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How to Get the Most Out of Your IVF Journey LIVE: Webinar Recording

How to Get the Most Out of Your IVF Journey Webinar

We know that IVF can be an intimidating process, which is why we at OC Fertility want to do whatever we can to make it easier for our patients! That's why OC Fertility's own, Dr. Nidhee Sachdev, hosted this informative and interactive session, walking patients through the IVF process.

Watch the full webinar recording below.

In it, Dr. S reviews the overall concepts of IVF, how it works and what the 2 week process will look like for anyone considering or planning to undergo an IVF cycle!

Patients who watched live asked fantastic questions! If you would like to see specific content from us or have a question, email us, phone 949-706-2229 or schedule online.

Our next event is on Frozen Embryo Transfer cycles! Register now.

Video Transcript

Below is a auto-generated transcript of the webinar. Any mistakes are inadvertent. Thank you for your understanding.

Dr. Nidhee Sachdev: Hey everybody, I'm Dr. Nicki sites, Dave. I'm one of the reproductive endocrinology doctors here and OC fertility. So anybody familiar with our practice here know that our practice is me and Dr. Moayeri

Dr. Nidhee Sachdev: And we function as a team.

Dr. Nidhee Sachdev: So today. The goal of this webinar is to talk about IVF.

Dr. Nidhee Sachdev: Really, the purpose is to kind of help our patients that a prospective patients understand what IVF is

Dr. Nidhee Sachdev: And how the process works. Talk a little bit about some statistics and then help you navigate our particular process of guiding you towards IPS

Dr. Nidhee Sachdev: Okay, so we're going to focus today on IVF. We're going to do other sessions for patients interested in doing a frozen embryo transfers and another one for egg freezing

Dr. Nidhee Sachdev: So anybody thinking about freezing embryos or doing IVF or even egg freezing today is going to be important. But if you're looking for specific statistics about egg freezing and frozen embryo transfers, we will cover those, but maybe not today in another session. Okay.

Dr. Nidhee Sachdev: So, um, we're going to spend the next hour reviewing things. And if anybody has any questions, feel free to type them out in the chat box.

Dr. Nidhee Sachdev: And at the end of the talk, I'm going to go through and try to answer as many of the questions that we can. Okay, if some of the questions don't get answered, feel free to reach out to us on info at OC fertility or will try to get back to you individually. Okay.

Dr. Nidhee Sachdev: Alright, so let's get started.

Dr. Nidhee Sachdev: Alright, so the goal today is to understand what IBM is it really to how to get the most out of your IV attorney.

Dr. Nidhee Sachdev: And in talking to patients and, you know, having done doing doing this for several years. I kind of realized that managing somebody's expectations is pivotal to helping them through the process. Okay.

Dr. Nidhee Sachdev: So,

Dr. Nidhee Sachdev: In the talk today, we're going to cover a few basic concepts one what is IDs for embryo banking to some brief statistics of the process.

Dr. Nidhee Sachdev: Three some overlap over all timelines, which I think is really pivotal for people to understand what your two week process is going to be like what you can expect to feel like what are some names of some of the medications, what you can and can't do,

Dr. Nidhee Sachdev: A big way that we at OC fertility communicate with our patients is our patient portal. So that's really helpful for you guys to understand what it is, how to use it and what it's going to look like.

Dr. Nidhee Sachdev: Okay, and then we'll go over some questions. Alright, so let's dive in. Okay, so what is IVF. So the basics IVF stands for in vitro fertilization. Right.

Dr. Nidhee Sachdev: Important concept to understand is that every month women, whether you're trying to get pregnant, whether you're on birth control or whether you are not trying to get pregnant.

Dr. Nidhee Sachdev: Our body is growing and recruiting many eggs right hundreds of X every month. Typically when we're augmenting every month.

Dr. Nidhee Sachdev: Our body will select one right. We'll have a dominant follicle, which is like in this right here. Okay.

Dr. Nidhee Sachdev: What happens to those other hundreds of eggs. They're just gone right. Our body says, Okay, we didn't need them, and then they're gone.

Dr. Nidhee Sachdev: The purpose of IVF is to try to utilize some of those eggs that we didn't get a chance to use right so we're not aiming for 500 eggs. But if we can get instead of one. If we can get 610 12

Dr. Nidhee Sachdev: That's going to be helpful. Okay.

Dr. Nidhee Sachdev: And

Dr. Nidhee Sachdev: The important concept to understand is that

Dr. Nidhee Sachdev: We're not necessarily taking away eggs that you can then use in the future. So by undergoing idea for

Dr. Nidhee Sachdev: An egg retrieval to have to freeze your eggs for to make embryos. We're not taking away from your future fertility in a year or two years.

Dr. Nidhee Sachdev: We're merely just utilizing the eggs that our body was not going to use anyway. Okay. So an important concept that I many people may have heard of is something called

Dr. Nidhee Sachdev: Something called an anthropological. Okay, so an animal follicle count is the number of eggs that we had as a fun. Okay. So typically we will do an ultrasound and assess the number of resting follicles are eggs that we have

Dr. Nidhee Sachdev: And we'll use that to assess okay what dose of medication, should a patient. Good. And by looking at your answer for accounting, creating a dose that can also help us.

Dr. Nidhee Sachdev: Talk to you and manage your expectations about the number of eggs that we think we're going to get. Okay, does that mean that we think we're going to get maybe on the lower side less than six.

Dr. Nidhee Sachdev: Or typical, average is anywhere between six to 12 terrific. We're going to get higher maybe 15 to 20 or above. Okay.

Dr. Nidhee Sachdev: Now, I think a lot of people are kind of focused on the number of it which understandably makes sense. But I think that after you go through this, you understand that numbers are important, but understanding how those can specifically be applied to you is really important. Okay.

Dr. Nidhee Sachdev: So,

Dr. Nidhee Sachdev: The process of IVF is to get your ovaries everyone's ovaries starts off looking something like this okay down here.

Dr. Nidhee Sachdev: To get to not having one follicle, but many right over the course of two weeks. We're going to slowly grow those follicles. Once we feel as if they're appropriate and ready

Dr. Nidhee Sachdev: We're then going to undergo a procedure called egg retrieval or transnational aspiration.

Dr. Nidhee Sachdev: This is done in our IDF lab. So at OC fertility. The IDF lab that we use is CRM Orange County. Okay, so our lab is in a different site than our actual clinic. It's just about two miles down the road and you port beach off January.

Dr. Nidhee Sachdev: So although all the ultrasound and monitors that we do are in our office, the actual egg retrieval is done in our IVF lab.

Dr. Nidhee Sachdev: Just on the other side of Newport. Okay, so when you have your egg retrieval. What's happening is that you're getting anesthesia from an actual anesthesiologist in operating room.

Dr. Nidhee Sachdev: That operating room is attached to our IVF love

Dr. Nidhee Sachdev: Okay so patients will get anesthesia. We call a general anesthesia. It's not the kind of anesthesia, where if

Dr. Nidhee Sachdev: Somebody needed to get their gallbladder taken out, it would be that sedated, meaning there's not a tube down your throat, you are breathing on your own.

