From Pudding to Pregnancy: The Real Ingredients of IVF Success

Welcome to another enlightening episode of "Taco Bout Fertility Tuesday" with Dr. Mark Amols. Today, we unravel the age-old phrase "the proof is in the pudding" and its surprising connection to the world of IVF success. This episode delves deep into the critical elements that determine the outcomes of IVF treatments.

Dr. Amols takes you on a comprehensive journey, examining the pivotal factors that contribute to successful IVF procedures. From the quality of embryos to the importance of the uterine environment, we leave no stone unturned. You'll gain valuable insights into how lifestyle choices, medical protocols, and cutting-edge technologies come together to create the optimal conditions for achieving pregnancy.

We'll also debunk some of the most common myths surrounding IVF, providing clarity and dispelling misconceptions that often cause unnecessary worry and confusion for hopeful parents. Whether you're at the beginning of your fertility journey or already navigating the complexities of IVF, this episode is packed with actionable advice and expert guidance to enhance your understanding and improve your chances of success.

Join Dr. Amols as he shares real-life stories, expert opinions, and practical tips to help you navigate the IVF process with confidence and hope. Tune in to discover how the right combination of factors can transform your dreams of parenthood into reality. Don't miss this essential episode that promises to inform, inspire, and empower you on your fertility journey.

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.

