Podcasts about Sterility

It began with a disagreement, and it led to the near total decimation of life on Earth. Those who survived hoped to rebuild society, but they faced foes in the forms of sterility and mutant frogpeople. Then came Sam Hell, and where he came was to Frogtown, and we won't touch the other obvious play on that verb. We're talking about the First Roddy Piper Lead Film Role... 1988's Hell Comes To Frogtown! And don't worry, there's a flap. We also recast the film in the MouthGarf Report and we see what each other did there in I See What You Did There! Plus, MEAT BEEF!Please give us a 5 star rating on Apple Podcasts! Want to ask us a question? Talk to us! Email debutbuddies@gmail.comListen to the archives of Kelly and Chelsea's awesome horror movie podcast, Never Show the Monster.Get some sci-fi from Spaceboy Books.Get down with Michael J. O'Connor's music!Next time: First Baseball Walk-Up Song

Fertility & Sterility on Air is at the Pacific Coast Reproductive Society 2025 Annual Meeting in Indian Wells, CA! In this episode, our hosts Kate Devine and Micah Hill talk with: PCRS leadership Alexander Quaas and Jason Franasiak discussing this and future conferences (0:41), Shannon Rainsford about Protamine 2 deficiency (9:54), Andria Besser about mosaic and segmental PGT-A results (16:15), Emily Patterson about comprehensive carrier screening (28:35), Esther Chung about a low-cost progestin protocol for oocyte cryopreservation (32:23) and Howard Li discussing the feasibility of microwave drying for long-term storage of human oocytes at non-freezing temperatures (41:28). View Fertility and Sterility at https://www.fertstert.org/  

Join current F&S editors Drs. Micah Hill, Kurt Barnhart, and Allison Eubanks in an engaging discussion with past Editors-in-Chief, Drs. Alan DeCherney, Craig Niederberger, and Antonio Pellicer!  View Fertility and Sterility at https://www.fertstert.org/  

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   02:17 Effects of preimplantation genetic testing for aneuploidy on embryo transfer outcomes in women of advanced reproductive age with no more than three retrieved oocytes 15:30 Using National IVF Registries to Validate Clinical Outcomes Following IVF Covered by Health Insurance  29:38 Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort 39:15 Systematic review and Meta-analysis of the impact of the re-freezing and re-biopsy embryos on reproductive outcomes in patients undergoing freeze-thaw embryo transfer   50:20 A blastocyst's implantation potential is linked to its originating oocyte cohort's blastulation rate: evidence for a cohort effect 01:02:56 Linzagolix rapidly reduces heavy menstrual bleeding in women with uterine fibroids: An analysis of the PRIMROSE 1 & 2 trials  View Fertility and Sterility at https://www.fertstert.org/

Join us for a special episode of F&S On Air: an interview discussing the seminal article, "Target trial emulation of preconception serum vitamin D status on fertility outcomes: a couples-based approach." Host Micah Hill interviews authors Julia DiTosto and Sunni Mumford. Read the article:  https://www.fertstert.org/article/S0015-0282(24)01963-0/fulltext View Fertility and Sterility at https://www.fertstert.org/

Take a sneak peak at this month's Fertility & Sterility! Articles discussed this month are:   4:08 Classification system of human ovarian follicle morphology: recommendations of the National Institute of Child Health and Human Development - sponsored ovarian nomenclature workshop  12:32 Impact of Prednisone on Vasectomy Reversal Outcomes (iPRED Study): Results from a Randomized, Controlled Clinical Trial 21:38 Triggering oocyte maturation in IVF treatment in normal responders: a systematic review and network meta-analysis 33:57 Parental Balanced Translocation Carriers do not have Decreased Usable Blastulation Rates or Live Birth Rates Compared to Infertile Controls  45:28 A re-look at the relevance of TSH and thyroid autoimmunity for pregnancy outcomes: Analyses of RCT data from PPCOS II and AMIGOS View Fertility and Sterility May 2025, Volume 123, Issue 5:  https://www.fertstert.org/issue/S0015-0282(25)X0004-2 View Fertility and Sterility at https://www.fertstert.org/

Fertility & Sterility on Air brings you a panel discussion from Best of ASRM and ESHRE 2025. Join our host, Dr. Eve Feinberg and the following panelists:  Aleks Rajkovic - 01:04 Henriette Nielsen - 10:09 Thomas Ebner/Sangita Jindal - 20:20 Angela Lawson - 29:24 Antonio Capalbo/Catherine Racowsky - 46:24 Herman Tournaye - 01:02:00

Fertility & Sterility on Air brings you a panel discussion from AAGL 2024 in New Orleans, LA! We bring you a joint episode with ASRM and the American Association of Gynecologic Laparoscopists. Join Pietro Bortoletto, Rebecca Flyckt, Zaraq Khan, and Charles Miller discussing management of endometriosis and adenomyosis from the eyes of the reproductive surgeon. View Fertility and Sterility at https://www.fertstert.org/  

In this micro-episode, we bring you an interview with Richard Paulson and Pierre Comizzoli, editors of the F&S Reports Special Issue, “Bridging Studies in Wild Animal Species and Humans to Better Understand, Assist, and Control Reproduction." Join us to discuss the connection between wild animal research and reproductive medicine. This interview provides an overview of this special issue, which is a series of articles in F&S Reports on topics ranging from koala reproduction to rhino ovarian tissue cryopreservation, from the microbiome to stem cells. View F&S Reports, April 2025, Volume 6, Supplement 1S1-66:  https://www.fertstertreports.org/issue/S2666-3341(25)X0003-9 View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

In this month's Fertility & Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include: how attacks on abortion access can threaten IVF (1:58), the prevalence of adenoymosis in young people (12:58), and the impact of short-term Western-style diet and hyperandrogenism on ovarian function (26:02). Consider This: https://www.fertstert.org/news-do/writing-wall-ivf-access-could-follow-abortion-s-path F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00040-9/fulltext F&S Science: https://www.fertstertscience.org/article/S2666-335X(25)00021-7/abstract View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

"Let us know what you think about this episode"We dive deep into the evidence behind aspirin use during pregnancy, examining why fertility clinics recommend it and how to weigh the risks and benefits of this common intervention. The podcast explores low-dose aspirin's role in improving blood flow to the placenta, potentially preventing complications for mothers with specific risk factors.• Low-dose aspirin (81mg) works by preventing tiny blood clots and reducing inflammation• Studies show aspirin may reduce preeclampsia risk by 24% in high-risk pregnancies when started before 16 weeks• Particularly beneficial for women with recurrent pregnancy loss, preeclampsia risk, or undergoing fertility treatments• Potential risks include increased bleeding during delivery, rare placenta abruption, and stomach irritation• Decision to use aspirin must be individualized and made with healthcare provider guidance• Important to question routine interventions and understand the specific reasoning behind recommendationsRemember, the best decisions are made with knowledge, care, and your unique circumstances in mind. If you found this episode helpful, please share it with a friend, leave a review, or subscribe for more evidence-based conversations about pregnancy and motherhood.Shownotes:Links to Studies:The Lancet - https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(24)00341-7/abstract?utmFertility & Sterility - https://www.fertstert.org/article/S0015-0282%2805%2900221-9/fulltext?utm

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   01:47 Puberty progression in girls with Turner syndrome after ovarian tissue cryopreservation 14:55 Optimal Restoration of Spermatogenesis following Testosterone Therapy using hCG and FSH 27:58 Human embryos with segmental aneuploidies display delayed early development: a multi-centre morphokinetic analysis 39:56 Neurodevelopmental or behavioural disorders in children conceived after assisted reproductive technologies: A nationwide cohort study 45:23 Efficacy and safety of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg combination in a cyclic regimen for the treatment of primary and secondary dysmenorrhea: A multicenter, placebo-controlled, double-blind, randomized study 51:13 Ovulation trigger versus spontaneous LH surge on live birth rate following frozen embryo transfer in a natural cycle: a randomized controlled trial 60:29 A Cost Analysis of Clomiphene Citrate, Letrozole and Gonadotropin with Intrauterine Insemination using Outcome Data from the AMIGOS Trial   View Fertility and Sterility at https://www.fertstert.org/

Join us each week as we do a quick review of three compelling stories from the pharma world — one good, one bad, and one ugly. Up this week: The good — Cellares, Cabaletta validate automated CAR T production The bad — FDA warns Aspen over sterility issues The ugly — FDA rejects Hengrui, Elevar cancer combo again

Sterility assurance isn't just another checkbox in our workflows—it's a commitment to excellence! In this episode of Beyond Clean Canada, we're breaking down the critical steps of equipment, exposure, pack, and load monitoring—where errors can happen and how to prevent them. With high turnover rates in MDR departments, Leeanne Ismail, Clinical Specialist at Solventum, stresses the need for ongoing education, industry collaboration, and forward-thinking solutions to maintain the highest patient safety standards. She also shares how advancements in sterilization technology are shaping the future of reprocessing and quality assurance. So, turn up the volume and join this can't-miss conversation today! A special shout-out to Solventum for sponsoring Season 1 of the Beyond Clean Canada Podcast! Make sure to follow us on LinkedIn and Facebook so you're always in the loop for every episode! #BeyondCleanCanada #MDR #SterileProcessing #EveryLoadMonitoring #Safety #Podcast #Solventum

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   01:46 It is time to rethink coordination of fresh oocyte retrievals with microscopic testicular sperm extraction 02:55 Rescue intracytoplasmic sperm injection improved cumulative live birth rate for cycles with second polar body extrusion rate

SpaceTime Series 28 Episode 29The Astronomy, Space and Science News PodcastExploring Callisto's Ocean Potential, Laser Fossil Detection on Mars, and ISS Cleanliness ConcernsIn this episode of SpaceTime, we dive into exciting new research suggesting that Jupiter's moon Callisto may harbor a subsurface ocean, potentially making it another ocean world in our solar system. This revelation builds on data from NASA's Galileo spacecraft, which hinted at the presence of a salty liquid water ocean beneath Callisto's icy crust. Advanced modeling techniques have strengthened these claims, setting the stage for further exploration by NASA's Europa Clipper and ESA's Juice missions.Lasers on Mars: Searching for Ancient LifeWe also discuss innovative research that proposes using lasers to identify ancient microbial fossils on Mars. Scientists have successfully detected microbial fossils in gypsum on Earth, raising hopes that similar techniques could uncover evidence of past life on the Red Planet. The findings suggest that gypsum deposits on Mars could conceal traces of ancient life, preserved in mineral formations that formed when water evaporated billions of years ago.Health Implications of Sterility on the ISSAdditionally, we explore a new study indicating that the overly sterile environment of the International Space Station may be negatively impacting astronaut health. The research suggests that introducing a diverse range of microbes could potentially alleviate immune dysfunction and other health issues experienced by crew members during long missions in space.00:00 Space Time Series 28 Episode 29 for broadcast on 7 March 202500:49 New findings on Callisto's potential subsurface ocean06:30 Implications for future missions to Jupiter's moons12:15 Using lasers to detect ancient life on Mars18:00 Analysis of gypsum deposits and their significance22:45 Concerns regarding ISS cleanliness and astronaut health27:00 Overview of March's night sky and celestial events30:15 Celebrating PI Day and its significance in astronomywww.spacetimewithstuartgary.comwww.bitesz.com

Send us a textThe two-week wait after fertility treatment can feel endless, but what if a single blood test could give you insight into your pregnancy's future? In this episode of Taco Bout Fertility Tuesday, we break down the science behind hCG levels at 16 days post-ovulation and how they predict pregnancy outcomes. We'll discuss the role of hCG beyond just a pregnancy test, how it rescues the corpus luteum to sustain early pregnancy, and why progesterone supplementation changes how miscarriages present in fertility treatments. Plus, we analyze a key study from Fertility & Sterility (2000) to understand how different hCG levels correlate with pregnancy success or loss. Whether you're in the midst of an IVF cycle or just love diving into the science of fertility, this episode is packed with valuable insights. Tune in to learn what your hCG levels really mean and how to interpret them with your doctor!Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   01:03 (Not) My body, my choice? - Should physicians be facilitating gestational carrier arrangements in the absence of medical indication? 05:22 Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound 12:17 Hormone-free vs. follicle-stimulating hormone–primed infertility treatment of women with polycystic ovary syndrome using biphasic in vitro maturation: a randomized controlled trial 24:37 Association of in vitro fertilization with severe maternal morbidity in low-risk patients without comorbidities 33:59 The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort (Canadian Longitudinal Study on Aging) 41:28 Target trial emulation of preconception serum vitamin D status on fertility outcomes: a couples-based approach 52:59 Predicting a successful match among applicants to reproductive endocrinology and infertility fellowship View Fertility and Sterility February 2025, Volume 123, Issue 2:https://www.fertstert.org/issue/S0015-0282(24)X0015-1 View Fertility and Sterility at https://www.fertstert.org/

Take a sneak peek at this month's Fertility and Sterility! Articles discussed this month are:   02:59 Preimplantation genetic testing for aneuploidy is associated with reduced live birth rates in fresh but not frozen donor oocyte in vitro fertilization cycles: an analysis of 18,562 donor cycles reported to Society for Assisted Reproductive Technology Clinic Outcome Reporting System 19:37 Sperm concentration remains stable among fertile American men: a systematic review and meta-analysis 26:02 Preovulation body mass index and pregnancy after first frozen embryo transfer in patients with polycystic ovary syndrome and insulin resistance 36:54 A retrospective comparison of the impact of industry payments on assisted reproductive technology practice and outcomes 44:55 Preimplantation genetic testing for aneuploidy in unexplained recurrent pregnancy loss: a systematic review and meta-analysis 61:03 Initiation and outcomes of women pursuing planned fertility preservation 65:49 First successful ovarian cortex allotransplant to a Turner syndrome patient requiring immunosuppression: broad implications   View Fertility and Sterility October 2025, Volume 123, Issue 1: https://www.fertstert.org/issue/S0015-0282(24)X0014-X View Fertility and Sterility at https://www.fertstert.org/

On this episode of the Spot Radio Podcast, host Charlie Webb CPPL sits down with Elon Goldbaum from the Network Partner Group to delve into the intricacies of performing a Corrective and Preventive Action (CAPA). They discuss the framework that underpins the CAPA process, highlighting its crucial role in ensuring product quality and compliance in the medical device industry.Charlie and Elon explore the vital importance of the CAPA process, shedding light on how it helps organizations identify, address, and prevent potential issues. They also share valuable tips and strategies to make the CAPA process more manageable and effective, ensuring that businesses can maintain high standards of safety and quality.Tune in to gain insights from industry experts and learn practical advice that can be applied to your own CAPA initiatives. This episode is a must-listen for anyone involved in quality assurance, regulatory affairs, or medical device manufacturing.About our guest:As Vice President, Client Solutions for Network Partners Group, Elon (Lon) brings over 20 years of experience in the medical device field specializing in packaging, labeling, quality management systems, CAPA and sterilization. Lon's multifaceted background provides support and leadership to Network Partners' packaging consulting, quality assurance, labeling, and the Apprentice Leadership Program.Prior to joining Network Partners, Lon held various roles with Baxter Healthcare, Edwards Lifesciences, Endologix and Danaher with a wide range of responsibilities. Lon earned his Bachelor of Science degree in Packaging from Michigan State University.Elon Goldbaum e-mail: elon.goldbaum@onenpg.com

