Secrets of IVF Stimulation

yeah welcome to the egg Whisperer show a

program exclusively designed to promote

reproductive health awareness and

discuss fertility preservation options

here is your host a harvard-educated

fertility specialist dr. Amy she's known

as the egg whisperer fertility expert

dr. haven possible and you have yet

another success story just launched by a

newspaper to Livi doctor hi everyone

welcome to another episode of the egg

Whisperer show tonight's episode is

titled the secrets of IVF stimulation so

I want you to relax wherever you are if

you're driving relaxed did you hear what

I just said take a look at this I am NOT

a product sponsor for this wine but I

just thought it was fun I saw it in my

favorite store tarjay and so I just had

to buy it and bring it tonight so relax

have a seat and enjoy I think I'm going

to pour some in my mug do you see what

it says dr. Amy at your cervix yes

someone did actually make that for me

isn't that fun I'm kidding I'm not going

to drink one as I'm talking so tonight's

show is titled the secrets of IVF

stimulation and the reason why I wanted

to talk about this tonight is because if

you're a patient of mine you're going to

get all my secrets and in fact one of my

favorite patients dedicated a blog to

her entire IVF cycle with me as her


I think IVF is fun I thought it was kind

of clever that she titled the website is

very fun and so my patients actually

benefit from her experience through her

IVF cycle but I realized that not

everyone has access to the website to me

and so I want to make sure that everyone

can learn from my secrets tonight and so

if you have questions you want to call

in feel free to do so this has also been

a really fun week I've been in the news

over or about a couple stories one is a

tinder type app to pick sperm donors

doesn't that sound brilli

I mean just find some random sperm donor

online that you've never met before you

don't know his family you don't know

what you know genetic problems he might

have you don't know what infectious

disease problems with you you know he

might have make a baby without a lawyer

no not smart at all

so while technology is you know going

very rapidly as far as matching people

together to make families and we call

that co-parenting there are great ways

of doing that with the help of a doctor

so if you think you want to be a mom or

a dad and find someone through one of

these websites bring that match to your

local fertility doctor guess what we'll

be open to that because we want you to

be safe we want you to have the

healthiest pregnancy possible with the

least number of surprises and all enjoy

down the line another study that I was

interviewed or not studied but another


I was interviewed for was about egg

freezing and how Facebook and Apple have

basically changed how we talk about egg

freezing and what I told them is that

egg freezing is now less taboo of a

topic and we can talk about it the

dinner table and people don't whisper

about how it's taboo or not something

that women should consider doing so if

you're my friend you know I basically

walk around saying get your levels

checked get your levels checked high did

you just have a baby get your levels


oh hi are you on birth control pills get

your levels checked add an IUD you place

get your levels checked just had a baby

thinking about another one get your

levels checked so if you've never met me

before please get your levels checked

it's a simple blood test you can do it

around your cycle you don't even have to

be cycled cycling to get an AMH level

checked you can track it over time so

that you're not surprised once you're

ready to have a baby if your levels show

that you are running out of eggs okay so

you're at the starting line of your IVF

cycle so what you want to do when you're

at that starting line is you want to

know why am I here how did I get here

have I done all the tests possible or

needed to understand what might happen

you know my patients ask me all the time

what might happen during my IVF cycle

what could go wrong and I don't like


out what could go wrong I like talking

about well what could we learn well we

could learn that maybe this isn't the

right protocol you might not get as many

eggs as we originally thought you might

not get as many embryos as originally

thought but whatever we learn it's going

to make us better and help us get that

much closer to our goal and there are a

number of tests that you can do now I

used to tell people that an IVF cycle

was actually the most comprehensive

fertility diagnostic test that you can

do it's one way to actually see how the

egg and sperm look and that's the only

way but I would say that there are a lot

of tests that you can do now

fertility gene tests on both men and

women that can potentially predict what

you might or what might happen with your

embryos so let's say you did a fertility

gene test for the sperm and you found

out that you might have less less

blastocysts than originally expected

well maybe that might guide you to

consider doing more than one cycle or at

least a better set of expectations so

that you wouldn't be surprised or

disappointed if you got less embryos and

you originally thought so you're back at

the starting line and you're wondering

well how am I going to start this well

I'm actually the worst cook ever like

awful horrible I can't cook anything