Dr. Nidhee Sachdev: But it's still a deeper anesthesia than if you had a colonoscopy, per se. Okay. So patients are not in pain during the procedure, they don't typically remember anything during the procedure for when we're done, they tend to wake up pretty quickly.

Dr. Nidhee Sachdev: So the egg retrieval procedure involves an ultrasound and using that ultrasound will undergo

Dr. Nidhee Sachdev: A transactional aspiration. What that means is that we take a needle and we go through the vagina into the ovary.

Dr. Nidhee Sachdev: Now I know that sounds intimidating and scary. But you have to remember that you're asleep.

Dr. Nidhee Sachdev: Okay. And it's minimally invasive. There's no big decisions that we're making. Right. It's a small little puncture that we're making in the vagina. So there's no scars or anything of that sort.

Dr. Nidhee Sachdev: So when he goes into the ovary. Okay. And then we go into every little follicles. So if you notice here in this bottom picture. There's multiple different little follicles.

Dr. Nidhee Sachdev: Right. The goal is that needs to go into each one and to collapse it to get all the fluid out and take out each and every egg right

Dr. Nidhee Sachdev: Now patients always say, Well, is this procedure dangerous all for all we felt very safe procedure. It's been an outpatient setting. Anytime you have a procedure, in theory, there's risks, right. So we're risk with a procedure is

Dr. Nidhee Sachdev: You know, we're putting a needle into the ovary. There's always a risk of bleeding now.

Dr. Nidhee Sachdev: The chances of that happening are low, because the diameter of the needles fairly small. But as a result of that we prohibit patients from taking any sort of

Dr. Nidhee Sachdev: Advil or blood thinner prior so we don't want to take any Advil or Aleve or ibuprofen right depending upon the patient's underlying medical condition. Sometimes we

Dr. Nidhee Sachdev: Do permit baby aspirin, but we typically will say if you have any discomfort during the process you can take Tylenol, but try to eliminate any ibuprofen Motrin

Dr. Nidhee Sachdev: Or Advil, okay.

Dr. Nidhee Sachdev: So,

Dr. Nidhee Sachdev: Once we take out the eggs, what happens. So it's important to understand that when we have eggs. Once we remove them. We

Dr. Nidhee Sachdev: We talked about access to being a two different categories. Okay. First, the egg is either mature or immature.

Dr. Nidhee Sachdev: So what we're doing the ultrasounds. Okay, and we're looking at the ovaries, we're actually measuring the diameter of each follicle.

Dr. Nidhee Sachdev: Because it's the diameter of the follicles that will guide us as to say if the egg is mature or immature.

Dr. Nidhee Sachdev: Now what that means is if you think back to what your high school biology class there's these processes called meiosis. There's meiosis one and meiosis to

Dr. Nidhee Sachdev: So it's as these eggs are sitting in our body waiting to be used. They're arrested in the middle of my office one once they articulate they complete meiosis one and are what we call mature eggs for me.

Dr. Nidhee Sachdev: It's these mature eggs that are actually able to be fertilized and it's the size of these diameters of the follicles that gives us

Dr. Nidhee Sachdev: A guide as to whether the egg from within each follicle is more likely to be mature. Okay, so it's important to understand that not every egg that we get is going to be able to be fertilized in the future.

Dr. Nidhee Sachdev: So typically, in an average stimulation about 80% of the eggs we receive will be mature.

Dr. Nidhee Sachdev: Now, oftentimes, based upon how the stimulation is going, we'll be able to guide patient to say, hey, I think he might have a little bit less a lower percentage of mature eggs.

Dr. Nidhee Sachdev: So will often refer to the group of follicles as a cohort. Okay.

Dr. Nidhee Sachdev: And so the goal is for the follicles to be like a bell curve distribution, you're going to have the majority in the middle. Some that a little bit bigger in some that are smaller, right, and

Dr. Nidhee Sachdev: If it's truly in a Belter of distribution, you should have about 80% on average to be mature.

Dr. Nidhee Sachdev: Sometimes people will have something which we call an asynchronous cohort, which means that you have maybe you have 10 follicles. But you have for that are really big and then you have six that are small.

Dr. Nidhee Sachdev: Okay, so when undergoing a simulation if you tend to have

Dr. Nidhee Sachdev: A dichotomous group of follicle something big something small, you might end up having a different like a lower percentage of mature eggs.

Dr. Nidhee Sachdev: Right. And typically, that's something that we will discuss with the during the process.

Dr. Nidhee Sachdev: Day. But the important thing to understand is not every egg that we retrieve can one be frozen. If you're freezing or eggs or two can be fertilized.

Dr. Nidhee Sachdev: Now, if somebody does happen to have a very low percentage of mature eggs, then our lab does have the opportunity to do something called

Dr. Nidhee Sachdev: In vitro maturation, in which they try to grow them overnight to see if they'll become mature egg, which we can fertilize the next day.

Dr. Nidhee Sachdev: Okay, so the day of the retrieval right we'll find out how many eggs that patient had so when they wake up from anesthesia will say, Hey, we got 15 x

Dr. Nidhee Sachdev: But it isn't until the next day that we find out how many of those eggs are actually mature and how many actually fertilized.

Dr. Nidhee Sachdev: Okay, so if somebody's having their egg retrieval on a Monday, the day of the procedure, they'll show up about an hour before they're scheduled procedure.

Dr. Nidhee Sachdev: Okay, if they have a partners and their partner will also come into producers burn sample. Some people will have frozen sperm previously banked or some people may use donor sperm.

Dr. Nidhee Sachdev: Because of coded the partner will be allowed in to produce a sample, but unfortunately they're not allowed to be there when the patient wakes up from recovery room.

Dr. Nidhee Sachdev: But typically, we will that the partners, oftentimes waiting on the car or waiting someplace else will call you and we'll go over the process and what happened a number of eggs. Okay.

Dr. Nidhee Sachdev: So the date of the procedural find out the number of eggs. We got and the next day we'll find out how many of those are mature and how many of them actually fertilized. Okay.

Dr. Nidhee Sachdev: Now once the eggs are fertilized. The then over the course of time need to grow and divide to become more mature embryos which we call blastocyst

Dr. Nidhee Sachdev: Okay, this will typically occur on days, five, six, and seven. So, the day of their tribal councils these zero. The next day counts as day one, right. So if your egg retrieval is on a Monday.

Dr. Nidhee Sachdev: They want is Tuesday, Wednesday, Thursday, Friday so Saturdays day five Sundays basics and Mondays day seven, right, which means that your embryos.

Dr. Nidhee Sachdev: If you have any org or we won't know whether you have embryos until Saturday, Sunday, Monday.

Dr. Nidhee Sachdev: OK. Now the important thing to understand is not every egg fertilize and not every for less egg will grow to continue to become a real, okay.

