How to Get Pregnant Easily and Faster: The Fertility Secrets Doctors Don’t Tell You | Dr. Aimee Eyvazzadeh

Dr. Aimee: [00:00:00] As our mitochondrial health declines, the rate of chromosomal abnormalities in our eggs increase. Your embryo viability will be lower. You won't be as successful each cycle when you're trying to conceive naturally. And then if you were to do IVF, you may not get as many healthy embryos as you had hoped for, or you may not get any healthy embryos.

Dr. Brighten: Age 35. We're told that like fertility plummets right off the cliff. Talk us through the myths and really what women should know about age and fertility. 

Narrator: Dr. Amy Ade, 

Dr. Brighten: affectionately known as the Egg Whisperer, is 

Narrator 2: a world renowned fertility specialist, sparking a global movement of hope. And empowerment, A-U-C-L-A and Harvard trained reproductive endocrinologist.

She has spent over 16 years helping patients navigate egg freezing IVF and fertility preservation with her signature, warmth and expertise as the host of the Egg Whisperer show a top rated fertility podcast. With over 3 million downloads and the creator of the Egg Whisperer School, Dr. Amy is redefining the [00:01:00] fertility journey, one egg at a time.

Dr. Aimee: Endometriosis can rob a young woman of her fertility, even if you have. Normal A MH levels for your age. It can make our eggs act biologically older than your chronological age adenomyosis as well, because adenomyosis can affect your ability to carry a pregnancy. And then there's also, 

Dr. Brighten: you have this.

Sparkle checklist for IVF that you've developed. And so for anybody who's considering going to a fertility clinic, I think this the little pneumonic is a really good one to know. Can you talk us through it? Each follicle check as you're going through IVF. So if you understand the data and what's happening, then welcome back to the Dr.

Brighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most UpToDate information to help you take charge [00:02:00] of your health and take back your hormones.

If you enjoy this kind of information, I invite you to visit my website, dr brighton.com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including a. Updates on this podcast now. As always, this information is brought to you cost free, and because of that, I have to say thank you to my sponsors for making this possible.

It's my aim to make sure that you can have all the tools and resources in your hands and that we end the gatekeeping. And in order to do that, I do have to get support for this podcast. Thank you so much for being here. I know your time is so valuable and so. So important and it's not lost on me that you're sharing it with me right now.

Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. We've got the egg Whisperer here today, and I'm so excited for this conversation. Dr. Amy, welcome. [00:03:00] Thank you, Jolene. You're 

Dr. Aimee: an egg whisperer as well.

We both are. We both are telling people how to prepare for their future fertility, their current fertility, whether you're a fertility patient or not. So thank you for all the work you do, Jolene, educating people. You're amazing. Oh. 

Dr. Brighten: Well, thank you. I think your platform is amazing, so we will include it all in the show notes.

But you have dedicated so much of your life, not to just to patients, but to people who need this information, who are struggling. You're all over social media. You've got your YouTube, you've got your own podcast. So, um, I sail that because for you to give me that compliment, it is high praise coming from somebody who has really been changing the game in women's health.

Thank you, Jolene. I learn so much from you every day. Aw. Well, likewise. I wanna jump straight into this conversation. We're gonna talk all kinds of fertility stuff and some really interesting new research that's coming out. But age 35 we're told that like. Fertility plummets right off the cliff. [00:04:00] It's like the end, end all, be all of like your ability to have a baby.

Talk us through the myths and really what women should know about age and fertility. Yeah, there's no 

Dr. Aimee: egg cliff. You're not dangling from the edge. When you're 35, it's just not how it happens. And our fertility just doesn't drop suddenly. 35 is a very arbitrary number, and we're labeled though, however, by doctors and I wanna change how doctors see their patients.

We should talk about egg health, mitochondrial health, and advanced mitochondrial age, not advanced maternal age, but as we get older, even 30, our mitochondria start failing us. It's really sad. And then as our mitochondrial health declines. The rate of chromosomal abnormalities in our eggs increase, and that's where 35 comes from.

Mm-hmm. 35 is just the age where your risk of having a baby with Down syndrome is. This is higher than your risk of losing a pregnancy from a procedure called the amniocentesis arbitrary. Right. And not [00:05:00] many people do that test anymore, but if women see a doctor get checked, find out about their fertility and talk to someone who can do some.

Fertility forecasting. I call myself a fertility fortune teller. I'm not perfect. I look into my crystal ball and I have data that I kind of put into the ball, and then outcomes, what I predict could happen with a patient. And then we talk about her goals, but 35 I. Arbitrary, you're not a number. You can get pregnant even at 42, 43, but that's not something that we should expect.

So we should just get educated about our numbers, what they mean, take really good care of ourselves, baby ourselves. I think so many women, they just wait and they say, okay, when I'm gonna, when I'm pregnant, then I'm going to take really good care of myself, but you should really treat your body really well as you're thinking about having a baby.

Dr. Brighten: I wanna talk about these inputs. What's going into your crystal ball that can [00:06:00] sometimes help you predict what, what the future will look like in terms of someone's fertility. So it's 

Dr. Aimee: a hormone level called the A MH. I do an ultrasound and I look for endometriosis, adenomyosis, fibroids, basically things that are fertility threatening.

Narrator: Mm-hmm. 

Dr. Aimee: Um, I'll sometimes encourage a patient to do a fallopian tube test because I really wanna know if you need IVF to have a baby. Yeah. Okay. And then also my inputs include genetic screening, so extended carrier screening. For some patient, it's an inherited cancer gene test because that could also be a fertility threatening condition if you have a high risk gene.

And then chromosome testing for both partners if applicable. When I say applicable, because not everyone is a mommy daddy couple, some people are mommy, mommy. Some people are daddy, daddy. And so we have to think about that individual and how they are planning on growing their family. So if your tubes are blocked, I wanna know early on if you have a fertility threatening condition, like, um, endometriosis.

I [00:07:00] wanna know if you and your partner share a common gene. I don't wanna find that out in pregnancy. 

Narrator: Yeah. 

Dr. Aimee: So then I, and then I also talk about family history, like, does your mom have endometriosis or did she, did your mom go into early menopause? Not that your mom's fertility is yours, but family history is also really important.

Dr. Brighten: Mm-hmm. I think that, you know, family history is often something that not a lot of people are able to gather, which is, puts even more emphasis on some of these tests. You brought up particular conditions like endometriosis. I'm curious, are there conditions. That women should start thinking about trying to conceive earlier in life.

Because you know, some women, we know many women are waiting right until they're mid to late thirties. But perhaps there's certain conditions where it's like you may wanna consider egg freezing or trying to conceive much earlier in 

Dr. Aimee: life. Yeah, I mean, I would say endometriosis is number one. 'cause endometriosis can rob a young woman of her fertility, even if you have.