I can't bake a cookie I am a master chef

though and I make a mean mom one get it

mom 'let omelette but mom I know you got

it so whenever I think of making embryos

I think okay well you know you think of

these people who are like amazing bakers

and then they can like add a little

something-something to make their eggs

or their cookies just a little chewy or

add a little something to make a little

salty but then you at the end of the day

it's a cookie so while I'm here sharing

my ivf secrets when you're seeing a

fertility doctor you really want to rely

on their expertise one of the things I

say or one of the many things I say is

don't believe everything you read just

because you see it on a blog or on a

YouTube show doesn't mean that it's true

or applicable for you so your fertility

doctor knows your body the best so be

sure to ask them why

why and why why are they doing what

they're doing why are they making the

cupcake get it baking a cup you know so

make sure you know everything about the

sperm and egg before you are actually

embarking on your cycle so back to

starting the cycle and starting

stimulation everyone wants to be natural

I mean especially in California who

doesn't we want to be as natural as

possible and there's this idea out there

that less is more

well certainly less is more in certain

cases so one thing that can confuse many

people is they don't understand why when

you're doing IVF you actually need to

take injections why can't you just show

up and have your eggs retrieved well the

reason why you can't do that is because

you have to basically grow or what I say

cook the eggs they have to mature only

mature eggs can turn into an embryo so

once eggs are retrieved the mature egg

is then either frozen if you're doing

egg freezing or turned into an embryo at

the same time and that's what we call

IVF and the other thing is that you have

to take medications because naturally

your body is only going to send enough

of an FSH signal to your ovary so that

you ovulate one egg a month right and so

I'm sitting up there on my life Garrett

guard post sending out little tiny life

vests to all the eggs because I consider

myself an egg rescuer I'm rescuing eggs

from being lost they're lost every day

it doesn't matter if you're on birth

control pills if you're breastfeeding if

you're pregnant women lose eggs we have

a finite supply and going through a

fertility treatment even if it's not IVF

basically is a way of saving eggs from

something that just automatically and

naturally happens so that's why you

actually have to take fertility hormones

and the hormones are higher doses of FSH

then your brain is sending to your ovary

so while your brain sends a certain

level to ovulate one egg remember I just

said that you have to take the shots so

that you

ovulation ovary looks like so to you you

probably see a bunch of you know black

circles and lots of you know grayness

around there

so to me I see something just so

beautiful right and so to me those are

follicles teeny-tiny basically balloons

and each balloon contains one egg inside

and so while you're taking the

medications those follicles are growing

from a small size to a size closer to

about two centimeters before the egg is

extracted so when you're trying to

figure out well what are my chances

before I go into the cycle you have to

remember that you're not a bunny we're

just human beings and each egg is not a


each egg is a chance for a baby and that

chance is basically determined by your

age I have a very sensitive clicker

today very very sensitive so at the

start of your cycle sometimes people

need birth control pills and the first

thing people do is look at me like I've

lost my mind

Amy I want to have a baby why are you

prescribing birth control pills and so I

want birth control pills to be rebranded

when it comes to IVF they really should

be called IVF readiness pills right

because we're not trying to prevent you

from getting pregnant we're just trying

to get your ovaries ready so there are a

lot of different ways of starting IVF so

there's a natural cycle start there's a

birth control pill start there's

something that sounds super sexy astrays

priming start right doesn't that sound

sexy you can also do testosterone

priming so the way you start a cycle is

determined by a number of things I'll

just tell you what I do so we know that

if a woman takes birth control pills

potentially she might get less eggs so

let's think about this if you're older

and you already have a lower number of

eggs well for me it doesn't make sense

to start you on birth control pills I do

have patients that need the birth

control pills even if they have a lower

number of eggs and that is if they have

a very set schedule for

gamble they can only be available on

very certain days and have their

retrieval fall on a very certain day and

so starting with birth control pills

gives them the opportunity to plan their

cycle even months in advance to do a

natural cycle start you have to be very


once your period starts you start meds

on cycle day number two so you have to

kind of be available ready to come into

my office you know be able to call me

let's say the first thing in the morning

and come in that day so that we can take

a look at your ovaries take a look at

your hormone levels and make sure that

the plane is ready for takeoff you know

like when you're sitting on that tarmac