Take a sneak peek at this month's Fertility and Sterility! Articles discussed this month are:   01:48 Trustworthiness criteria for meta-analyses of randomized controlled studies: OBGYN journal guidelines 06:24 Playing the long game for reproductive rights 08:04 Limiting the number of fresh donor oocytes inseminated with sperm as a strategy to minimize supernumerary embryos 15:38 Effectiveness of degradable polymer film in the management of severe or moderate intrauterine adhesions (PREG-2): a randomized, double-blind, multicenter, stratified, superiority trial 26:37 Aneuploidy rates and likelihood of obtaining a usable embryo for transfer among in vitro fertilization cycles using preimplantation genetic testing for monogenic disorders and aneuploidy compared with in vitro fertilization cycles using preimplantation genetic testing for aneuploidy alone 38:13 Antimüllerian hormone levels are associated with time to pregnancy in a cohort study of 3,150 women 47:50 Racial disparities in the outcomes of euploid single frozen-thawed embryo transfer cycles – analysis of the Clinical Outcome Reporting System of the Society for Assisted Reproductive Technology 2016–2018 data 57:14 No association between celiac disease and female infertility: evidence from Mendelian randomization analysis   View Fertility and Sterility October 2024, Volume 122, Issue 6:  https://www.fertstert.org/issue/S0015-0282(24)X0013-8 View Fertility and Sterility at https://www.fertstert.org/  

Take a sneak peek at this month's Fertility and Sterility! Articles discussed this month are:   04:20 LGBTQ+ family building: progress but lots more to do/Therapeutic donor insemination for LGBTQ+ families: a systematic review 09:52 Confirmation and pathogenicity of small copy number variations incidentally detected via a targeted next-generation sequencing-based preimplantation genetic testing for aneuploidy platform 23:40 Trends and outcomes of fresh and frozen donor oocyte cycles in the United States 34:11 A survey study evaluating donor gamete utilization rates, patient satisfaction, and fertility treatment outcomes according to desired race and ethnicity 39:29 Racial and ethnic disparities in wait times for donor oocytes 41:16 Return rates and pregnancy outcomes after oocyte preservation for planned fertility delay: a systematic review and meta-analysis 49:23 Longer duration to optimal endometrial thickness in women with premature ovarian insufficiency is associated with clinical pregnancy rate in donor egg cycles 56:30 Feasibility and efficacy of a subcutaneous catheter for controlled ovarian stimulation 01:00:23 International Committee for Monitoring Assisted Reproductive Technology world report: assisted reproductive technology, 2015 and 2016 View Fertility and Sterility October 2024, Volume 122, Issue 5:  https://www.fertstert.org/issue/S0015-0282(24)X0012-6 View Fertility and Sterility at https://www.fertstert.org/

In this month's Fertility & Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include: a review of segmental aneuploidies and mosaicism (2:00), early removal of zona pellucida to improve embryo fragmentation (18:12), inflammatory markers in female infertility (31:53), and debating the role of adult content in collection rooms (44:51). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00039-2/abstract F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00092-8/fulltext F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00078-8/abstract Consider This: https://www.fertstert.org/news-do/providing-adult-material-fertility-clinics-antiquated-and-nonessential View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

3 sections- series of potential solutions to cure jaundice, when allowed/not to drink "kos shel ikarin " that causes sterility, using vinegar on Shabbos for toothache or smears for loin-pain

3 sections- series of potential solutions to cure jaundice, when allowed/not to drink "kos shel ikarin " that causes sterility, using vinegar on Shabbat for toothache or smears for loin-pain

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   03:06 Embryos derived from single pronucleus are suitable for preimplantation genetic testing 09:59 Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia 24:46 Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective 32:14 Minimum number of mature oocytes needed to obtain at least one euploid blastocyst according to female age in in vitro fertilization treatment cycles 40:02 In vitro fertilization and perinatal outcomes of patients with advanced maternal age after single frozen euploid embryo transfer: a propensity score-matched analysis of autologous and donor cycles 46:57 Imprinting disorders in children conceived with assisted reproductive technology in Sweden View Fertility and Sterility October 2024, Volume 122, Issue 4:  https://www.fertstert.org/issue/S0015-0282(24)X0010-2 View Fertility and Sterility at https://www.fertstert.org/  

Fertility and Sterility On Air brings you the best of ASRM 2024! In Part 1, our hosts bring you: in vitro maturation with Christian Kramme (1:40), uterine transplant data updates with Leigh Ann Humphries (9:21), novel characterization of ploidy abnormalities with Ludovica Picchetta (21:50), maternal age and euploid transfer success with Philip Romanski (24:45), ultrasound assessment of ovarian stiffness to evaluate reproductive aging with Elnur Babayev (32:45), cost effectiveness of PGT-A in good prognosis patients with Ariel Dunn and Josh Combs (42:33), long-term follow up of oocyte donors with Jerrine Morris (51:16), and combining platforms to improve identifiation of mosaic embryos with Christopher Weier (58:28). View Fertility and Sterility at https://www.fertstert.org/  

Fertility and Sterility On Air brings you the best of ASRM 2024! In Part 2, our hosts bring you: home semen testing with Dan Greenberg (0:40), state insurance mandates for fertility coverage with Adeola Adeyeye (7:13), resource utilization difference between programmed and natural transfers with Ben Peipert (12:23), patient perspectives on embryo donation with Deb Roberts (21:37), corpus lutea and preeclampsia risk after embryo transfer with David Huang (35:02), exercise during stimulation with Maren Shapiro (40:57), combination of letrozole and clomiphene with Rachel Mejia and Jessica Kresowik (49:07), the impact of Alabama's personhood bill with David Monroe (54:06), and embryo quality and polygenic risk with Jordan O'Donnell (58:40). View Fertility and Sterility at https://www.fertstert.org/  

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   02:17 In vitro fertilization practice in patients with absolute uterine factor undergoing uterus transplant in the United States 21:22 Classification and treatment of vaginal strictures at the donor-recipient anastomosis after uterus transplant 31:18 Impact of time interval from cesarean delivery to frozen embryo transfer on reproductive and neonatal outcomes 37:37 Multiplexed serum biomarkers to discriminate nonviable and ectopic pregnancy 50:20 Urinary benzophenone-3 concentrations and ovarian reserve in a cohort of subfertile women 53:38 Assessment of pregnancy outcomes in donor oocyte thaw cycles comparing fresh embryo transfer to cryopreserved-thawed embryo transfer: a sibling oocyte study View Fertility and Sterility September 2024, Volume 122, Issue 3:https://www.fertstert.org/issue/S0015-0282(24)X0009-6 View Fertility and Sterility at https://www.fertstert.org/  

In today's Egg Whisperer Show Podcast, I'm so excited to be joined by Dr. Paula Amato. She is a fertility specialist who froze embryos in her 30s using sperm from an anonymous donor. Later, Dr. Amato decided to donate her embryos. She shared about this journey and what she learned as a fertility doctor in a recent article published in Fertility and Sterility titled: "The fertile window: what donating my embryos taught me about being a fertility doctor." We're going to talk all about her decision to donate her embryos, what looking into the genetics of those embryos taught her, and what she learned from the process. It's an amazing story, and it's interesting to hear a fertility specialist talk about her experience as both a doctor, and a patient. Dr. Paula Amato is a Professor of Obstetrics and Gynecology, at the Oregon Health & Science University School of Medicine in Portland, Oregon. She also is a Reproductive Endocrinology & Infertility Specialist and has over 33 years of experience in the medical field. She graduated from University of Toronto medical school, and did her fellowship at UC San Diego. Thank you for joining me, Paula!   Read the full show notes on Dr. Aimee's website. You can read her article here: https://www.fertstert.org/article/S0015-0282(21)02289-5/fulltext Would you like to learn about IVF?Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, April 22, 2024 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom. Listen to this episode on Dr. Aimee's website. Subscribe to my YouTube channel for more fertility tips! Subscribe to the newsletter to get updates  Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.

In this month's Fertility & Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include: mechanical contractions and fibroid progression (2:22), endometriosis classification and risk of infertility (15:15), the roles of endometrial and mesothelial cells in endometriosis formation (29:36), and fertility coverage for military personnel (43:30). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00036-7/fulltext F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00090-4/fulltext F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00053-3/fulltext Consider This: https://www.fertstert.org/news-do/building-family-while-serving-our-nation   View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Dr Hernandez Rey specializes in treating patients with polycystic ovary syndrome (PCOS), recurrent pregnancy loss (miscarriage), and severe endometriosis. He is especially interested in fertility preservation (egg freezing) for patients who must delay childbearing for personal or medical reasons, including cancer and systemic lupus erythematosus. As one of only two fertility specialists offering robotic surgery in Miami, Dr. Hernandez-Rey is able to offer minimally invasive surgeries with faster recovery times and minimal scarring, often as an alternative to advanced treatments such as IVF. He has performed numerous tubal reanastomosis procedures (tubal ligation reversal), myomectomies (removal of fibroids), and surgery for severe cases of endometriosis for the management of infertility.Dr. Hernandez-Rey has made dreams come true for hundreds of families from South Florida and across the world. He prides himself on being accessible to his patients to ensure they are calm and reassured, a key component to his success. Dr. Hernandez-Rey is an assistant clinical professor at the Herbert Wertheim College of Medicine at Florida International University and serves as an ad-hoc reviewer for the prestigious peer-reviewed journal, Fertility and Sterility.

In this month's Fertility & Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include: radiofrequency ablation of fibroids (3:00), an opinion piece on testing embryos to reduce type 1 diabetes risk (17:42), preeclampsia risk with abnormal semen analysis (29:34), and a review of PCOS and miscarriage (44:33). F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00078-3/fulltext Consider This: https://www.fertstert.org/news-do/preimplantation-genetic-testing-type-1-diabetes F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00055-7/abstract F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00035-5/abstract#:~:text=Some%20studies%20have%20suggested%20an,receptivity%2C%20and%20the%20uterine%20environment View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Take a sneak peak at this month's Fertility & Sterility! Articles discussed this month are:   04:19 Assessment of obstetric characteristics and outcomes associated with pregnancy with Turner syndrome 13:55 Effect of postthaw change in embryo score on single euploid embryo transfer success rates 22:38 Effectiveness of preconception weight loss interventions on fertility in women: a systematic review and meta-analysis 37:17 Functional evidence for two distinct mechanisms of action of progesterone and selective progesterone receptor modulator on uterine leiomyomas 43:47 Predicting risk of endometrial failure: a biomarker signature that identifies a novel disruption independent of endometrial timing in patients undergoing hormonal replacement cycles 54:28 Analysis of factors affecting the prognosis of patients with intrauterine adhesions after transcervical resection of adhesions 01:05:29 Effects of a eucaloric high-fat diet on anterior pituitary hormones and adipocytokines in women with normal weight View Fertility and Sterility August 2024, Volume 122, Issue 2: https://www.fertstert.org/issue/S0015-0282(24)X0008-4 View Fertility and Sterility at https://www.fertstert.org/  

Fertility and Sterility On Air brings you the best of ESHRE 2024! In Part 2, hosts Micah Hill, Paul Pirtea, and Kate Devine bring you: progesterone levels in a randomized controlled trial with long-acting FSH with Annalisa Racca (01:19), live birth of day 7 embryo transfers with Marcela Colonge and Nicolas Garrido (10:57), an ICSI vs conventional IVF randomized controlled trial with Sine Berntsen and Nina la Cour Freiesleben (17:17), limitations of reporting mosaicism in PGT-A with Dhruti Barbariya and Antonio Capalbo (27:15), interview with ASRM president Paula Amato and president-elect Elizabeth Ginsburg (32:41), and ovarian aging with Kutluk Oktay (45:17).   View Fertility and Sterility at https://www.fertstert.org/  

Fertility and Sterility On Air brings you the best of ESHRE 2024! In Part 1, hosts Micah Hill, Paul Pirtea, and Kate Devine bring you: embryo reexpansion and live birth with Ibrahim Elkhatib (01:30), a discussion with the RBMO editor, Nick Macklon, and F&S editor, Kurt Barnhardt, about “IVF add-ons” (11:21), rescue in vitro maturation with Danilo Cimadomo (24:43), discussion with F&S On Air listener Elizabeth Glanville (31:38), one side of the debate on dual/double triggers with Raoul Orvieto (35:27), and cross-border reproductive care for same-sex male intended parents with Brent Monseur (48:59).  View Fertility and Sterility at https://www.fertstert.org/  