Normal A [00:08:00] MH levels for your age, it can make our a eggs act biologically older than your chronological age. And that can be really frustrating. And it drives me crazy when patients have had, let's say, cysts of endometriosis removed and they come to me 10 years later and no one talked to 'em about preserving their fertility.

So endometriosis is one adenomyosis as well. Same because adenomyosis can affect your ability to carry a pregnancy and that can also get worse over time. Mm-hmm. And then. There's also, let's say PCOS, so women who have PCOS really need to think about treating PCOS before they're planning their pregnancy.

Because so many women, what they're told is, oh, it's just something you have to worry about when you're ready to get pregnant. 

Dr. Brighten: Yeah. 

Dr. Aimee: And that's it. And so their symptoms are ignored, and then by the time they see me. Now they have endometrial hyperplasia that they need to deal with for like a year or two before they get pregnant.

So PCOS, you don't necessarily have to freeze eggs if you have it, 'cause it doesn't mean you have bad eggs. But you should certainly start thinking about [00:09:00] fertility early on and controlling the symptoms as as soon as you have that diagnosis. 

Dr. Brighten: Mm-hmm. So for people listening endometrial hyperplasia, the buildup of the endometrial lining becomes very, very fit thick.

Sometimes that results in a DNC, so you actually have to have a procedure to remove that tissue and that, am I correct, can also negatively impact someone's fertility because of how it affects the uterus? 

Dr. Aimee: Absolutely. And 

Dr. Brighten: it's 

Dr. Aimee: also a pre-cancerous lesion. And so that's why we wanna treat it before you get pregnant and that delay.

So let's say you're seeing me at 36 or 37. Now you have to do something first and treat something, and that can take time and that can be really frustrating because you wanna get pregnant right away because of your age. So it's cases like that where I encourage women to preserve their fertility and then we can treat the hyperplasia and then use their eggs or embryos later.

Dr. Brighten: Mm-hmm. Why do you think it is Endometriosis cyst? PCOS? These women don't get talked to [00:10:00] about their fertility. They often get past things like birth control. I was just talking to someone the other day who was put on Lupron for four years, like they're given all these other treatments, but nobody is having this fertility conversation.

It's almost like, we'll just, we'll deal with it when we get there. As if, you know, you just flip a switch and when you wanna get pregnant, you just. Get pregnant. I think because patients are being managed by 

Dr. Aimee: doctors that are not, that are not experts. Unfortunately, these well-intentioned doctors. Don't understand their limitations.

Yeah. And, um, they're not referring the patient to the right expert. So if you have endometriosis, you should see an endometriosis expert. Mm-hmm. An excision expert. You shouldn't be having your endometriosis surgery by the same doctor that's doing pap smears all day and has no training in minimally invasive gynecologic surgery.

Patients don't know that. The consumer does not know that. And so by talking about it today. Someone out there, we're gonna save them. Jolene, we're gonna save them. Absolutely. From having a surgery unnecessarily and being told, oh yeah, you have [00:11:00] endometriosis, but nothing was done about it. It wasn't removed.

Or if it was removed. Mm-hmm. It was just a ablated rather than excised. 

Dr. Brighten: Yeah, and I think that is a huge problem. I often say, and I think I get pushback from gynecologists. I will say it well. I say, if you're struggling with your fertility in any way, you have questions about your fertility, honestly, leapfrog that gynecologist and get to a reproductive endocrinologist.

Unfortunately. There's not always one in someone's area. Their insurance might not cover it. There are a lot of barriers that people face, but I think it's really problematic. I mean, we could go, we could talk for like YA year straight about all the problems in women's medicine, but I think a really big problem is.

Acting as if like your gynecologist should be your one stop for everything and not recognizing that they do have those limitations, because it's equally frustrating for them as well when they can't get a patient over to that, you know, provider that they are trying to refer to. 

Narrator: Yeah, 

Dr. Brighten: these conversations take 

Dr. Aimee: time.

[00:12:00] You know, and OBGYNs are busy doing so many other things now more than ever, just because of the lack of, you know, we, we hear, we hear about maternity deserts and so OBGYNs are really strapped and, and they don't have the time to dedicate to these conversations that women need to have when they're dealing with these types of 

Dr. Brighten: conditions.

It's, I mean, that is absolutely true. And I wanna go back though to something you said that I also feel like most providers are not aware of, but this idea of mitochondrial age, can you talk more about that? Because as you said, it's not just your biological age, but what is going on at the cellular level?

For the individual makes such a difference, 

Dr. Aimee: right? Absolutely. And so, um, if, let's say your mitochondria are not healthy and there are things that can make them unhealthy, like inflammation, for example, from endometriosis, um, your embryo viability will be lower. I. You'll, you won't be as successful [00:13:00] each cycle when you're trying to conceive naturally.

And then if you were to do IVF, you may not get as many healthy embryos as you had hoped for, or you may not get any healthy embryos, and that's really normal, let's say for a woman who's over 40. And it's not because you didn't try hard enough, it's just because the egg health wasn't strong enough to achieve, um, your goals.

Dr. Brighten: I really appreciate you saying that because I feel like when you're on a fertility journey, you always feel like you're not doing enough and when something goes wrong, which. It's a miracle that our species exists when you look at how bad we are at actually reproducing in terms of like how, how, how hard it can be, even in the average healthy individual with no issues.

And so for anybody listening, I really want you to take that to heart that it isn't necessarily that you haven't done enough. But also hearing that doesn't always feel like enough. What can we do to support our mitochondrial health? 

Dr. Aimee: Well, the simple things are things everyone knows. So be healthy. I [00:14:00] mean, eat healthy, sleep well, reduce stress.

Mm-hmm. Those are really important things. Um, nurture your personal relationships, talk to people, socialize, I mean, all those things. Decrease inflammation. Mm-hmm. So things that bring you joy. Things that will make you the healthiest version of yourself. Those are all good things. Exercising, lifting weight, strength training, avoiding environmental toxins.

Look at your toxin exposure. Environmental toxins that are really bad for mitochondrial health, nicotine exposure. Um, so those things are not good. So women who smoke regularly, you know, they'll go into menopause sooner, and that's. Just how it is. And unlike sperm, it doesn't reverse, you know, sperm, if you stop smoking three months later, it's like you never saw a cigarette.

But our eggs don't know that. They, they remember, they, they, they remember those insults. And then I have my supplement list that I think works. It doesn't work for everybody, but I have patients who've been struggling years doing IVF. IVF cycles haven't worked, and then they go on the supplements [00:15:00] and then they email me, oh my God, I'm, I'm pregnant.

So, um, you know, things like nicotine riboside that increases NAD in our cells, resveratrol coq 10. Um, those are the supplements that I are. Are my go-to supplements right now for patients. There are other things people can do, like red light therapy, HGH, hyperbaric oxygen therapy, ovarian, PRP. I know that's, that sounds like a lot of stuff, but, uh, that I just rattled off a lot of, um, different names and things.