and you have to have everything checked

to make sure that everything is

absolutely perfect before you start the

plane well that's the same thing when it

comes to starting an IVF cycle so the

other thing is every Center every doctor

is different so some centers actually

don't have the flexibility to do natural

cycle starts but I'm a little bit

different next time I think I need to

wear a shirt I should go to that

direction that says if your ovaries are

working so am I so it doesn't matter if

it's Sunday if it's Memorial Day if it's

Thanksgiving if your ovaries working I'm

going to be there too so that's why I

can offer natural cycle starts to my

patients because I don't let say batch

cycles that's something that a lot of

even excellent centers they do for a

number of reasons so before you start

your IVF cycle remember I said ask why

why why and then why and why why am I on

this protocol why did you choose this

protocol for me and if you if you start

off with that then you're going to be

more informed know why things are

happening the way they're happening so

that you can be a part of the process

rather than feel like something is

actually happening to you so let's say

you want to do IVF so in order to plan

the stimulation you have to make a

calendar so that's me no that's not me

but I will make a calendar for you we

can do it in person we can do it over

video call or a phone call and I will

actually mock up exactly how your life

will look it'll start with a baseline


baseline just means that starting scan

and I like to do it maybe a couple days

before your period will start especially

if it might start on a weekend otherwise

ton of flexibility because if let's say

your period starts on a Saturday and you

need to start med Sunday night well it's

very hard to get medications to someone

on a Sunday night so I just want to make

sure that you're never feeling

overwhelmed and rushed and everything

can go very smoothly so that first

appointment lasts about an hour to an

hour and a half where you're going to

meet with me or one of my assistants to

teach you how to mix the medication what

I find is that patients waste a lot of

money with medication errors and I was

trying to find this it was hilarious

but I couldn't find it on my phone it

was a snap I just took a screenshot of

me I all my patients get my cell phone

number and I tell them to FaceTime me I

tell everyone to do your shots between

7:00 to 9:00 p.m. and that's so that I'm

not asleep or in my pajamas so I was

facetiming with someone and I had a mud

mask on and I didn't realize I was

covering up my face let's just say this

is my phone I was covering up my face on

the phone thinking they couldn't see me

but really I should have been covering

up the camera so I'm sorry to the person

who I was trying to teach how to do your

shots or trying to fix the medication

error that you almost made my apologies

in advance so whenever people say IVF I

mean you think of these big hypodermic

needles I mean I'll show you one here's

an example of a needle this is what

everyone thinks and that's going to go

on your butt but nothing goes in your

butt in my office

good joke right so the reality is the

needle looks more like something like

this okay it's much much smaller and it

goes in the skin of your tummy so

exactly where tummy it really doesn't

matter I mean you have less sensory

nerves in the lower part so it hurts

less if you go in the skin of your tummy

and most patients say I cannot give

myself the shot it actually hurts less

if you are giving yourself the shot if

someone is coming at you with a needle

it might hurt more than if someone let's

say prepares it for you and brings it to

you or you prepare it for yourself each

shot will take about 15 minutes or so

for you to prepare and know this guy

does not come to your house

to do your shots for you he doesn't so

we teach you how to mix your medications

and if you ever have any questions at

all you call you don't go to Google you

don't go to YouTube you don't phone a

friend you call me because your

medications and making sure they're

right is actually the most important

thing to me there's only one time I get

annoyed I get annoyed when people don't

ask a question that's when I get annoyed

if people make a mistake because they

think that maybe they're going to bother

me but I'd only get bothered if you

don't bother me so you saw that original

calendar right so once your period does

start if let's say we were doing a

natural cycle start we would then make

another calendar for you that tells you

exactly what to do every single day

we'll sit down at that bass light

appointment that appointment is in three

stages stage one is or step one is

ultrasound to make sure gnosis do a

blood draw okay then a meeting to review

the protocol and that protocol kind of

depends on your follicle count that day

so if your follicle count is let's say

over 15 I would consider lower dose of

medications if your follicle count is

let's say under five well then maybe

perhaps we'll consider a more natural

cycle start or a hybrid or a natural

cycle I should say or a hybrid cycle

using fertility pills with injections so

on on this calendar right here what

you'll see I feel like a weather girl


so on this calendar right here you'll

see that I use a medication oh look at

my hand that's really cool I think

that's way too much fun I can't stop

