Same Treatment, Different Results: Understanding Fertility Variability

In this episode of "Taco Bout Fertility Tuesday," Dr. Mark Amols delves into the perplexing world of fertility treatments and why doing the same thing can yield different results. Inspired by the idiom often attributed to Einstein—"the definition of insanity is doing the same thing over and over and expecting different results"—Dr. Amols explains why this doesn't always apply to the human body.

Join Dr. Amols as he unravels the complexities of human biology and fertility, highlighting how factors like body variability, medication absorption, and even month-to-month physiological changes can influence treatment outcomes. Using relatable analogies and real-life examples, this episode reassures patients that repeating a treatment isn't necessarily a recipe for disaster but a reflection of the body's intricate nature.

Whether you're undergoing fertility treatment or supporting someone who is, this episode offers valuable insights into why it's sometimes okay to try the same protocol again. Tune in to learn when it might be time to switch things up and when sticking with a tried-and-true method might just be the key to success.

Don't miss this enlightening discussion that emphasizes the importance of patience, understanding, and communication with your fertility specialist. If you find this episode helpful, please share it with others and leave us a five-star review on your favorite platform.

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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Today we talk about is doing the same treatment in fertility over and over, a recipe for disaster. I'm, Doctor Mark Ammels, and this is taco. About fertility Tuesday. There's an idiom out there that was a tribute to Albert Einstein that goes, the definition of insanity is doing the same thing over and over again and expecting different results. I'm sure you heard that from someone or might have even said it yourself, but the question comes with fertility. If you are a fertility patient or if you're going to go through it, one of the things that's going to come up is that once in a while, your practitioner is going to recommend doing a treatment again. Now, what do I mean by this? What I'm saying is that, for example, it can be any treatment, whether they're telling you to trichlomid and have time to intercourse, whether it's an IUI with a certain protocol, maybe even the IVF with the same protocol, or even an embryo transfer with the exact same protocol. Now, at first, you're not going to be frustrated. Matter of fact, you're going to think, hey, this doctor knows what they're doing and you're going to do it again. But for some of you, you may, right in the beginning, go, well, that's weird. Why are we doing the same thing that didn't work? And for those of you who have had, let's say, poor success, you may be really questioning it, going, what are we doing? This is exactly the same thing. Does this doctor not know that idiom that this is insanity? Now, this is not a defense of all doctors. Yes, doctors make mistakes, and doctors may do things that are wrong, but in this situation, it's actually not always wrong to do the same thing. The question about today is why, is it okay? Because it really would drive people crazy in other situations. But the difference here is the human body is not like other situations. Matter of fact, I love physics. The great thing about physics is there are laws to physics. And so when we do experiments, we're able to control all the factors and only study one factor. And so Einstein is correct. Expecting a different result doesn't make sense when everything else is controlled for. But this is one of the problems with the human body. We have no control over the factors of the human body. Matter of fact, even taking a medication that may work for a while after some time may not work. For example, I have to, about every year or two, have to switch between the different anti allergy medications, such as like Claritin and Zyrtec, because it just stops working for a while, and then I have to switch to another one, and then it starts working again, and then again a year later, I have to switch over. It's not that the medicine doesn't work. The medicine works great. It's that the human body does things different. It builds up tolerances. There can be differences, maybe my diet, difference in my health, that may affect it. Maybe my allergies are too strong now, and the problem's much worse. I need a stronger medication. And so the purpose of this podcast is to help you realize that there is a point to ask if maybe you should try something else. But it's always important to look at everything and go, well, why am I changing it? And so I'll go over some examples of this, of when it should be questioned, but I want to make sure you understand that don't be too concerned that you're doing the same thing. Remember that if it's something has a low chance, like timed intercourse or even iuis, we don't expect anyone really to be pregnant in the first cycle, maybe 20% of people at the most. So when someone doesnt get pregnant, we dont get too worried, because we know that, hey, its not a perfect treatment. after three cycles of that treatment, like weve talked in other podcasts, then you might