Transcript

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Have you ever heard the phrase, the proof is in the pudding? It's actually a phrase that came from an original one called the proof of the pudding is in the eating. But then Bill Cosby famously used the phrase the proof is in the pudding for his commercials for jello pudding. But Cosby wasn't wrong. The proof is in the pudding. And we're going to talk about how that relates to IVF success today. I'm Doctor Mark Ammels, and this is taco. About fertility Tuesday. One of the things I see a lot of doctors do is they'll constantly watch FSH levels or AMH levels, or antral follicle count. And one of the things that is really important to understand about fertility is it's all about adjustments. There is no number that is ever going to define how well you do. Whether your FSH level is high, whether your amh is good, or even your antral follicle count is good. You can still have a poor outcome. And poor outcome doesn't always mean not getting enough eggs. It could be bad fertilization, it could be that your embryos don't make it. Well to blastocyst having a poor blastulation rate. There can even be issues with things that are, unknown, such as how well the embryos look at the time of grading, or even how they come back with genetic testing. But the one thing that's most important that I always tell people is looking at the results afterwards. After every IVF cycle that has failed, or even someone coming back for another IVF cycle, I take the time to look through everything. I look at the point of how well did the embryos make the blastocyst, how many of the embryos I thought would be good, were good, meaning the genetics of the embryos. I look at how many eggs I thought would be mature, were mature. I, look at the fertilization. I, even look at things like, did the dosage? I predict do as well as I thought it would? And do I think there's any room for improvement, because that's what makes IVF so amazing. We can actually go back and make changes that we see. You can't do that with other treatments. When you do timed intercourse, no one can tell you why it didn't work. When you do artificial inseminations, iuis I can't tell you why they didn't work, unless the sperm on that day was bad. But IVF is different. In IVF, you can look at it and then make adjustments. And so that's where I come with this comment that the proof is in the pudding, meaning once you've been through an IVF cycle, your doctor should really be looking at that versus just looking at numbers. It doesn't mean there's not extra testing to be done, but you need to be looking at the pudding because that is the real world experiment, and there's no better test than IVF. Let me give you a clinical example. Let's say I have a patient who I already know has dementia, ovarian reserve. Her FSH is like twelve, her amh is maybe 0.7. And I know I'm going to use aggressive stimulation, and so I go and I put her, let's say, on, microdose Lupron protocol with a high dose of 300 of golf or fall stim and 150 Amenopur. And then I do the stimulation and the results were even worse than I expected. Maybe she only made three or four eggs and she didnt have the success we wanted. And so ill get asked by that patient, well, should we recheck the cycle? Day three laps? Should we recheck everything again? And I say to her, well, no, we dont need to because we already know the situation is bad. And, she said, well, what do you mean? I said, well, because we already saw the cycle again, the proof is in the pudding. We know what happened. We don't need a test to tell us things are bad. We already know it is matter of fact. The test will only make things more difficult. The test comes back and says things are great. Am I going to just throw away the knowledge of the past cycle? And we go, you know, I know that cycle wasn't good, but this number says it will go better, so I'm going to lower the dose. Absolutely not. Just like you wouldn't sit there and say, I'm going to try a new pudding. You're like, no, this pudding is good. I know it's good. I'm not going to change the ingredients now. I made it very well. The proof is here. And that's the principle here. It can go the other way if someone, let's say, has bad labs and everything goes very well. So let's say you have a higher FSh and you start with more medication and you're trying to push them hard and they make too many eggs, you're like, oh, my God, this person's going to go into ovarian hyperstimulation syndrome on your next cycle, for whatever reason why youre doing it. Maybe youre just banking embryos. I might go down on the dosage. Someone could say, what? My labs are worse. Well, it doesnt matter because we just went through a cycle. Its what I always go back to every time. These tests are not predictive of success. Theyre not predictive of your chances of getting pregnant. All these tests do is help us guess what would be the best protocol and the best dosage for you. But the thing about these tests are, is there only so much value from them, because there are situations that are outliers and we have to make adjustments. And on the same token, the best information is the past. I mean, isn't that true for most things you learn from your mistakes? I'm not saying that the doctor made a mistake. The doctor did the best they could using the current information. But once you have that information, it doesn't make sense to keep getting more information that wasn't helpful the first time. And so I find it kind of strange when I see some of these clinics where they're constantly repeating over and over ovarian reserve testing and following AMH levels. Now, again, if your insurance requires it, that's a different scenario. They're doing it because your insurance requires it. But if they don't, what are they looking to change? Are they looking to just tell you it won't work anymore? That may be a reasonable reason. Maybe you're just watching AMH levels because you don't want to do something at this moment and want to wait until it drops before you start something. But if you're actively going through an IVF cycle, the most important test to look at is how did you do in that IVF cycle? So, let's talk about a couple of clinical situations. Let's say your cycle, day three labs showed a low estrogen level and your FSH levels were normal. That doctor is not going to suspect that you have maybe early recruitment. But then when you go through the IVF cycle, you keep going to lead follicle, and that gets ahead. Well, again, here's a situation where testing didn't tell us that, but clearly that keeps happening to you. So if the doctor doesn't adjust for that situation, then they're not looking back at the past. The same thing goes with, let's say, fertilization. If your doctor assumes out of your 20 follicles that 16 will be mature and it comes back and only ten are mature, then it doesn't matter what the labs say. It doesn't matter that the estrogen said something. They have to adjust. What I would do in that situation is if I had someone who? Let's say I looked at everything, the sizes, I looked at the estrogen and I made a decision to trigger, but more of the eggs came back immature than I expected. Then I'm going to change things. And the way I'm going to change things is I may go a little bit later. Now, I'm not going to look at that estrogen level as much because again, the proof