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Egg Retrieval to Embryo: Your Next Steps Explained (with Dr. Carrie Bedient)
52 Plays6 days ago
Okay, so you’ve harvested eggs—now what? 🤯
That question is exactly why Dr. Carrie Bedient is joining us today. As Southern Nevada’s first female board-certified reproductive endocrinologist, a fertility expert at The Fertility Center of Las Vegas, and co-host of the Fertility Docs Uncensored podcast, Dr. Bedient has a gift for simplifying what often feels overwhelming.
In this episode, we break down what happens after egg retrieval:
✅ How embryos are created
✅ Genetic testing—when it helps and what to consider
✅ Deciding whether to use donor eggs and/or move toward surrogacy
✅ Emotional fatigue and decision overwhelm
✅ What to expect from your embryology team
✅ The science and the emotion behind your next steps
If you’re deep in IVF, considering donor eggs, or staring down a dozen fertility decisions with no idea where to start—this is your roadmap. You'll walk away feeling more confident, informed, and empowered in your fertility journey.
🎧 Subscribe, rate, and share to support others on the path to parenthood.
#IVFJourney #EggRetrieval #EmbryoGrading #GeneticTesting #FertilityPodcast #DonorEggs #SurrogacySupport #FertilityDecisionFatigue #FertilityEducation
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Transcript
Introduction to 'Me, You and Who' Podcast
00:00:00
Speaker
Hey everyone, welcome to the Me, You and Who podcast, where we hear stories and provide support for those building families and those who help make them possible. Okay, so you've harvested eggs, now what?
00:00:14
Speaker
This stage of the journey can feel like standing at a fork in the road with 10 different paths and no map.
Guest Introduction: Dr. Keri Bediant
00:00:20
Speaker
Today, I'm joined by Dr. Keri Bediant, Southern Nevada's first female board certified reproductive inchronologist, Ari at the Fertility Center of Las Vegas, and co-host of the podcast, Fertility Docs Uncensored.
00:00:32
Speaker
She has a gift for breaking down the complex into the understandable. And in this episode, she explains the often overwhelming next chapter infertility.
Empowering Fertility Decisions
00:00:41
Speaker
So whether you're deciding between texting options, wondering if donor eggs are right for you, or just feeling lost with full on decision fatigue, you will leave this episode feeling empowered, educated, and like you actually know what to do next.
00:00:56
Speaker
Enjoy. Me, you, and who? Who knew it would take more than two people to have a baby in a world where infertility is no longer a taboo topic.
00:01:08
Speaker
This podcast will take you through all of the different aspects of surrogacy and egg donation through the lens of many who walk this journey in different ways.
Surrogacy Experiences with Whitney Hall
00:01:18
Speaker
My name is Whitney Hall and I am a two-time surrogate now turned surrogacy coordinator for egg donor and surrogate solutions. the very agency I used when I chose to carry for two amazing families.
00:01:32
Speaker
With this podcast, it is our goal to help guide and support you as you learn about what it takes to grow a family in an alternative way, as well as hear inspiring and beautiful stories of how this path has changed lives forever. We can't wait for you to hear about just one more way happy families are created every day.
Science Behind Egg Retrieval and Fertility
00:01:55
Speaker
Dr. Carey, thank you so much for just coming and, you know, getting to, i mean, I'm just so excited to talk to you and kind of just, you know, about all of the fun that kind of happens behind the scenes with just the science of everything that, you know, we do around here.
00:02:15
Speaker
ah Thank you so much for having me. I was super excited about this. I got up early this morning and like, okay, let me make sure that I'm fully awake and very good ah and it's it's a very nice way to start the day.
00:02:30
Speaker
It's so fun. It's so fun to start the day this way and just, you know, getting to have a conversation, especially about something that you know, we're just so passionate
Post-Retrieval Egg Processes
00:02:37
Speaker
about. But so to get started, we, I really want to talk about just the egg retrieval process, kind of behind the scenes, all of the different facets and, you know, what people can expect when it comes to, it seems mysterious, but we all kind, I mean, generally when you're part of this process, you know the basics of it, but you know, let's, let's go back. So, okay.
00:03:01
Speaker
You've retrieved eggs, cue the celebration, right? We're very excited. Um, but then you're kind of like, okay, now what do they hang out a Petri dish somewhere?
00:03:12
Speaker
Do they get tested, frozen, labeled for future use? What? I mean, and maybe especially for, you know, someone using an egg donor or And planning a surrogacy journey, you know, some of those decisions just around all of that, you know, feel huge. So i kind of want to break it down, like, what really happens behind the scenes after that egg retrieval? And how do people even begin to make smart and informed choices from there?
00:03:41
Speaker
Okay, so this is a ginormous talk but topic. And so we'll just kind of break it. We'll break it down. So the first part of things that happen are the lab things.
Role of Embryologists in Egg Maturation
00:03:53
Speaker
And so with that, and...
00:03:58
Speaker
As you're going through the lab, keep in mind that the embryologists are typically the ones who are making a lot of decisions here. It's not necessarily the physicians, which is good. if You don't want it to be the physicians. You want it to be the embryologists who eat, sleep, live, breathe these little cells because it is a different world completely. Right. Totally different medicine.
00:04:21
Speaker
you think You think that reproductive endocrinologists are meticulous? Go meet the embryologists and they put every single one of us to shame. And I say that as someone who's really fairly compulsive and and who is part of a compulsive practice where we are just on top of everything and our embryologists are amazing. and But we love that. We want that.
00:04:40
Speaker
We want that. That is a very good quality in an embryologist. I don't know how it makes them at home as somebody's spouse, but I don't really care because they're amazing at what they do.
00:04:52
Speaker
There we go. Yes, we love that part. So the first thing that happens when those eggs come out is that they need to be assessed for maturity.
Egg Maturity Stages
00:05:00
Speaker
And so the way that I think of this is that eggs come in three different flavors.
00:05:04
Speaker
There's fully mature. These are the adults. They're useful, productive members of society. These are who you're going for. Then on the opposite end of the spectrum, you have the toddlers.
00:05:15
Speaker
These are the fully immature germinal vesicles. They are cute, but of no use to anybody.
00:05:24
Speaker
And then in between, you've got your teenagers. And those are the ones that they may or may not be productive. you give them a little bit of time. Some of them are gonna mature into fully matured usable eggs, more like adults. And most of them aren't.
00:05:39
Speaker
And a lot of them are going to, not a lot of them, some of them may grow into embryos. so But I would say in general, my expectations of those embryos are considerably lower than the ones who were mature from the get-go.
00:05:54
Speaker
And so doesn't mean that they can't make good babies. It doesn't mean that if you do have a live birth from it, your child's going to have six eyes and horns and a tail. Like that's that is not what I'm saying at all.
00:06:06
Speaker
It's just that the expectation that it's going to implant and go the distance is a lot lower. So that's the very first thing that
Insemination Methods: Conventional vs. ICSI
00:06:13
Speaker
happens. Once the embryologists get all those little vials of fluid, usually media that we grow the eggs in, which is what we're rinsing with,
00:06:21
Speaker
And they get those little vials. They're going to dump them into a dish either in the retrieval room or in the embryology lab. And they're going to make the quick identification of, yes, I've got an egg. No, I don't have an egg.