Dr. Nidhee Sachdev: Another important part of the process is understanding that not every egg is going to have the appropriate number of chromosomes. Right. So taking a backup step just basic reproductive biology is that

Dr. Nidhee Sachdev: Humans. We all have 46 chromosomes. Okay, we typically have to set the chromosomes 23 came from our dad, the sperm 23 came from our mom, the egg right to make 46 as women we have two X's men have an x and a y

Dr. Nidhee Sachdev: Now because women were born with all the eggs that we have right over time. If we're 40 and we're then taking that egg out and it has to undergo the process of

Dr. Nidhee Sachdev: maturing and making sure it has the right number of chromosomes, as we get older, that process is more likely to have errors in it, versus IF WE'RE YOUNGER if we're in our 20s.

Dr. Nidhee Sachdev: So as we get older, the eggs that we are taking from these bodies during IVF.

Dr. Nidhee Sachdev: Don't always have 23 chromosomes. So when we go to mix with a sperm, there's a higher chance of having an embryo that instead of having 46

Dr. Nidhee Sachdev: Might have extra copy of something 47 or be missing a copy to be 45. Okay. So not every egg will be mature, not every angle fertilize

Dr. Nidhee Sachdev: Not every fertilized egg will become an embryo. But then, depending upon your age, the percentage of the embryos that you make.

Dr. Nidhee Sachdev: May or may not be normal. Right. And as we get older, we're less likely to have a normal embryo.

Dr. Nidhee Sachdev: Okay, so what I always tell my patients is to just take a step back and say, hey, no matter how you're trying to get pregnant, whether you're trying to get pregnant on your own.

Dr. Nidhee Sachdev: With wire IVF. The overall concept and the process is the same, right. First you have to have an egg, then it has to fertilize then it has to grow and divide to become an embryo.

Dr. Nidhee Sachdev: Then we have to see if that one came from one that's chromosomally normal because that's the one that's more likely to lead to a baby. Okay.

Dr. Nidhee Sachdev: The process of IVF is just taking up more eggs. Ideally, so that we can fertilize more and make more embryos and then ideally through those multiples, select the one that's likely to lead to a pregnancy.

Dr. Nidhee Sachdev: Now the question is, well, what am I chances of getting to here, right. So the key is understanding the statistics and everything.

Dr. Nidhee Sachdev: And we call it the fertility funnel because you start off with a certain number of eggs and it tends to decrease as with every step of the way. It's an attrition rate.

Dr. Nidhee Sachdev: And I think this is a pivotal thing to talk about in understanding this truly when I talked to patients and then having a good understanding of these statistics really help them navigate the process. OK.

Dr. Nidhee Sachdev: So the day of the procedure we find out the number of eggs. And as I mentioned, I expect on average about 80% of the X to be mature. Okay. But if I feel as if a patient is likely to have less mature patients will typically know

Dr. Nidhee Sachdev: All right, because as we're doing the the process and we'll go over that we're going to be talking to you about the number of eggs. We kind of anticipate and you know how they're looking at stuff. Okay.

Dr. Nidhee Sachdev: So we expect about 80% on average to be mature. Now, not all of them fertilize. But on average about seven to 9070 to 90% of the echo fertilized. Okay.

Dr. Nidhee Sachdev: So let's say you have 10 eggs and on the low end 70% fertilized. So now you're at seven fertilized eggs.

Dr. Nidhee Sachdev: Not all of those fertilized egg will grow to divide the become embryos, right. So on average between day 537 we have about 30 to 50% of all fertilized eggs will become blastocyst

Dr. Nidhee Sachdev: So let's say optimistically added seven fertilized eggs we have close to 50% you have four embryos now. Okay. So you started off the 10 eggs, you now have four embryos, not all of these embryos, we know are going to be chromosome a normal. So one

Dr. Nidhee Sachdev: What percentages of these embryos are going to be chromosome a normal. This is heavily dependent upon your age.

Dr. Nidhee Sachdev: The younger you are, the more likely you are to have a chromosome a normal embryo and the older we are, the less likely we are to have right so if somebody is under 35 right we expect about 65% of all their embryos to be chromosome a normal

Dr. Nidhee Sachdev: Okay. And you're going to see here that that number decreases.

Dr. Nidhee Sachdev: As we get older, right in the 35 to 37 age range, you see that it's actually not significantly different. We expect about 55% of all the embryos to be normal. And as we get to

Dr. Nidhee Sachdev: 3839 to 40 we see we start to see more of a decline in the percentage of normal embryos and then you see far fewer as we hit our 40s.

Dr. Nidhee Sachdev: Now, these numbers are helpful, but you have to understand these statistics come from pool data, right, it's hard to apply 65% to somebody for embryos. So what I always counsel patients is that, you know,

Dr. Nidhee Sachdev: When you're 35 I expect about half to be normal. Okay, so if you have four embryos.

Dr. Nidhee Sachdev: It's totally within the normal range to have 123 or even four the normal if you have four and you're 35 what I expect you to have zero normal

Dr. Nidhee Sachdev: No, but we do see it sometimes. So, at the age of 35 that's about a five to maybe 10% chance of not having any normal

Dr. Nidhee Sachdev: But the statistics can kind of fall on either end of the spectrum, but the overall you have some sense of what to expect. Okay.

Dr. Nidhee Sachdev: So it's important to understand that the number of eggs is important but age oftentimes is just as important of a prognostic factor.

Dr. Nidhee Sachdev: Okay. And it's important to understand that there is an attrition at every rate.

Dr. Nidhee Sachdev: Now, the intention is not to be not to intimidate you. The intention is just to understand that we might start off with a number and dwindled down. It doesn't mean that everybody needs to have

Dr. Nidhee Sachdev: 25 eggs to have a normal embryo, but it will help us understand to say, hey, you know, once we hit a certain age, how many girls can we expect. So we typically will counsel patients that in our patients who are 40 and above.

Dr. Nidhee Sachdev: We usually typically will get about one normal embryo per cycle, we definitely pack patients who've gotten more

Dr. Nidhee Sachdev: But on average, regardless of the number of eggs just due to the the attrition rate of the blast formation rate is the number that are

Dr. Nidhee Sachdev: The percent that are chromosome a normal, on average, we end up having about one per cycle. Okay. So I think it's important to understand that every rates. The numbers change.

Dr. Nidhee Sachdev: But once we have a Chrome is only normal embryo, whether you're 2535 or 43 your chances of getting pregnant with that Chrome is only normal embryo are the same.

Dr. Nidhee Sachdev: Okay, because the hardest part of the process is getting to this normal embryo. The younger we are, the more likely we are to get multiple normal embryos.

Dr. Nidhee Sachdev: But if you're 42 and you have one normal embryo versus someone who's 31 and as three normal embryos your one normal embryo gives you just as good of a chance of getting pregnant as somebody who has another normal embryo. Okay. And that's important to understand now.