Yeah, but that's impulsive. Well, what I wanna 

Dr. Brighten: say though yeah, is exactly what you did, is you said, here's the foundation, right? Mm-hmm. Where we all should be doing things, eating your vegetables, making sure you get quality protein, managing your blood sugar, your sleep, like mm-hmm. You went through the foundational stuff and Exactly.

I think you went in the exact progression of things. And then we add on this, the supplements, and then we think about hyperbaric oxygen. I think red light therapy is something that we all can be doing and can have benefits from. I mean, the, the worst case scenario is your skin gets better, right? Um, it's, it's [00:16:00] non-invasive.

It has a lot of benefits, but. You just gave a whole list of things, and I want everybody listening. That was like the order of considering things of like tier one, right? Tier two, tier three. Right. And I 

Dr. Aimee: think there's something that we just don't talk about enough, and that's the amount of alcohol we're drinking.

And I think Americans drink a lot. And the thing is, when you have a negative pregnancy test, patients say things to me like, okay, I just found out I'm not pregnant. I'm gonna go out and drink. And I then they'll share with me, I got so drunk. But if you're drinking a lot, then what happens? You're not eating well and then you're not exercising.

And then your weight, you know, your weight stack, you, you get stacking of weight. Over time, and then you have to catch up with that. So I also encourage patients, I mean, if possible, to be alcohol free, but obviously even light, uh, intake is, is okay. Um, I don't want to shame people, but that's one thing that I think could be really helpful too.

Dr. Brighten: Absolutely. And when you consider that the liver has to prioritize a toxin, that's what alcohol [00:17:00] is. We see in the research that estrogen levels. Also climb. So if you're thinking about someone with endometriosis, you're thinking about someone with PCOS that can be just compounding the problems, not to mention the metabolic chaos that it can cause in your body.

You, you mentioned weight and I think that is such a controversial one, uh, in the movement, in the wake of body positivity, which. I embrace the idea of love yourself, where you're at. When it comes to fertility, though weight is a consideration. Can you break that down for us? 

Dr. Aimee: I mean, absolutely. And what I didn't add on my list are the GLP ones.

GLP ones I think are miracle drugs. So for people who don't know what that is, these are the drugs like ozempic, manjaro, ze, um, those are the types of medications that we're talking about that that's also a tool in my tool chest that I, that there's a reason why the term ozempic babies is trends. 

Dr. Brighten: Yeah.

You 

Dr. Aimee: know, decreasing inflammation, um, can improve your fertility. I mean, it's a fact. Mm-hmm. And so that is something for women who are struggling with their [00:18:00] weight, they can go to these medications and obviously we don't want you to be on them when you are pregnant, but my goal for my patients is A BMI under 30.

And ideally I want them to get to a healthy BMI for their pregnancy because the heavier you are in pregnancy, then there are other risks that go along with that, like. Diabetes in pregnancy, hypertension and women who have those problems in pregnancy can also then see later on in life that they're at high.

We see that they're at higher risk for diabetes and hypertension, chronic hypertension. Later 

Dr. Brighten: on, 

Narrator: I. Mm-hmm. 

Dr. Brighten: You mentioned the anti-inflammatory effect of GLP ones. I feel like so many people when they hear, you know, semaglutide, they automatically jump to this. Like people are just doing it for vanity to lose weight or they didn't try hard enough.

Like there's a lot of shame and guilt. I, it kind of cracks me up. 'cause like right now, HRT is having its moment, but then there's people who will prescribe HRT but also simultaneously hate [00:19:00] on GLP ones. And I'm like, that's very, um. Very funny. You've contradicting yourself there, but the anti-inflammatory piece is so important.

Can you just speak a little bit more about how you are leveraging these? And of course I want everybody to know this is education. This is not medical advice. So before you try to go jump on a new medication or treatment, you wanna talk to your provider first. So with that caveat in mind, can you share with us, you know, what you've seen to be effective in your clinic?

Dr. Aimee: Yeah. Well, I first start with sharing my own personal stories. So I lost 60 pounds on a GLP one 60. Wow. Six zero. I'm the happiest, healthiest that I've ever been. I struggled with my weight for 46 years. 46. Mm-hmm. And I think that, um, sometimes people think that if they take a drug, they'll take it for the rest of their life.

What I tell people is, so what? Right? I mean, if I struggle with my weight for 46 years and I have to take something periodically to keep myself as healthy as possible. I'm going to do it. I, [00:20:00] I don't see any shame in that. Um, and it's not, uh, cheating. Right. It still takes hard work. I still have to eat healthy.

I still work out. I still have to lift weights, you know, just to maintain, just to maintain my muscle mass. So, um, so I start off with my own personal story and I share patients with the side effects so they're less afraid because if you go online and you read about them, they're pretty darn scary. 

Narrator: Yeah.

As far 

Dr. Aimee: as what the side effects are. Um, but I think some, what I'm seeing right now is a movement, which is really exciting for me. Where, um. Doctors are now encouraging their patients to take it for fertility purposes. Mm-hmm. Whereas before these telemedicine companies were saying if, oh, if you're trying to get pregnant, we won't order it for you.

Dr. Brighten: Yeah, 

Dr. Aimee: but now the things are shifting. So I just start with that. I just tell them my personal story. I talk to 'em about patients who've taken it successfully, who've been successful in getting pregnant and having better outcomes from their transfers [00:21:00] and their IVF cycles. I mean, I have, so GLP one is part of my, like egg quality, um, uh, support.

Sauce, so to speak, for some patients. And you know, I, I'll share a story. I have a patient, she was 43 years old. She did six cycles. Um, she was ready for egg donor and I said. Let's just try this protocol. And I put her on a GLP one. I also gave her rapamycin and HGH, and she did hyperbaric. I know it sounds like a full-time job, but then, 

Dr. Brighten: um, no.

You know what? I just wanna say anybody listening, infertility is a full-time job, like managing it. It absolutely is. In the same way that autoimmune disease, endometriosis, or any of these chronic conditions is a full-time job. And I think we just need to honor that, uh, because it is. It just is, right? And then 

Dr. Aimee: I also gave her, I did ovarian PRP for her.

I got five blasts and one was eulo. She turned 44 on the day that I told her her embryo was normal. [00:22:00] Grade one, oh, day five. So it's like these things, these things work and mm-hmm. Um, and it, the goal wasn't necessarily to get her to lose 20 pounds. She lost about 10, and the cycle went really well. And it's not just about the weight, it's about inflammation as well.

Dr. Brighten: And I think that the women we've been seeing benefit so much are women with PCOS that, you know, we know that my acetol can be helpful, metformin can be helpful, but GLP ones are one. They seem to just really tip the scale in the favor of fertility outcomes. 

Narrator: Yeah, 

Dr. Brighten: yeah, absolutely. 