okay I'll stop

so I use a combination of letrozole you

should see my producer and director here

I think they're paying in their pants I

think they need a glass of relax in my

cup dr. Amy at your service there you go

I know it looks like word the way I'm

holding it but I'll get this I'll get

this right okay so let rizal is also

known as Samara it's used for breast

cancer prevention

and unlike clomid that requires an

exorcism I promise you it does it has

less side effects it lasts in your

system only two days also so you know

like a lot of meds some patients will

have hot flashes mood changes nausea

vomiting you know but for the most part

Samara doesn't have those side effects

like clomid but I would say that there

are maybe one out of ten patients that

will actually have lower leg cramps it's

actually not an insignificant side

effect that people report so I combined

the fertility pills for five nights with

fertility shots and you come in a lot

it's not just Oh start your meds see you

in seven days I mean I see some people

after just two nights of meds after

three nights of meds after five nights

of meds and the decision when to come

back in is really determined by what's

going on with you what have we learned

from your prior cycles are you someone

that makes a follicle really really fast

I want to see you earlier so that we can

start the antagonist and on this

calendar right here it's the how I'm

gonna do that again

OOP set you're tied right there wait and

plan and so the cetra tried three right

there would actually slow the follicle

growth so going down the list you have

the tomorrow which is a fertility pill

menopur which is the FSH and LH hormone

remember in the beginning I said that we

have to give patients a higher signal of

these hormones that their brains since

their ovary

so they ovulate more than one egg and

then the estradiol blood test is

something that we do at each visit

because we like to watch the rate of

rise because we expect approximately a

doubling every with every visit just to

track the follicle growth and then the

ultrasound also guides us about the

sizes and when to start the antagonist

also known as such a tide and there are

there number of brands to these

medications but basically the antagonist

refers to a medication to slow down the

growth and prevent the egg from actually

leaving the ovary okay so the next thing

that you'll see on there is actually

something called human growth hormone

another name for it is amna trope that's

the generic version brand name is

Cezanne so I offer growth

basically to any patient who I might

think has lower egg quality so I have a

fun slide but I'll show it to you in a

second but before I do that I just want

to show you another example of other

protocols so I do have patients that are

on actually much higher doses of

medication so they're taking straight

FSH hormone and the brand names for that

oh that one does that too is follow stem

and gonal-f

so those are the different brands for

straight FSH with men appear at night so

I do sometimes have patients do twice

daily dosing but for the most part with

me it's one shot a night every night for

approximately ten nights a total of five

visits from start to end so here's a

another example of a straight menopur

protocol and this is one shot a night

and then the way we teach patients how

to do medications is while you might be

taking up to three maybe even four

different injectable forms of medication

we actually teach you how to mix them

all together in one shot so you never

have to give yourself more than one shot

or feel like a human pin cushion so back

to HGH when I say oh I want you to take

HGH everyone thinks oh I'm going to get

tall I'm going to get buffer and with

you know all those things no I mean

basically it's an anti-aging supplement

so the thought is that it might help

with egg quality it might help a woman

get one extra egg it doesn't seem to

hurt it just hurts your pocketbook

because it's rather expensive and most

insurance companies will not cover it

even if you have coverage with IVF I

mean there are the lucky few who have

the coverage for the HGH so I offer HGH

to every woman automatically over 40 any

woman regardless of age with an elevated

FSH level and anyone who let's say I

sense might have lower egg quality for

example someone with a history of

endometriosis so that's who I would

offer HGH to so when it comes to the

secrets of IVF stimulation I think the

most important thing is to ask questions

ask more questions and ask why why are

you know ask your doctor why am i doing

IVF if you don't know the answer to that

question you should know is there

anything that I can do to make my

chances better or higher why am I taking

the meds that I'm taking why did you

pick this protocol for me so my patients

know the answers to those questions and

I find when I see patients who come from

all over and let's say they've done

multiple IVF cycles and I ask them well

why did you have to do IVF in the first

place and they say well I don't know I

think it's important to know because

ideally I like to setup each patient so

that they have the best chance for

getting pregnant without my help

so if I can give people an idea as to

what they can do on their own to give

themselves the best chance whether it's

let's say losing weight making sure the

triglyceride level is low then perhaps