Dr. Nidhee Sachdev: How do we tell if an embryo is normal. Okay. Going back to this slide. I think that's important to understand in that

Dr. Nidhee Sachdev: We have the option and the ability to take a few cells from the embryos to assess the chromosomes within those cells and to say does this does this embryo have

Dr. Nidhee Sachdev: 46 chromosomes right we've into that normal. Are you bored or does it have an extra hours at missing something to be called and deployed.

Dr. Nidhee Sachdev: So by way of doing that. It's called a Trifecta term biopsy. So these embryos actually have two groups of cells.

Dr. Nidhee Sachdev: This tightly compacted group of cells here is called the inner stillness that actually goes on to be the fetus, the cells are on the outside here.

Dr. Nidhee Sachdev: Or what go on to become the placenta. So we're not actually taking any cell from what goes on to be the baby, we're taking the cells from what goes on to be the placenta and by taking a few cells. We're assessing where we're using that as a

Dr. Nidhee Sachdev: As an extrapolation of what all the cells are right. So you're taking five cells and saying, hey, these are normal and saying that this is an accurate representation of the entire embryo.

Dr. Nidhee Sachdev: Now it's not something that every patient has to do, but often patients will do it because although by doing the biopsy. We're not changing anything in the embryo. It's helping us identify which embryo, we should use and transfer

Dr. Nidhee Sachdev: Right, because if somebody is 40 and has four embryos instead of transferring them one at a time or two at a time.

Dr. Nidhee Sachdev: By identifying which one is normal. We can then eliminate the heartache of trying to transfer those and maybe not.

Dr. Nidhee Sachdev: Getting somebody pregnant or resulting in a miscarriage and then we can just focus on the one okay for patients who choose not to biopsy. That's also ok we then depending upon your age will transfer one or two at a time.

Dr. Nidhee Sachdev: Okay.

Dr. Nidhee Sachdev: So the next thing I'm going to talk about is the timeline. I think that's really important to understand

Dr. Nidhee Sachdev: So for anybody who has a new patient consultation or a follow up or even in the middle of an ROI cycle. I think it's important to talk to your doctors are our clinic team about if you're thinking about doing Nivea

Dr. Nidhee Sachdev: So what's involved in the prep. So first of all, anybody thinking about doing it. So we like to know like about a month in advance.

Dr. Nidhee Sachdev: That because as everybody probably knows is that fertility treatment is based around our menstrual cycles, things are cyclical

Dr. Nidhee Sachdev: Okay, so if the goal is do IDF and October we want to know in September that we can have everything ready before you get your period and you want to start in October.

Dr. Nidhee Sachdev: So what are things that we need to prepare you to do idea. So one is blood work. You got to make sure that your blood count is okay. Your platelets are functioning and there's no

Dr. Nidhee Sachdev: End to current issues like your thyroid your vitamin D or anything that's out of the ordinary.

Dr. Nidhee Sachdev: An important one is genetic carrier screening in which you can have blood test done that look to see if you're a carrier for different diseases and if so then we make sure your partner is not a carrier for the same disease.

Dr. Nidhee Sachdev: This one is particularly important for patients doing IVF, because in the event that you both are positive for the same disease.

Dr. Nidhee Sachdev: Have the ability to screen the embryos for that disease. Now, if that is the case, that requires a little bit of planning prior to actually starting the IVF cycle.

Dr. Nidhee Sachdev: So we highly recommend that our patients get the genetic carrier stream and what's important is that whereas the other bloodwork comes back pretty quick.

Dr. Nidhee Sachdev: These genetic carrier screens take about two weeks to come back. So if your goal is to start in October and you haven't had that done yet. We really want to know in advance so we could bring you in and have it drawn. Okay.

Dr. Nidhee Sachdev: For anybody using a male partners sperm. It's really important that we have a semen analysis prior to ideas.

Dr. Nidhee Sachdev: Okay, because we need to be prepared. We don't want somebody to go through the process and then the day of the egg retrieval. The embryologist be surprised as to the quantity and quality of the sperm.

Dr. Nidhee Sachdev: So it's really important that we have a semen analysis within a year of starting idea. Okay. During this

Dr. Nidhee Sachdev: Two to four week prep time, right, you're going to get your blood work done, we'll get the semen analysis done, but this is the time and we're going to have you check in with your ideas coordinators.

Dr. Nidhee Sachdev: They're going to make a tentative protocol for you so you can understand the timelines. So when you're going to start your meds, how often we're going to see you when your tentative procedure might be and all those things. Okay.

Dr. Nidhee Sachdev: We're going to begin to order your medications so anybody who has insurance coverage will have to make sure that you have a prior authorization if needed will go through the appropriate channels to get your medications covered with sometimes takes longer.

Dr. Nidhee Sachdev: You'll receive the consent forms right it's it's multiple pages of information that we want to make sure that you've read and have an opportunity to ask us questions about before you start

Dr. Nidhee Sachdev: So you're going to receive your consent and with the goal of you having your consent signed and started prior to starting your IVF cycle. Okay. So by the time you are ready to start your IVF cycle. Everything has been signed and completed and we have that in our system.

Dr. Nidhee Sachdev: A really important pivotal part is the financial consultation, we want to make sure you understand the costs involved and how much it is

Dr. Nidhee Sachdev: And we give you an accurate breakdown for anybody who has insurance coverage that you understand your in our network benefits. And if you need a prior authorization that's done beforehand.

Dr. Nidhee Sachdev: prior authorization for insurance coverages sometimes can take two to three weeks. So for anybody meeting that prior to starting I've yeah we really need to know the cycle beforehand. Okay.

Dr. Nidhee Sachdev: So once all that prep work prep work is done. Okay. Typically, we will start your idea of cycle on your period.

Dr. Nidhee Sachdev: Sometimes we will we will use the birth control pill and for some patients, we often will do something called estrogen priming where we will give you estrogen medication prior to the start of your period. Okay.

Dr. Nidhee Sachdev: So your goal as a patient should be to review all the medication instructions prior to starting

Dr. Nidhee Sachdev: Right, which means that there are videos on our website and will guide you as to how to reach them, which you can kind of wash the prime yourself so you have an understanding of what the different parts are

Dr. Nidhee Sachdev: The day that you come into start your idea of cycle, our team will review with you. But if you've done your homework ahead of time. It makes for the process to be a little bit easier. Okay.

Dr. Nidhee Sachdev: But we want to make sure that you walk out if you're feeling comfortable and confident or as confident as you can feel about doing these shots.

Dr. Nidhee Sachdev: And if for anybody who's starting IDF and you're doing a shot you have questions, there's always someone available to answer your questions, you can call the office and follow the prompts and you can reach the doctors directly. Okay.

Dr. Nidhee Sachdev: So you're going to review your idea of calendar on our patient portal. That's really important. And I'm going to talk about the patient portal, because that has your calendar and gives you clear instructions. Okay.

Dr. Nidhee Sachdev: You're going to receive your medication. And when you receive your medications, you're going to get multiple boxes and vials and medication.

Dr. Nidhee Sachdev: It's really important that you do an inventory. Upon receiving them.