Presented in partnership with Fertility and Sterility onsite at the 2024 ANZSREI meeting in Sydney, Australia.  The ANZSREI 2024 debate discussed whether patients with unexplained infertility should go straight to IVF. Experts on both sides weighed the effectiveness, cost, and psychological impact of IVF versus alternatives like IUI. The pro side emphasized IVF's high success rates and diagnostic value, while the con side argued for less invasive, cost-effective options. The debate highlighted the need for individualized care, with no clear consensus reached among the audience. View Fertility and Sterility at https://www.fertstert.org/ TRANSCRIPT: Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussion with authors, and other special features. F&S On Air is brought to you by Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, and Dr. Pietro Bordoletto, Interactive Associate-in-Chief. I'd just like to say welcome to our third and final day of the ANZSREI conference. We've got our now traditional F&S podcast where we've got an expert panel, we've got our international speaker, Pietro, and we've got a wonderful debate ahead of us. This is all being recorded. You're welcome, and please think of questions to ask the panel at the end, because it's quite an interactive session, and we're going to get some of the best advice on some of the really controversial areas, like unexplained infertility. Hi, everyone. Welcome to the second annual Fertility and Sterility Journal Club Global, coming to you live from the Australia and New Zealand Society for Reproductive Endocrinology and Infertility meeting. I think I speak on behalf of everyone at F&S that we are so delighted to be here. Over the last two years, we've really made a concerted effort to take the podcast on the road, and this, I think, is a nice continuation of that. For the folks who are tuning in from home and listening to this podcast after the fact, the Australia and New Zealand Society for Reproductive Endocrinology is a group of over 100 certified reproductive endocrinologists across Australia and New Zealand, and this is their annual meeting live in Sydney, Australia. Today's debate is a topic that I think has vexed a lot of individuals, a lot of patients, a lot of professional groups. There's a fair amount of disagreement, and today we're going to try to unpack a little bit of unexplained infertility, and the question really is, should we be going straight to IVF? As always, we try to anchor to literature, and there are two wonderful documents in fertility and sterility that we'll be using as our guide for discussion today. The first one is a wonderful series that was published just a few months ago in the May issue, 2024, that is a views and reviews section, which means there's a series of three to five articles that kind of dig into this topic in depth. And the second article is our professional society guideline, the ASRM Committee Opinion, entitled Evidence-Based Treatments for Couples with Unexplained Infertility, a guideline. The format for today's discussion is debate style. We have a group of six experts, and I've asked them to randomly assign themselves to a pro and a con side. So I'll make the caveat here that the things that they may be saying, positions they may be trying to influence us on, are not necessarily things that they believe in their academic or clinical life, but for the purposes of a rich debate, they're going to have to be pretty deliberate in convincing us otherwise. I want to introduce my panel for today. We have on my immediate right, Dr. Raewyn Tierney. She's my co-moderator for tonight, and she's a practicing board-certified fertility specialist at IVF Australia. And on my immediate left, we have the con side. Going from left to right, Dr. Michelle Quick, practicing board-certified fertility specialist at IVF Australia. Dr. Robert LaHood, board-certified reproductive endocrinologist and clinical director of IVF Australia here in Sydney. And Dr. Clara Bothroyd, medical director at Care Fertility and the current president of the Asia Pacific Initiative in Reproduction. Welcome. On the pro side, going from right to left, I have Dr. Aurelia Liu. She is a practicing board-certified fertility specialist, medical director of Women's Health Melbourne, and clinical director at Life Fertility in Melbourne. Dr. Marcin Stankiewicz, a practicing board-certified fertility specialist and medical director at Family Fertility Centre in Adelaide. And finally, but certainly not least, the one who came with a tie this morning, Dr. Roger Hart, who is a professor of reproductive medicine at the University of Western Australia and the national medical director of City Fertility. Welcome, pro side. Thank you.  I feel naked without it. APPLAUSE I've asked both sides to prepare opening arguments. Think of this like a legal case. We want to hear from the defence, we want to hear from the plaintiffs, and I'm going to start with our pro side. I'd like to give them a few minutes to each kind of introduce their salient points for why we should be starting with IVF for patients with unexplained infertility. Thanks, Pietro. To provide a diagnosis of unexplained infertility, it's really a reflection of the degree investigation we've undertaken. I believe we all understand that unexplained infertility is diagnosed in the presence of adequate intercourse, normal semen parameters, an absence ovulatory disorder, patent fallopian tubes, and a normal detailed pelvic ultrasound examination. Now, the opposing team will try to convince you that I have not investigated the couple adequately. Personally, I'm affronted by that suggestion. But what possible causes of infertility have I not investigated? We cannot assess easily sperm fertilising capability, we cannot assess oocyte quality, oocyte fertilisation potential, embryonic development, euploidy rate, and implantation potential. Surely these causes of unexplained fertility will only become evident during an IVF cycle. As IVF is often diagnostic, it's also a therapeutic intervention. Now, I hear you cry, what about endometriosis? And I agree, what about endometriosis? Remember, we're discussing unexplained infertility here. Yes, there is very good evidence that laparoscopic treatment for symptomatic patients with endometriosis improves pelvic pain, but there is scant evidence that a diagnostic laparoscopy and treating any minor disease in the absence of pain symptoms will improve the chance of natural conception, or to that matter, improve the ultimate success of IVF. Indeed, in the absence of endometriomas, there is no negative impact on the serum AMH level in women with endometriosis who have not undergone surgery. Furthermore, there is no influence on the number of oocytes collected in an IVF cycle, the rate of embryonic aneuploidy, and the live birth rate after embryo transfer. So why put the woman through a painful, possibly expensive operation with its attendant risks as you're actually delaying her going straight to IVF? What do esteemed societies say about a diagnostic laparoscopy in the setting of unexplained infertility? The ESHRE guidelines state routine diagnostic laparoscopy is not recommended for the diagnosis of unexplained infertility. Indeed, our own ANZSREI consensus statement says that for a woman with a minimal and mild endometriosis, that the number of women needed to treat for one additional ongoing pregnancy is between 3 and 100 women with endometriosis. Is that reasonable to put an asymptomatic woman through a laparoscopy for that limited potential benefit? Now, regarding the guidelines for unexplained infertility, I agree the ASRM guidelines do not support IVF as a first-line therapy for unexplained infertility for women under 37 years of age. What they should say, and they don't, is that it is assumed that she is trying for her last child. There's no doubt if this is her last child, if it isn't her last child, sorry, she will be returning, seeking treatment, now over 37 years of age, where the guidelines do state there is good evidence that going straight to IVF may be associated with higher pregnancy rates, a shorter time to pregnancy, as opposed to other strategies. They then state it's important to note that many of these included studies were conducted in an area of low IVF success rates than those currently observed, which may alter this approach, suggesting they do not even endorse their own recommendations. The UK NICE guidelines, what do they say for unexplained infertility? Go straight to IVF. So while you're listening to my esteemed colleagues on my left speaking against the motion, I'd like to be thinking about other important factors that my colleagues on my right will discuss in more detail. Consider the superior efficacy of IVF versus IUI, the excellent safety profile of IVF and its cost-effectiveness. Further, other factors favouring a direct approach to IVF in the setting of unexplained infertility are what is the woman's desired family? We should not be focusing on her first child, we should be focusing on giving her the family that she desires and how we can minimise her inconvenience during treatment, as this has social, career and financial consequences for those impediments for her while we attempt to help her achieve her desired family. Thank you. APPLAUSE I think the young crowd would say that that was shots fired. LAUGHTER Con side? We're going to save the rebuttal for the time you've allocated to that, but first I want to put the case about unexplained infertility. Unexplained infertility in 2024 is very different to what it was 10 and 20 years ago when many of the randomised controlled trials that investigated unexplained infertility were performed. The armamentarium of investigative procedures and options that we have has changed, as indeed has our understanding of the mechanisms of infertility. So much so that that old definition of normal semen analysis, normal pelvis and ovulatory, which I think was in Roy Homburg's day, is now no longer fit for purpose as a definition of unexplained infertility. And I commend to you ICMART's very long definition of unexplained infertility, which really relies on a whole lot of things, which I'm going to now take you through what we need to do. It is said, or was said, that 30% of infertility was unexplained. I think it's way, way less than that if we actually look at our patients, both of them, carefully with history and examination and directed tests, and you will probably reduce that to about 3%. Let me take you through female age first. Now, in the old trials, some of the women recruited were as old as 42. That is not unexplained infertility. We know about oocyte aneuploidy and female ageing. 41, it's not unexplained. 40, it's not unexplained. 39, it's not unexplained. And I would put it to you that the cut-off where you start to see oocyte aneuploidy significantly constraining fertility is probably 35. So unexplained infertility has to, by definition, be a woman who is less than 35. I put that to you. Now, let's look at the male. Now, what do we know about the male, the effect of male age on fertility? We know that if the woman is over 35, and this is beautiful work that's really done many years ago in Europe, that if the woman is over 35 and the male is five years older than her, her chance of natural conception is reduced by a further 30%. So I put it to you that, therefore, the male age is relevant. And if she's 35 and has a partner who's 35 years older than her or more, it's not unexplained infertility. It's related to couple age. Now, we're going to... So that's age. Now, my colleagues are going to take you through a number of treatment interventions other than IVF, which we can do with good effect if we actually make the diagnosis and don't put them into the category of unexplained infertility. You will remember from the old trials that mild or moderate or mild or minimal endometriosis was often included, as was mild male factor or seminal fluid abnormalities. These were really multifactorial infertility, and I think that's the take-home message, that much of what we call unexplained is multifactorial. You have two minor components that act to reduce natural fecundability. So I now just want to take you through some of the diagnoses that contribute to infertility that we may not, in our routine laparoscopy and workup, we may not pick up and have previously been called unexplained infertility. For instance, we know that adenomyosis is probably one of the mechanisms by which endometriosis contributes to infertility. Chronic endometritis is now emerging as an operative factor in infertility, and that will not be diagnosed easily. Mild or minimal endometriosis, my colleagues will cover. The mid-cycle scan will lead you to the thin endometrium, which may be due to unexpected adhesive disease, but also a thin endometrium, which we know has a very adverse prognostic factor, may be due to long-term progestin contraception. We are starting to see this emerge. Secondary infertility after a caesarean section may be due to an isthma seal, and we won't recognise that unless we do mid-cycle scans. That's the female. Let's look at the male. We know now that seminal fluid analysis is not a good predictor of male fertility, and there is now evidence from Ranjith Ramasamy's work that we are missing clinical varicoceles because we failed to examine the male partner. My colleagues will talk more about that. We may miss DNA fragmentation, which again may contribute via the basic seminal fluid analysis. Now, most of these diagnoses can be made or sorted out or excluded within one or two months of your detailed assessment of both partners by history and examination. So it's not straight to IVF, ladies and gentlemen. It's just a little digression, a little lay-by, where you actually assess the patient thoroughly. She did not need a tie for that rebuttal. LAUGHTER Prasad. Thank you. Well, following from what Professor Hart has said, I'm going to show that IVF should be a go-to option because of its effectiveness, cost-effectiveness and safety. Now, let me first talk about the effectiveness, and as this is an interaction session, I would like to ask the audience, please, by show of hands, to show me how many of you would accept a medical treatment or buy a new incubator if it had a 94% chance of failure? Well, let the moderator please note that no hands have been raised. Thank you very much. Yet, the chance of live birth in Australian population following IUI is 6%, where, after IVF, the live birth is 40%. Almost seven times more. Now, why would we subject our patients to something we ourselves would not choose? Similarly, findings were reported from international studies that the hazard ratio of 1.25 favouring immediate IVF, and I will talk later about why it is important from a safety perspective. Cost-effectiveness. And I quote ESHRE guidelines. The costs, treatment options have not been subject to robust evaluations. Now, again, I would like to ask the audience, this time it's an easy question, how many of you would accept as standard an ongoing pregnancy rate of at least 38% for an average IVF cycle? Yeah, hands up. All right, I've got three-quarters of the room. OK. Well, I could really rest my case now, as we have good evidence that if a clinic has got an ongoing pregnancy rate of 38% or higher with IVF with single embryo transfer, then it is more effective, more cost-effective, and should be a treatment of choice. And that evidence comes from the authors that are sitting in this room. Again, what would the patients do? If the patients are paying for the treatment, would they do IUI? Most of them would actually go straight to IVF. And we also have very nice guidelines which advise against IUI based on cost-effectiveness. Another factor to mention briefly is the multiple births, which cost five to 20 times more than singleton. The neonatal cost of a twin birth costs about five times more than singletons, and pregnancy with delivery of triplets or more costs nearly 20 times. Now, the costs that I'm going to quote are in American dollars and from some time ago, from Fertility and Sterility. However, the total adjusted all healthcare costs for a single-dom delivery is about US$21,000, US$105,000 for twins, and US$400,000 for triplets and more. Then the very, very important is the psychological cost of the high risk of failure with IUI. Now, it is well established that infertility has a psychological impact on our patients. Studies have shown that prolonged time to conception extends stress, anxiety, and depression, and sexual functioning is significantly negatively impacted. Literature shows that 56% of women and 32% of men undergoing fertility treatment report significant symptoms of depression, and 76% of women and 61% of men report significant symptoms of anxiety. Shockingly, it is reported that 9.4% of women reported having suicidal thoughts or attempts. The longer the treatment takes, the more our patients display symptoms of distress, depression, and anxiety. Safety. Again, ESHRE guideline says the safety of treatment options have not been subjected to robust evaluation. But let me talk you through it. In our Australian expert hands, IVF is safe, with the risk of complications of ectopic being about 1 in 1,500 and other risks 1 in 3,000. However, let's think for a moment on impact of multiple births. A multiple pregnancy has significant psychological, physical, social, and financial consequences, which I can go further into details if required. I just want to mention that the stillbirth rate increases from under 1% for singleton pregnancies to 4.5% for twins and 8.3% for higher-order multiples, and that multiple pregnancies have potential long-term adverse health outcomes for the offspring, such as the increased risk of health issues through their life, increased learning difficulties, language delay, and attention and behavior problems. The lifelong disability is over 25% for babies weighing less than 1 kilogram at delivery. And please note that the quoted multiple pregnancy rates with IUI can reach up to 33%, although in expert hands it's usually around 15%, which is significantly higher than single embryo transfer. In conclusion, from the mother and child safety perspective, for the reason of medical efficacy and cost effectiveness, we have reasons to believe you should go straight to IVF. We're going to be doing these debates more often from Australia. This is a great panel. One side, please. Unexplained infertility. My colleagues were comparing IUI ovulation induction with IVF, but there are other ways of achieving pregnancies with unexplained fertility. I'm going to take the patient's perspective a little bit here. It's all about shared decision-making, so the patient needs to be involved in the decision-making. And it's quite clear from all the data that many patients with unexplained infertility will fall pregnant naturally by themselves even if you do nothing. So sometimes there's definitely a place in doing nothing, and the patient needs to be aware of that. So it's all about informed consent. How do we inform the patient? So we've got to make a proper diagnosis, as my colleague Dr. Boothright has already mentioned, and just to jump into IVF because it's cost-effective is not doing our patients a justice. The prognosis is really, really important, and even after 20 years of doing this, it's all about the duration of infertility, the age of the patient, and discussing that prognosis with the patient. We all know that patients who have been trying for longer and who are older do have a worse prognosis, and maybe they do need to look at treatment quicker, but there are many patients that we see that have a good prognosis, and just explaining that to them is all they need to achieve a pregnancy naturally. And then we're going to talk about other options. It's wrong not to offer those to patients, and my colleague Dr. Quick will talk about that in a moment. Look, we've all had patients that have been scarred by IVF who've spent a lot of money on IVF, did not fall pregnant, and I think the fact that they weren't informed properly, that the diagnosis wasn't made properly, is very frustrating to them. So to just jump into IVF again is not doing the patients a justice. And look, there are negatives to IVF. There's not just the cost to the patient, the cost to society. As taxpayers, we all pay for IVF. It's funded here, or sponsored to some degree, and it's also the family and everyone else that's involved in paying for this. So this is not a treatment that is without cost. There are some harms. We know that ovarian hyperstimulation syndrome still exists, even though it's much less than it used to be. There's a risk of infection and bleeding from the procedures. And we can look at the baby. The data still suggests that babies born from IVF are smaller and they're born earlier, and monozygotic twinning is more common with IVF, so these are high-risk pregnancies, and all this may have an impact on the long-term health of the babies somewhere down the track at the moment. That is important to still look out for. But I come back to the emotional toll. Our colleagues were saying that finishing infertility quicker helps to kind of reduce the emotional toll, but the procedure itself does have its own toll if it doesn't work, and so we've got to prepare patients, have them informed. But at the end of the day, it's all about patient choice. How can a patient make a choice if we don't make a proper diagnosis, give them a prognosis and offer them some other choices that exist? And running the anchor leg of the race for the pro side. IVF in couples with unexplained infertility is the best tool we have in our reproductive medicine toolkit for multiple reasons. Professor Hart has clarified the definition of unexplained infertility. As a reflection of the degree of investigation we've undertaken. He's explained that IVF is often importantly diagnostic as well as therapeutic, both demonstrating and overcoming barriers to natural conception. Dr Stankiewicz has convinced us that IVF is efficient, safe and cost-effective. My goal is to show you that IVF is the correct therapy to meet the immediate and big picture family planning goals for our patients with unexplained infertility. More than 80% of couples with defined unexplained infertility who attempt IVF treatment will have a baby. In Australia, ANZSREI data shows us that the average age of the female patients who present with primary unexplained infertility is over 35 years. And in fact the average is 38 years. We're all aware that the average age of first maternity in Australia has progressively become later over the past two decades. Currently it stands in the mothers and babies report at 32 years. If the average age of first maternity is 32 years, this means that at least 50% of women attempting their first pregnancy are over 32 years. Research I conducted in Melbourne University with my student Eugenie Pryor asking university students of their family planning intentions and aspirations demonstrated that most people, male and female, want to be parents and most want to have more than one child. However, in Australia, our most recent survey shows that births are at an all-time low, below replacement rate and falling, with an ever greater proportion of our population being unable to have the number of children they aspire to and an ever growing proportion seeking assisted reproductive care. Fertility declines with age. Factors include egg quality concerns, sperm quality concerns and the accumulation of pathologies over time. Adenomyosis, fibroids, endometriosis are concerns that no person is born with. They exist on a spectrum and progress over time and may be contributing factors for unexplained infertility. Our patients, when we meet them, are the best IVF candidates that they will ever be. They are the youngest they will ever be and they have the best ovarian reserve they will ever have. They will generate more euploid embryos now than they will in years to come. The sooner we get our patients pregnant, the sooner they will give birth. It takes nine months to have a baby, 12 months potentially to breastfeed and wean and of course most patients will need time to care for a young infant and recover prior to attempting another pregnancy. IVF and embryo banking may represent not only their best chance of conception with reduced time to pregnancy but also an opportunity for embryo banking to improve their cumulative live birth rate potential over time. By the time our 38-year-old patient returns to try to conceive for a second child, she will undoubtedly be aged over 40. Her chance of live birth per cycle initiated at IVF at this stage has reduced phenomenally. The ANZSREI dataset from our most recent report quotes that statistic to be 5%. Her chance of conception with an embryo frozen at 38 years, conversely, is one in three to one in four. There is no room for doubt that IVF gives couples with unexplained infertility not only the most effective treatment we have to help them have a baby, but their best opportunity to have a family. Last but certainly not least, Dr. Quick, to round out the con sides arguments before we open up for rebuttal. And I'll make a small plea that if you have questions that you'd like to pose directly to the panel, prepare them and we'll make sure we get to them from the audience shortly. Thank you. So, whilst we have heard that we may be bad doctors because we're delaying our patients' time to pregnancy, I would perhaps put it to you that unexplained infertility is a diagnosis which is made based on exclusion. So perhaps you are the bad doctors because you haven't looked hard enough for the cause of the unexplained infertility. So, in terms of the tests that we all would do, I think, we would all ensure that the woman has an ovarian reserve. We would all ensure that she has no structural anomaly inside the uterus. We would all ensure that her tubes are patent. We would all ensure that she has regular cycles. We would ensure that he has a normal semen analysis. I think these are tests that we would all do when trying to evaluate a couple for fertility who are struggling to conceive. And therefore, the chance of them getting pregnant naturally, it's never going to be zero. And one option therefore, instead of running straight to IVF, would be to say, OK, continue timed intercourse because the chance of you conceiving naturally is not actually zero and this would be the most natural way to conceive, the cheapest way to conceive, the least interventional way to conceive. And whether that be with cycle tracking to ensure appropriate timed intercourse, whether that be with cycle tracking to ensure adequate luteal phase support. When you clear the fallopian tubes, we know that there are studies showing an improvement in natural conception. Lipidol or oil-based tubal flushing techniques may also help couples to conceive naturally. And then you don't have this multiple pregnancy rate that IVF has. You don't have the cost that you incur with IVF, not just for the couple but to Australian society because IVF is subsidised in this country. You don't have the risks that the woman goes through to undergo IVF treatment. You don't have the risks that the baby takes on being conceived via IVF. And so conceiving naturally, because it's not going to be zero, is definitely an option for these couples. In terms of further tests or further investigations that you could do, some people would argue, yes, we haven't looked hard enough for the reason for infertility, therefore we know that ultrasound is notoriously bad at picking up superficial endometriosis. We know that ultrasound cannot pick up subtle changes in the endometrium, as Dr Boothroyd referred to chronic endometritis, for example. So these patients perhaps should undergo a hysteroscopy to see if there is an endometrial issue. Perhaps these patients should undergo a laparoscopy to see if there is superficial endometriosis. And there are meta-analyses showing that resecting or treating superficial endometriosis may actually help these couples conceive naturally down the track and then therefore they avoid having more interventional treatment in order to conceive. There is also intrauterine insemination with or without ovarian stimulation, which may improve their chances of conceiving naturally. And that again would be less invasive, less intervention