say, okay, this isnt working, we should adjust it. And that doesnt mean that it wouldnt work with the same treatment. It just means that at that point, statistically, we would expect enough people to be pregnant, that its worth at least trying something else. But what about the situation IVF? What about the situation in IUI, where you're taking medications to force eggs to grow, and they grow at a decent rate, and you get enough follicles, but it doesn't work. Now, do you change the protocol now because of the fact that it didn't work? Does that outcome have anything to do with the follicles being developed? In the previous podcast, I kind of talked about this topic, where sometimes the outcome has nothing to do with the protocol. We talked about things like when you do an embryo transfer, and if then you have, let's say, a miscarriage, it doesn't mean the protocol caused it. The example I gave in that situation was, if you were in a car accident and you lost a pregnancy, you wouldn't change the protocol. And that's a really obvious situation, but it's not so obvious when it comes to the stimulation. And so sometimes, you know, people want to just try things different, and especially when you talk about looking at things online, there's people out there saying, oh, if you do a natural cycle, you have better chances. Or if you use less medicine, some will say more medicine, another person will say, excessive medicine. One will say, use growth hormone. Once it's down in your head. There's so many different opinions out there, and there's nothing wrong trying things. But the question here is that, is it harmful to sometimes stay the same? And so what's interesting is that when you do multiple cycles of anything, it's interesting that there's this variability that occurs, and this variability is the human variability. So when you take a pill, let's say, like femara or Clomid, the way your body absorbs it may affect how it responds, and so you may do better one time or worse the next time. And sometimes your very first cycle is your best cycle ever. It's actually the fluke, and your normal is actually less eggs. And then people are wondering, well, what's going wrong? Why am I not getting the right amount of eggs? And it, takes a few tries to figure out, oh, wait, that was the normal one. All these were normal. The first one was the fluke. And so an example I would give you is thinking like a garden analogy. Imagine you are a gardener planting seeds in your garden. Each time you plant the same type of seed, you follow the exact same process where you prepare the soil. You plant the seeds the same depth, you water them regularly, and you ensure they get the same amount of sunlight. Now, despite doing everything the same way, the results can be different. Why? Because of variability. So, for example, soil conditions, even though the soil looks the same, its composition, its nutrient, can all be slightly different. Every time you plant it, the weather, the amount of sunlight it gets, rain, the temperature, all that you can't control, even the seed quality can be different. It's the exact same product, but there can be some that are a little bit stronger, healthier than others. And there's things like pests and stuff that you can't control. Now, the good thing in the human body, we have some things we can control, but just like that, there are these conditions, like soil conditions. Who says the uterine cavity is just as good one month over the next? Unfortunately, we don't have the ability to be able to determine that right now. Weather. How do you know if your body's body temperature might be different one month? Maybe the temperature is different. That could be affecting the process of how well you're metabolizing medications. If you get a fever during it, your temperature goes up and you process things faster, even see quality. That goes back to the point of embryos. What's the quality of that embryo? Maybe that's why it didn't work. And disease and pests. Maybe there's polyps, maybe there's infection. The point is, we think of the human body as this perfect machine that will do the same thing every time. But for some of our seasoned IVF patients who have gone through, they know that that's not true, that you can do the exact same thing and get different results, and that's expected, that shouldn't be surprising. Matter of fact, the idiom of that insanity is a definition. Doing things over is completely different in the human body. We should change it to infertility treatment. Doing the same thing over and over can yield different results. It's a reminder of the body's complexity, not insanity. The point is, dont always be upset if the same things happen. Dont be too worried. But its still fine to ask questions. So lets talk about situations where it wouldnt make sense to do the same thing over and over. So, for example, if you take a medicine and it doesnt work, meaning you take Clomid and you dont ovulate well, doing clomid again at the same doses makes no sense. You either want to at least increase the dosage or try another medication. The same thing in IVF, if you use a protocol and your expectation was, let's say, x, but when you did the protocol, you got half of x, meaning half the number of eggs. At that point, you can say, okay, listen, I should try something different because it