Dr. Nidhee Sachdev: The pharmacies that we use are really good. But we all know there's human error. And we want to make sure that you have everything. More importantly,

Dr. Nidhee Sachdev: By doing an inventory. It'll help you become more familiar with the different medications and their names, so that way when we review them with us. They seamless born and confusing.

Dr. Nidhee Sachdev: Okay, when do you start your stimulation, you need to have your consent signed and turned in. Okay, that's, that's a really big one, because prior to starting the meds. We don't want you to know the risks and benefits and that you're okay. During the procedure.

Dr. Nidhee Sachdev: So when you get your menstrual cycle, give us a call and we'll bring you in on either cycle, day one, two or three. Okay. During the stimulation, it's about to a two week process where you're giving yourself injections every day.

Dr. Nidhee Sachdev: It starts off with two. And later on, eventually goes to three and in some patients goes to four. And although that seems really daunting 99% of the patients, save that after the first few days they're more than okay with it and it's not as big of a deal.

Dr. Nidhee Sachdev: But during that process, we see you a lot on average it's five to six visits over the course of two weeks.

Dr. Nidhee Sachdev: Depending upon your particular cycle if it goes longer or if you are a robust responder and need more careful monitoring that might go up. Okay, so it might be eight or nine visits.

Dr. Nidhee Sachdev: But that's important to plan for because we typically we need to see you. Prior to a certain time because your labs are dependent upon your dose of medication for many of you,

Dr. Nidhee Sachdev: So we like to see all of our IVF patients prior to 1130 or 11 o'clock, so we can get the results back the same day. Okay, so when looking at your calendar. We want to make sure that your schedule will allow you to be seen that frequently

Dr. Nidhee Sachdev: So over the course of two weeks. Okay, you're going to do the medication and you're going to have your egg retrieval.

Dr. Nidhee Sachdev: Following that, when the embryo development happens. So the active parts and the patient parts are two weeks, the part that happens in the lab. The patients, you're at home, you're recovering and you're starting to feel back to normal. Okay.

Dr. Nidhee Sachdev: All that embryo development that occurs happens for one week in the lab. We talked about the day of the egg retrieval, we find out the number of eggs retrieved the day after the egg retrieval will call you will go over the number of mature eggs and the number fertilized.

Dr. Nidhee Sachdev: We don't know anything about the embryos until day five, six and seven. That's when the embryos are frozen.

Dr. Nidhee Sachdev: And biopsied if that's the option that you chose okay we typically review these in person at your post op appointment.

Dr. Nidhee Sachdev: So it's important that patients understand they need to schedule a post up appointment.

Dr. Nidhee Sachdev: Five, six or seven days after their egg retrieval and that's when we will go over it with you in person. Okay, or if your post op three of the phone or zoom the coven that's what we'll go over it will answer all of your questions and we'll talk about your next step. Okay.

Dr. Nidhee Sachdev: For anybody who is biopsy their embryos and doing CCS comprehensive chromosome screening or pre implantation genetic testing. It's

Dr. Nidhee Sachdev: It's the same thing, just different phrasing or office uses CCS

Dr. Nidhee Sachdev: Those results take about two to three weeks now. The timing of those results may vary depending on what clinic. You go to the here at OC fertility because our lab is few CRM CB in Colorado.

Dr. Nidhee Sachdev: The samples actually get sent out to Colorado for testing. Now it's really important to understand is your embryos will stay here. Your embryos are not flying back and forth.

Dr. Nidhee Sachdev: But the cells that are being analyzed that we biopsied that's what's being sent to Colorado. Okay, and based upon those results will then be able to tell which of those embryos are normal.Dr. Nidhee Sachdev: So when we buy out to the embryos, the results that we get are essentially binary, they're going to be chromosomally normal meaning 46 either male or female.

Dr. Nidhee Sachdev: Those are the ones that are okay to transfer or aneuploidy meaning does not have 46 chromosomes has extra are missing those are ones that we do not transfer

Dr. Nidhee Sachdev: So a really important concept to understand here is that there is a possibility when we biopsy the embryos that the results might end in a chromosomally abnormal embryo, but one that is compatible with life. Most commonly, it's down syndrome. Okay.

Dr. Nidhee Sachdev: Even if that embryo has Down syndrome and many patients feel that that is an embryo that they would be comfortable having transferred and having a baby with down syndrome.

Dr. Nidhee Sachdev: But just because it's chromosomally abnormal our policy and frankly I think majority of labs in the country, the policies that we only transfer the ones that are chromosomally normal

Dr. Nidhee Sachdev: So I can't put patients that if this is something that you don't feel comfortable with the idea of having an embryo that you know might be compatible of life, but you

Dr. Nidhee Sachdev: Are not allowed to transfer that testing the embryos is not an option for you, okay, because you have to be comfortable knowing that the only embryos, you can transfer the ones that are diagnosed as being chromosome a normal

Dr. Nidhee Sachdev: Okay. And when you get the results in the process of understanding of something as chromosome a normal or not we do get the gender information.

Dr. Nidhee Sachdev: So for patients interested in knowing the gender. We can tell you that for patients who don't want to know the gender and then we we tell you how many normals, you have, you don't have to know the gender. Okay.

Dr. Nidhee Sachdev: And for patients who have embryos a multiple of both genders and when you're doing the transfer you that have a choice. If you have a preference for gender. If you don't

Dr. Nidhee Sachdev: So what is the two week process look like. Okay, so when you get your period you're going to come in and you're going to

Dr. Nidhee Sachdev: Have an ultrasound that we can look at your ovaries. Make sure the dosing of medications that we have ordered peers appropriate make sure there's no large ovarian cysts or anything that we think could impede you starting. Okay.

Dr. Nidhee Sachdev: If everything looks appropriate we make sure you want to set how to do your medications and you start your injections.

Dr. Nidhee Sachdev: Okay, we'll start your injections, usually on a cycle. Day two or three and you're taking injections for on average about 11 days and then that process. We're going to see you frequently for blood and ultrasound.

Dr. Nidhee Sachdev: And your ovaries will slowly go from here to looking like this.

Dr. Nidhee Sachdev: During this time, and this is less of an issue now because the coven but we don't want you traveling. We want to have the ability to see you for your appointments. Okay, so we don't want you traveling

Dr. Nidhee Sachdev: Too far, where you can't come back to have your ultrasound appointments when needed. Another really important thing is that we limiting your exercise because your ovaries are getting big. And they're attached to your body. The pendulum like a blood supply.

Dr. Nidhee Sachdev: Me for doing a lot of physical activity, they have the ability to kind of twist on each other and in worst case situation that can cut off blood supply to that ovary.

Dr. Nidhee Sachdev: So for that reason we limit your exercise, starting from the second or third day of your shots by limiting your exercise and we say, No running no strenuous

Dr. Nidhee Sachdev: Activity like know spinning or CrossFit of that sort. Yoga is OK to do but no hot yoga and nothing where you're doing any quick transitions. Okay, walking in really light upper bodies. Okay.