Dr. Aimee: They're, they're, I think they're extremely helpful for women with PCOS.

Mm-hmm. And I think that the benefits. Far are far better than the benefits, even from Metformin. A lot of HMOs, for example, you have to fail Metformin first, then you have to fail phentermine next, and then you, they will allow you to go to the GLP ones. But there are ways to get it from clinics online that are [00:23:00] pretty cost effective for some patients.

Dr. Brighten: It seems to me that insurance companies create a lot of barriers for women who are on a fertility journey, wouldn't you say? Oh, without a doubt. And 

Dr. Aimee: so it's really hard because that's a huge. Um, what's the word? It's a barrier to access care because if you need your insurance to pay for care and your insurance is, you know, not paying for things that you really need, then it could impact your ability to get pregnant.

In a lot of cases, and I see it all the time, so let's say someone needs surgery for endometriosis. Their insurance won't cover it then, or they'll say, because it's for fertility purposes, then that patient's kind of in a bind. 

Dr. Brighten: And a lot of insurance companies will do that, or even if you find endometriosis because it's, you know, found during your fertility journey, sometimes they'll try to claim it was preexisting, that's why you had infertility, or that it's all [00:24:00] wrapped up in infertility as if it is not.

An all-encompassing disease affecting every aspect of your life. You mentioned rapamycin. I think that's a new one for people. Can you tell us what this drug is? And I know that you've personal experience, you have clinical experience with it as well. 

Narrator: Yeah, 

Dr. Brighten: so rapamycin 

Dr. Aimee: is an an FD, A approved drug. It's been around for a really long time.

It is FDA approved though, for something that's totally different than what we're using it for. For the prevention of fungal infections in kidney transplant patients. 

Narrator: Yeah. 

Dr. Aimee: And it's too bad that it sounds like rat poison, right? Yeah. Rapid M and rat poison. Yeah. I mean, yeah. And then what they found in the animal model is an increase in longevity by almost 15%.

It was actually 14% in the studies and then in menopausal mice, when they gave it to the menopausal mice, it reversed their menopause and they started having healthy. Mouse babies and then pups is what they call them. And then, um, Columbia did a clinical trial looking at a cohort of women. [00:25:00] And the headlines outta that clinical trial wa were a little bit, um, I think it was a reach, uh, I mean it was probably how the mainstream press.

You know, analyzed it to get clicks on their articles, but the headlines were you take this drug for three months and you're, you're gonna have menopause five years later. They only follow the women for nine months. So I don't know how you could ever say that they didn't follow the women through menopause.

So that was, uh, that was this year and there are now IVF studies, um, published in humans showing that women who, let's say, failed IVF took it for two months, did IVF, had much higher blast formation rates, pregnancy rates, so that's. That's amazing. Mm-hmm. And then back in the nineties it was, even if, I wish I knew about this drug back in the nineties, um, and I had seen these studies, but it, it was studied to even treat endometriosis.

Oh wow. So one clinical one, one, not necessarily a clinical trial, but one study that was done looking at the effects in women, it was done on, uh, endometriosis patients going through IVF. So all [00:26:00] the women had endometriosis and we know how hard it is to make a healthy embryo when you have that for some people.

Um, so it's something that after two months, I, in my experience, I've seen, uh, increase in the A MH an increase in the follicle number and in some patients better IVF outcomes. So I am now giving it to my IVF patients about two months before they start their IVF cycle in some cases. Um, hoping to see a better result and I have been seeing that.

Dr. Brighten: And have you been seeing this in certain populations more than others or just across the board? We are seeing improvement. 

Dr. Aimee: You know, I even give it to perimenopausal or menopausal patients and they've resumed ovulating again in the menopausal group, which is very cool because, you know, just because you've run out of eggs doesn't mean that you've run out of your desire to have a baby.

And, um, you know, I would say, I, I think the younger you are, the more eggs you have, you might see a better. Uh, effect than if you're older and have a lower egg count. But I think [00:27:00] every woman should be offered these kinds of treatments before they move on to egg donation. 

Dr. Brighten: Yeah. And it's just so, uh, this medication's taken daily for just two months, and then you begin the, the trans, or excuse me, the, uh, egg retrieval process.

Yeah. So it's 

Dr. Aimee: actually even simpler than that. It's just two and a half pills, five milligrams once a week. 

Dr. Brighten: Oh gosh, that's it. Oh my gosh. Yeah. When you compare it to, like anyone listening to this right now that's been through IVF and the injections and, and all of the things you've listed off being like once a week, once, we just do this once a week.

Once a week, 

Dr. Aimee: and it's, it's relatively cheap. It's about $150 out of pocket insurance usually does not cover it because we're not using it for, mm-hmm. For the FDA indication indicated use, but $150 a month. You know, uh, most 

Dr. Brighten: people can swing that and, uh, for people want, you know, 'cause whenever you want a baby, you want a baby yesterday.

So some women might be like, well, can I just use it for like four weeks or can I use it for two? Why is it that two months? Like, if [00:28:00] we can just explain what's going on with the physiology that two months is Yeah, the minimum. 

Dr. Aimee: I mean, I don't know why it wouldn't go up after one month or three months. I don't think we really know mm-hmm.

The answer to that question. But it seems to take about two months I think. To see a rise in the a MH. 

Narrator: Mm-hmm. 

Dr. Brighten: And for people who are listening, we've, we've said a MHA few times. What exactly is the a MH measuring and, and what's an ideal number that we're looking for? 

Dr. Aimee: Yeah. So an A MH level is kind of like a sperm count for women.

It's the closest thing that we can get. I wish women could take a cup, ejaculate eggs into it, and then we can count them and see how many they have. We can not, it would be a lot more pleasant. It really would. Um, an orgasm for 

Dr. Brighten: a test. Yes, I know. Exactly. 

Dr. Aimee: I know. So, um, so it's a reflection of your ovarian reserve or how many eggs you have left, or, or how many eggs I could potentially get from you.

Should I do IVF? For you. So for example, an am mh of 1.0, it's not, rocket science is equivalent to about 10 [00:29:00] follicles. An am mh of 0.5 is equivalent to about five follicles. So it, I, I don't like to use the word like the ideal number. I've heard doctors say things like, anything less than 1.0 is terrible.

And it's like, that's not true. Like this is your level. It's something to understand. And if, if, let's say I can get someone's a MH to go from 0.1 to 0.3, that's great. Now I could get three eggs from her. And I have had patients on rapamycin where their A MH has gone from 0.1 to over 1.0, 1.4. 

Narrator: That is a 

Dr. Aimee: huge jump.

Yeah. And in that patient over 40, she went from being able to get one egg to her last IVF cycle with me was 11 eggs. Wow. And that was after two months of rapamycin. So, um, so those are the kinds of things that I'm seeing. And a friend of mine just texted me like before we started this call, that there's a, uh, there was a speaker at A SRM talking about rapamycin and how it improves egg counts too.