00:06:35
Speaker
And then a little bit later, they're going to take them back to the embryology lab and they're going to put them under more powerful microscopes and they're going to clean them, which is where you're stripping away the cumulus cells.
00:06:46
Speaker
So these are the the cushy cells that the eggs grow into. And so cumulus is it if you if you're. Yeah, I mean, it's a fluffy cloud. You want a nice fluffy cloud a lot around your egg.
00:06:59
Speaker
And so they strip that away. And then that's where they're identifying your toddlers, your teenagers and your adults. And then at that point, they're going to sit and hang out in the lab for a couple of hours.
00:07:13
Speaker
And any additional maturing is going to happen. And then usually about four ish hours, give or take a little bit. That's when the embryologists are going to take the sperm and inseminate. However that happens, because there's a couple ways that can happen. And so if you've got someone who needs additional work to get the sperm, it's not just a simple ejaculated sample, then that's when that work is happening. You know, whether it is a testicular extraction that's happened the morning of or the day before. They're sorting through their finding sperm if they need to.
00:07:47
Speaker
They're washing the sperm sample if it's a fresh ejaculated sample. They're thawing the sample if that's what has to happen. So they're prepping the sperm, the eggs are sitting, and then a couple hours later, usually around lunch-ish time because all these retrievals, everything's happening the morning.
00:08:06
Speaker
what they'll do is they'll get the sperm and they'll inseminate. And that can be conventional insemination, which refers to dumping it in essentially and letting the sperm and the egg cohabitate and see what happens.
00:08:21
Speaker
Or it's ICSI, which stands for intracytoplasmic sperm injection, which is actually injecting the sperm into the cytoplasm of the egg so that you have all of that genetic material right there.
00:08:35
Speaker
And so the way that I kind of think about this is blind date format. I love this. And so if you've got... natural conception happening in the tubes, whether it's insemination or spontaneous, whatever it may be, that sperm has to get the phone number of the egg. It's got to figure out, like set the GPS so that you know exactly where it's going. It's got to show up on time. You better hope that it's put on the right clothes and that it can work all the technology that it's going to need to get to the sperm, the egg's house.
00:09:09
Speaker
And there's an awful lot that has to happen. So when it does happen and it works, fantastic. Wow. But there is a very high chance that something's going to go wrong on that journey. And it's just not going to happen.
00:09:21
Speaker
Sure. GPS is going to break down. Something's going to happen. Exactly. Then you've got conventional insemination. So this is where the eggs are out, the sperm is out, and they're placed together in the same dish. So this is kind of akin to both people are being dropped off at the door of the restaurant at the same time. And so odds are a lot more likely something's going to happen because they're both there. Some of the biggest challenges...
00:09:44
Speaker
have already been removed. Like you've already signed them both to therapy. You know that both of them are very reasonable to start a relationship. they can They can get going. They've passed some of those tests.
00:09:56
Speaker
They've made it to the restaurant. They're dressed well enough so that they haven't gotten thrown out on site. and But you still are relying on a lot of chemistry to happen to make it work. Sure.
Lab Decisions on Insemination Methods
00:10:06
Speaker
And just for clarity is the, are all of the eggs and all of the sperm, they're all in, in this point, they're all in a, they're all in a car together or are these all like individually in, in spaces?
00:10:21
Speaker
Yeah. So everything's going to depend on the lab because every lab is unique and they're going have their own ah flavor. But a lot of times they'll just all be in together. And so you're putting in more than enough sperm.
00:10:31
Speaker
And in this in this case, it's it's not necessarily like two people being dropped off. It's almost like a speed dating setup. There we go. I was about to say. Yeah. yeah Where you've got one one egg that's sitting there and the sperm we're rotating through trying to impress her.
00:10:48
Speaker
and And one of them is going to potentially make that happen. Then you've got ICSI. And this is akin to both of them being dropped off in the same bed at the same time.
00:11:00
Speaker
So it doesn't guarantee that anything good is going to happen. But it makes it considerably more likely because everybody's been primed for, yeah we're dropping you both off in a bed. Let's see what happens.
00:11:12
Speaker
And you don't have to go through a lot of the other rigmarole because it's that's already occurred. You've already passed the test to to get that far.
00:11:23
Speaker
And so you know it doesn't mean anybody's going to be good at what they're doing there. But it greatly increases the likelihood of a good time. Okay. Okay. And is there... to...
00:11:36
Speaker
Is there advantages, disadvantages? Is that a unique lab thing? Is there, are there testing prior to kind of with a decision of which way we're doing? Okay.
00:11:47
Speaker
Absolutely. And so with samples that are very, low sperm counts with samples where the motility is really awful with samples where they are frozen previously. So if you've had a frozen sample, that acrosome reaction, which is the act of the sperm opening the door to get into the egg, like putting the key in the lock, fiddling with it, doing that two, three times to get in.
00:12:13
Speaker
None of that can happen with with frozen sperm. So you have to have fresh sperm for that. If you've got some compromise in the sperm, then you want to do ICSI. There's a test out there called sperm QT, where if that's abnormal, then you want to go in. If you've got poor DNA fragmentation, where um this is more common in patients who had a lot of miscarriages, if any of those things are happening, you're going to go directly to ICSI.
00:12:38
Speaker
Do not pass go. Do not collect $200. straight there. With conventional, this is something where it's a little bit more lab preference. So for example, our lab does ICSI for pretty much everybody.
00:12:49
Speaker
And in part, that's because we have a very high volume of frozen samples and people coming from a distance where that is logistically what we need to do.
00:13:00
Speaker
ah But it's also in part built on ah muscle memory from the physicians where when you have conventional insemination,
00:13:11
Speaker
you inseminate or ICSI, whatever insemination, you inseminate a couple hours after the retrieval. You don't check until the next day. Like there's nothing that's visible to know, did this work until the next day?
00:13:24
Speaker
And so when you go and check, If there's no insemination that's occurred with conventional insemination, you start to jump to do we do rescue ICSI, where it's done essentially after the fact. It's a late response.
00:13:38
Speaker
You put the sperm in and you just cross your fingers and pray and and hope that it works. And sometimes it will, but not always. Mm-hmm. As opposed to ICSI, where you know from the beginning, you have done absolutely everything to make sure that those eggs and sperm get together and they do what they need to do. Because there is absolutely nothing. That's not true.
00:13:58
Speaker
There are not a whole lot of things that are worse than having to call a couple or a patient and say, hey, none of the none of the eggs fertilized. And so when we're talking about all of the things that can go awry the in an IVF cycle and how you can not get embryos, not inseminating and having successful fertilization is one of those things. And when someone asks, well, what could we have done to prevent this? And you say, well, we could do ICSI and they go, well, why didn't you do that?