Dr. Nidhee Sachdev: So once you've been taking the shots for about two weeks and we feel like the eggs or have an appropriate size. You take a medication called a trigger shot that trigger shot happens at a very specifically times

Dr. Nidhee Sachdev: Time that we give you and based on that time your egg retrieval happens 35 hours later. Okay.

Dr. Nidhee Sachdev: For the egg retrieval, you will you will get anesthesia. So you will need a driver and we do recommend a chaperone so that you're not alone.

Dr. Nidhee Sachdev: By yourself after the procedure. Okay. The procedure itself takes about an hour, but the whole process takes about two and a half hours you get there, an hour before the procedure and after the procedure or you're in recovery for about 45 minutes

Dr. Nidhee Sachdev: No incisions know scarring. Everything is rational and in for people who are making embryos and are using sperm from a partner than that part department will come in and produce for that day. Okay, or if you have a frozen sample the frozen sample will be used at that time.

Dr. Nidhee Sachdev: Okay, so that's the overall process. Now, the important part of the process here at OC fertility is using our patient portal. Okay, so a big part of that is AR AR T calendar for anyone doing IVF and egg freeze or frozen embryo transfer that's going to be pivotal

Dr. Nidhee Sachdev: It's also a secure way for us to give and receive information to you from our patients right so you can communicate with us on that and send us a message if you have questions. We're also going to send you messages on there too. Okay.

Dr. Nidhee Sachdev: Um, any blood test results thread throughout the process that we want to share with you are going to be shared on there.

Dr. Nidhee Sachdev: And you can see any prescriptions that we are sending electronically.

Dr. Nidhee Sachdev: In addition, there also is a billing tab on there. So if you have questions or concerns up billing, you will be able to see some invoices and things on there. Okay.

Dr. Nidhee Sachdev: And those who are patient portals app right to OC fertility. We have a very specific clinic ID. If you have not registered for our patient portal.

Dr. Nidhee Sachdev: It's super important that you do. So whether you're going through IDF egg freezing or frozen embryo transfer it, it's really important that you do that.

Dr. Nidhee Sachdev: It's the most important way that we communicate with our patients. Okay, so if you have any questions about how to do that call to our office and we will get you set up. So when you log in to your portal. This is what the dashboard looks like. And there's these different icons. Okay.

Dr. Nidhee Sachdev: So when you click your AR T calendar, it'll show up in various views, it'll show up in the month for you. And if you click on each one. You know, show you what your instructions are for that day.

Dr. Nidhee Sachdev: So this is an example of an IVF. A RT calendar, you'll notice that each day or instructions. Okay. It'll say, and Tuesday, September 29

Dr. Nidhee Sachdev: You're going to take in the evening this dose of medication was called follows them and this is your dose 300 international units, then your meta pure is another medication you're going to take in the evening, you're going to take two vials of that.

Dr. Nidhee Sachdev: In addition, this patient is also taking in the evening a medication called Clomid

Dr. Nidhee Sachdev: Okay. For the next day it'll say the morning. Take this medication and again in the evenings. Take this medication. So it will list out all your medication.

Dr. Nidhee Sachdev: For IVF. It's really important that you keep track of your calendar and you follow it, because oftentimes, some patients, we might be changing their dose, we might go down, we might go up, we might add something else in

Dr. Nidhee Sachdev: So we'll always communicate with you in person via phone, but a portal is another written way to see it because for many people, it's really confusing. And by having something visually.

Dr. Nidhee Sachdev: Here. That's really important. Okay, so it's important to understand. You can look at it from a month view or you can look at it in the list view.

Dr. Nidhee Sachdev: Additionally, our patient portal will also keep track of your different appointments. Okay. You don't tell you what your past appointments are, what your future appointments are

Dr. Nidhee Sachdev: It'll tell you who you're seeing now there's two providers in our office myself and Dr. Mary we function like a team.

Dr. Nidhee Sachdev: That being said, you know, each of us. We try to see our own patients for, especially during the IDF simulations.

Dr. Nidhee Sachdev: But sometimes given your schedule or our schedule, you will see, you know, my patients will see Dr Moines area or Dr. Maria will will see my or I will see her patients. Okay.

Dr. Nidhee Sachdev: For anybody who wants to know who they're seeing and they're not sure. Check your portal app because it'll say who you're seeing, especially on weekends.

Dr. Nidhee Sachdev: We take we you know we take recover call for each other. So on the weekend warrior, you often scan my patients and I'll scan hers, and if you're ever not sure who you're seeing, you can always call the office, but it'll say who you're scheduled with here. Okay.

Dr. Nidhee Sachdev: Additionally, your patient portal app will tell you when you receive messages from us. So anytime we send you a message, we should click our button on our end that says to notify you via email. And if you go into your message section you will see the messages that you've gotten. Okay.

Dr. Nidhee Sachdev: So that is the basics of what I wanted to talk about. We do have some time for any specific questions. So I'm going to talk a little bit. I may try to answer some of these questions. Okay, so for anybody.

Dr. Nidhee Sachdev: Has questions, feel free to type them out in the chat. But one question I have is

Dr. Nidhee Sachdev: Okay, so one question. Somebody asked is What do you recommend for embryos that are found to be mosaic during genetic testing.

Dr. Nidhee Sachdev: That's a really good question. So

Dr. Nidhee Sachdev: What is a mosaic embryo. So Moses ism is something which will we biopsy the embryo. So if you remember, we're not taking the whole embryo. Right. We can't we're taking just a few cells from them.

Dr. Nidhee Sachdev: So we're taking five to eight cells. And when we take those five eight cells were assuming that they each have the same number of chromosomes in them. And when we analyze them will get a result that will say 46 chromosomes or maybe as an extra 47 or missing 145

Dr. Nidhee Sachdev: In mosaic embryo is one in which we have a result that isn't clearly 46 or 47 or 45 it seems as if some of the cells in that embryo may have a different number of chromosomes and the rest. That's what we call a mosaic.

Dr. Nidhee Sachdev: Meaning that the cell line in in every each cell and all the embryo is not necessarily equal. Okay.

Dr. Nidhee Sachdev: Now, there's a lot of debate about Mosaic system because there's some thought to say, well, is it truly that that embryo has cells with different number of chromosomes.

Dr. Nidhee Sachdev: Or is it that that was just a error when the testing it just you know that result was a little bit nebulous. And we're not sure. So should we really be discarding those embryos, or discounting them.

Dr. Nidhee Sachdev: And so the important thing to understand is that when talking about Moses ism oftentimes will categorize them this low level Moses isn't or high level Mosaic system.

Dr. Nidhee Sachdev: High level, meaning that there's a greater percentage of cells that are abnormal, meaning that

Dr. Nidhee Sachdev: You know the results. Instead of saying it was 100% having 46 chromosomes for this particular chromosome meeting chromosome 12 it was 70% mosaic.