and cheaper for the patient. And we know that therefore there are a lot of other treatment options available to help these couples to conceive. And if it's less invasive, it's more natural, it's cheaper, that ends up being better for the patient. Psychologically as well, which the other side have brought up, even with Dr Stankiewicz's 38% ongoing pregnancy rate, that also means that 62% of his patients are not going to be pregnant. The psychological impact of that cannot be underestimated because for a lot of patients, IVF is your last resort. And when you don't get pregnant with IVF, that creates an issue too for them. Embryo banking, which was also brought up, what happens when you create surplus embryos and what's the psychological impact of having to deal with embryos that you are then not going to use in the future? So therefore for those reasons we feel that IVF is not your first line treatment for couples who are diagnosed with unexplained infertility. There are many other ways to help these couples to conceive. We just have a multitude of things to unpack. And I want to start off by opening up an opportunity for rebuttal. I saw both sides of the panel here taking diligent notes. I think all of us have a full page worth of things that kind of stood out to us. Since the pro side had an opportunity to begin, I'm actually going to start with the con side and allow the con side to answer specific points made by the pro side and provide just a little bit more detail and clarity for why they think IVF is not the way forward. My learned first speaker, wearing his tie of course, indicated that it was all about laparoscopy and IUI, and it's way more than that. I just want to highlight to you the paper by Dressler in 2017 in the New England Journal of Medicine, a randomised controlled trial of what would be unexplained infertility according to the definition I put out, the less than 35 ovulatory normal semen analysis. And the intervention was an HSG with either oil-based contrast or water-based contrast. And over the six months, there was clear separation, and this is an effective treatment for unexplained infertility or mild or minimal endometriosis, however it might work. And there's probably separation out to three years. So as a single intervention, as an alternative to IVF, the use of oil-based contrast is an option. So it's not just about laparoscopy and IUI. I guess the other thing the second speaker did allude to, fairly abysmal success rates with IUI being 6%. That is a problem, and I would like to allude to a very good pragmatic trial conducted by Cindy Farquhar and Emily Lu and their co-workers in New Zealand that really swung the meta-analysis for the use of clomiphene and IUI to clinical efficacy. And they reported a 33% chance of live birth in their IUI and clomiphene arm. I'm going across to Auckland to see what the magic is in that city. What are they doing? The third speaker did allude to the problem of declining fertility, a global problem, and Australia is not alone. We have solved the problem to date, which we've had for 40 years, with immigration. But Georgina Chambers' work shows beautifully that IVF is not the answer to the falling fertility rates. It is a way more complex social problem and is probably outside the scope of today's discussion. So those are my three rebuttals to our wonderful team. Thank you very much. So... You can't bury them. We'll give them an opportunity. Thank you for the opportunity. So I'd like to address some of the points that my learned debaters on the opposition raised. The first speaker really suggested quite a few things that we probably omitted, like endometritis, failing to examine the male. I think things like that... I think, at a good history, that is essential what we do as part of our investigation. We're looking for a history of cesarean section, complications subsequent to that. We're doing a detailed scan, and that will exclude the fact that she's got a poor endometrium development, she's got a cesarean scar niche. A good history of a male will allude to the fact that he has some metabolic disorder, degree of hypogonadism. So we're not delaying anything by these appropriate investigations. Adenomyosis will be raised. I talked about a detailed gynaecological examination. So I honestly think that a very... As my opening line was, a detailed gynaecological scan, obviously with a very good history taken, is essential. We're not delaying her opportunity to go straight to IVF if we've addressed all these factors. The second speaker talked about shared decision-making, and we'd all completely agree with that. But we have to be honest and open about the success, which my second speaker talked about, the success of the treatment we're offering. And one thing we should sort of dwell on is it's all... It's a fundamental description of the success of treatment is probably all about prognostic models, and that who not model, that's the original model about the success of conception, is really... Everything flows on from that, which basically talks about a good prognosis patient. 30% chance of live birth after a year. That's what they talk about, a good prognosis patient. Perhaps the rest of the world is different to your average Australian patient, but if we talked about that being a good prognosis, you've got a one in three chance of being pregnant by a year. I think most of our patients would throttle us. So that is what all the models are sort of based on, that being a good prognosis patient. So I completely agree with the second speaker that we do have a shared decision. We have to be honest with our patients about the success. We have to be honest about giving them the prognosis of any treatment that we offer. But really, as my third speaker was talking about, it's about giving the patient the opportunity to have a family, minimal career disruption, minimal life disruption. We have to be honest and talk about the whole picture. They're focused on the first child because really they can't think beyond that. We're talking about giving them the family that they need. The third speaker spoke very eloquently about the risks associated with the treatment we offer. I believe we offer a very safe service with our IVF, particularly in Australia, with our 2% twin pregnancy rate. We talk about the higher risk of these pregnancies, but they perhaps don't relate to the treatment we're offering. Perhaps, unfortunately, is the patient, if she's got polycystic ovary syndrome, if she's more likely to have diabetes, premature delivery, preeclampsia. So I think often the risks associated with IVF and potentially the risks associated to the child born from IVF perhaps don't relate to the treatment of IVF per se. It may well be the woman and perhaps her partner, their underlying medical condition, which lead those risks. So I strongly would encourage you to believe that you take a very good history from your patient, you do a thorough investigation, as I've alluded to, looking for any signs of ovulatory disorder, any gynaecological disorder by a detailed scan, checking tubal patency and a detailed history and the similarities from the man, and then you'll find you're probably going straight to IVF. APPLAUSE I'd like to talk a bit about the embryo banking and having been in this field for a long time, as a word of caution, we're setting a lot of expectations. I remember going to an ASRM meeting probably 10 years ago where they had this headline, all your embryos in the freezer, your whole family in the freezer, basically expecting that if you get four or five embryos frozen that you'll end up with a family at the end. We all know that for the patient, they're not a percentage, it's either zero or 100%. And if all the embryos don't work, they don't have a family at the end, you know, it didn't work for them and their expectations haven't been met. And the way we talk about the percentages and that we can solve the patient's problems, that we can make families, it doesn't always happen. So the expectations our position is setting here, we're not always able to meet and so we're going to end up with very unhappy patients. So this is just a warning to everyone that we need to tell people that this doesn't always work and sometimes they'll end up with no success at all. And from that point of view, I think the way it's presented is way too simplistic and we've got to go back to looking at the other options and not promising things we can't always deliver. So just taking into account all our esteemed interlocutors have said, we don't necessarily disagree with the amount of investigations that they described because nowhere in our argument we said that as soon as the patient registers with the receptionist, they will direct it to an IVF lab. I think to imply so, we'd be very rich indeed. Maybe there are some clinics that are so efficient. I don't know how it works overseas, but certainly not in Australia. The other point that was made about the cost of IVF and our, again, esteemed interlocutors are very well aware from the studies done here in Australia that actually every baby that we have to conceive through IVF and create and lives is actually more than 10 to 100 times return on investment because we are creating future taxpayers. We are creating people that will repay the IVF treatment costs over and over and over again. So I'll put to you, Rob, that if you are saying that we can't do IVF because it costs money, you are robbing future treasurers of a huge amount of dollars. I hope the American audience is listening. In America, we call embryos unborn children in freezers in certain parts and here they're unborn taxpayers. Con side, final opportunity for rebuttal before some audience questions and one more word from the pro side. Well, actually, Dr Stankiewicz was very happy to hear that you're not going to send your patients straight to the IVF lab because we've managed to convince you that that's not the right thing to do. I clearly have forgotten how to debate because I did all my rebuttals at the end of my presentation but essentially I'll recap because when we're talking about IVF, as we're saying, the chance of pregnancy is not going to be 100% and so there is a psychological impact to IVF not working. There is a psychological impact to banking embryos and creating surplus embryos that eventually may not be used and they were my main rebuttal points in terms of why IVF was not the first-line treatment. Thank you. So we've heard from the opposition some very valid points of how our patients can be psychologically impacted when fertility treatment is unsuccessful. I will again remind you that IVF is the most successful fertility treatment we have in our treatment armoury. We are most likely to help our patients have a baby with IVF. The cumulative pregnancy rates for IVF have started back in the late 70s and early 80s in single-digit percentages. We now, with a best prognosis candidate, have at least a one-in-two chance of that patient having a baby per embryo transfer and in our patients with unexplained infertility, the vast majority of our patients will have success. We also heard from the negative team about the significant chance of pregnancy in patients with expectant management. You're right, there's not a 0% chance of natural conception in patients who have unexplained infertility, but there is a not very good chance. We know from data that we've had for a really long time, going back as far as the Hutterite data, to today's non-contradictory models, which tell us that a couple's chance of conception per month in best prognosis candidates is one in five. If they've been trying for six months, it's one in ten. If they've been trying for 12 months, it's only 5%, and if they've been trying for 24 months, it's less than 1%. So it may not be zero, but it isn't very good. In terms of our team reminding us of the extended ICMART definition of unexplained infertility, we don't argue. When we say someone has unexplained infertility, we make the assumption that they have been comprehensively diagnosed by a robust reproductive endocrinologist, as everyone in this room is. And I would say one closing rebuttal. IUI success rates have been the same for the last 50 years, whereas IVF success rates continue to improve. Why would you offer your patient a treatment from 50 years ago when you can offer them one from today? Thank you. APPLAUSE I'm going to take a personal privilege and ask the first question, in hoping that the microphone makes its way to the second question in the audience. My colleagues on the pro side have said IVF, IVF, IVF. Can you be a little bit more specific about what kind of IVF? Do you mean IVF with ICSI? Do you mean IVF, ICSI, and PGT? Be a little bit more deliberate for us and tell us exactly how the patient with unexplained infertility should receive IVF. As I said in my statement, I think it's a diagnostic evaluation. I think there is an argument to consider ICSI, but I think ICSI does have some negative consequences for children born. I think perhaps going straight to ICSI is too much. I think going straight to PGTA perhaps is too much, unless there is something in their history which should indicate that. But we're talking about unexplained infertility. So I believe a standard IVF cycle, looking at the opportunity to assess embryonic development, is the way to go. I do not think you should be going straight to ICSI. I think the principle of first do no harm is probably a safe approach. I don't know whether my colleagues have some other comments, but I think that would be the first approach rather than going all guns blazing. I can understand, though, in different settings in the world, there may have... We're very fortunate in Australia, we're very well supported from the government support for IVF, but I think the imperatives in different countries may be different. But I think that approach would be the right one first. We'll start with a question from the audience. And if you could introduce yourself and have the question allowed for our members in the audience who are not here. It's Louise Hull here from Adelaide. The question I would like to put to both the pro and con team is that Geeta Mishra from the University of Queensland showed that if you had diagnosed endometriosis before IVF, you were more likely to have a pregnancy and much less likely to have high-order IVF cycles. Given that we now have really good non-invasive diagnostics, we're actually... A lot of the time we can pick up superficial or stage 2 endometriosis if you get the right scan. We're going to do IVF better if we know about it. Can you comment on that impacting even the diagnosis of unexplained infertility? Thanks. I'd love to take that. Can I go first, Roger? LAUGHTER Please do. Look, I'd love to take that question. It's a really good question. And, of course, this is not unexplained infertility, so this is outside the scope here. And I think, really, what we're seeing now, in contrast to where we were at the time of the Markku study, which was all... And the Tulandy study on endometrioma excision, we now see that that is actually damaging to fertility, particularly where there is ovarian endometriosis, and that we compromise their ovarian reserve by doing this surgery before we preserve their fertility, be it oocyte cryopreservation or embryo cryopreservation. So I think it's a bit outside the scope of this talk, but I think the swing of the data now is that we should be doing fertility preservation before we do surgery for deeply infiltrated ovarian endometriosis. And that would fit with Gita's findings. A brief response. Thanks very much, Louise. Yeah, we're talking about unexplained infertility here, and my opening line was we need a history, but a detailed gynaecological ultrasound. I think it's important it's a really good ultrasound to exclude that, because the evidence around very minor endometriosis is not there. I agree with significant endometriosis, but that's not the subject of this discussion. But I do believe with very minimal endometriosis there is really no evidence for that. Janelle MacDonald from Sydney. I'm going to play devil's advocate here. So everyone is probably aware of the recent government inquiry about obstetric violence. I'm a little concerned that if we are perceived to be encouraging women to IVF first, are we guilty as a profession of performing fertility violence? That's just digressing a little bit, just thinking about how the consumers may perceive this. I think our patients want to have a baby, and that's why they come to see us, and that's what we help them to do through IVF. I'm not sure the microphone's working. And just introduce yourself. I'm from Sydney, Australia. Can I disagree with you, Roger, about that question about minimal and mild endometriosis? I'm 68, so I'm old enough to have read a whole lot of papers in the past that are probably seen as relics. But Mark Khoo published an unusual study, because it was actually an RCT. Well, sorry, not an RCT. It was a study whereby... Well, it was an RCT, and it was randomised really well. It was done in Canada, and there were about 350 subjects, and they were identified to have stage 1 or stage 2 endometriosis at laparoscopy. And the interesting thing is it was seen as an intervention which didn't greatly increase the chance of conception, but it doubled the monthly chance of conception. So there was clearly a difference between those patients who didn't have endometriosis and those that had stage 1 and stage 2 endometriosis. So the intervention did actually result in an improvement. One of the quotes was, well, I heard since then, well, it didn't make much difference. But when you realise that infertility is multifactorial, there were probably other factors involved as well. So any increase like that in stage 1 and stage 2 endometriosis sufferers was clearly beneficial for them. So I wouldn't disagree with you completely, but I do think you've got to take it on board that there is some evidence that surgical intervention can help. And certainly in those patients whereby the financial costs of IVF are still quite, even in Australia, astronomical. Many patients can get this through the public sector or the private sector treatment of their endometriosis laparoscopically very cheaply or at no cost. Thanks, Dr Persson. So you're right that there was also a counter-randomised controlled trial by the Grupo Italiano which was a counter to that. And actually did not show any benefit. But I believe the Marcu study demonstrated an excess of conception and with treatment of minima and endometriosis of about 4% per month for a few months. So absolutely, that shared decision-making. Personally, I wouldn't like a laparoscopy to give me an extra 4% chance of a natural conception for four months, which I think the data was. So basically, the basis to my statement that I said without going into great detail was a review article published by Samy Glarner recently in Reproductive Biology and Endocrinology. And their conclusions were what I basically said, that from looking at all the data, there is no real evidence of intervention for minor endometriosis. We're not talking about pain or significant diagnosed endometriosis on the outcomes of IVF, ovarian reserve, egg quality, embryo development, and euploidy rate. So that was the basis of my... I hate to disagree... I hate to agree with my opponents in a debate, but I'm going to... But there is actually a new network analysis by Rui Wang and some serious heavyweights in evidence-based medicine that pulls together the surgical studies. And the thing that made the most difference to this of mild and minimal endometriosis from a fertility point of view, not pain, is the use of oil-based uterine contrast. And I commend that paper to you, which fits with exactly what Roger is saying. Hi, my name's Lucy Prentice.  I work in Auckland. And I just wanted to point out the New Zealand perspective a little bit. Where we come from a country with very limited public funding for IVF. I'm currently running an RCT with Cindy Farquad directly looking at IVF versus IUI for unexplained infertility. And I'd just like to point out that both the ASRM and ESHRE guidelines, which are the most recent ones, both suggest that IUI should be a first-line treatment with oral ovarian stimulation. We have no evidence that IVF is superior based on an IPD meta-analysis published very recently and also a Cochrane review. And although we would love to be able to complete the family that our patients want from IVF and embryo banking, that option is really not available to a lot of people in New Zealand because of prohibitive costs. We know that IUI with ovarian stimulation is a very effective treatment for people with poor prognosis and unexplained infertility. And I also would just like to add that there's not a cost-effectiveness analysis that shows an improvement in cost-effectiveness for IVF. There's also never been a study looking at treatment tolerability between the two, so I don't think that you can say that IVF is a treatment that people prefer over IUI. So I may turn around and shoot myself in the foot based on our results that will be coming out next year, but I think at the moment I don't think you can say that IVF is better than IUI with ovarian stimulation for unexplained. We have time for two more questions from the audience, and we have two hands in the back. Now we can. It's the light green. OK. Hossam Zini from Melbourne. Thank you very much for the debate. It's very interesting. The problem is that all of the studies that have been done about comparing IUI to IVF, they are not head-to-head studies. The designs are different. They are having, like, algorithmic approach. For example, they compare three or four or five cycles of IUI to one cycle of IVF. But about 10 years ago, our group at the Royal Women's Hospital, we have done a study, a randomized control study, to compare IUI to IVF head-to-head, and we randomized the patients at the time of the trigger who only developed, so we did a low stimulation to get two to three follicles only, and that's why it was so hard to recruit lots of patients. So the criticism that was given to the study that it's a small sample size, but we end up with having IVF as a cost-effective treatment. Our IVF group had a live birth rate about 38%, and on the IUI, 12%. And with our cost calculations, we find out that the IVF is much more cost-effective than the IUI. But I believe that we all now believe in individualized kind of treatment, so patients probably who are younger than 34 years old probably wouldn't go straight to IVF. Maybe I'll do a laparoscopy and a histroscopy first, okay, and we may give them a chance to achieve a natural conception in the next three months or so. Patients who are older than 35, 37 years old probably will benefit straight from IVF. But again, in day-to-day life cases, we will not force the patient to go straight to IVF. I will talk to her and I'll tell her, these are your options, expectant treatment. This is the percentage that you would expect. IUI, this is what you expect. IUI with ovulation induction, this is what you expect. IVF, this is what you expect. And then she will discuss that with her partner and come back to me and tell me what she wants to do. Thanks. I saw a hand show up right next to you, so I'll add one more question given our time limitation. Thanks so much, Kate Stone-Mellon. I'd like to ask our panel to take themselves out of their role playing and put themselves in another role where they were the head of a very, very well-funded public service, and I'd like to ask the two sides what they really think about what they would do with a patient at the age of 35 with 12 months of unexplained infertility. Well, can I say that? Because that's my role in a different hat. LAUGHTER So, yeah, I run the state facility service in Western Australia. We looked at the data, because obviously that's what we're doing, IUI, IVF, and unfortunately we stopped doing IUI treatment. The success rate was so low. So we do go straight to IVF with unexplained infertility. Disappointing, as I'm sure you hear that, Kate, that we do. We looked at the data. Yeah, I think that I would still offer the patients the options, because some people don't want to do IVF. Even though it's completely free, they may not still want to do the injections and the procedure and take on the risks of the actual egg collection procedure. I don't know, religious issues with creating embryos. Yeah, I would still give patients the option. We have time for one more question in the back. We'll take the other ones offline afterwards. We'll get you a microphone just to make sure our listeners afterwards can listen. Following on from the New Zealand experience, which I've experienced... Hello? Yeah. From the New Zealand experience, and having worked here extensively and in New Zealand, you're not comparing apples with apples, Claire. That unexplained couple in New Zealand will wait five years to get funding and currently perhaps another two years to get any treatment. That's then an apples group compared to the pilot group who may, in fact, walk past the hospital and get treatment. The other thing about this, I think, that we need to forget, or don't forget, is the ethics of things here, two of which is that the whole understanding of unexplained infertility needs research and thinking. And if it wasn't for that understanding of what is the natural history of normal and then the understanding of pathology, we wouldn't do a lot of things in medicine. So if we have got a subgroup here that's unexplained, it's not just to the patient, we have a responsibility to future patients and ourselves to be honest and do research and learn about these factors. Now, it doesn't answer the debate, but it is something that's what drives the investigation and management of unexplained delay. And, for example, at the moment, there's quite a discussion about two issues of ethics, one about the involuntary childlessness of people that don't get to see us but don't have those children that they wanted to have because they didn't want to undergo treatment, or it was the involuntary childlessness of a second or subsequent child. And that's quite a big research issue in Europe, I realise, at the moment. And the final thing is about the information giving. The British case Montgomery 2015 has changed consent substantially, for those of you from England, that all information given to patients must include and document the discussion about expectant management versus all the different types of treatment, for and against and risks. And we're not currently doing that in IVF in this area, but if you read about what's happened in England, it's transformed consent in surgery. And I think a lot of our decision-making isn't in that way. So there are a couple of ethical principles to think about. Wonderful questions from the audience. Since we're coming up at the end of our time, we typically end the debate with closing remarks, but we'll forego that for this debate. And I'd actually like to just poll the audience. After hearing both the pro and the con side's arguments, by a show of hands, who in the audience believes that for the patient with unexplained infertility, as defined and detailed here broadly, should we be beginning with IVF? Should we be going straight to IVF? So by a show of hands. And I would say probably 50% of the room raised their hand. And those who think we should not be going straight to IVF? It feels like a little bit more. 40-60, now that I saw the other hands. Well, I'm going to call this a hung jury. I don't know that we have a definitive answer. Please join me in a round of applause for our panelists. In America, we would call that election interference. I wanted to thank our panelists, our live audience, and the listeners of the podcast. On behalf of Fertility and Sterility, thank you for the invitation to be here at your meeting and hosting this debate live from the Australian New Zealand Society for Reproductive Endocrinology meeting in Sydney, Australia. Thank you. This concludes our episode of Fertility and Sterility On Air, brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While the podcast reflects the views of the authors and the hosts, it is not intended to be the only approved standard of living or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.    