00:14:30
Speaker
Sure. It's the likelihood of that happening is very low, but it's one of those things that when it does happen, it's really devastating yeah for everybody involved. And so we're trying to avoid that. And so there's a lot of research that's being done about whether or not you should ex exceed everybody, conventional or not, those types of things.
00:14:50
Speaker
um And so there's there's a lot of push and pull right now of of who does what. And so there are absolutely wonderful labs that do most things conventional, except for those indications where we talked about.
00:15:03
Speaker
It just kind of depends on the overall The overall feel of the lab, the needs of that patient. you know When I have patients who say that they feel really strongly about conventional, absolutely. you know It's easy to do. The embryologists prefer it because they just dump it in and they walk away as opposed to having to spend hours immobilizing the locating them, immobilizing them, injecting them directly. Right, right. now Yeah, yeah.
00:15:29
Speaker
But that sounds like a really great... question to ask your RE, the lab, when you're looking at different clinics, you know, that, I mean, I wouldn't know that that's a question to ask in my head, I would think, okay, you have an egg, you have a sperm, you're going to put them together. I didn't even, you know, I wouldn't even think to break down how you even put them together and all of the parts, you know, that come with that. So that's a great, solid question to ask your lab and to find out more and to find out what makes sense for you in that moment. And you know, and all of those things. So, you know, that's fantastic.
Link Between Follicle Size and Egg Maturity
00:16:01
Speaker
When a lot of times, so, you know, we've, we've gone on our blind date. We have had a successful blind date. Um, actually, wait, let me go back real quick. You said the maturity of the eggs, the adult eggs, our teenager eggs, and then our toddler eggs.
00:16:17
Speaker
That's something that we find out at the lab. When you're in there retrieving, you don't know that thinking like when you're going through, Correct. So part of the the way that we stim is that we know that bigger follicles are more likely to yield mature eggs.
00:16:32
Speaker
And so that's part of the reason why we watch the ultrasounds, we check the lab results, and we're pushing to get as many of those follicles to be as big as possible. Now, just because you can see a follicle doesn't mean that there's an egg there.
00:16:45
Speaker
And there's some mixed information out there about how big the follicles can be, because it used to be when we did fresh transfers all the time that you hit three follicles that were measuring 18 millimeters or greater and you triggered because if you let it go that much further, they saw that pregnancy rates dropped. Well, the reason those pregnancy rates dropped had nothing to do with the follicle size. It had everything to do with the hormonal environment.
00:17:09
Speaker
and how that changes. And so, What had changed when frozen embryo transfers got to be really good and the freezing technology improved was that all of a sudden you didn't have to trigger at that certain point because you could focus on the eggs and do the best by them.
00:17:27
Speaker
Get as many of them big as possible. Let the the smaller part of the cohort grow up. You weren't quite as worried about this post-maturity syndrome, which is actually an endometrium issue, not necessarily an egg issue.
00:17:40
Speaker
And so it really changed how we do things. So we did a study at the Fertility Center of Las Vegas a couple of years ago, where we measured all of the follicles as we were taking the eggs out and we tracked everything.
00:17:54
Speaker
Everybody in the office hated this project because it just it was it was a huge ask of every single person who came in contact. shoot. um And so, but the really cool thing is that we found you can push these. So what a lot of folks had been doing was just crossing their fingers and pushing. Now we have data for it to go, hey, this is this is fine. You don't have to trigger at that early point. You can really push further and get as many of those eggs big, which means they are more likely to yield an egg and they are more likely to be a mature egg.
00:18:26
Speaker
And so all of those things downstream meant you've got a better shot at embryos because you've got to with. For sure. With that pushing in your in your study, was there any issues with hyper stimming?
Preventing Hyperstimulation During Retrieval
00:18:42
Speaker
So no. And right part of the reason for that is because of the Lupron trigger that yeah we give. And we're very meticulous about if someone has a high number of eggs, only giving the Lupron trigger, or giving some of the preventative medicines right out of the gate to minimize them.
00:19:00
Speaker
um The other thing that helps prevent hyper stim is that hyperstim gets much worse in the presence of HCG, which is of course the pregnancy hormone. right And so if you get somebody pregnant, who's got a crazy high number of eggs, not only are you going hyperstim her, but she's going to hyperstim for weeks because that HCG is continuously present. And back before Lupron triggers were really common, I remember being a fellow and going to round in the hospital more days than not, because we had somebody
00:19:32
Speaker
in the ICU or admitted to the floor with HyperStim. And so HyperStim is a big deal and the Lupron trigger is huge. And being able to add some additional medications, modify that and not do a fresh transfer means that you can push people a lot more because you can avoid giving that HCG trigger. or give it in a much smaller titrated amount to get her just what she needs, but no more.
00:19:59
Speaker
And it's a very self-limited condition because you you're burning through that HCG. And once it's gone, it's gone. You don't have this pregnancy that's providing it continuously. That's going to cause issues. Now there is a lot of overlap between a really good STEM and hyperstem.
00:20:15
Speaker
And so that bloating feeling, the, the kind of vague nausea of, Oh, I don't feel good. All of that absolutely happens, but that's, that's true of a really good STEM where someone's got a lot of eggs. And so there's a fair amount of crossover there.
00:20:30
Speaker
Right, right. No, absolutely. Well, I love that you have that that data of, you know, the push just justin enough, just enough to be successful, but being conscientious of...
00:20:43
Speaker
Again, that overlap. I love that yeah description. Hey, we'll get right back to the show, but I wanted to take a quick moment to speak directly to those of you dreaming of growing your family.
Guidance from Egg Donor and Surrogate Solutions
00:20:54
Speaker
For the past 18 years, we at Egg Donor and Surrogate Solutions have had the privilege of walking alongside hopeful parents, guiding them through egg donation and surrogacy with empathy, expertise, and personal experience.
00:21:09
Speaker
Many of us on the team have been intended parents or surrogates or egg donors ourselves. So we understand just how important this journey is. Whether you're just starting to explore your options or ready to take the next step, we're here to help.
00:21:23
Speaker
You can schedule a free 15 minute call with our team at create a happy family dot com. to get your questions answered and see if we're the right fit for your journey. You don't have to figure this out alone.
00:21:34
Speaker
This is your invitation to learn more and take the next step toward the family you've been dreaming of. All right, let's get back to the show. description So, okay, we've gone on our date.
00:21:45
Speaker
It's been successful. What can intended parents expect in terms of embryo development and and
Embryo Development and Lab Conditions
00:21:56
Speaker
timing?
00:21:56
Speaker
And i I think even with that, you know, there's a lot of... um thoughts and different ideas behind, you know, the pros and cons of day three embryos versus like day five or six. And maybe we need to even break it down a little bit more before we even get to that day five or six. so what are what can what can parents kind of expect once, you know, we've had a successful date?
00:22:19
Speaker
So they can expect not a lot of information in real time, I would say is fairly common. That's great. Yeah. That's a really good thing to know. And it's it's a lot of hurry up and wait because everybody's like, okay, when's the retrieval? When's the retrieval?