the egg quality is going to be even

better even if we end up doing IVF so

that's my philosophy as far as IVF

stimulation so I thought I would close

by just showing you Paula

interrupt me if I have any questions at

all okay did I hear anti-aging yes you

did hear anti-aging and I would say that

there's a lot of exciting stuff and I'm

if you follow me on Twitter anytime and

I have Google alerts for everything but

I feel like there is something that

women are going to be able to use as a

tool to potentially slow down ovarian

aging or reverse it all together I feel

like we're so close I can't imagine that

egg freezing is going to be something

that women will need to do to preserve

their young egg so I'm very hopeful so

until that time get your levels checked

your levels checked and get your levels

checked and then freeze your eggs if

it's right for you somebody else is in

love the stems I don't know exactly what

they love the stems it can mean a number

of things right we are not getting into

sex toys Paula we are not not this week

however if you stay tuned in about two

months and I'm totally serious we are

coming out with a version of fertility

pants now let your mind go where you

would like it to go because that's

probably exactly what we're doing

but we're not going to demonstrate

someone else that okay are there other

supplements you recommend for women

going through yeah I do I do have my

hocus pocus list of supplements and it's

individualized for the patient so I ask

patients to consider taking a sigh berry

resveratrol depending on their situation

DHEA Oh Vasa tall and the other

equivalent would be something like

pregnant to a really great prenatal with

fish oil melatonin and people look at me

again like I've lost it like a me I have

no problem sleeping why are you telling

me to take melatonin and the reason is

there are some studies that suggest as a

very potent antioxidant it can also help

with egg quality and then in some cases

turmeric as well so at the end of the

day when I go through this list of

supplements it can be upwards of fifteen

different tablets someone needs to take

so I also tell people exactly what doses

to take as well but I've been so lucky

to help patients even over the age of

let's say forty four with their own eggs

and I don't know if the supplements

helped but they certainly didn't hurt at

all another one yeah Facebook is going

on okay okay

should someone did say I think they want

me to drink some of the relax just relax

people I don't know why is not bit with

the crotchless pants I swear no it's

coming I was gonna wear them tonight

just to prove to people but I thought

that would be kind of weird especially

children are watching yes not on

Facebook no for air quality is that

determined even before stim absolutely

so there are like I said fertility gene

tests that you can do to see if you have

let's say a gene for P oh I or primary

ovarian insufficiency

so women with that gene may have lower

egg quality so yes and the other tests

that you can do are the levels you know

how I keep saying get your levels

checked get your levels checked high I

mean get your levels checked at this age

estradiol am eight so if your FSH level

is close to ten or even above ten that's

a suggestion that you might have lower

quality than you then or I should say

that you should do IVF because hopefully

you have good eggs but maybe not all of

them will be

of the highest quality so whatever you

can do beforehand to basically give your

eggs the best chance and the other thing

is there's this idea that you have to be

on these things for three months or six

months in order to take effect and the

reality is that we're born with all the

eggs that we'll ever have eggs aren't

like sperm

you know sperm lifecycle is about two

months or so so a guy can positively

impact a sperm quality by basically

taking supplements or doing things like

losing weight changing lifestyle habits

but our fertility isn't skin deep

doesn't matter how awesome you look on

the outside if you start your

supplements now that's the best thing

that you can do for your cycle even in

two weeks six weeks or eight weeks from

now would you have a couple more on okay

okay you guys there yeah there's also

good someone waiting online from Los

Angeles okay okay hello Los Angeles you

are with us hi Los Angeles hi this is

Lisa hi Lisa

you know I went to UCLA oh that's

awesome yes they're in LA and I went to

UCLA traffic right now so I'm trying to

relax like okay yeah don't drink the

wine so um I got my level checked okay

said um I had like a 1.3 I think um AMH

level yeah and then Lisa how old redo

you mind sharing how old you are

oh sure sure yeah I'm 34 okay so you're

34 mhm 1.3 so you know the thing is what

this tells me is that you are most

likely fertile right now but if you're

someone who wants more than one child

what I would suggest to you is

considering doing something to preserve

your fertility because what I see so

often is women you know they get

pregnant very easily for baby number one

and then show up at my door 37 or 38 and

then they say okay I'm ready for baby

number two and then I say well your

image is now 0.3 and they look at me and

said but baby number one was so easy so

you know I want you to reach your goals

and have the family size that you want

and I want that for everybody but one of

the many things that I tell people is