is in the pudding. I saw what happened the cycle before. Even though it's ingrained in me to know that when that estrogen level is there, I should trigger, I'm going to resist that. And then I'm going to go a day later and, I'm going to focus on a higher estrogen level for that person because I know that for their body, things are different. And that's really the point. We all know everybody is different. Human bodies rarely act the same with everything. This is why there are different forms of medication. There are even medications that work better for people who are African American versus Caucasians. So it's not surprising that sometimes not everything works the same between every person. And so you have to adjust things. And that also means that the testing that you do isn't always going to be perfect. And sometimes the doctor's going to have to make an adjustment based off of how the cycle went. Even in my own IVF cycle, when my wife and I went through a second time, when we were going to try to have another pregnancy, I remember making adjustments again. And thats because we learned things in the first few IVF cycles that we did. Matter of fact, the very first IVF cycle we did was actually horrible. We had to stop it partway through after spending thousands of dollars, because we just realized how bad it was. So when I went in the future, when we're trying to have another pregnancy, I didn't say, well, let's see what the labs look like. Why would I care what the labs look like? It's not like I'm going to change my mind of what I already know. I know my wife's eggs didn't get better over time. I don't expect now she's going to respond better. Sure, there are small adjustments we can make with things like supplements and health, but at the end of the day, the proof is in the pudding. How your body responds is how it responds. There's some differences month to month, but in the end there's a general theme. And so my point is that I didn't repeat her labs just to repeat them. I repeated them only for the purpose of maybe looking at FSH levels to determine if maybe she's too far out now to be able to stimulate. But I wasn't testing them to figure out what to do because I already knew based off the prior cycle that had to be very aggressive or otherwise we wouldn't have success. So how does this help you? Well, the purpose of this is I wanted to make sure that patients understand that it's not just about the testing. And I would even make the argument that your historical data is probably the most important test you do, and it should basically guide you more than anything else, because that is your data, that is how you respond, not how everyone else responds. Just like you can probably assume, just because you have an amh m, the same as, let's say someone else does, doesn't mean you're going to respond the same way as them. And so everything the doctor does to try to predict how you respond is done through that testing. But once you've gone through, we don't have to guess anymore. We know how you are now. the thought could come up, well, can't things change? Well, a little bit here and there, but not much. Your antral follicle count rarely is going to go up and it might go up a tiny bit. Your FSH levels are not really going to change much. Your amh m is probably going to keep going down. So in reality you kind of are your worst test. Meaning that is going to define where people look at things and your treatment is how things respond. And sometimes it's paradoxical. There are crazy things that happen. There's many people out there who say oh, lower doses, I had a better cycle. That's crazy. You don't get better cycles for lower doses, but there are times it does happen. I'm not saying they're lying, they're absolutely correct. They did a lower dose and they got more eggs, or they got a lower dose and they got better eggs that month. That is absolutely possible. That doesnt mean that they would have used higher doses that month, they would even got more eggs. Thats the point im trying to make. So this is where the proof is in the pudding concept comes from. If you are someone that has poor ovarian reserve who already is not making a lot of eggs, there is nothing wrong experimenting and doing things like lowering the dosage, there's nothing wrong changing your lifestyle and seeing that will help. But in the end you don't throw away all the data that you've accumulated through the cycles. That's important because that data is all about you. And so don't look at future testing as something that throws away that data. Think of future testing as just maybe making small adjustments or finding out if you're still a good candidate for something or not. But in the end, you and your doctor should always be using that prior data to help formulate a plan moving forward. I know low dose stim cycles are very hot topic, and that is something we're going to do in the future. So I don't want you to think I'm just going to leave that unanswered. I've had many patients, even in my own clinic, who have done full IVF cycles elsewhere and then come to us and we do a very minimal stim cycle with, let's say, IVC intravaginal culture, and they had success where they didn't have it at the prior clinic. Now, I don't come to the theory then that IVC is better than IVF from that clinic. I just understand that in that situation, was right for that patient, and it helped them in that situation. But as I said, and I stand by this, and so does the research, low dose stimulations do not always benefit patients. The only patients it truly benefits are going to be people who have pcos for fresh embryo transfers. There they can't make too many aches or they won't have a good fresh transfer. However, if they are doing a, frozen transfer, it doesn't make a difference. The other benefit is a financial benefit for some people. Outside of those things, I would have to see some data that supports that using low dose actually makes better embryos or more eggs than using higher doses. At this time, I am m not aware of any valid study that proves that, whereas there are many studies that prove the opposite. By this time, I'm pretty sure you must be craving pudding. I know I am. And I'm not even a sweets person, so I've been talking a lot about pudding. Hopefully this was a very helpful episode for you. I know it's a common concern people have with why aren't the doctors checking this? Why are they not checking this other lab? Why aren't they following my FSH levels? And I wanted to make sure you understand the reason why, because that historical data is actually more important than even rechecking those FSH levels. And by the way, if you want them drawn, your doctor is not going to say no. It's just that they don't need it. And most of us have been trained to not order things that we don't need. So if you want it, just let your doctor know. I'm pretty sure they're not going to mind getting it for you. But keep in mind, most of them are going to use your prior history to help make decisions. And if this episode didn't help you, maybe it may help your friend, maybe it may help a family member. Main thing is, hopefully it was helpful to someone. And if you like this, as I always say, please give us a five star review on your favorite medium. And it's always, the most important thing is to always come back. I'll talk to you again next week on Taco Bell fertility Tuesday.