00:22:33
Speaker
And then you hit the retrieval and then, okay, well, what's happening? And nothing. We're watching. We're letting them do their thing. You've gone there you know every day basically to like, okay, is it time yet? Is it time yet? I mean, yeah, exactly. Like you said, it's a lot of hurry up. And then this Sitting time.
00:22:50
Speaker
Yeah. Yeah. And so while it's sitting, what's happening is that the embryos in culture are in culture. And so they're what that means is that they're in an incubator with very controlled temperature and light and oxygen, nitrogen, carbon...
00:23:05
Speaker
components being pumped in. And it's it's extremely controlled to the extent that, I mean, in our lab, we have all these individual incubators. And so the embryos each get their own little place. And the nice thing about them is they they're very small. And so when the embryologist opens them to take them out to checkers, change media or do whatever they need to do, as soon as they put them back in it re-equilibrates very, very quickly. And so it gets them back to that ideal state as soon as possible. And so most the time they're sitting there in the dark doing their thing.
00:23:37
Speaker
love that And what will happen next is usually the lab's going to check on them on day three or so. And let me grab... oh There we go. So for anybody who's watching on YouTube.
00:23:50
Speaker
Okay. Yes. Pictures. We love a visual. Oh my gosh. That's amazing. So this up here is a mature egg. You can see it's got a really thick zona around it. It's nice and even. There's not a lot of graininess in the cytoplasm. It's not very dark. Everything looks good.
00:24:07
Speaker
This next one is the fertilized one. You can see the two pronuclei, so 2pn, this is what we're referring to when we say that. And it's it's a packet from the sperm and a packet from the egg.
00:24:17
Speaker
And then you can see the cells start to divide. And so this is a beautiful picture of two very even cells. And as it grows over the next couple of days, those cells continue to divide. So you go from two to four to six to 16 and so on.
00:24:30
Speaker
And so on day three, this is kind of a classic day three embryo where you can see roughly eight cells They're very even. They're very nicely divided. You don't see any fragmentation in there.
00:24:42
Speaker
It's a really beautiful picture. Yeah. It almost looks like a flower. For those who listening, it almost looks like just petals of a flower is kind of what what we're seeing here. Yes. Yes. I think that's a beautiful description. I'm going to remember that.
00:24:56
Speaker
Yeah. ah So once you have that, that's what we're seeing at day three. Now, the issue with this is that this is very early in development. And that that leads leads to a couple of questions. Number one is, well, should we transfer at this point?
00:25:13
Speaker
And when you transfer at this point, You absolutely can get babies, but there is an awful lot of attrition that happens between day three and day five or day six. Because when I'm looking at numbers, typically I'll see once you get your mature eggs, the majority of those are probably going to fertilize and hit the 2pn stage.
00:25:33
Speaker
And the majority of those are going to hit the multi-cell stage. So there's very little discrimination in terms of what grows between the egg and the mature embryo. excuse me, between the egg and the day three embryo. And so as a result, you don't really know which ones to put back.
00:25:50
Speaker
And in an area that is so involved and expensive, you don't want to just be putting embryos back willy nilly because that doesn't serve you. Right.
00:26:02
Speaker
And you also can't do genetic testing on them. And so we'll get to that in a minute. So let's talk about the development into a day five, day six blastocyst and what that
From Early Embryo to Blastocyst
00:26:11
Speaker
is. And then we'll kind of kick back to some of the genetics. so So you've got your little flower embryo here on day three.
00:26:19
Speaker
And then it's going to start getting so busy in there the lines blur. Cells start to come together and you get morula. And that's that's these types of pictures where everything is kind of gelled together. It almost looks like the egg does again, where it's it's all kind of glommed together.
00:26:37
Speaker
yeah And then as you start to hit day five, you start to see cavitation occur. And so there's a fluid filled collection and there's a distinction between the inner cell mass and the trophectoderm. And so this is an early blast where you can start to see the beginnings of it compared to a mature blast, which in this picture, you can see a very clearly defined ICM, inner cell mass,
00:27:01
Speaker
and trophectoderm, which is this outer part. And so the trophectoderm becomes the placenta, the inner cell mass becomes the baby. So you've got to have these two parts. right Now, the distinction between day three and day five is day three, you've got this little flower petal and you can't see a whole heck of a lot beyond that versus day five, you can look at the internal component parts.
00:27:23
Speaker
And so when you're talking about doing genetic testing, If you take cells from a day three embryo, there's really only about eight in there. And so if you take out three, two or three to do the genetic testing, you have significantly damaged that embryo.
00:27:40
Speaker
And that shows up in the success rates. Okay. And it shows up in the embryo development numbers. And so that practice has pretty much gone by the wayside. i don't often hear about people doing that.
00:27:54
Speaker
When you're looking at a biopsy of a day five, day six embryo, that's a little different because that's got about 150 to 300 cells in there. So you can take out five or six, get more material to work with, and you're really not damaging the embryo because you're taking from the trophectoderm part that becomes placenta, which is literally a throwaway organ. After delivery, they put it in the trash most of the time. right.
00:28:19
Speaker
And you're not sort of touching the inner cell mass. And so you get that information without causing damage. And you're also at a point in development where there's a lot of attrition
Selecting the Best Embryos
00:28:28
Speaker
that's already happened. So natural selection has occurred and nobody in the lab, nobody, ah no parent has to make that decision. No physician makes that decision.
00:28:39
Speaker
It's already happening on its own. yeah, people don't realize just how horribly inefficient human reproduction is. Like if anybody did our jobs, if any of us did our jobs with the inefficiency of our reproductive system, we would all be fired hands down.
00:28:56
Speaker
I love it. And it's it's not even close. No, sure. Best case scenario, you've got a 25-year-old who's cycling regularly. She's got like a 20%-ish chance each month of getting pregnant.
00:29:09
Speaker
If you showed up 20% of the time, you'd be out the door. You're fired. You're fired. Yeah. And so... It's nice to be able to see that happening because it means that we're not putting a lot of time, energy, resources, which frankly, most of those resources are in the emotional, mental part of this.
00:29:28
Speaker
like You want to see those numbers go down because you want the ones that were never going to make it to go away so that you don't spend time with them.
00:29:38
Speaker
And you don't put your money into the transfer and you don't put your butt through the progesterone shots and you don't put your GC through all those monitoring visits. And you you don't want to invest in that embryo because it's much better to invest in the you know the two, maybe three best friends that you're going to have than the 20 acquaintances that you might have.
00:30:00
Speaker
Like you want, you want to be a little picky. You want to let some of this, some of the the slackers fall off by the side so that the the cream rises to the top and you can choose the best ones.
00:30:13
Speaker
Sure. That's a really great perspective because I think there's so much, put into numbers and the more, the better. And, you know, i mean, we're even thinking about that with egg retrievals and, you know, just think the more, the better.
00:30:28
Speaker
i But you're right. There's, you know, in, when you get to this stage, now we're looking at quality over quantity. Right. And don't get me wrong. If you've made you give me the option between two beautiful embryos and 10 beautiful embryos, I'm going to take 10 every time and twice on Tuesdays.