In this month's Fertility and Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include a review of studies of menstrual fluid (2:18), changing our language regarding progestin protocols (18:35), and nanoscale motion tracing of spermatozoa (26:46). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00032-X/fulltext Consider This: https://www.fertstert.org/news-do/language-matters-rename-progestin-priming-progestin-protocols-vitro-fertilization-ivf F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00037-5/fulltext View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Take a sneak peek at this month's Fertility & Sterility! Articles discussed this month are:   4:56 A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media 18:17 The impact of microfluidics sperm processing on blastocyst euploidy rates compared with density gradient centrifugation: a sibling oocyte double-blinded prospective randomized clinical trial 25:20 Prediction of pregnancy-related complications in women undergoing assisted reproduction, using machine learning methods 40:36 The effect of laser-assisted hatching on vitrified/warmed blastocysts: the ALADDIN randomized controlled trial 50:49 Assessment of clinical pregnancies in up to eight ovarian stimulation with intrauterine insemination treatment cycles in those unable to proceed with in vitro fertilization 1:02:56 Comparative analysis of pregnancy outcomes in preimplantation genetic testing for aneuploidy and conventional in vitro fertilization and embryo transfer: a stratified examination on the basis of the quantity of oocytes and blastocysts from a multicenter randomized controlled trial 1:09:45 Predictive models of miscarriage on the basis of data from a preconception cohort study   View Fertility and Sterility July 2024, Volume 122, Issue 1: https://www.fertstert.org/issue/S0015-0282(24)X0006-0 View Fertility and Sterility at https://www.fertstert.org/  