plan your fertility like you would the

most amazing

vacation and the way you would plan

let's say your retirement so take the

time to talk about what your goals are

and do what you can now because women

have a finite supply of eggs so your

levels to me are reassuring and if I

were to kind of predict maybe how many

eggs would be retrieved in an IVF cycle

you can take an AMH level and say well

probably close to ten eggs would be

retrieved if you were to need ivf do you

know if there's are you guys actively

trying to conceive right now VESA well

actually I was just going to say that

that's funny you said ten would probably

be average because I'm in I was in well

I should say what was in a cycle and

being simulated but I was only five days

and taking the shot and they said that I

was at risk for hyper stimulation okay

and so they may make it off the hormone

and take a lupron shot and I did that on

Sunday and then because they want to

check me for PCOS interesting so I would

say that an AMH level of 1.3 so you know

when I look at a patient you're you're

never a number to me so it's a

combination of the hormones the

ultrasound your age and all together so

when you look at someone's ovaries and

if it's not consistent with the AMH

level that you see something's off and

it's usually the AMH level so I've

actually had that before where I saw a

patient I was like you have so many

follicles it's not consistent with your

AMH level you just repeat the MH and you

realize that that actually it was

probably not handled appropriately when

the blood was drawn let's say it wasn't

fun in the right amount of time or run

within a certain period of time needed

to get an accurate level but that's good

because it sounds like you were followed

very very closely and taken care of in a

very safe way and Lupron is one of the

many things that we do for women to

prevent ovarian hyperstimulation

syndrome and are you feeling well

because it sounds like this is all very

recent for you yeah I was this week well

I mean I was started on 250 Oh follow

semi-thing huh or maybe it was going to

last and and then

it's basically they thought it was too

high and that I had a monster follicle

Oh interesting so if you had a monster

follicle sometimes that means that you

had one what we call lead follicle that

was preventing the other follicles from

growing so when when you do IVF and you

learn early on that this might not be

the very very best cycle so my

philosophy is when I do a cycle I say to

myself am I giving this person their

very best chance as if I only get one

chance to do it right and so if there's

something early on from the stimulation

that makes it seem like this cycle isn't

going to be the very best for them it's

a good call to tell the patient and

that's what I do and it sounds like

that's what your doctor did too and

consider perhaps maybe not moving

forward and I don't like to use the word

cancel I like to use the word well we

learned from this cycle so we're going

to take these lessons so next time

they're going to do something

differently I'm sure for you did they

tell you what they were going to do

differently next time yeah they said

they were going to reschedule me and do

like 150 a little bit less okay I think

that I was few responses yeah I bet your

AMH is actually 13 not 1.3 you have to

call us back and tell us I have a

feeling I'm right about that okay okay

okay well at least I have a safe drive

okay I know it's LA cuz and you're

probably not moving very fast but let us

know if you see us celebrating while

you're on the freeway per hour yeah okay

thanks thanks exact same please that

there are a couple other questions on

the face okay let the answer it okay

it's jumping over there what are your

thoughts on acupuncture during IVF

I recommend acupuncture to everybody

people ask me why and I said well it's

been around for thousands of years they

have to know what they're doing

we have great acupuncture centers around

us in the Bay Area San Francisco San

Jose San Ramon Lafayette orinda Berkeley

Oakland they're everywhere and I make

recommendations to patients based on

where they live where they work and

what's most convenient to

them so I tell everyone at least go do a

consult because like I said I want you

to do your IVF cycle one time and never

look back and say I wish I would have

done something differently so if you

hate it don't do it again

but if you if you loved it I want you to

do it with your cycle and patients ask

me well what protocol what how often

should I go I say well they're the

experts here's the calendar that I made

for you give it to the acupuncturist and

then tell them work your magic making me

look really good okay actually that is

exactly what I say

so I want the acupuncturist to be able

to communicate with me whenever they

have questions and they often do they

ask me what the follicle sizes are what

the hormone levels are they want to see

the FSH levels and I work very closely

with acupuncturist in our area and

there's also a great acupuncture book I

can post a link later that's all about

fertility and acupuncture written by one

of my fertility doctor friends dr. Laura

Shaheen it's a great resource that I

send to patients it's a really good very

nice read

that talks about all the fertility

benefits other questions let's eat do

you believe but do you believe in

putting a patient on a higher than