00:30:47
Speaker
Right. But you don't want to spend a lot of time on these really crummy ones. And that's where you start to get into the the concept of grading and or what those embryos look like. Because there's two parts to assessing an embryo. There's the beauty competition and there's the talent competition.
00:31:05
Speaker
I love this. And so the talent competition is the PGTA results and the beauty competition is the morphology or it's grading. And with that, what we're looking for is how good is that ICM?
00:31:16
Speaker
How good is that trophactoderm? Is the blastocyst expanding? Is it hatching? Is it fully hatched? Where is it in that... that range, that spectrum of what it can be. And so this is where some labs differ because there will be some labs that freeze and biopsy absolutely everything from the most beautiful textbook specimen down to the one where you're like, is that really an embryo or did I sneeze in the dish and that's causing problem? Like,
00:31:45
Speaker
Disclaimer, no one ever sneezes in a dish. there we are that For the record. ah For the record. That was a purely illustrative example to make you think of snot. Not anything else.
00:31:55
Speaker
And so with with that, it's nice because you get to hear about, oh, I've got a bunch of embryos frozen. But I find it's also very challenging because the difference between your best and your worst embryo can be phenomenal.
00:32:10
Speaker
And you don't have as clear of an idea of, well, what do I have that's really good? That's going to have a chance of making it. and And so there are other labs that are picky when they go through things. They want to see a good ICM. They want to see a trophectoderm. They want to see all of those things come into play.
00:32:27
Speaker
That's where my lab tends to stand because because there is all of those non-tangible costs associated with having a bunch of embryos that are for crap. um Because that's going through a transfer and having an embryo that doesn't survive the thaw or having an embryo that doesn't stick when we could have seen that a mile away.
00:32:48
Speaker
It's mean. It's really mean. and And like I said, there's all these costs associated with it. sure And so we don't you don't want to put people through that. And it's part of what helps make our success rates particularly good is because we're pulling up the high power microscope and really going in in detail and taking
Significance of Embryo Grading
00:33:07
Speaker
a look at it. And I've had some senior embryologists who have come to us from other places going, oh my God, I put so many crappy embryos. I must've put so many crappy embryos back in at prior centers, which is reflected in pregnancy rates.
00:33:20
Speaker
And they're like, I never, i never knew. i never thought to look. And it's not a knock on anybody because whether you look or not, if the embryo is going to make a baby, the embryo is going to make a baby.
00:33:31
Speaker
It's just, there's a lot of experience that that goes into this experience of the lab and the experience that the patient, gc everybody around, even the physician, you know calling people with a negative pregnancy test Those days suck.
00:33:47
Speaker
And those phone calls, it doesn't matter how many you do. They still hurt. It's hard every time. Yeah. Like, I hate it. hate it. I hate it. I hate it. I hate it. And I want to do everything I can to get ah positive test so that that's a really fun call. And like if they're not going to hear what I say, I want it to be because I just told them they're pregnant and they're jumping up and down and they've dropped the phone and they're hugging and they're dancing.
00:34:12
Speaker
Yes. That's why I want them to not hear me, not because I just gave them devastating news that... changed changed their their world right right exactly so okay going back to the pgta testing the you know we're you're using words like we're pulling cells that can kind of feel scary when you hear that and i love that you mentioned like hey we're pulling from a placenta we're not pulling from you know the cells that can turn into a baby so that's kind of helpful
00:34:44
Speaker
um But can you kind of maybe explain it in a way, that testing aspect, can you explain that in a way that's kind of a easy digest?
Process of PGTA Testing
00:34:54
Speaker
Sure.
00:34:55
Speaker
So what they'll do is once they see that the blastocyst is mature, and that can be on day five, day six, day seven, day five is textbook. They showed up right on time. They're not early. They're not late. Day six is 15 minutes fashionably late.
00:35:13
Speaker
Day seven is you're showing up to the party, like almost as it's shutting down. And so When you get babies out of all of those, they're wonderful. Day seven embryos, again, we have less faith in those because it took them a two extra it took them two extra days to show up to the party as they should. Right.
00:35:30
Speaker
So once you have that embryo, what they're going to do is they're going to go in and very carefully just gently tease out about five or six of those cells. And so what they're doing is they're creating a very tiny, precise hole, oftentimes with a laser, that they are aiming at ah the exact opposite point of the inner cell mass. And so looking at this picture, if you've got your inner cell mass here, they're going to take the biopsy from up here. So directly opposite. So if you figured the ICM is at six o'clock, they're going to take it at 12 o'clock.
00:36:09
Speaker
And they make a very tiny, precise hole. And then they take a ah very fine needle or pipette and, and just very gently kind of tease it out and draw it out. And so if you're ever, um,
00:36:28
Speaker
I'm trying to think of a good analogy for this. And I was going to go with if you've ever made those, ah the eggs where you kind of suck out the inside of the egg and then paint the outside so it's beautiful. Oh, sure. Yeah.
00:36:39
Speaker
yeah i That's kind of a good example. That is that is a much more delicate process, ah frankly, than doing it for an embryo. Embryos are really robust. Like we've actually found in some cases, the rougher you are with ICSI, the insemination, the better it is.
00:36:57
Speaker
Oh, interesting. Yeah. And so, no, you don't necessarily want to be that with ah the biopsy to get the cells out. but Sure, sure. Like we're not going to go play volleyball, but yeah. Yeah, no, no, we're not going to, we're not going to spike it. We're not going to do any of that. But you just very gently kind of tease it out and, and pull it out. And so this is not something where you're cracking open the whole thing and all of the insides can spill out.
00:37:23
Speaker
Sure. This is not something where you're just going in there willy nilly and pulling anything like they can see exactly what they're doing. They're working under really powerful microscopes. They've got all of these robotic kind micro instruments that they're working with.
00:37:37
Speaker
It looks like when you go in the lab when they're doing ICSI, it looks like they're playing video games. And I have to admit, I'm a little bit jealous because it just, it looks like so much fun.
00:37:49
Speaker
oh love it. And so, and and that's from, you know, back in my residency days when I was in training, I i did mouse embryology as one of my projects and was doing a lot of bench work. And i'm like, yeah.
00:38:01
Speaker
This is cool because you you go through and you you manipulate them And I was doing, you know, super low level stuff, but but they just very, very gently tease that out. And they're using lasers and they're they're being very discriminant.
00:38:16
Speaker
And what they're doing. And they want to get five to six cells out. And this is something where experience matters. Because when you send off to the PGT company, because this is not typically done in-house in any embryology lab. It requires special equipment, special expertise.
00:38:34
Speaker
You have to be a different level of anal retentive. And... And so it it happens for the most part in different places. There's not very many in-house genetics facilities anymore because the technology is just too big and too cool.
00:38:49
Speaker
And so you send it out and you're sending out just those five to six cells. Your embryo is going to stay frozen typically because you can't let it just sit in culture.