So [00:30:00] I feel like more and more fertility doctors will be hearing about it and hopefully doing this as well for their patients. 

Dr. Brighten: Yeah, well I heard about it first because of the, the sensationalized news, but seeing that, I mean, it's gonna be a while until we get more data and the trials are done. But for us being able to prolong our years until menopause, and I think.

There's always people who say like, well, it's natural, so like, why would I wanna delay it? It's because we know once you enter into menopause, now our risk for cardiovascular disease, for dementia, for all kinds of chronic conditions, they start to rise. And that nothing is better than our own hormones. So whatever we can do to keep our own hormones cycling, um.

As I say that, I know some people are gonna be like, I feel like my hormones hate me. You're probably already in perimenopause. Maybe we need to talk about rapamycin because you are, I saw that you posted, um, that you were, you were talking about how you had used it [00:31:00] and when we were talking, you were like, I don't have gray hair.

And I'm like, say more. So could you share about your experience? Yeah. 

Dr. Aimee: As soon as I heard about this drug as a way to. Delay menopause. I immediately got on it. So this is May of 2023. Once the clinical trial started recruiting, I started taking it the way that those, um, uh, trial subjects were taking it, which is exactly what I shared with you.

So I've been taking it since May of 2023. Uh, I think I have maybe one gray hair. I feel like, uh, no wrinkles around the skin, uh, around my eyes, um, the skin on my arms, and I feel like my skin is actually looking younger. Or maybe it's just all in my head. Maybe it's the filter that I'm using. I'm just kidding.

I'm not using the filter. Um. My husband's aging a lot faster. I joke with him and I say, this is my chance to marry a younger man. 'cause I'm not letting him take it. No, he do. Everyone. That's a joke. It's hilarious. It's a joke. I will not be on Dateline, I promise. Although that is my dream one day. Um. [00:32:00] You heard it here first.

I almost choked on my teeth. Um, so my periods are like clockwork, 26 to 28 days. My A MHI don't wanna talk about it because it's not like, I don't want to feel like there's a competition. I always tell people that if someone sell asks you what those numbers are, it's like, um, it's, it's good or whatever.

It's like, it, it's not a competition. But my FSH is normal. Uh, and so I'm almost 49, so that's, that's crazy. 

Dr. Brighten: That, that is fantastic. Yeah. I, I mean, I know what you're saying about the A MH, um, not, we don't want it to feel like a competition, but you know how proud men get about their sperm count. I felt that proud when I got my A MH and you know, I was, I was 42 and a half and to see where my numbers were and I was like.

What it felt like is all the 20 years of, of the, the two decades before where I was not going out drinking, I was not staying a plate [00:33:00] like I was eating the right diet. All, everything I was doing like as a 20 something, as a 30 cent. I'm like, good job, yo. Like, good job. Yeah. Like you totally, you punted some fun, but like it's it paid off.

Dr. Aimee: Yeah. I'm no fun. I'm alcohol free. I'm buzzkill at every party, but I have my own, um, you know, zero proof drinks that I bring with me to every party. And then what's crazy and fun is that people like my drinks and they start drinking my drinks. Yeah. Um, rather than the wine and the, you know, the totally other stuff they drink.

Dr. Brighten: I love making like herbal mocktails and I have to, I need to like get a setup, but I told my husband I want a whole bar set up in my house and it's gonna be nothing. But basically like, you know, what I used to keep in my clinic is like a full medicinary of all these tinctures and everything. And I'm like, it's gonna be that and it's gonna be, and I'm just gonna make herbal cocktails.

Like, who doesn't want like, like a night cap with like passion flour and skull cap And like, yes please. I'm gonna sleep well. Yes, absolutely. [00:34:00] Yeah. So if I do that, everyone, I will let you know. I'll give you behind the scenes, but rapamycin does have some side effects. I want, I do wanna make sure that we, uh, give that a little bit of attention.

'cause I don't want, I'm always cautious that people think like this, a miracle drug. Just jump on it because everything has, you know, it has risk and benefit that we need to know about. 

Dr. Aimee: Yeah, so cosmetic side effects are real acne. So it's not just like a zit on your fa face, it can be cystic acne, the kind that really hurts and pulsates and they're terrible.

And occasionally I'll get one. In the beginning I looked like a 16, like when I was 16, I had to take Accutane when I was a teenager because of really bad cystic acne. So cystic acne is one of them. The other one is stomatitis, which are tinker sores in the mouth. That hurt like heck. And when you start it, you can get them and they, you just have to power through and they'll go away If and saline rinses.

It mainly can really that have to, yeah. Yeah. And some people say that it can cause loss of muscle mass, so it's really important. I have 10 pound and five pound weights over there in my corner, and I lift weights, you know, in between patients just to maintain my muscle [00:35:00] mass. 

Dr. Brighten: Yeah, and I'm also a fan of weighted vests.

I've shared this before, but we, I used to be a group fitness instructor and I got this job where I was working in a senior citizen center and they were all coming in with weighted vests, and I was like, what is this about? And they're like, I have osteopenia. And I was like in my late twenties, and I was like, well, I don't want duns.

I'm gonna get a weighted vest. And um, it really, like, the other thing I like about weighted vest, you can get 5, 10, 15, 20 pounds. You can wear it just like if you're doing desk work and you're standing there like you're, do you know, at a standing desk where you're doing dishes just as a little extra like oomph to those postural muscles.

To your bone mass. 'cause of course we don't want osteoporosis. But the other thing is that for people who have hard time with grip strength, like we tell women all the time, like lift weights, lift weights. But when you're getting started, you might be able to squat more than what you can actually grip and hold.

And a weighted vest can be a nice way to just have extra on there as well. 

Dr. Aimee: Okay, 

Dr. Brighten: I need to [00:36:00] buy one that's my next, yeah. I will sell weighted vests. Like, uh, it's so funny because like I, uh, people will come over my house and I have them on and we, we were doing this bathroom remodel and the guys were like, uh, is your wife wearing a bulletproof vest?

Like, what is going on? Asking my husband, he is like, no, she wears a weighted vest. She'll run up the stairs like multiple times a day in her weighted vest. Like, that's so funny. It's things like that where, um, I love that you're like, between patients, I do this 'cause I think people think. Exercise has to happen one way in a chunk during the day.

And it's really, you know, there are studies that show like the more times you have movement and you have that, that stress to your muscles, the more it reinforces building them. 

Dr. Aimee: Absolutely. I do squats. If I'm waiting for the microwave to make some, 

Dr. Brighten: you 

Dr. Aimee: know, one minute, I'll do one minute of squats. Yeah, I'll do lunges as I'm waiting for the embryologist to be ready to bring me an embryo.