recommended dose for dor if that will

help produce more eggs for example a

dose of 750 FSH versus 400 right so

imagine a cup of coffee

hello cup of coffee just in case you are

just coming on and want to see my cup of


so imagine coffee and you're putting

sugar I don't have a spoon but I'll

pretend with my syringe

I'm putting sugar in my coffee there's

only so much sugar that will actually

melt in or saturate at the bottom of the

cup after a certain point there's a

super saturation point where that

there's there's no more sugar that you

can add the sugar just collects at the

bottom it doesn't dissolve so that's

kind of like fertility meds it seems

like 300 units of medication is that

point where anything above that might

just be a total waste of money

and the problem is I'm not Wonder Woman

I can't create eggs if you don't have

them I can only work with the eggs that

you have and when you have a certain

number of follicles or eggs I know they

look like testicles

but they're actually eggs they were

supposed to be white but they can tan so

that's what we call them stress T's and

stress toogle so there is a certain

number of eggs that a woman has and when

you do IVF you don't actually help them

create more eggs so if your starting

point is let's say three eggs then you

want to give the dose that's appropriate

to grow the three eggs but what I find

is that blasting someone and screaming

at the ovaries

hence whisper right by talking slowly or

softly to the ovaries first and getting

all three to grow then bring in the

stronger shots for me seems to be better

for patients when it comes to trying to

extract every single egg that they have

in that cohort if you have DOR and for

those of you who don't know what do are

is what I tell people that do are is not

depleted ovarian reserve it's actually

decreased ovarian reserve and dor does

not mean donor so I want every patient

to be their own egg donor and not have

to use an egg donor and I don't believe

in FSH discrimination either so no

matter what your FSH is no matter how

many eggs you have in my office we

believe in the fertility of every single

patient no matter what your hormone

levels are we want to give everyone a

chance we have two more okay ready I'm


okay what is your opinion on natural

cycle for dor women I do natural cycles

for all do our women's that's just kind

of what I do it doesn't make sense to

give someone something to suppress their

ovaries like let's say birth control

pills because we know from studies and

just from experience that giving birth

control pills makes the follicle count

less and you'll end up with less eggs so

when you have already a smaller supply

of eggs you should do everything

possible to maximize the chances that

you'll get every single egg to grow so

that's my answer no suppression for do

our patients you know some people like s

trace priming and it sounds like I said

really sexy and also I'm going to prime

your ovaries with estrogen and we're

going to make those eggs better or more

but I don't find that that really I

don't really find that to be the case I

think yesterday's priming can sometimes

help with preventing the lead follicle

but other than that I feel like a

straight natural cycle might be coming

in earlier

starting the setter tied earlier seems

to be the best in my hands and again in

my hands so you have to do what your

fertility doctor thinks is best for you

for your body because they know your

body better than some woman up here

who's talking about crotchless pants and

for the last question yeah do you

recommend PG d / PG s for all women with

diminished and quality yes so imagine

you're pregnant with an abnormal

pregnancy and you have DOR and then you

find out after four months that

potentially the pregnancy has stopped

because it has a chromosomal issue so

that's heartbreaking but you can never

get that fertile window or fertile life

back so that's basically waste of time

where you could have been trying for

pregnancy I understand that doing

genetic testing is expensive but the

what the way I described genetic testing

is it's as closest to the IVF quick as

close as a crystal ball and IVF medicine

that you can get it's not perfect but if

a patient can afford it and do it and

it's something that they have no ethical

issues with I do think that PGS which

stands for pre-implantation genetic

screening is something that every

patient should consider embryos are not

like diamonds and I think it's really

hard for human beings because we look at

an embryo and we see how pretty it is

and we want to believe that it's also

pretty on the inside but an embryo can

be gorgeous on the outside and

genetically not viable on the inside and

not transferring it can save patients

from a lot of heartache and miscarriages

and I don't I don't like miscarriages

they're the enemy miscarriages and

periods we don't like periods periods

aren't emergency in my office we don't

like them okay okay did a great job oh

thank you thank you everyone for

watching so remember get your levels

checked your levels checked get your

levels checked and if you have a hard

time getting someone and get your levels

checked go to egg whisperer calm and

join us next Wednesday for another show

and we're going to have a lot more fun

I'll find more props to show you so come

back and tune in to see what wacky props

I have next Wednesday have a great night