Genetic Testing Benefits and Counseling
00:38:57
Speaker
it It doesn't want to sit around for the couple of weeks that it's going to take to get these results back.
00:39:01
Speaker
You need to freeze it. So they send it off to the genetics lab and then they're going to take those five to six cells and they're going to amplify them. And it's kind of the equivalent of putting an original in the copy machine and having it spit out several thousand copies and then running your test on those copies so that you have enough material to get, get the information you need to get.
00:39:26
Speaker
Yeah. Okay. Okay. Yeah. No, that makes a ton of sense. That's super, that's super helpful. When, When it comes to, you know, counseling as to whether or not testing is something that you want to do I feel like maybe you've kind of already answered the question of like, we just want your odds to be know the best, but there can be some concern and yeah really just some personal preferences and and things like that. How, how does a, you know, how would you counsel your patients or how do you counsel your patients when it comes to that?
00:39:57
Speaker
So PGTA is always optional. There is no requirement to do it. I would say the advantages of getting PGTA results back are that you know what you have before you have it.
00:40:10
Speaker
And you know, do you have 46 chromosomes? Are they arranged appropriately? Do you have a male or a female, which sometimes people just prefer out of preference, but other times there are really solid genetic reasons why somebody wants...
00:40:24
Speaker
one or the other because of genes and traits that can be passed on the X chromosome that are going to really impact what the health of that child is. And so so, that information can be very valuable. The reason that is particularly valuable in women over 35 is because roughly I would say 50% higher of the eggs that are coming out are going to be abnormal.
00:40:50
Speaker
That is true no matter how young you look, how cute you are, how healthy you are, how many vegetables you eat in every day. That's always going to be true. And so we know that there's going to be abnormals. So we want to sort through them so that we're not spending time on them.
00:41:05
Speaker
And so it is particularly helpful when you've got somebody over the age of 35 because you can say, okay, I've got three embryos, but actually only one is normal. You want two kids. Let's do another retrieval now.
00:41:17
Speaker
Get the eggs out while you're as young as you're going to be and then move to transfer later when we have a better likelihood of being able to get to two babies in your family ultimately. Yeah.
00:41:28
Speaker
So family planning is one benefit. Avoiding ah need for a termination is another because sure many of these conditions are not survivable. The embryo just flat out won't implant or will miscarry.
00:41:40
Speaker
But there are a handful that are survivable. And... Down syndrome, Turner syndrome, Edwards, Pitot's, all of these things that are primarily an extra chromosome landing where it shouldn't.
00:41:52
Speaker
Those have really devastating consequences. My husband is a pediatric intensive care doc. So he takes care of super, super sick kids. And when he tells me about some of these genetically abnormal children who come in.
00:42:05
Speaker
They are on a ventilator. They don't have meaningful communication. They're not able to communicate with their caregivers. They're ah technology dependent to exist.
00:42:18
Speaker
And that that is a horrible position for a parent to be in. It's a horrible position for the child to be in. And when we can avoid many of those, it's really helpful, particularly with the the climate around termination of pregnancy right now.
00:42:34
Speaker
Sure. There are many places where having a termination of pregnancy or an abortion is just not accessible. And so in those cases, you you kind of want to keep yourself out of trouble before you get in.
00:42:44
Speaker
And PGT can be really valuable for that. And so those are a lot of the things that are really helpful about it. Now, PGT is not necessarily going to change the ultimate outcome, right? So if you've got three embryos and two of them are bad and one is good, let's say you transfer the first bad one and it's a negative test.
00:43:02
Speaker
You transfer the second bad one and it's miscarriage. You're still going to get to the third one and transfer it and have a baby. But what you go through to get there is going to be very different. And a lot of people have trauma going through the fertility process because they feel like their bodies failed them, they feel like they are broken, and they feel like it's their fault.
00:43:20
Speaker
And so having somebody go through all of those extra things, it won't necessarily change anything physically, but it's gonna leave a mark. And so if we can avoid some of those, it's really helpful because many people quit the IVF process when they still have embryos because they have lost hope, they have lost faith, they're out of money, they're frustrated, they just have thrown in the towel of this just isn't gonna happen for me. And if we can skip over that, it helps us to get to where we want
00:43:52
Speaker
faster. And I, I remember when I first started practicing it at fertility center of Las Vegas, I was having a conversation with this, our statistician who is an amazing numbers guy, but he was like, well, it's just a miscarriage. I'm like, there's nothing benign about a miscarriage.
00:44:07
Speaker
They hurt. And so if you can avoid them, There's, there are enough screwball things that happen with pregnancy and parenthood. Let's not add to it if we don't have to, because there's going to be plenty that happens that nobody's got control over. And so let's try and make the things that we do have control over a little bit gentler.
00:44:27
Speaker
Yeah, absolutely.
Limits of Genetic Testing
00:44:29
Speaker
When it, thinking back to, so again, kind of what you're typically testing for and, you know, all of those things there, you know, How much can an intended parent expect to, okay, i know i know that this is a great embryo genetically testing. And then maybe down the line, you find out, whoa, my kiddo has this you know rare heart disorder and you know things like that.
00:44:56
Speaker
So it's it's like it's a net to catch a lot of things, but it's not 100%.
00:45:02
Speaker
You got it. And I am so so glad you, you said that because it's not a hundred percent a couple ways. Number one, it's not a hundred percent in the results of the test. It's 98.5% roughly, or usually 95% or greater depending on the the type of platform that you're using, um which there are differences in those. And those differences are important.
00:45:22
Speaker
And, um and so that's, that's a whole conversation in and of itself. Right. But yeah, no test is 100%, even the absolute best ones. And so that includes PGT. So there's you know roughly a 1%-ish chance, at least using the platform that we use, that you're gonna get an abnormal result that's truly normal, or you're going to get a normal that's actually abnormal.
00:45:43
Speaker
Now, that happens very rarely, but it does. And so that's that's something to consider. Many of the other platforms that are out there allow for higher levels of mosaicism.
00:45:56
Speaker
And mosaicism is two cell lines. And so it means your result comes back and it's not totally normal. It's not totally abnormal, but it's not totally normal. And that is, and in general, it's a function of the test and how precise it is.
00:46:09
Speaker
And so when you get mosaics, there's a big discussion of, do we transfer this or do we not? And so that's one thing where you may be able to transfer a mosaic and get a baby. You also may be able to transfer a mosaic and have a negative pregnancy test, a miscarriage or an affected child.
00:46:23
Speaker
And so being intentional and thoughtful about that and talking to the genetics counselors is super important because that's going to be a very individualized discussion pending which chromosomes are affected.
00:46:36
Speaker
So you've you've got a mosaic with an extra 21, that's Down syndrome. Nobody's going to transfer that. Or it's going to be far harder to get that transferred for a variety of reasons. let's say you've got a missing chromosome two.