Dr. Nidhee Sachdev: Saying that they thought the 70% of the cells had that extra chromosome versus low level would be that maybe had 30% Mosaic system.

Dr. Nidhee Sachdev: So that's the important one. You want to determine, is it high level or lower level if it's low level, it's more likely to be one that's going to lead to a live birth versus a high level.

Dr. Nidhee Sachdev: The other thing you want to know is which chromosome is it, is it a chromosome that's associated with abnormalities like trisomy 21 is down syndrome.

Dr. Nidhee Sachdev: So if you had a mosaic embryo for chromosome 21 that is one that is likely to lead to a live birth with possible delays, because we know that there are people out there who have mosaic.

Dr. Nidhee Sachdev: Down syndrome. Okay, versus ones that are not compatible life because if that really is the case, then that's less likely to lead to a pregnancy with developmental issues or challenges.

Dr. Nidhee Sachdev: So anybody considering transferring the mosaic embryo. The recommendation is that you talked to a genetic counselor and then for that specific mosaic says, and we see, is there any literature on

Dr. Nidhee Sachdev: Pregnancies that came from those mosaic embryos and what are the outcomes.

Dr. Nidhee Sachdev: For these low level of it, we're finding that the results are that there is a higher rate of miscarriage. But the pregnancies that do result and implementation those babies are born, and they tend to be healthy and find

Dr. Nidhee Sachdev: Especially if it's the most as as a not for the whole chromosome, but for part of the chromosome. So segmental ones, those actually tend to do really well. So if you end up having multiple mosaic embryos which really is not very common.

Dr. Nidhee Sachdev: In you're debating, which ones to transfer the ones that are not a whole chromosome, but partial the chromosome is more likely to have better outcome.

Dr. Nidhee Sachdev: Embryo. Great. Okay. So, somebody asked, can you talk a little bit about embryo grading. So that's a great question. So what is embryo grading. So will we look at the embryo or the blastocyst, right. I meant I mentioned there's two

Dr. Nidhee Sachdev: Groups of cells. There's the inner cell mass. And then there's the truck factor. So by assigning a great to an embryo, that means that the embryologist is visually looking at the embryo.

Dr. Nidhee Sachdev: And objectively assigning grades, just like in school ABC or D and every lab has different art lab uses

Dr. Nidhee Sachdev: Letters. Okay, so we're looking to say how are those cells. How to Be a look how many are they are they tightly compacted. Are they loosely compacted. Do they have what they call fragmentation.

Dr. Nidhee Sachdev: And they're assigning a letter grade to the inner cell mass and the truck factor.

Dr. Nidhee Sachdev: In addition, they're looking to see how expanded is that blastocyst, is it a little bit expanded or is it significantly expanded right if it's really expanded that's going to give us a higher grade.

Dr. Nidhee Sachdev: And we put that together and the grades tend to be five A or four BA or six, AB. Okay. Now, if you're testing the embryos, the chromosomes Trump degrees.

Dr. Nidhee Sachdev: Right, because we'll have ones that are a great gray, but to be chromosome layer of normal so studies have shown that great alone can't necessarily determine if something's chromosome a normal or not.

Dr. Nidhee Sachdev: But that being said, if somebody has multiple embryos and a chromosome a normal or if they're deciding what gender to put in the grade can help us because the grade will

Dr. Nidhee Sachdev: Give us which embryos are more likely to implant. It doesn't tell us which one is going to be a healthier pregnancy, right, because there's more involved in making a healthy pregnancy outside of just chromosomes.

Dr. Nidhee Sachdev: But it will tell us which one is more likely to implant. So if you have three different embryos and genders not important. We typically will say,

Dr. Nidhee Sachdev: Transfer the single best embryo and the embryologist have a hierarchy, based on your age, the date of the embryo. This biopsied and the grid and then determine which one is best

Dr. Nidhee Sachdev: So oftentimes patients are really focused on the grades.

Dr. Nidhee Sachdev: I think it's important to you know to understand so you feel comfortable, but the grades are mainly for implementation potential and the difference between the higher grades in the lower grades often is not dramatic, it's usually about, you know, 5% 10% at most. Okay.

Dr. Nidhee Sachdev: So the next question we have is our women starting IVF required to take birth control to regulate their cycle know

Dr. Nidhee Sachdev: So every clinic does things differently. Right. So some clinics will do we call badging where they'll try to have all their patients. Start at the same time.

Dr. Nidhee Sachdev: To coordinate into to make things a little bit easier. We don't, we're, you know, we're kind of like a small boutique factors. So we don't really feel the need to do that.

Dr. Nidhee Sachdev: So we will have patient start with their menstrual cycle. That being said, there's multiple different IV of protocol.

Dr. Nidhee Sachdev: Some idea protocols do actually require the birth control pill to be taken first so that way we can give you another medication on top.

Dr. Nidhee Sachdev: Okay, so it typically those protocols are like a micro dose protocol will need to put you on the pill for a little bit and then we overlap it with micro dose.

Dr. Nidhee Sachdev: But typically, we don't require patience to be on the birth control pill. The only reason that we will is if timing as an issue if somebody has a very specific time frame that they need to undergo their procedure.

Dr. Nidhee Sachdev: Then we will put them on the birth control pill, but we typically don't we will use her menstrual cycles, as they will

Dr. Nidhee Sachdev: If Since Dr. Mary and I we do our own procedures if there's a chance that you know

Dr. Nidhee Sachdev: We happen to be out of town or unavailable to do a procedure will know that in advance in will tell our patients until the patients will have the option of

Dr. Nidhee Sachdev: Going on the birth control pill, so that they can then time their start for when the retrieval will be when either of us are in town or than the other covering physician will do the retrieval for them.

Dr. Nidhee Sachdev: Okay, but that was a good question. Yeah, so we don't usually

Dr. Nidhee Sachdev: Another important

Dr. Nidhee Sachdev: Or I got another question.

Dr. Nidhee Sachdev: So this question is can you elaborate on testing that takes place prior to IVF treatment.

Dr. Nidhee Sachdev: So that's a good question. So there's two ways to answer your question. So when talking about IDs. I think it's important to understand that the term idea.

Dr. Nidhee Sachdev: In general encompasses making the embryos and transferring the embryos.

Dr. Nidhee Sachdev: However, the way we do things now is that we often it'll be two different sections. Right. The process of creating the embryos and then a second process of transferring the embryo.

Dr. Nidhee Sachdev: So an important part of transferring the embryo is making sure the uterine cavity and lining is appropriate for that embryo to implant, especially if somebody had failed implementations before

Dr. Nidhee Sachdev: So there's numerous steps that we go through

Dr. Nidhee Sachdev: But it depends on the person. Right. So, depending upon their age and their chances of having a normal embryo, we might say let's focus on getting the embryo. First let's focus on doing the IDF taking the meds.

Dr. Nidhee Sachdev: retrieving the eggs and making the embryo. Once we know you have an embryo over waiting for the results. That's when will embark down the route of

Dr. Nidhee Sachdev: evaluating your uterine cavity. So to evaluate your uterine cavity will do an office sister asked up which we take a little telescope, we look inside the uterus.