I'll do lunges in the hallway going up and down. So I try and use my time very wisely because you know, we're all busy and our schedules are full, and this [00:37:00] is how I can build in fitness into my daily routine. 

Dr. Brighten: Yeah. No, I, I just, I love the real world talk of like, this is how we implement things and we do things it seems, you know, sometimes it seems like we don't have time to work out, but there's always that in-between time.

Uh, you know, even things like, um, I'll teach people like the sost pushup that if you're sitting in the carpool line and you're just sitting there waiting for your kid to come out. Sous pushup, you can start activating that muscle, which I call it the greedy glucose goblin because it pulls all your glucose out of your bloodstream.

It doesn't make its own sugar stores, so it just sucks it right up. So it's a great way for blood sugar management and it's those little simple things that can add up. And speaking of little simple things, um, somebody who's listening to this right now and they're like, I'm ready. I wanna have a baby. What things would you recommend?

We've talked about testing, we've talked about those things to consider, but in terms of their lifestyle, like what are things that they can [00:38:00] start implementing right now? I mean, lifestyle, we kind of 

Dr. Aimee: talked already about the foundational things. Right. Mm-hmm. Eating healthy. I think the most important thing is to make sure you're on a prenatal vitamin that has folic acid or folate in it.

Mm-hmm. So that's really important. And then get an A MH checked and get your partner to have a semen analysis done and they're do. It do it yourself. It's always do it yourself for guys. 

Narrator: Yeah. 

Dr. Aimee: I encourage letting him do it himself please. Um, but there are tests you can order online and you can just check a se analysis just from your cell phone.

You don't even need to ship a kit out, but you can do that too. Or he can go to a clinic and get checked. It's just doing some basic tests and then understanding what your menstrual cycle is doing, making sure that you're ovulatory, you know, you and I are both wearing an aura ring. That's an easy way of doing it.

It, I have an 

Dr. Brighten: aura ring. And now an Apple watch because I am, yeah. Uh, I am kind of a data whore. That's what I would call it. I'm like so obsessed with like, having this data. 

Dr. Aimee: Yeah. So those are simple things that you can do, making sure that you [00:39:00] know when you're ovulating, making sure you're timing intercourse correctly.

Um, I mean, I can go on and on about all the things that you can do and track to give yourself the best chance of getting pregnant naturally. 

Dr. Brighten: But when you say healthy diet, like that's such a broad thing. And in the United States we don't really have education about nutrition. So what does it look like to have a fertility diet?

Dr. Aimee: You know, I'm not a nutrition expert by any means. You know, I rely on experts, so I send my patients to someone, uh, like, and this is who I send patients to. Her name is Judy Simon, and she wrote a book Getting to Baby, and it's. It's a great book because it's really, it, it makes suggestions for different types of proteins and vegetables and, you know, not everyone eats meat and so, and she doesn't, it's not restrictive.

So I think an overall, I think the most important thing is to avoid foods that are ultra processed and almost everything is processed or ultra processed. So just trying to minimize exposure to those kinds of foods. 

Dr. Brighten: Mm-hmm. I think that's an important [00:40:00] distinction. 'cause you know, people will say, avoid processed foods and, and then they're like, I add collagen.

Oh, that's processed. Yeah, I have a smoothie. Well, technically that's processed, but when you're saying ultra processed food, these are the things that you could never, ever. Ever make in your own kitchen, you could never create this type of food because it is so synthetic. Yeah. And it's food-like ingredients going in.

Why is that an important consideration when it comes to fertility? 

Dr. Aimee: I mean, it increases inflammation, it increases insulin, it increases your glucose levels, and it's just not good for you. I mean, we're talking about the foods like the Cheetos and the Oreos. I mean, you have, just trying to stay away from those types of snacks I think is important.

Dr. Brighten: Yeah, and I will say there are alternatives these days. So whenever people hear this and they're like, okay, no Doritos. Ste. I will always forever be a fan. I love that family and I love their company and I love anybody who makes Mexican food like so that [00:41:00] anyone can access it. But you know, there's other alternatives out there.

So if you hear this and you're like, great, so I just heard I can never eat an Oreo again. Mm. As it turns out, there's companies even doing like knockoff Oreos that are healthier for you, that sometimes they even have nutrition benefits in them or they'll even have more fiber and I'm like. That is the kind of like knockoff that we want, but it's not to say that you can never have pleasure, like pleasure for your palate.

It's just to say, to be very mindful, I think especially as you said before, when women get pregnant, they're like, I'm gonna change everything, but we need to do this upstream before that. Positive pregnancy test. 

Dr. Aimee: Yeah. Both men and women. I mean, my favorite indulgent snack is uh, pop kettle corn Pop chips are my favorite.

I always make sure when I'm close to my period, I have them at, you know, close by. 

Dr. Brighten: Yeah, those are like something I will bribe my kids with on flights. And they're like, yes. Okay. What do you need us to do? I'm like, sit down, be quiet. They're like, done. And then 10 minutes later, I gotta get a toy. Like [00:42:00] I, let's be real here.

Uh, you brought up ovarian PRP. This is gonna be new to a lot of people. What is PRP? And then let's get into how it's used in terms of stimulating the ovaries. 

Dr. Aimee: Yeah, so ovarian PRP is a way to rejuvenate the ovaries. Think of it as like a facial for your ovaries. It might freshen them up. For some people, it's not for everybody and it doesn't work all the time.

The concept is that we have growth factors in our platelet rich pr, in the platelet rich plasma in our own blood that we can deliver to the ovaries that might improve ovarian function. The benefit is not long lasting. It lasts about three months or so. I have seen some women where you can actually see the benefits longer, but I tell women to expect only a benefit for a round.

Three months. Mm-hmm. It can be done, I think anytime in your cycle, whether you're on your period or close to ovulating or ovulating. It's not cycle day dependent. And it's a procedure just like an egg retrieval where you're asleep. I do it on patients when they're asleep. Some doctors do it awake and um, it's delivered through a tiny little needle through the wall of the [00:43:00] vagina into the ovary.

And there are so many ovarian rejuvenation procedures now than there were, let's say, five years ago. There's also stem cell, uh. There's, um, uh, adipocyte stem cell rejuvenation where they take your own fat cells and extract the stem cells from those cells and deliver them into the ovary. There's also umbilical cord, uh, ovarian rejuvenation where they're taking.

Umbilical cord blood that's banked from someone else and delivering that into your ovary, that's not legal in the United States. So that's something that you have to get in either Mexico or The Bahamas. Mm-hmm. So there, it's an exciting time. I mean, I hope that there's something that could be a little bit more in the future, a little bit more permanent.

I just read a study about a drug that's being evaluated that's. Already used to treat lung fibrosis. And the issue with our ovaries is they shrink and they become fibrotic and really tiny and they basically shivel up and you can't even see them by the time you're 50. So this is a drug that's [00:44:00] being evaluated now in animal studies as potentially a way to.