Host James Jacobson is joined by Kate Basedow, a seasoned veterinary technician with extensive experience assisting with dog surgery. She's got terrific insights into how you can optimize your dog's experience on their big day. This is part two of a three-part series on canine surgery. Part 1: Dog Surgery Pre-Op Checklist for Dog Owners https://www.youtube.com/watch?v=aWHnMNzc5HA Key Points Covered: ·        Why No Breakfast Is Safer ·        How to Be Prepared AND On Time ·        Why You'll See So Many Shaved Areas ·        Safety and Privacy Concerns in the Hospital ·        Understanding Discharge Instructions ·        Post-Anesthesia Behavior: What to Expect and When to Worry Join our Facebook support group at https://www.dogcancer.com/support Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos:            Is your dog too old for surgery? https://www.youtube.com/watch?v=lEOeHwt-Wus Surgery tips from Dr. Demian Dressler https://www.youtube.com/watch?v=5VjHzlCmaIg Plan for post-surgery pain control: https://www.youtube.com/watch?v=sjY-hViqRuA Related Links: Questions to ask your veterinarian about dog cancer: https://www.dogcancer.com/articles/building-your-team/questions-to-ask-your-vet-about-dog-cancer/ Our everything-surgery article: https://www.dogcancer.com/articles/diagnosis-and-medical-procedures/your-dog-surgery-guide/ Chapters: 00:00 – Introduction from Molly Jacobson 01:30 - Guest Introduction: Kate Basedow, LVT 02:12 - What to Do on the Morning of Surgery 02:45 - No Breakfast for Your Dog 03:19 - Show Up on Time 03:30 - Complete Paperwork 04:00 - Anesthesia Safety and Risks 04:30 - Vaccination and Flea Notes 04:42 - DNR Forms and Surgery Day Routine 05:15 - What to Bring to the Vet 06:00 - Records and Medication 06:45 - Shaving for Surgery 07:28 - Sterility and Shaving Expectations 08:00 - Catheter Placement 08:11 - Owner Presence During Surgery 09:03 - End of Day Expectations 09:15 - Discharge Instructions 09:45 - Written Discharge Instructions 10:24 - Post-Anesthesia Behavior 11:00 - Different Reactions to Anesthesia 11:45 - Final Thoughts Get to know Kate Basedow: https://www.dogcancer.com/people/kate-basedow-lvt/ For more details, articles, podcast episodes, and quality education go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this month's Fertility & Sterility: Unplugged, we examine articles from F&S's sister journals! Topics this month include biomarkers for improving sperm parameters with varicocele repair (1:42), side effects with minimal controlled stimulation with in vitro maturation (14:48), and the use of a GnRH antagonist for heavy menstrual bleeding with fibroids (33:53). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00007-0/abstract F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00029-6/fulltext F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00073-4/fulltext View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Dr. Armando Hernandez-Rey is Conceptions Florida's medical director and triple-board certified in Reproductive Endocrinology and Infertility; Obstetrics and Gynecology; and Surgery. Dr. Armando Hernandez-Rey has over 24 years of experience in the medical field. He graduated from Universidad Autonoma de Ciencias Médicas de Centro America in 1998. He attended medical school at the University of Miami Miller School of Medicine for his specialization in Obstetrics and Gynecology. He specializes in treating patients with polycystic ovary syndrome (PCOS), recurrent pregnancy loss (miscarriage), and severe endometriosis. He is especially interested in fertility preservation (eggfreezing) for patients who must delay childbearing for personal or medical reasons, including cancer and systemic lupus erythematosus. Dr. Hernandez-Rey is an assistant clinical professor at the Herbert Wertheim College of Medicine at Florida International University and serves as an ad-hoc reviewer for the prestigious peer-reviewed journal, Fertility and Sterility. He has also published several articles and chapters in medical literature.   Website https://www.conceptionsflorida.com Instagram https://www.instagram.com/conceptionsflorida/ Facebook https://www.facebook.com/conceptionsfl Tiktok https://www.tiktok.com/@conceptionsflorida     For more information about Michelle, visit: www.michelleoravitz.com   The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook:https://www.facebook.com/thewholesomelotus/     Transcript:   Michelle (00:00) Welcome to the podcast, Dr. Hernandez -Ray.   Armando Hernandez-Rey MD (00:04) Thank you, Michelle. Thanks for the invitation. It's really an honor and a privilege to be on your show, on your podcast.   Michelle (00:09) Yes, well, I've heard a lot about you over the years because I've had a lot of patients go to you. And one of the things that I've heard is that you do really well with surgeries and fibroids and you're able to in and   but in a way that still preserves fertility. So that was one of the things that I've learned.   Armando Hernandez-Rey MD (00:32) Well, reproductive endocrinology and infertility as a subspecialty is a surgical subspecialty as is OB -GYN, which is a mandatory path to get to the infertility route. Unfortunately, a lot of the newer generation is not operating because they're not taught, not through no fault of their own, they're not taught. The reality is that it is...   Michelle (00:47) Mm -hmm.   Armando Hernandez-Rey MD (00:55) for a myriad of reasons this phenomenon has happened. Number one, the minimally invasive surgery tract has been developed where you have the person who's really just really perfected their obstetrical skills. And then you have the gynecologic oncology route and the pelvic urogynecology or pelvic reconstruction route and the minimally invasive surgical route. And a lot of the reproductive endocrinologists,   have said, you know what, I'm going to forego surgery and I'm going to refer it out. My personal philosophy, and this is in no way critical to absolutely anybody, it's just my own, is that I went into medicine to be a surgeon, I actually wanted to be an orthopedic surgeon. I ended up not liking it, I had a very bad fracture when I was in my teens playing competitive soccer, and I really had some PTSD from that fracture, so I just couldn't see myself doing   orthopedic surgery, but I somehow found my way towards OBGYN, absolutely loved it. And eventually towards the reproductive endocrinology route, which encompasses a lot of surgery, should you allow it. And so yes, like you said, fibroids are an important part of fertility. you, tubal reconstruction used to be much more important than it is now. People are more, are bypassing that route and going directly to in vitro fertilization.   Endometriosis, as I said, I was running a little bit late today. I was in a very, very complex endometriosis case with a patient with bilateral endometriomas and complete frozen pelvis and scar tissue. And, you know, just a little bit longer, I had to work with the colorectal surgeons to do some resection of the colon because it was, you know, endometriosis is such an awful, awful disease. So yes, to answer your question, I...   Michelle (02:41) Yeah.   Armando Hernandez-Rey MD (02:44) Absolutely love surgery. I think it's an integral part of the infertility journey to get a patient from being infertile to getting them to a high level of success with any sort of treatment. And hopefully it's more conservative than having to resort to artificial insemination or in vitro and with just surgery and corrective surgery, we can help the couple achieve a pregnancy.   Michelle (03:07) Yeah, and I think it's important because I think that a lot of people might not realize that there are certain people that specialize in this or have experience doing that, doing surgery and really getting in there because it is important to find somebody who's specialized if you have a complicated case.   Armando Hernandez-Rey MD (03:23) I think it's important. I think people feel well taken care of. Again, my perception, people feel well taken care of when everything is done in house. Meaning, you know, there's no messages that get lost as you refer a patient out who may have the minimally invasive surgery knowledge, but not necessarily the focus on infertility, reproductive endocrinology.   Michelle (03:33) Mm -hmm.   Armando Hernandez-Rey MD (03:50) specialist has and I think people feel comfortable with that.   Michelle (03:52) Yeah, absolutely. Because there's some people that will take out fibroids, but they're not doing it with fertility in mind. You know, for many women, it could just be just taking out fibroids, but you're doing these things with fertility in mind.   Armando Hernandez-Rey MD (04:07) There are many great surgeons out there that are not infertility specialists. You know, I want to make sure that I'm clear. I just think that I was, I always love surgery. I happen to do surgery and I feel my patients feel very comfortable with me doing the surgery and not being referred out. It's what I think. You know, the journey, the infertility journey is very complex. It requires a lot of a woman in particular more than the male and to be   Michelle (04:25) Yeah.   Armando Hernandez-Rey MD (04:36) you know, passed around, it gets complicated. And I think it's nice to be able to offer that service to patients.   Michelle (04:44) Yeah, for sure. And then you do specialize in miscarriages.   Armando Hernandez-Rey MD (04:49) Sure, I mean, I think we all really have a focus on on as you know, we're all specialized in miscarriages and and PCOS and all that there's some people that tend to see More miscarriage patients or they people will refer miscarriage patients to us We have a particular kind of focus on that, you know, I think a lot of it is   genetic, a lot of it is immunologic, a lot of it is just taking a holistic approach to things and not just focusing on one or the more common causes of infertility. And even now, I think that, you know, the use of supplements, which maybe 15 years ago was maybe considered some snake oil. Now, I think there's a lot of provocative data that has shown that supplements do work, in particular in   Michelle (05:18) Mm -hmm.   Armando Hernandez-Rey MD (05:44) cases with recurrent miscarriage. And now we have the ability to measure those levels and we are now ability to supplement those levels and they have tremendous impact positively on these patients.   Michelle (05:57) And what supplements have you seen help with miscarriages?   Armando Hernandez-Rey MD (06:02) Well, I think a lot of it has to do with what the cause of the miscarriages is. Oftentimes, believe it or not, miscarriages can alluded to fibroids, it could be anatomical, sub -mucosal myoma. Well, there's not gonna be any supplement that's gonna help with that. It's just purely the surgical route or the diminished ovarian reserve,   Michelle (06:07) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (06:29) cause for recurrent miscarriages, which is older women or ovaries that are behaving or eggs that are behaving older than what their chronological age would dictate, you have a higher chance for aneuploidy. And in those cases, there's a variable cocktail of supplements that we use, including ubiquinol, including N -acetylcysteine, including vitamin E, even melatonin has been shown to be very, very effective. And I can go on and on, even alpha lipoic acid.   Michelle (06:50) Mm -hmm.   Armando Hernandez-Rey MD (06:57) as well. There's some very nice studies coming out of Mayo Clinic that have shown that aflalipoic acid is very, very good for recurrent miscarriages. So again, things that we thought were, well, they can't hurt, now we know that they absolutely help.   Michelle (06:57) Yeah.   Right. Yeah. I mean, that's great because it just helps to know that there's something that people can do that really does make a difference. And it's not just like in theory with miscarriages when it comes to immunology. I'd love to talk about that because I know that that's a big one. Actually, I did see a study that showed that women who have are more sexually active, that their immune system calms down. It behaves differently in the luteal phase.   Armando Hernandez-Rey MD (07:31) Mm -hmm.   Michelle (07:44) so that it's able to receive life so that it's not seeing like the sperm as an invader the, yeah.   Armando Hernandez-Rey MD (07:50) So women that are more sexually active than others, it's probably a function of repeated antigen exposure, which is the more the woman is exposed to the antigens of the sperm, more there becomes an acquiescence by the immune system to be more receptive of that embryo. Because remember, the embryo is   Michelle (08:06) Mm -hmm.   Armando Hernandez-Rey MD (08:19) a haplotype, meaning it's half female, half the woman, half the mother, and half the male. And the only genes that the immune system of the mother has got to harbor the pregnancy are her own. And so oftentimes the immunologic processes are heightened because it does not recognize the male antigens that are formed part of the embryo in general. But as a whole, I mean, recurrent pregnancy loss,   Michelle (08:33) Mm -hmm. Right.   Armando Hernandez-Rey MD (08:47) is, is a small portion of the general population and, it's skewed towards advanced maternal age and advanced paternal age. so the immunologic component, while absolutely important, I think it's the one where we're still not a hundred percent sure how to absolutely treat it. Although supplementation and.   immune suppression definitely are known to work. It's the testing that I think we still need a lot more work in doing because you know people talk about NK cells and you know that was part of my thesis when I was a fellow. So we talk about NK cells and ANA and antiphospholipids and all of that and the reality is that these tests have very very   poor sensitivity in the realm of immunologic infertility or reproductive immunology. And so you may have COVID and then you can test positive or lightly positive for NK cells. And so I think that the overwhelming response by the treating physician is, well, they're positive, they must be immunologically incapable of handling a pregnancy. So therefore we should treat.   Michelle (09:40) Mm -hmm.   Armando Hernandez-Rey MD (10:04) with nowadays what we use as intralipids. Back in the day, we used to use IVIG that has kind of fallen by the wayside a little bit. I think it's better to treat empirically than to have someone treat or test for all of these different immune markers that really, really in the presence of immunology and reproductive immunology,   They have very low sensitivity. Now if you're treating or you're looking for lupus or rheumatoid arthritis or mixed collagen disorder or Sjogren's for sure, they are your go -tos every single time.   Michelle (10:44) And what about a PRP for ovaries? What has do you do offer that?   Armando Hernandez-Rey MD (10:50) ovaries. American study of reproductive medicine came out with a black box warning that they do not recommend PRP for ovaries. Now, PRP for recurrent implantation failure, poor lining development, there is some very robust data that there may be some room or benefit for this.   Michelle (10:57) okay.   Mm -hmm.   Armando Hernandez-Rey MD (11:14) And we do do offer that. We do not offer intra ovarian PRP because ASRM has a huge black box warning on this. It's a liability. The potential for infection is there. Tubo ovarian abscess have been reported, adhesions, periovarian adhesions, and with very little to no benefit whatsoever. I mean, the whole premise for it is that we are...   Michelle (11:16) Okay.   wow, okay, I didn't know that.   Mm -hmm.   Okay, got it.   Armando Hernandez-Rey MD (11:42) regenerating the follicle complex and therefore improving egg quality and that definitively has not been shown to be the case. Although anybody who suffers from that as I would be would be like, slide me up. But unfortunately, you know, it's very easy for us to fall prey to things that we desperately want without having the medical literature to corroborate it or back it up.   Michelle (11:49) Got it.   Right.   Got it. So that's actually showing to not necessarily be what a lot of people originally thought, but for the uterus, it has been shown to help.   Armando Hernandez-Rey MD (12:15) Yes, we are doing PRP installations and very select group of women with those diagnoses in particular. And.   Michelle (12:25) So who would be a good candidate? Somebody who's had failed transfers, inflammation.   Armando Hernandez-Rey MD (12:30) Yes, someone with very high quality embryos, high quality embryos that are not getting pregnant. Also patients, for example, patients who have adenomyosis that do not develop a nice lining, a thickened lining. Those have been shown. Our numbers are very small, you know, by no means.   Michelle (12:42) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (12:53) they are in the realm of what a randomized controlled trial should be. We're following the data from the randomized controlled trials and from the literature that's out there. So patients with adenomyosis who have poor lining development, recurrent implantation failure, so patients with euploid embryos, that means a normal embryo that's tested that looks to be high quality. Also, after a second implantation failure, we'll...   offer that to the patient as a possibility.   Michelle (13:19) Mm hmm. Got it. Awesome. And then also we were talking about Ozempic pre -talk. So I'd love to get your... Yes. Yeah. Ozempic babies.   Armando Hernandez-Rey MD (13:24) the topic du jour these days, right?   It's right. So as we were discussing, I mean, this, this phenomena is not really a phenomenon that's surprising at all. It is just a, a byproduct, a side effect of, of how the medication works and the effects that positive effects that I have on women with in particular, and ambulatory disorders, specifically polycystic ovarian syndrome, which is often tied to or associated with insulin resistance, obesity, sometimes even overt.   type 2 diabetes and the elevated levels of insulin, the elevated testosterone levels, they all work together to create this sort of environment within the ovary and the system of the female which creates an ovulatory disorder or dysfunction. And as a woman loses weight by virtue of the way that these GLP1s or glucocortes   Michelle (13:58) Mm -hmm.   Armando Hernandez-Rey MD (14:22) Glucagon like peptides work They're very successful. They're very good at number one slowing gastric emptying which in turn slows down the release of sugar into the blood system to the Number one number two it stops the the release of glucose produced by the liver and Number three increases insulin levels so increase insulin levels helps get the the   the sugar into the muscles out of the circulation and out of stimulating the ovaries and the theca cells to produce more androgens which then get produced produce more estrogen which then stops the hypothalamic pituitary ovarian axis from functioning correctly and as these levels drop patients automatically begin to have spontaneous ovulation if the system is working and the male has normal sperm and they're sexually active.   this is how the ozempic baby phenomena occurs. And what we discussed also is that the concern is of the downstream consequences of ozempic babies given that the current recommendations are to have at least a two month washout period before anybody starts to try to conceive.   Michelle (15:32) So two month washout means like really not trying anything. Yeah. And then also, I know like naturally, myonocytol is really helpful as well for insulin resistance. It might take a little longer. And then also metformin has been used as well.   Armando Hernandez-Rey MD (15:37) No exposure, right? No exposure.   Yeah. Yes. So, my own hospital is, is a, is a great product. my own hospital alone, although you will find oftentimes my, my own hospital with a D chimeric, hospital and really the literature shows that my own hospital by itself is the one that truly has the most benefit might be hard to find.   Michelle (16:06) Right, yeah.   Right because for a little while they said my own hospital and dechiro, but now they're going back to saying just my own ocital, correct?   Armando Hernandez-Rey MD (16:23) Yeah, well the way that it's normally found in the body is at a ratio of 20 to 1. And that's what those supplements show, 20 to 1. Although we know now that in the ovary it's almost 40 to 1 ratio of myoinocytol to D -chimeric, inocytol.   Michelle (16:30) Mm -hmm.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (16:49) Myo Inositol is actually not an essential vitamin, but it's considered like a vitamin, but it's in the category of B8 It's a glucose like peptide that basically helps to Help the system function by processing the circulating blood sugar in a way that's more physiologic and there by lowering insulin levels and thereby also helping tremendously with   Michelle (16:56) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (17:16) regularity of cycles and even spontaneous ovulation as well. And metformin obviously is medication that's been around for many, many years. It is somewhat of a controversial drug. It is an anti -aging drug even these days because we know that insulin levels are so profoundly toxic for aging for the muscle and for the system in general.   Michelle (17:29) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (17:45) And so we know it works, we know that it helps with the efficiency of insulin. And so it's certainly been used for many, many, many years in the presence of patients with polycystic ovarian syndrome. I would challenge people to be a little bit more meticulous about using it in patients who are the lean PCOS.   Michelle (18:11) Right.   Armando Hernandez-Rey MD (18:11) or the skinny PCOS or the ovulatory PCOS even though insulin levels have been shown to be higher, slightly higher in...   Michelle (18:19) So you're talking about being cautious with metformin, not necessarily myonositol. Yeah, yeah.   Armando Hernandez-Rey MD (18:22) Metformin, you also don't want very high levels of myelonostetal because they can be, you know, there is some quote unquote toxicity. I think the recommendations are up to four grams per day. I think all the recommendations are four grams per day in two divided doses, two grams in the morning and two grams at night. I've seen patients be on eight grams and 10 grams and toxicity really starts happening around the greater than 10 gram dose.   Michelle (18:29) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (18:52) I in our office we only use it, you know, what's recommended which is the four gram total per day two grams in the morning two grams at night and I don't think it's the end -all be -all I don't think it's you know treating anything in life is multi -pronged. It's not just one single thing perhaps but I definitely believe very wholeheartedly that it does assist in in adjunct treatment, although we certainly have patients put patients on on myocytil and combined with   Michelle (19:06) Yeah. Right.   Armando Hernandez-Rey MD (19:20) diet and exercise and have been able to achieve pregnancies on their own, which is obviously what we want instead of having to go through treatments.   Michelle (19:27) That's great. I mean, I will say that I was very surprised this past year. two different patients came from different, different places, not yours, it was other doctors, but I think the nutritionist there suggested metformin when they did not have insulin resistance or PCOS for egg quality.   Armando Hernandez-Rey MD (19:47) Yeah, I'm not familiar with any studies that have shown that have improved that. In fact, when I was a fellow, we were, just as I was coming into fellowship, where I trained, Rutgers was involved with a very well known and publicized study, it's called the PP COAS study, which looked at patients on placebo versus metformin alone versus metformin with Clomid, sorry.   placebo versus clomid versus clomid with metformin and there was no difference in pregnancy rates or anything else. I'll go one step further with them going back to the myonocytol. It has even been shown to decrease the rates of gestational diabetes and so in our patients with PCOS with who are you know   Michelle (20:18) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (20:39) Stage one, type one obesity, type two, we'll continue them on the myonostetal throughout the pregnancy and when they leave us and go to their OB -GYN, in our referral letter back, we'll say that we're recommending for her to continue on myonostetal because there have been improvements in sugar levels and glycemic control and reduction in gestational diabetes overall.   Michelle (20:54) Yeah, that's good to know.   another big one is vitamin D. A lot of people, even though we're in Florida here, we have a lot of sun. A lot of people are very deficient in vitamin D.   Armando Hernandez-Rey MD (21:11) Yeah, What it is is a combination of things. Number one, we're not as sun exposed as you think we are. You know, we're always in a car, we're always indoors, it's very hot. And yes, we go out to the beach and there is a lot of sun, but we become very, very sensitive to the sun and to the untoward effects of the sun.   Michelle (21:17) Mm -hmm.   Armando Hernandez-Rey MD (21:35) So we protect ourselves tremendously. That's number one. Number two is that I think the levels are set higher than what the average person can sustain with just diet and sun exposure. And actually the recommendations now in the infertility world that when you order a vitamin D from Quest, they'll tell you that the levels are, you want them at   Michelle (21:38) Mm -hmm.   Armando Hernandez-Rey MD (22:04) definitively above 20 Certainly above 30 and now recently now the recommendations are that for them to go above 40 and and and Yeah, I'm not yeah, so I heard I've read 40 I it was a Paper that came out of Either the Lancet or   Michelle (22:11) Yes, yep, I've been hearing that or even 50. Yeah.   Armando Hernandez-Rey MD (22:27) or fertility necessarily, anyone, one of, that they recommend now for vitamin D levels to be above 40. So that's really hard. I mean, I work really hard. I take a lot of vitamin D and I'm just barely scraping like 50. You know, I take about 5 ,000 units a day, which is what we're recommending nowadays, 5 ,000 units of vitamin D. And I take that every single day and I barely scratch,   Michelle (22:38) Mm -hmm.   Yeah.   Armando Hernandez-Rey MD (22:56) you know, 45, 50 every time I get an average check. So I'm not getting as much sun as I think I am, number one. I am out fairly often. I do play some golf, not enough. And yet it's not enough. So definitely supplementation's important.   Michelle (23:03) Mm -hmm.   Yeah, magnesium is also important. That's another thing. It's to not be deficient in magnesium because magnesium plays an important role of our absorption of D, which, you know, obviously doing this, I learned, I was like, that's might be deficient magnesium and be taking a lot of D and then their body's not processing, which is why it's important sometimes even in foods, foods have everything. So like,   even beef liver, you know, from Chinese medicine perspective is so beneficial because it has iron, but it has it in a combination of nutrients that helps the body absorb it.   Armando Hernandez-Rey MD (23:46) Yeah, B6, B12 are incredibly important for iron absorption as well. So all of these things are extremely important. Everything is all intertwined and we're just learning about this. And for us, I've really gotten grabbed hold of this whole longevity thing, hence my aura ring and all of this. And...   Michelle (23:57) It is.   Yeah.   Armando Hernandez-Rey MD (24:09) I'm just trying to apply a lot of the things that we know today work for longevity medicine and anti -aging principles to the infertility world because it's all intertwined. It's all intertwined.   Michelle (24:16) Yeah.   without a doubt. It's funny because that you say that because I always say it's pretty much anti aging. Yeah.   Armando Hernandez-Rey MD (24:26) Yeah, totally, totally. They're even coming up with a way to stop menopause.   Michelle (24:36) wow. How?   Armando Hernandez-Rey MD (24:37) which is extremely interesting. Believe it or not, recombinant antimullerian hormones.   Michelle (24:42) How is that? Explain that.   Armando Hernandez-Rey MD (24:46) So the way that antimullerine, the function of antimullerine hormone at the level of the ovary is that it stops follicular recruitment. That's why women with PCOS have higher AMHs and therefore they have higher egg counts and higher, they tend to go into menopause later on, et cetera. That's because they have high levels of antimullerine hormone. So by reproducing or creating it in the laboratory and then from an early stage,   This is in its infancy, by the way, okay? So this is, yeah, this company, I believe she's a Harvard scientist, biochemist or something, who's coming up. My point is that, listen, that it's all intertwined, aging and even in menopause, for God sakes. Now I've been doing this for so long that I now,   Michelle (25:18) It's new.   Mm -hmm.   Armando Hernandez-Rey MD (25:39) seeing menopausal patients who were like, you know, listen, you took care of my baby, you're a reproductive metachronologist, you understand the science, will you treat me? And, you know, like, and I realized, like, somewhere, some women got like, they got a some bad luck thrown their way because, you know, with the WHI results and the way they were interpreted, they made hormones bad. And somewhere along the way, someone said,   It's okay for women to suffer from menopause, just suck it up. Like it's not okay. That's not okay. That's not okay. And so if you start from very early on and, you know, and, and really practice what you preach, which is healthcare and not sick care, which is what we practice in the United States, you know, we're just very, we, we're not proactive. We're reactive to when a patient is sick instead of early intervention, early screening and all of that.   Michelle (26:25) Yeah, absolutely.   Armando Hernandez-Rey MD (26:30) And that goes for the infertility world and that goes for a woman's long reproductive life extending past menopause. I think we still have a lot of challenges to overcome, but I think that we're heading in the right direction. Sorry to digress a little bit. I went off on a tangent there for a second.   Michelle (26:43) Yeah, for sure. no, it's okay. But you know what? I love the passion and I love that, that, you know, ultimately is great. It's important, very important, because it's true. And I agree a lot with what you just said, that we should be proactive when it comes to healthcare. I mean, really when it comes to so many things and something else that I...   that I read, it was an animal study. It was a study on, I believe it was like, I don't remember which kind of animal it was. I think it was like either sheep or cows or some form of those where they actually gave them oxytocin right before IUI. And that improved the chances of the conception rates, which I thought was very interesting because I think that that's one of the things with IUI that's missing because obviously you're taking away the connection.   that is usually there when you're just under natural circumstance. And I thought it was interesting because I was looking into it for something else to understand from a Chinese medicine perspective, because they have this heart -uterusconnection, that connection, the bonding. And so what I found was interesting too is that oxytocin increases around ovulation and after intercourse. And usually what they look at it as its role is usually for labor.   not so much conception. So I was just going to kind of like pick your brain on that. Any thoughts on that?   Armando Hernandez-Rey MD (28:13) Well, I mean, oxytocin is secreted at the time of... I'm not sure of ovulation, I didn't know that. But definitely at the time of...   Michelle (28:21) or it increases around that time, like right before ovulation in the cycle, a woman cycle.   Armando Hernandez-Rey MD (28:27) What we know that it's involved is at the time of orgasm. And so this may promote uterine contractility, which is what is used for intrapartum, to promote contractility of the uterus, to promote descent and eventual delivery. And we know that it's intimately involved in orgasm, we're seeing.   Michelle (28:33) Mm -hmm.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (28:55) during intercourse and orgasm and so with you know the projection of with the secretion of oxytocin and it causing uterine contractility obviously not at the same level that it does during labor but at smaller amounts then I can see how there could be a role for oxytocin in artificial insemination.   Michelle (29:18) even in fertility in general and because it's got to be there for a reason why would the body produce it around that time?   Armando Hernandez-Rey MD (29:25) Well, yeah, I guess, but it's either IUI or IVF and we definitely don't want oxytocin during the IVF cycle.   Michelle (29:33) Right, because you don't want to contract, right?   Armando Hernandez-Rey MD (29:35) Right, because we're transferring an embryo where there should not be any oxytocin. And you can have the most beautiful embryo, but if you screw up the embryo transfer, through no fault, just because it's a difficult transfer for a myriad of reasons, and you cause uterine contractility, then there's a high likelihood of pregnancy not occurring during that time.   Michelle (29:57) Right. I think it would be an interesting thing to look into for IUI. There might be something to it, because if it works with animals, and the animals obviously have similar certain functions that we do, mammals, that seems like an interesting thing.   Armando Hernandez-Rey MD (30:10) Yeah.   I think there's not going to be a lot of resources put into improving IUI, to be honest with you. IUI, I think it is what it is. And I mean, I think the majority of research is going to go to improving even more IVF rates, because I think ultimately patients are going to want to go more.   Michelle (30:22) Mm -hmm. Yeah.   Armando Hernandez-Rey MD (30:40) towards IBF, no matter how hard we try to say, hey, listen, there's this option or this option or this option. It's more become a more of an instant gratification society. Number one, number two, people are waiting longer. So therefore they're more pressed for time, if you will. And I think there will be less of a motivation to go down a treatment option that frankly,   Michelle (30:48) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (31:07) You know, has a low pregnancy rate.   Michelle (31:09) Right. And then my other question is, what are your, thoughts about a lower intensity cycle?   like lower amounts of hormones for older women. In some cases I've heard it might be a little better. you do? Yeah, yeah.   Armando Hernandez-Rey MD (31:24) We use it all the time. Yeah, we use it all the time. I think it's...   a very successful option in cases with severely diminished ovarian reserve. I think that the senescent ovary does not do well with high impact medication or high doses of medication separately, but you know, jointly the medication costs are exorbitant and you end up having the same number of eggs that are mature, that get fertilized with a mini stent protocol as you do with   Michelle (31:38) Okay.   Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (31:59) a high dose regimen.   Michelle (32:02) Okay, so you've seen good success with that.   Armando Hernandez-Rey MD (32:06) Well, I mean, not good success because generally these cases are, we've seen success. Let's call it that. Because the patients that you're treating with these medics, with this protocol are patients who are POI, you know, premature ovarian insufficiency, diminished ovarian reserve, poor egg quality, high rate maniploidy. So these are your poor responders essentially. And they're very...   Michelle (32:12) Yeah, okay.   Mm -hmm. Mm -hmm.   Armando Hernandez-Rey MD (32:34) specific factors that propel a woman to have success with this protocol compared to her twin sister with almost the same testing who doesn't do as well.   Michelle (32:47) Got it. And then lastly, we talked about this in the pre -talk, let's talk about marijuana and sperm, data is showing. Yeah.   Armando Hernandez-Rey MD (32:55) I don't do it myself, but I have no problem with people that do. What the data has shown that we're just becoming more and more familiar because the overwhelming number of people who are using cannabis and open about it, which is the second part, which was very difficult to conduct studies because it was so people were ostracized. They were looked at.   not the wrong way and seen as in the fringe. And now it's, you know, it's so mainstream. but so now we're, we're keenly aware, of patients were able to analyze them and what we know without a shadow of a doubt that the potency of the cannabis that's being produced these days is anywhere between eight to 12 times more potent than I think I use the joke of the guys at Woodstock back in the sixties, right?   Michelle (33:21) Mm -hmm.   Mm -hmm.   Armando Hernandez-Rey MD (33:46) where everybody was getting pregnant and everybody was high on life, all of those things. And then what we've also known, which I did mention, is that using the vape pens, whatever types of inhalers as opposed to the traditional joint, if you will, increase the potency of that by a factor of two to three. The cannabis that was already potent to begin with.   Michelle (34:08) Yeah.   Right.   Armando Hernandez-Rey MD (34:14) So what you're seeing in males in particular, and I'm not sure that the literature is so complete on the female aspects, are that we're seeing a high levels of fragmentation. And what fragmentation is, is imagine that sperm is like an Amazon box. And inside that box, there's a porcelain doll that's wrapped in these packing cubes. They're held very, very tight. And under...   Michelle (34:26) Mm -hmm.   Armando Hernandez-Rey MD (34:40) The best of circumstances, those packing cubes are wound so tight, packed so tight that nothing, if I kick the box off the Amazon truck, nothing is gonna happen to the porcelain doll. Well, as fragmentation occurs and it happens under natural conditions and old guys like me, you know, patients who, occupational hazards, firefighters, exposed to toxins, a lot of people who use fertilizers, et cetera, et cetera.   you see high levels of fragmentation. I'm talking about DNA fragmentation. And so what we're seeing is high levels of fragmentation at the level of the DNA of the sperm, which has significant effects on embryo quality, embryo development, and pregnancy rates, and high levels of aneuploidy, which is abnormal embryos. So,   Michelle (35:10) So you're talking about DNA fragmentation. Yeah. Yeah.   Mm -hmm.   Armando Hernandez-Rey MD (35:33) You know, I'm not here to like, you know, slap you on the wrist and say don't smoke weed, but really that's what you're facing. And we know that this happens in women with cigarette smoking. Like this is a well -known cause of an accelerated transition to perimenopause. You know, 65 % of women who smoked a pack a day for greater than 15 years will go into menopause before the age of 40, assuming they started before their 20s. That's a pretty...   Michelle (35:40) Bye.   Mm -hmm.   Armando Hernandez-Rey MD (36:03) ominous number, actually. Thankfully, not many women smoke these days, cigarettes anyway. So I guess the results of cannabis on females is yet to be elucidated, but we definitely have some pretty compelling evidence in terms of the male data that show that it can have detrimental or deleterious effects on sperm quality and not necessarily on numbers.   Michelle (36:04) Yeah.   Mm -hmm.   right, which is what people look at usually when I mean, that's like the, the analysis is always on numbers shape and, numbers shape it. Yeah. And morphology and they won't necessarily look at the DNA fragmentation. That's actually not something that REIs usually initially look at.   Armando Hernandez-Rey MD (36:33) Exactly.   the thesis in morphology.   is done in a well not initially unless there's comorbid situations or things that raise your red flags. For example, advanced paternal age, we always do it. Particularly in egg donor cycles, right? Because patients will be like, well, I'm using an egg donor and why don't I have bad energy? Well, because your husband could be 70 or 60 and   Michelle (37:11) Yeah.   Armando Hernandez-Rey MD (37:14) And then their fragmentation is completely elevated and through the roof. So yeah. So, you know, firefighters, occupational hazards.   Michelle (37:18) Right. So, yeah, it's important. It's important for people to hear this because they can go in and say, the semen analysis was perfect. But that, like what you just said, is not really checked. So they may not, in a healthy, like, younger guy.   Armando Hernandez-Rey MD (37:35) It's not as nuanced as we once thought it was.   Michelle (37:38) Yeah. Yeah. Interesting. It's, it's fun. It's always fun for me to talk to our, our ease, you know, just to get, to pick your brain and get your thoughts. and you're my neighbors. So it's pretty cool.   Armando Hernandez-Rey MD (37:50) That's right. Thank you very much for the invitation. This was really fun. We spoke about a wide array of different topics here. So this was really nice to connect this way.   Michelle (37:53) Yeah.   Yeah.   Yeah, for sure. And I know that a lot of people are going to be like, this is interesting information. Cause I know that what you just mentioned, a lot of it is not common knowledge. people don't know automatically hear about this or really know to think about asking about it. So, so I appreciate all your information, all your good, good data. And, for people who would like to work with you or in town, how can they find more about you?   Armando Hernandez-Rey MD (38:27) Well, we are at Conceptions Florida. We have two offices in Merritt Park, Coral Gables and one in Miramar and hopefully soon also in Boca. And I'm there Armando Hernandez -Ray, MD I'm sure. Easy to find these days on Google, but I'm happy to help in any way that we can. We've been doing this for a long time, quite successfully, thankfully. And we take a lot of pride, humbly speaking, but probably also.   in having a good footprint in South Florida and the infertility world and trying to offer the best care possible.   Michelle (39:01) Awesome. Well, this was such a pleasure and thank you so much for coming on today.   Armando Hernandez-Rey MD (39:05) Thank you, Michelle.    