Dr. Nidhee Sachdev: And we look to see, is there anything that could be there that impedes the embryos ability to implant meaning, could there be a polyp or some scarring or a fibroid or something that we think needs to be removed prior to the transfer. Okay.

Dr. Nidhee Sachdev: Other things that we can do with something called an individual biopsy, which we take a sample of the uterine lining to assess is there any underlying inflammation or infection going on that can affect things

Dr. Nidhee Sachdev: But that we tend to do once we know we, for sure. Moving forward for the transfer as we get closer to the transfer

Dr. Nidhee Sachdev: But testing that's involved prior to IVF big thing is the basic bloodwork right. A really important test is your age, we use that information.

Dr. Nidhee Sachdev: Coupled with your history and your ovarian ultrasounds, your answer for account to determine what dose of medication to take right free to give you

Dr. Nidhee Sachdev: And giving you your dose is really important because for somebody who has a really high age, we want to make sure we don't give you too high of a dose to temper your response versus somebody who might have a lower he needs a higher dose.

Dr. Nidhee Sachdev: So that's really important.

Dr. Nidhee Sachdev: Another good question. We got is how soon after the retrieval. Can you plan on the transfer happening. So that's a great question. And that kind of goes back to the timeline.

Dr. Nidhee Sachdev: So the way that process works is, let's just use the date of October 1 ok October 1 someone starts. Dr. Yes Men average is about two weeks of taking the meds and your egg retrieval. So let's say hypothetically, the egg retrieval is on October 14

Dr. Nidhee Sachdev: If the egg retrieval is on October 14 will know around October 21 how many embryos, we had. Okay.

Dr. Nidhee Sachdev: And it depends from here if we are testing the embryos meaning biopsy men and determining what's chromosome. The normal or not.

Dr. Nidhee Sachdev: From that point, it'll be about two weeks to we know how many of those embryos are normal in which one. Okay, which puts us at, you know, the first week of November, let's say, November 7

Dr. Nidhee Sachdev: Once we know we have a normal embryo that's when we start the transfer process. Okay, and we're going to go over this in another webinar documentaries going to do in a few weeks.

Dr. Nidhee Sachdev: But there's different protocols that we use for transfer cycles, depending on the protocol that protocol could be three weeks or four to five weeks. Okay, and

Dr. Nidhee Sachdev: The important thing to understand is that if your egg retrieval is on October 14 we don't have any embryos. The 21st, you're going to get a period around October 28

Dr. Nidhee Sachdev: Okay, so, but we won't know the results of your embryo biopsy till about November 7

Dr. Nidhee Sachdev: So we have two options there and we can put you on the birth control pill, while we wait for the results to get back and then as soon as we get the results back. We can stop you from the pill and then move forward to get your frozen embryo transfer

Dr. Nidhee Sachdev: And if we don't put you on the pill, then we have to wait for your subsequent period right so then that means that you get your next period by November 28 and that's when we get things started.

Dr. Nidhee Sachdev: So it's kind of a long winded answer to your question, but I tell patients. All in all, from the beginning of your idea of stem to your transfer

Dr. Nidhee Sachdev: Is about six to eight weeks, mainly because we have that gap of time where we're waiting for the the embryo biopsy results to come back.

Dr. Nidhee Sachdev: If you don't use the embryo biopsy. If you just freeze embryos, then we can get started as soon as you get a period and that cuts down about two weeks. Okay.

Dr. Nidhee Sachdev: Okay, here's another good question. Is it difficult for the egg or embryo to implant. If you have an immaterial says, and is there a difference between using a fresh embryo versus a frozen embryos. That's a really great question. So first, let's talk about fresh versus frozen embryo.

Dr. Nidhee Sachdev: So what are the reasons why we freeze the embryos versus doing a fresh transfer

Dr. Nidhee Sachdev: So, in the event that we think that patients not going to have if someone's had a prior failed IVF, where they didn't have any embryos to freeze.

Dr. Nidhee Sachdev: Meaning that from the fertilization stage to the blast stage. They just had very poor embryo development.

Dr. Nidhee Sachdev: That's somebody which we might talk to you about doing a fresh transfer meeting. We won't freeze embryos will just transfer whatever embryos, we have given the number that you have. Okay.

Dr. Nidhee Sachdev: Meaning that will will take a fresh embryo and transport that same cycle. If you have multiple embryos, who will freeze them. Okay.

Dr. Nidhee Sachdev: Typically we don't do that very often because the majority of our patients want to test the embryos. If you want to test the embryos those embryos have to get frozen because

Dr. Nidhee Sachdev: We will know the results for two weeks and then embryo can sit there for two weeks. Okay, maybe there are other clinics to have the ability to do them. The

Dr. Nidhee Sachdev: Transfer the same beta test and a recent article and it doesn't. There's also data that shows that frozen embryo transfers have a higher success rates and fresh.

Dr. Nidhee Sachdev: Because when you're doing IBM and you're growing multiple eggs through estrogen levels are what we call super physiologic there are much higher than they are in a natural cycle.

Dr. Nidhee Sachdev: And as a result, your uterus tends to be a little bit more advanced stage than where the embryo is

Dr. Nidhee Sachdev: Because if you think about it, we're trying to time things perfectly the embryo and the uterus, and when we do a fresh IVF, because you have such a high

Dr. Nidhee Sachdev: estrogen level and you have a release of a hormone called progesterone, the uterus. By the time we implant the embryo thinks that you're maybe on day seven or eight one. That's a day, five unreal.

Dr. Nidhee Sachdev: So studies have shown that frozen embryo transfer is actually have a higher success rate. So we typically tend to recommend frozen embryo transfer over fresh

Dr. Nidhee Sachdev: But we recommend fresh in the event that we think a patient has had a prior outcome that they didn't have embryos, or they may not have any embryos to freeze.

Dr. Nidhee Sachdev: Okay, I got another question here. Okay, so what had pollitz removed after the egg retrieval.

Dr. Nidhee Sachdev: What happens appalled scroll back during the pregnancy. Does it increase your chances of miscarriage. So, good question. So polyps that arise. Typically, they don't arise every month.

Dr. Nidhee Sachdev: You know, it's often something that isn't super common but when we're looking for things and we do an office across to be well even if it's a small something in there, we'll take it out.

Dr. Nidhee Sachdev: Okay, so we typically will lie to evaluate the uterine cavity within six months of the transfer

Dr. Nidhee Sachdev: The main thing is developing a polyp prior to the implementation, right, if we go in and we evaluate your uterine cavity and we clear up any issues or policy and then you do a transfer

Dr. Nidhee Sachdev: And the embryo and plants, the ability of developing a polyp after is not going to affect the pregnancy because it's implanted

Dr. Nidhee Sachdev: Nothing is that it's going to affect it. It's more about the time before you do the transfer and the embryo and planting, which is why we try not to have too large of a gap between when we evaluate the

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