00:46:50
Speaker
All right, let's transfer it. Cause odds are, if this is real, it's not going to stick. And, and we just, you know, we're not going to have any long-term consequences of it in the same way as we would with a baby that can survive with a, you know, a significant problem. So that's, that's one area where this is not 100%. The other area where it's not a hundred percent is that,
00:47:09
Speaker
There is a ton you can pick up from chromosomes, but there's some stuff that doesn't exist yet. So like you said, the heart doesn't exist at the embryo stage. Eyes don't exist, the brain doesn't exist. like they They're not formed yet. And so you can't tell if that's gonna go awry because it doesn't exist. And so I always tell people, even with PGT, make sure that you are getting the genetic testing your OB is offering because nothing is perfect.
00:47:36
Speaker
The goal of all of this is information at a point where you can have the most options. And so get the genetic testing, get the anatomy scan, get all of those things, because if there's something that's picked up, you want to confirm it and you want to then be able to make a decision on it. Now, I do make my patients, especially my really anxious ones, solemnly swear that they will not freak out if they get an abnormal...
00:48:01
Speaker
non-invasive prenatal testing, the NIPT, like those, these tests are all designed to pick up the abnormality. The sin is to miss it. The sin is not to over call it. The sin is to miss it.
00:48:13
Speaker
And so the absolute next step in any of these things, if you have an abnormal NIPT, which is the testing that happens kind of towards the end of the first trimester, they're going to do a confirmatory test. And so I make people promise me that they will not freak out if they get an abnormal until they get the confirmatory test because Because the vast majority of the time, it's totally fine.
00:48:32
Speaker
It's just the test is designed to pick up anything. anything and And you want that. You want that information. But it is very anxiety provoking. For sure. For sure.
00:48:43
Speaker
So in situations where, okay, you've had all of this, you've had the PGT testing, you've had, you know, you've you've gotten all your embryos, you've gone through a series of transfers, things like that.
Deciding on Egg Donation or Surrogacy
00:48:54
Speaker
How do you counsel parents to know when, hey maybe it's time to look at a donor egg scenario or maybe surrogacy is the right step or both?
00:49:08
Speaker
huh How does that conversation there's, there's some hard and fast yeah parts of it. And then there's a lot of nuance to it. So the hard and fast things are the, the big obvious, like if you've got an intended parent who's 48 years old, she's going to need donor egg because yes, there will always be the news reports of that person here and there who conceived at a very late age, but the odds are it's not going to happen. And while we do deal in miracles, we work with statistics and
00:49:41
Speaker
And we want to work with probability. And I don't want to have to treat a thousand patients just to get that one 48 year old who's going to get a baby. I want the other 999 to have babies too. And most the time that's going to mean but donor in this case.
00:49:56
Speaker
So there's some of the obvious ones. Now there's the less obvious ones, the people who they stim and they just can't get embryos. The people who We get embryos, but they're just abnormal, abnormal, abnormal, abnormal. abnormal And they're running out of steam.
00:50:13
Speaker
They're just they're getting tired and they're frustrated and they don't want to to go that route. There are some people who we get to transfer and their embryo, their endometrium just will not thicken up. And a lot of times we'll do a test transfer and say, okay, you know, let's put this embryo in We know it's not ideal, but this is the best we can get. So let's see.
00:50:32
Speaker
and And sometimes that does work. But if you only have one embryo and you had to work really hard to get it, you may be more likely to say, okay, I need a surrogate because I can't take any chances with this embryo.
00:50:45
Speaker
there There are going to be people who have miscarriage after miscarriage after miscarriage. Some of them will find out that they have a uterine abnormality where the shape is not as it should be. And it's, it's abnormal in some way. And so I have a patient who she is absolutely wonderful. She's Mrs. Nevada and, um and her entire platform that she, she worked with at when she was her, her reigning queen year was you are not broken because, oh She went through multiple miscarriages. She has a heart-shaped uterus.
00:51:16
Speaker
All of this is public. I'm not giving up any secrets. No, for sure, for sure. But she ended up using a surrogate in order to to have her little girl because she just, her uterus was not involved. It was not wanting to cooperate. We could get her pregnant and then would just be lost again and again. And so she opted for a surrogate. And so there's a lot of personal in this. I have some people who, i have one woman who she went through two embryo transfers, a negative and a biochemical.
00:51:45
Speaker
And she was like, I cannot do this. I just, I absolutely can't do this because she had had a miscarriage before. And so she got a surrogate and then eight weeks later, she was pregnant with her own baby. Oh, wow. so she's going to have sorobaby and a child that she delivers within about eight weeks of each other.
00:52:03
Speaker
Power you, mama. Amen to that. She's the sweetest woman who makes the best pumpkin bread. um Her mom makes the best pumpkin bread, I should say. And so there's some of these things are hard and fast, and some of them are more nuanced. of Where is this couple? In the same way that some people, they need to skip over the minimal treatments. They need to go straight to IVF because they're just they're not in a place where they can handle...
00:52:27
Speaker
the difficulties and the, the really nasty potholes in the road to get to building their family. Right. Right. No, that makes, yeah, that makes a ton of sense.
00:52:39
Speaker
What's one thing you wish every patient or donor or even surrogate knew after the egg retrieval process?
Focus on Quality in IVF
00:52:55
Speaker
The numbers are going to go down. It's normal and it's expected and take a deep breath because we only need one. And that's beautiful. There's, uh, and all of us have stories of one follicle, one egg, one mature egg, one embryo, one baby. And while, yes, I would much rather have 20 follicles and 20 eggs.
00:53:18
Speaker
You know, it sometimes it just takes one. And so given the option, you know, I would love to not tell parents anything until the final number of this is your PGT tested embryo number.
00:53:31
Speaker
That is not realistic. Everybody wants to know all along the way. Right. Absolutely. But I think people put themselves through a lot of unnecessary pain and angst when they're agonizing over these numbers. Like I'll have somebody who's got 20 eggs and it goes down to five embryos.
00:53:47
Speaker
And I'm sitting here ecstatic because I've got five gorgeous embryos to work with. And they're upset because... It was 20 eggs. It was 20 eggs. Where did all those go? Why didn't they grow?
00:53:57
Speaker
And they, they didn't grow because they weren't supposed to grow. you know, something, something wasn't working about them and that's normal. And it's good that they fell off when they did so that we didn't invest in them and that we can put our energy in the ones that do. And so I think a lot of people have just a ton of angst about those numbers when,
00:54:19
Speaker
what they're watching is natural selection and process. And normally we don't get to see that, but in the IVF lab we do. Right. Right. No, that makes a ton of sense. If you could give just maybe one sentence of reassurance for someone feeling overwhelmed, no matter what stage you're in,
00:54:41
Speaker
I feel like when it comes to IVF, it's just, it's
Managing Decision Fatigue
00:54:45
Speaker
decisions. You get decision fatigue. You have to. Oh yes. Yeah. absolutely the route Is this the fork in the road? I mean, you get decision fatigue and it can feel so overwhelming.
00:54:54
Speaker
So if you could give any sort of, you know, just reassurance reassurance at any stage, what would that be? Just do the next best thing. Take, take the next step forward because If you can't move forward in any way, you're not getting anywhere.