Keep our ovaries younger longer because as we're aging, society is shifting. Our milestones are changing. In the Bay Area, it's very typical to start thinking about your fam having a family at 40, but that's the age where your bo, your ovaries are going through perimenopause and for a lot of women menopause as well.

Hopefully these kinds of, um, breakthroughs would be helpful in the future. We're not talking about tomorrow for a drug like this, maybe in 10 or 15 years. 

Dr. Brighten: I have to say that, so when I lived in the Bay Area, I noticed going to the park. So I had my son in my early thirties and I was like the young mom there, uh, which was kind of wild sometimes.

Um, when you think about like, when I was a kid and like, you know, at my kids' age, all the moms were like in their early twenties, like a decade sooner. But I would see so many twins on the playground and my husband was like, why are there just so many twins in the Bay Area? I'm like. They're IVF. They're like, talk to their moms.

Their moms have [00:45:00] PhDs. Their moms are doctors. Their moms are CEOs, like their moms have had these long careers. Anyhow, I bring this up because I didn't know you then, but I wonder how many of those babies, poor doctor, how many those babies my son was playing with that you helped bring into the world. Um, so PRP for the ovaries, they're going to extract your blood, spin it down, that's gonna be injected.

You can be put to sleep for that, or you can be awake. I have had. I actually just had a friend who told me she did it awake, and I was like, you're hardcore. I would be like, no, no, thank you. Just I'll see you guys like in an hour. Um, with that though, the quality of your, of your plasma is gonna matter and sometimes.

Like people aren't thinking about, um, you know, so I know that somebody was talking to me. I had a patient that was like, oh, A PRP, I don't think it worked. And we were talking about things and they were like, well, you know, I was drinking the night before. Uh, you know, I didn't have the best diet. And like, your, what is in your [00:46:00] plasma?

Is what you've been taking in. And so we really, you know, have to emphasize that component. You said it can be done anytime in the cycle. How like, and it'll take three months. That's the effects. How soon will it affect the quality of the eggs? Yeah, I see it 

Dr. Aimee: improve the egg number by even as little as two weeks.

And so depending on a patient's story and her situation, sometimes I'll have them come in every two weeks until I start seeing a rise in her egg count, because I do this also on perimenopausal and menopausal women as well. And so I wanna catch that egg as soon as I can. I can see one, if I see a follicle, I wanna ride that wave and start stimulation medications if possible, so as, as early as two weeks.

Um, so I tell patients, you know, two to four weeks later is usually when we'll start your stimulation. Some doctors encourage patients to do two sessions 30 days apart and then start IVF two months after the first session. I don't think that's based on any data, but in their experience that's, you know, what they find to be [00:47:00] most helpful.

But I like to monitor patients really closely and just. Watch and see when we see the rise in the follicle count and the A MH and then start treatment then. 

Dr. Brighten: So presumably in the best case scenario, somebody could ovulate, have this procedure done, be monitored, and even by the next time they get their period possibly be going into an IVF cycle.

Dr. Aimee: That's correct. My first ovarian PRP live birth was a 41-year-old patient that had done three IVF cycles before without success and then got pregnant with an IUI, not even IVF with the very next ovulation. 

Dr. Brighten: Yeah. And there was, we didn't talk about, you know, doing. Uh, PGTA testing, but you didn't have concerns about that or was she not interested in doing testing?

Um, no, she wasn't scared. 

Dr. Aimee: I mean, anytime you say, I, I wanna get pregnant, you accept all possibilities. But for her, it was just, she wants, I, I tell patients not to be scared and, and just to know that if a pregnancy is abnormal [00:48:00] for most patients, we find out by 10 weeks of pregnancy because of non-invasive prenatal diagnostic test that we can do at nine weeks.

And so most abnormal pregnancies stop growing usually by six weeks. And it's very rare to have to have a termination for an abnormal pregnancy. 

Dr. Brighten: Mm-hmm. I ask this because there's a lot of fertility clinics that will not work with a woman over 40 unless they do PGTA testing. For everybody listening, this is where they're screening the embryos, whether it's euploid has the right number of chromosomes or doesn't.

Uh, can you just explain some of the reasoning behind that? I know that, you know, fertility's kind of, there's things that it's like there's not necessarily a right and wrong. There's like people doing the best they can with the current information we have. I mean, I think a lot of 

Dr. Aimee: these 

Dr. Brighten: clinics 

Dr. Aimee: are just pressured into, uh, or the doctors are pressured into just doing IVF and, and again, if, if the fast, the, the, I'm not gonna say it's, um, it's not cheating.

It's [00:49:00] um, it's basically, uh, you know, if you just put everyone on the same protocol, it's just easier. 

Narrator: Mm-hmm. And just 

Dr. Aimee: tell people that this is how you do things, rather than having conversations about what. A patient's priorities are. Yeah. So if you're asking a patient what your priority is, and for some patients it's, I want to give every embryo a chance, and if that's the case, then don't do PGT testing because we know that it's not a hundred percent accurate.

In fact, it's, it's very inaccurate. But doctors are not using it as what I think and how I think they should be using it as a way to prioritize embryos. Not as a way to discriminate against embryos because it's not accurate, but you know, as far as why doctors require patients to do PGT, I think it's, it's based on what they assume PGT is, which is this very powerful tool that is extremely accurate and can increase a woman's chance to get pregnant and decrease risk of miscarriage.

Um, which can be [00:50:00] true, but at the same time, um, it's. It's also limiting a patient's possibilities for a healthy pregnancy because it's so inaccurate. 

Dr. Brighten: Mm-hmm. There are women who very much do wanna give every embryo a chance. They still do the PGT testing for whatever reason, and clinics will deny them. If they have an abnormal, they'll say like, I will not transfer that.

What do we know right now in terms of the probability? Like how certain are we that that is actually abnormal? Um, we're not, I 

Dr. Aimee: mean, there are certain chromosomal abnormalities that you can say it's probably accurate, but there are many that you could say it could be a false positive. Mm-hmm. And so before a woman chooses a clinic, she should know what the clinic's policies and protocols are around transferring abnormal embryos, and also make sure she knows what their protocols and policies are.

For low mosaic, high mosaic segmental, because these are embryos that have a chance, a, a, a very good chance of being genetically normal. So if, let's say you're 42 and you [00:51:00] have a low mosaic, that embryo I think should be considered normal, not abnormal, but some patients are denied the chance to even consider those embryos and are told inaccurately that they're abnormal and then they're discarding these perfectly potentially healthy embryos.

So that's why, you know, getting, uh, I, I encourage women not to sign discard forms. Before they know what their abnormalities are. So make sure you don't direct the clinic to discard before you know what you have. Mm-hmm. Getting a genetic consultation, not just from the genetic testing company, but also from an outside genetic counselor that is an expert in embryos.