Fertility & Sterility on Air brings you a deep dive into the June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders. With Micah Hill, Ernest Ng, and Zhi Chen. Read the article: https://www.fertstert.org/article/S0015-0282(24)00030-X/abstract View Fertility and Sterility at https://www.fertstert.org/  

Take a sneak peak at this month's Fertility & Sterility! Articles discussed this month are:   4:33 A randomized controlled trial to compare the live birth rate of the first frozen embryo transfer following the progestin-primed ovarian stimulation protocol vs. the antagonist protocol in women with an anticipated high ovarian response 20:24 Improved fertilization, degeneration, and embryo quality rates with PIEZO–intracytoplasmic sperm injection compared with conventional intracytoplasmic sperm injection: a sibling oocyte split multicenter trial 31:15 A comparison of pregnancy outcomes and congenital malformations in offspring between patients undergoing intracytoplasmic sperm injection and conventional in vitro fertilization: a retrospective cohort study 37:05 A follicular volume of >0.56 cm3 at trigger is the cutoff to predict oocyte maturity: a starting point for novel volume-based triggering criteria 47:35 Midluteal serum estradiol levels are associated with live birth rates in hormone replacement therapy frozen embryo transfer cycles: a cohort study 57:10 First pregnancy and live birth from ex vivo-retrieved metaphase II oocytes from a woman with bilateral ovarian carcinoma: a case report 1:00:56 Associations between race and ethnicity and perioperative outcomes among women undergoing hysterectomy for adenomyosis   View Fertility and Sterility June 2024, Volume 121, Issue 6: https://www.fertstert.org/issue/S0015-0282(24)X0005-9   View Fertility and Sterility at https://www.fertstert.org/  