didn't meet my expectation. Now, if you got exactly x, the number of eggs you expected, then you really don't have to change things that much. Then theres even another situation, which is what if youre already maximizing everything? Meaning, lets say youre on the absolute strongest protocol and the highest dosage, at that point, changing things might actually hurt your chances now, because if youre getting the maximum of eggs your body can get, so lets say youre limited to like three or four, and now youre lowering doses or changing things, you might get less. There's nothing wrong with that, by the way. I tell patients all the time, hey, if you want to try something, I'm more than happy to try it, because I believe sometimes people need to see things for themselves. But the purpose is that if your doctor says, I think this would be best to do again, I want you to feel comfortable that your doctor is not crazy, it actually does make sense, even though that idiom exists. And so this doesn't mean there aren't different ways to do things. So it doesnt mean this is true for everyone. There may be situations where you need to change things. Matter of fact, one of the things that made me do this podcast today was I had a patient who I was seeing for a second opinion, and the doctor was doing the same thing over and over. And every time she kept getting this lead phone call, and they just do the same thing over again. Now, in that situation, yes, I think it's perfectly fine doing the same thing. If two times before that everything went normal, and then one time something went wrong. You don't change the whole protocol, but this is not three times in a row the same thing happening. You need to change something. I don't care if we won't blame the human body, but there's a point where you have to go, this isn't working. And so in that situation, I told her no, I would do something to prevent that lead Volko from developing. And there's something you can do with medications. In the end, there is no wrong or right. There's nothing wrong changing things up every time. There's nothing wrong with doing things the same way every time. The purpose of this was really just to help you understand that it's not as crazy as it sounds. If everything went well, now things don't go well. We like to change things. But like I talked in that podcast, when I talked about spaghetti recipes, you don't have to change the whole thing completely. You can make small adjustments, and that's what IVF is about, is those small adjustments. But when it comes to doing the same thing, don't always feel like it's wrong, like doing a transfer. There's nothing wrong doing the same thing on the protocol, but it's always good to look at. Is there anything else we can do to add to help? If the answer is no, you don't want to just change things, just to change things, because it's not about that. The protocol is wrong, but it's because that variability that occurs in the human body. And just like the example I gave before, there are times it changes. Just like a console I had today, I had a patient who did a transfer. It didn't work. Then we did a second transfer, and it did work, but then she had a miscarriage, and then we did a third transfer using somewhat the same protocol, small little changes, but this time it was a very weird implantation. And so at that point, I took everything and I said, wait, yeah, there was one good one, but there was two bad ones. So now I'm thinking I'm going to change things, because statistically speaking, she should have had a live birth now. And so I'm, not repeating the same thing again, because now I see there's something not right there. And that's why we're going on to do some more testing, and then we'll make adjustments from there. In the end, as I always say, talk to your doctor, feel free to ask questions, but don't be too upset if they're doing the same thing. But there's nothing wrong questioning it. Just understand that it's sometimes not a problem with the treatment, it's sometimes the variability that occurs. And that's why some people go through an IUI, get pregnant on the first try, come back the next time. It takes four times until they get pregnant. There's other people who get pregnant naturally and then don't get pregnant again and have to do fertility treatments. It's because the human body is not a machine. It's quite variable. For that reason, the idiom is not true when it comes to the human body. Doing the same thing over and over can yield different results. It's a reminder of the body's complexity, not insanity. Hopefully this was an episode that helped you, or maybe will help a friend of yours. If you know someone who's about ready to go through fertility treatment, or even who's just trying on their own and frustrated why they aren't getting pregnant this time, but they did everything the same as last time when they were just trying to get pregnant, this podcast may help them and let them know about it. As always, I really appreciate everyone who listens to this podcast, and I appreciate the people who give us, great reviews. If you like it, please give us a five star review on your favorite medium. Tell your friends about us. As always, I look forward to doing this every week, and I look forward to again talking to you next week on taco Bell fertility Tuesday.