A regular genetic counselor who doesn't have IVF expertise is not gonna be able to guide you. 

Dr. Brighten: So someone can take their results and then they can take it to an expert who can read those results and let them know based on these chromosomes, who, who's more, more likely to be a false negative or, well, in terms of saying this, uh, you know, an pl so who's more likely to be a true [00:52:00] abnormal and who's not exactly.

Dr. Aimee: And so for example, when you get a report, it'll say low mosaic, but it won't tell you what the percentage rate is of the mosaicism. When you get a report that says segmental, it won't tell you how much of the DNA is missing or how much is extra. So that genetic counselor will help you with the questions that you need to ask the genetic testing company.

And then you can talk about what are the worst case scenarios if we end up transferring this embryo. Okay. 

Dr. Brighten: And 

Dr. Aimee: for people listening, what is a mosaic? What's a segmental Uh, a mosaic embryo is an embryo that has a small percentage of cells that are abnormal in the placenta. And then a segmental is an embryo that either has an extra, uh, a little bit of, uh, DNA missing or a little bit of DNA.

That's extra. 

Dr. Brighten: Mm-hmm. Okay. How does someone find this type of genetic counselor? That's, 

Dr. Aimee: that's a million dollar question, right? Yeah, so, um, the pat, my patients go to Megan Doyle and her website's, daid.com, D-N-A-I-E-D e.com, and she's [00:53:00] fabulous. And if, if she's not licensed to talk to you where you live, then she can potentially direct you to someone who could 

Dr. Brighten: speak with you.

That's fantastic. 'cause I feel like so often we hear these things that we should do, but then knowing who to trust and who to go to can be so, so difficult. I do wanna ask you, and this is kind of changing a little bit, you know the conversation a bit, but we've been talking about IVF, you have this sparkle checklist for IVF that you've developed.

And so for anybody who's considering going to a fertility clinic, I think. This little, the little mnemonic is a really good one to know. Can you talk us through it? Absolutely. 

Dr. Aimee: I mean, I'm still stunned today that patients go through IVF and they have no idea what was happening to them, the size of their follicles, why they were taking, what they were taking, the protocol that they were on, why the doctor chose that protocol.

Mm-hmm. So my patients, when they come in for their monitoring visits, for their ultrasounds during their IVF cycles, they leave with all this information the size of the pulp. The size of the [00:54:00] follicles, the plan and protocol from one day to the next and what their IVF pyramid looks like. I'll tell them, am I happy?

I want them to hear that from me. I'm happy with how things are going. If I'm not happy, I want you to know why I'm not necessarily happy and what will make me happy and what I'm gonna do to. At what point will I be happy? And then when the retrieval is gonna be is also important because you need to plan your life.

You need to make sure you have enough medications as well. You don't wanna have a medication or pharmacy emergency. You shouldn't be overwhelmed by ordering medications last minute and then talking about, are we gonna keep going with each visit? And then we also look at the lining of the uterus and we look at your estrogen levels.

So those are all the things that we look at in each follicle check as you're going through IVF. So if you, if you understand the data and what's happening, then. You're not gonna feel like something is happening to you that you have no control over. You're getting the information so you can process it and you can understand what's happening along the way.

Dr. Brighten: Yeah, I, I love that checklist for people to have so that they understand the [00:55:00] information they should be walking away with from the clinic because it is so overwhelming. And sadly, I feel like too many women get most of their information from fertility boards, from Facebook groups, from Reddit, um, and that's and it, and it's often after things go wrong, they then learn what questions they needed to be asking, and that shouldn't ever be on the patient.

I. No it shouldn't. And 

Dr. Aimee: I, I, I just, you know, when patients come through here, they're like, I've never seen pictures of my follicles before. They always turn the screen away from me. Mm-hmm. No one's ever shown me what they look like or handed me the images and my patients get their images every single time they get the calendar.

You know, I'm talking. I'm also scanning my own patients too, which I know not every patient has the ability to have their own doctor do the scan for them. 

Dr. Brighten: Mm-hmm. Yeah, I definitely encourage people to always ask to see the ultrasound image, um, and to, to, you know, have them turn the screen. Some clinics even have screens in different places, but to always make sure that you can see what's going on.

I feel like if [00:56:00] somebody has a wand in your vagina, part of the consent is for you to be informed of every step of the way. And you should, like, it's not fun. So like, gimme that data. Let me see it in real time. So I know that laying here is worth it right now. Um, you mentioned lining. What are some tips people can do for the uterine lining?

Firstly, what, you know, what we should ask is like, what do we need that lining to be at for implantation to be successful? So my goal is lining over seven. 

Dr. Aimee: Mm-hmm. So it's a lining texture and thickness and a texture that's trilaminar. So those are the two things that we look for in aligning, and there are different ways of getting to that lining.

What I would encourage patients to do is ask and make sure that their lining is good enough for transfer and the doctor's really happy. You don't just want someone to toss an embryo in and then say, oh yeah, your lining wasn't good enough. Next time we'll do this. You want the option to cancel your transfer if it's not perfect.

So just reinforce with your doctor that I really wanna make sure that this transfer works and that. You're [00:57:00] not that we're not gonna have regrets if this transfer doesn't work. And if your doctor has any doubts about your lining, if you're constantly having to go in and increase your estrogen, you might wanna try a different protocol before you transfer.

I. 

Dr. Brighten: Mm-hmm. And the options for protocols. There's the full medicated protocol that a lot of doctors like to do because it's, uh, very easy to control. Some patients want to go completely natural. And I know you're a fan of a modified natural. Can you explain why and what that is? 

Dr. Aimee: So modified natural just means your ovaries are gonna be helping out a little bit more by ovulating, more than one egg if you respond that way to Letrozole.

So I have patients take Letrozole for five days and then we trigger ovulation with a trigger shot, and then we add progesterone support before the transfer. And this is. Best for pregnancy, um, and women who are able to do this. Not everyone can, because some patients go through treatments that are menopausal or they're, you know, they're not ovulating anymore.

And so if that's the case, then the controlled cycle is still really good. The pregnancy rates are just as good [00:58:00] as the modified natural, but the difference is with the modified natural, you have lower risk of pregnancy complications like IUGR, SUBC, chorionic hemorrhage, and preeclampsia to name a few.

Dr. Brighten: Yeah, which we definitely wanna avoid. Yes. This has been such a fantastic conversation. I definitely am gonna have to have you back because I'm sure people will have more questions. You all can leave it in the comments. You guide the conversation as always. So let me know. But I really want to just tell you, I appreciate you so much, the work you're doing in this world and for taking the time.

'cause I know you're in between patients right now to chat with us today. Thank you 

 

Dr. Aimee: Jolene. Thank you for having me. It's such a pleasure. I look forward to coming back on and talking to your listeners and talking to you. Yeah. Alright, take care. Thanks Jolene.