In this month's Fertility & Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include counseling on pregnancy complications in PCOS patients (2:05), sorting early spermatocytes from testicular biopsies (14:04), and diversity statements on REI fellowship websites (27:01). F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00055-2/fulltext F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00015-6/abstract Consider This: https://www.fertstert.org/news-do/diversifying-future-analyzing-rei-fellowship-websites-and-their-diversity-statements View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Take a sneak peek at this month's Fertility and Sterility! Articles discussed this month are:  6:24 Iatrogenic and demographic determinants of the national plural birth increase 18:10 Comparison of outcomes between intracytoplasmic sperm injection and in vitro fertilization inseminations with preimplantation genetic testing for aneuploidy, analysis of Society for Assisted Reproductive Technology Clinic Outcome Reporting System data 24:54 Retrospective cohort study comparing the success of medical management of early pregnancy loss in pregnancies conceived with and without medical assistance 33:31 Association of duration of embryo culture with risk of large for gestational age delivery in cryopreserved embryo transfer cycles 38:32 Endometriosis diagnosed by ultrasound is associated with lower live birth rates in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection treatment 47:29 Quantitative ultrasound measurement of uterine contractility in adenomyotic vs. normal uteri: a multicenter prospective study 53:13 Unhealthy air quality secondary to wildfires is associated with lower blastocyst yield 1:03:22 The American Society for Reproductive Medicine's new and more inclusive definition of infertility may conflict with traditional and conservative religious-cultural values  View Fertility and Sterility May 2024, Volume 121, Issue 5: https://www.fertstert.org/issue/S0015-0282(24)X0004-7 View Fertility and Sterility at https://www.fertstert.org/  

Dr. Natalie Crawford reviews three of the latest research studies by Fertility and Sterility. These studies include AMH and Vitamin D, AMH and PCOS, and periods and the lunar cycle. Dr. Crawford has a masters degree in clinical research, so staying up to date on the latest data is something she is very passionate about. You can't make decisions on data you don't know. Natalie answers your questions in FFS-For Fertility's Sake I'm trying to conceive while postpartum and my period has not returned. Do you have any tips? I'm trying to conceive while postpartum and my period has not returned. Do you have any tips? can high intensity exercise be a cause of a luteal phase defect? We have moved Fertility In The News to the weekly newsletter in order to keep the podcast more evergreen. If you want to sign up go to nataliecrawfordmd.com/newsletter to sign up! Don't forget to ask your questions on Instagram for next week's For Fertility's Sake segment when you see the question box on Natalie's page @nataliecrawfordmd. You can also ask a question by calling in and leaving a voicemail. Call 657–229–3672 and ask your fertility question today!      Thanks to our amazing sponsors! Check out these deals just for you: Quince- Go to Quince.com/aaw for free shipping on your order and 365-day returns Ritual-Go to ritual.com/AAW to start Ritual or add Essential For Women 18+ to your subscription today. Rocket Money - Cancel your unwanted subscriptions by going to RocketMoney/com/AAW Apostrophe- Get your first visit for only five dollars at Apostrophe.com/AAW or use the code AAW at checkout. Prose- Go to prose.com/aaw and take your FREE in-depth hair consultation and get 50% off your first subscription order PLUS 15% off and free shipping every subscription order after that! If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Sunday. Plus, be sure to follow along on Instagram @nataliecrawfordmd, check out Natalie's YouTube channel Natalie Crawford MD, and if you're interested in becoming a patient, check out Fora Fertility. Studies reviewed: Association between serum 25-hydroxyvitamin D and antimüllerian hormone levels in a cohort of African-American women Subramanian, Anita et al. Fertility and Sterility, Volume 121, Issue 4, 642 - 650 The menstrual cycle is influenced by weekly and lunar rhythms Ecochard, René et al. Fertility and Sterility, Volume 121, Issue 4, 651 - 659 Antimüllerian hormone level predicts ovulation in women with polycystic ovary syndrome treated with clomiphene and metformin Komorowski, Allison S. et al.Fertility and Sterility, Volume 121, Issue 4, 660 - 668 Learn more about your ad choices. Visit megaphone.fm/adchoices

James K. Galbraith joins me to discuss the flaws in the field of economics and its pseudoscientific justifications

In today's Egg Whisperer Show Podcast, I'm so excited to be joined by Dr. Paula Amato. She is a fertility specialist who froze embryos in her 30s using sperm from an anonymous donor. Later, Dr. Amato decided to donate her embryos. She shared about this journey and what she learned as a fertility doctor in a recent article published in Fertility and Sterility titled: "The fertile window: what donating my embryos taught me about being a fertility doctor." We're going to talk all about her decision to donate her embryos, what looking into the genetics of those embryos taught her, and what she learned from the process. It's an amazing story, and it's interesting to hear a fertility specialist talk about her experience as both a doctor, and a patient. Dr. Paula Amato is a Professor of Obstetrics and Gynecology, at the Oregon Health & Science University School of Medicine in Portland, Oregon. She also is a Reproductive Endocrinology & Infertility Specialist and has over 33 years of experience in the medical field. She graduated from University of Toronto medical school, and did her fellowship at UC San Diego. Thank you for joining me, Paula! You can read her article here: https://www.fertstert.org/article/S0015-0282(21)02289-5/fulltext Would you like to learn about IVF?Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, April 22, 2024 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom. Listen to this episode on Dr. Aimee's website. Subscribe to my YouTube channel for more fertility tips! Subscribe to the newsletter to get updates  Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.

As the Medical and Laboratory Director at Columbia University Fertility Center, Eric Forman, MD, HCLD, oversees the medical practice as well as the IVF embryology and andrology laboratories. He also actively sees patients with infertility and those seeking to preserve their fertility. Dr. Forman has extensive clinical and laboratory research experience. He has published more than 50 articles in peer-reviewed journals on a wide range of topics in assisted reproductive technology (ART) and serves as an Associate Editor at Fertility and Sterility.Dr. Forman specializes in providing individualized patient care to solve each unique couple's challenge. He is active on social media where he frequently writes blogs and commentaries on important topics in reproductive medicine and the patient/physician experience. Follow him on Facebook, Twitter, and Instagram.When not working, Dr. Forman enjoys spending time with his wife, three children and four cats; running (including completing the 2016 NYC Marathon with Team Every Mother Counts); and rooting on his favorite sports teams, the Mets, Jets, Knicks, Rangers and Duke Blue Devils. Dr. Forman came in 3rd place in the ARI Fountainhead Essay contest around 1994.http://columbiafertility.org/team-mem...https://doctors.columbia.edu/us/ny/ne... / ericformanmd / ericformanmd / ericformanmd Show is Sponsored by The Ayn Rand Institute https://www.aynrand.org/starthereandExpress VPN https://www.expressvpn.com/yaronJoin this channel to get access to perks: https://www.youtube.com/@YaronBrook/joinLike what you hear? Like, share, and subscribe to stay updated on new videos and help promote the Yaron Brook Show: https://bit.ly/3ztPxTxSupport the Show and become a sponsor: / yaronbrookshow or https://yaronbrookshow.com/membershipOr make a one-time donation: https://bit.ly/2RZOyJJContinue the discussion by following Yaron on Twitter (https://bit.ly/3iMGl6z) and Facebook (https://bit.ly/3vvWDDC )Want to learn more about Ayn Rand and Objectivism? Visit the Ayn Rand Institute: https://bit.ly/35qoEC3 #fertility #ivftreatmentforpregnancy #abortion #capitalism #philosophy #Morality ​ ​#Objectivism​ #AynRand #politics