonna do this, and hopefully we're gonna end up being where we are.

But sometimes those conversations are also talking about things that you may not have ideally wanted to do when you started this journey. Thinking about things like third-party reproduction, donor eggs, donor sperm, donor embryos, gestational carriers, all those types of things. And whenever your doctor brings those things up, those are never things you have to do. No one is ever going to force you to do anything that you don't feel comfortable with.

But there are also things that as physicians, when you come in and we've had a failed IVF cycle and we're talking about all of the options available, those are sometimes things that we really do have to at least bring up on a superficial level to say, hey, we're really concerned that this may not happen. Now that's not what you're always gonna hear. So if you're been through a failed cycle, don't think hey, they're gonna automatically want to throw donor egg at me. There's lots of people who have unsuccessful first cycles that we end up being able to correct and then go on to successful cycles. But there are some people that considering third-party reproduction in some way, shape, or form may improve their odds. And always remember as you're going through this, it is a journey. There is a beginning, there is an end.

As in most things in life, we don't know exactly where that end is going to be and how exactly we're going to get there. But your IVF doctor, your IVF nursing team, your embryology team, they are all there with you on that journey. You are not on this all by yourself. We are we are there with you, but we also want to make sure that you know what the options are available to you. And you may decide, no, that's not going to be the right thing for me.

And you may decide, hmm, you know what? I'm tired of doing what we're doing. I really want something that's gonna give me better chances. And I'm ready at this point. And if you've said in the past, hey, something is never going to be okay with me, say donor egg or donor embryo. And if you change your mind, know that it's okay to do that. Most people do not show up to our offices saying, hey, I want to use donor egg. We have a few because they're in certain situations.

But that's not what most people are aiming for. But that doesn't mean that people may not get to that in their personal individual journey.

Carrie Bedient MD (34:10)

Definitely. The ability to have the mental flexibility to change your mind and to think about things a different way in this is huge. And clarifying before you go into this appointment.

What are your priorities? Is your priority still to use your own eggs, your own sperm? Is the priority to get pregnant as soon as possible? Is the priority to do this as financially efficiently as possible? Where do you want to go with this? Is the priority not doing anything more that's really invasive?

There are a ton of ways that you can look at this, but only you can tell us what your priority is. I always tell my patients, I offer the same general things to everybody. I mean, the all the nuances are, of course, quite different, but the same general options are there. But how we get there and why we get there will vary greatly with you because we're going to shape this based on what your value system is. And that will affect what we do. And so we don't know that until you tell us, but you have to know in order to tell us. Thinking about that and being open to it changing throughout the course of your journey is really important.

Susan Hudson MD (35:14)

Another thing to kind of dovetail onto that is this is a visit that if there are two of you involved in trying to create a family together, this is a visit both of you should be at. Because there is no way that you can go from doctor telling you everything they want to tell you and answer all of those questions, and you being able to convey all of that completely effectively to your partner.

Also understanding that your partner is also grieving and may not be grieving in the same way you are, because that often happens. This is of all the appointments that I think it's important for a couple if you're going at this as a couple to go to together. This is one of them. If you're going down this journey by yourself, I highly recommend somebody else come with you.

Just because it's so much to remember and filter that it's nice to have another set of ears so that afterwards you're like, what did Dr. Hudson say about this? I remember she said something, but I have no idea what it was. Have that and also if there's two of you involved, that gives both of you an opportunity to ask the questions that are important to each of you because chances are they're not the same questions.

Carrie Bedient MD (36:33)

Agreed.

Having that second set of ears is huge. And having, when it's available, an impartial set of ears is huge. Because also keep in mind you're hearing everything through a lens of grief. And that changes what we are saying because we can say the exact same statement, but whether you're in a positive or negative frame of mind will change how you hear it. And saying you have a 50% chance of success, people can take that as

You're halfway there, or half of the time it's not gonna work. And it's the same data, but it's different interpretations. And having someone there who can be a little bit more objective, and go, no, they didn't say that. This is what they said, this is how you're interpreting it, and that may be right, but it also may be wrong. And just keep in mind X, Y, and Z of what your doc was saying.

That extra set of ears is really important for this visit if you can get it.

Susan Hudson MD (37:29)

Think probably the most important thing is realize that there's not one set of decisions that's going to be the absolute best. The best decision is the one that you and your partner, if you have one, feels the most comfortable with. And like I said, this visit, no one's ever going to say you have to make a decision today of what you're going to do. They may say, Hey, do you have kind of a feeling of what you may want to do? And I think that's fine.

No one's gonna hold your feet to the fire, but we really wanna be able to see you, have you come in, ask those questions, make sure there's no misinterpretation, misinformation that has been conveyed, and really be able to give you all the information you need to make the right decision for your future family.

Carrie Bedient MD (38:18)

Exactly. If you need another visit later on, it's okay because you will hear different things at every visit and sometimes you just need that initial influx of information so that when you come back for another one. You have even more directed questions and you've got a much better idea of what you want to do. So we are here to help you. Getting bad news is very rarely the end of someone's journey. It just means that there's a fork in the road and we have to decide which direction we're going to go with it.

Susan Hudson MD (38:45)

Well, on that note, I wanna thank each of you for spending a part of your day with us.

Carrie Bedient MD (38:50)

If you enjoyed this episode, leave a review, send us your questions at fertilitydocsuncensored.com.

Susan Hudson MD (38:56)

And if you want even more fertility information, pick up a copy of the IVF Blueprint, our practical guide to understanding fertility treatment, IVF, and the decisions you'll face along the way.

Carrie Bedient MD (39:06)

Before we go, remember, this podcast is for education and entertainment only.

Susan Hudson MD (39:11)

Well we are fertilly doctors, we are not your fertilly doctors.

Carrie Bedient MD (39:14)

Nothing we discussed should replace medical advice from your own physician who knows your individual history and circumstances.

Susan Hudson MD (39:20)

Thank you for listening. Bye.

Susan Hudson MD (39:26)

This podcast is sponsored by ReceptivaDx. When fertility questions remain unanswered, ReceptivaDx helps reveal why. Trusted by fertility specialists for over a decade, ReceptivaDx identifies inflammatory changes in the uterine lining associated with endometriosis and other conditions that may interfere with implantation and pregnancy. From unexplained infertility, recurrent pregnancy loss, or simply undiagnosed pain, ReceptivaDx helps women and their physicians make more informed treatment decisions and move forward with confidence.