00:55:13
Speaker
But if you can take one tiny step and get the entire database of donors down to a selection of 10. Mm-hmm. Then you can take the step after that and take 10 down to three and then three down to that one.
00:55:28
Speaker
And if you can take teeny tiny steps, there's, you know, the joke, how do you eat an elephant? One bite at a time. ah Right. How do you climb a mountain? One step at a time. it's It's true. You take, you just do the next best thing.
00:55:43
Speaker
And ah yes, I am stealing that from the lyrics of Frozen 2 that, ah that um Yeah. um Yes. No, absolutely. On an Olaf. No, what's up? 100%. And so it's, but it's, it's true. It is absolutely true. You have to just take that next little step. And I see so many people with analysis paralysis where they're trying to decide the entire course of treatment and their lives in one setting. And you don't need to do that.
00:56:14
Speaker
Yeah. There is a point at which you you truly have to trust your team because I know full well when I'm counseling someone, they can't look that far ahead. It doesn't matter how smart they are. They are in it. It is their family.
00:56:27
Speaker
It is them. There's a ton of emotions that they are having that their team has, but in a very different way because, and and i I know this for sure is true of my team and it's true of most other docs and their teams that I know of, we are all very invested.
00:56:44
Speaker
And so, no, it's not going to be the same as you, but when something doesn't go well, we feel that very acutely. And so we want to look at the big picture and say, all right, what do you need? So we will take care of a lot of that big picture stuff.
00:56:58
Speaker
And, and then we will just kind of inch you through, okay, this is the next thing that's going to happen. You know, you're, we're at the retrieval stage. You don't need to know all about the transfer stage right now. right and And there is a level of trust there. And there is a level of this team is doing the best thing for me.
00:57:15
Speaker
And there will always be times where we don't hit the mark for whatever reason. But it's very rarely from carelessness or a lack of trying or or thinking we're doing anything other than the best.
00:57:29
Speaker
And so there's a lot of trust that you have to put in the team of they're they're doing what they can to get that positive pregnancy test to get me where I need to
Trust in the Fertility Team
00:57:38
Speaker
be. Because Because I promise you, it's it's not just me that wakes up at 2 a.m. I have staff members coming to me going, I was thinking about this woman and I just, like, i'm I am awake at night thinking about whatever her circumstances are.
00:57:53
Speaker
And so we carry that with us and we are better able to distance from it and take an analytical look and go, okay, these are the pieces of chess that we need to move in the right direction to get you to checkmate where you want to be. Yeah.
00:58:10
Speaker
So no, I mean, yeah, that's I beautifully said because you're so right. It's, it takes a lot of trust to be a part of this process. And part of that trust is having trust in that team that you're building for all the way from your clinic, your agency, your donor, your surrogate, all of it requires that trust, but it's exactly like what you said that, that, that team is there.
00:58:40
Speaker
rooting for you, just rooting for you. And those decisions, yes, we can take a step back and kind of look at it in a more analytical way. i' But that emotion hasn't gone away. It's just not, it's just different.
00:58:57
Speaker
Yeah. Yeah. Very much so. Very much so. If I could figure out a way to put a hug in an email, I would. Oh, I know. I know. I think that's where I break down with like too many smiley faces and too many exclamation points.
00:59:08
Speaker
Cause I'm just like, I really just need for you to know that I'm cheering you on. Like it just yeah just really make it clear. Yes. Yes. You need to know that I'm there. You need to know that I'm feeling this too, even though I'm giving you a ton of additional technical information and all that. Like this is, it is not lost on me what you were going through.
00:59:24
Speaker
Yes, for sure. For sure. Dr. Carrie, I have one last question for you. And, you know, again, just thank you so much for taking something that is so
00:59:36
Speaker
detailed and complicated and can be so overwhelming and breaking it down for us. um My last question for you, and it's my favorite.
Dr. Bediant's Personal Reflections
00:59:44
Speaker
um You've seen me this whole time. I'm sipping on my ah my cup of coffee over here. Me and coffee, we have a beautiful relationship with each other. and um And I always love to ask the question, um what has filled your cup today? And I know it's morning, but what has filled your cup today, literally or figuratively? What's been the thing that has filled you up today?
01:00:08
Speaker
So I would say today i am most excited in a couple of days. My family and I are going on a trip. My mom is going with me. It's super low key. We're just going to hang out in a beautiful place. And i am i am so excited about the opportunity to just...
01:00:26
Speaker
chill with my people and, and play card games and go look for shells and things like that. And so that's, that's really what I am very excited about right now and what is keeping me going.
01:00:41
Speaker
Oh, for sure. Just getting to getting to have some simple time. ah Very much. Very much. My goal is to turn off all the technology and avoid it as much as possible for week.
01:00:53
Speaker
Absolutely. No, for sure. For sure. And yeah i very deserved. Very deserved. No, that's fantastic. I'm so excited for you and your family to get to have that. Well, again, thank you
Promoting 'Fertility Docs Uncensored' and Upcoming Projects
01:01:04
Speaker
so much. um And if you want to hear more from Dr. Carey, you can check out her podcast um with two other docs, Fertility Docs Uncensored. um And then exciting, you guys have a book coming out, The IVF Blueprint, Everything You Need to Know About In-Vitro Fertilization, Egg Freezing, and Embryo Transfer, and that
01:01:26
Speaker
comes out September 23rd, but you can order it now. yeah Is there anything? so it's going to break it all down for us. It's very much breaking it down in a way that is digestible, achievable for to lay people who have no medical experience to understand.
01:01:42
Speaker
It's divided into four sections, the the prep, the retrieval phase, the transfer, and what happens after. And then the last section is really focused on egg donation, egg freezing, surrogacy, sperm donation, the reasons that you do IVF that aren't for fertility, like some of the genetic things, um all of the the other circumstances that people go through fertility treatment for. And so we took a lot of time and care in making sure that it's it's technical enough to get you the information you need, but it's presented in such a way that you don't want to just ah use it as a doorstop.
01:02:18
Speaker
ah Yeah. It's not a textbook. It's not textbook. It's not going to, it's not going to gather dust. And so right we really wanted it to be something that somebody could just grab, shove in her purse and have it be a comfort object so almost as she's going through this process. So she's got,
01:02:35
Speaker
something to flip open and go, oh my God, they just told me what, like, why can i how do I do this? What do I do? how do I not freak out and And knowing what to expect is very helpful because uncertainty is what drives really a lot of us over the edge and having an idea what to expect is helpful. And so we wanted to do that because there's no way that any one physician appointment can explain everything. And this is really the first definitive authoritative guide that's written by multiple physicians vetted across multiple systems.
01:03:06
Speaker
to break down just the IVF process from start to finish. That is awesome. That is so, so exciting. Well, i'm thank you again. i super appreciate you and everything you do. um And yeah, just, and again, if you want to go hear more from Dr. Carey um and her cohorts, it's fertility or yeah, fertility docs uncensored.
01:03:28
Speaker
So thank you so much, Dr. Carey. Thank you so much for having me. This is a lovely way to start my day. The best, the best.