Relatable with Allie Beth Stuckey - Ep 1018 ｜ Former IVF Doctor Blows the Whistle ｜ Guest： Dr. Lauren Rubal

00:00:00.660 Dr. Lauren Rubal is a double board certified integrative medicine doctor in OBGYN.

00:00:07.120 She spent years as a reproductive endocrinology and infertility physician working with patients 0.90

00:00:14.140 through the IVF process.

00:00:17.500 Eventually, she woke up to the ethical and moral issues with IVF and she opened up her

00:00:24.320 own practice that helps couples from a holistic standpoint get pregnant naturally.

00:00:33.080 And today she is going to tell us all of the scientific medical ins and outs of the IVF

00:00:39.220 process.

00:00:39.980 She is going to tell us things that you probably did not know goes into the entire procedure,

00:00:47.800 the risks associated with it.

00:00:50.120 There is a lot that she told me that I did not know about this whole process.

00:00:53.800 And what we should be thinking about when it comes to fertility and pregnancy.

00:00:58.900 This episode is brought to you by our friends at Good Ranchers.

00:01:01.740 Go to GoodRanchers.com.

00:01:02.960 Use code ALI to check out this GoodRanchers.com code ALI.

00:01:16.040 Dr. Rubal, thanks so much for taking the time to join us.

00:01:19.220 If you could just tell everyone who you are and what you do.

00:01:23.040 Absolutely.

00:01:23.440 Thank you for having me.

00:01:24.640 I am an OBGYN who did a fellowship in reproductive endocrinology and infertility, which is a three

00:01:31.780 year subspecialty after the four years of OBGYN residency, practiced as a full scope

00:01:36.820 REI for a number of years.

00:01:39.340 And as I tell everyone, my biggest career achievement was leaving all of that behind, opening my own

00:01:46.040 practice dedicated to a more restorative reproductive medicine model and also in the meanwhile, completing my

00:01:54.780 integrative medicine two-year fellowship.

00:01:57.140 So I'm now double board certified in that plus OBGYN.

00:01:59.240 Yes.

00:02:00.480 And your story is so fascinating.

00:02:02.520 We talk a lot about IVF on this podcast, and that's because it's in the news really more

00:02:09.260 than ever.

00:02:09.900 I feel like a lot of Christians are thinking about reproductive technology in a way that

00:02:15.340 we didn't really think about even five years ago.

00:02:18.980 Surrogacy, IVF, the ethics behind this.

00:02:22.540 And so I'm so excited to get to talk to you, someone who is such an expert in this, but you

00:02:27.400 worked in the IVF industry, if you will, or specialty for a long time.

00:02:34.680 And of course, then you didn't have any qualms with it.

00:02:37.640 And so tell us what that was like and what your thinking was then.

00:02:42.200 Yeah, that's a great question.

00:02:44.140 I mean, I think that it goes without being said that infertility is a profound and unique

00:02:49.420 suffering.

00:02:49.900 And the couples who are undergoing it, I just have so much empathy for.

00:02:55.260 So I think that first and foremost is so important to always remember.

00:02:59.920 With that being said, I know from my experience, I was so focused at the beginning on just trying

00:03:05.300 to help those in that suffering, help those who were trying to conceive or were having

00:03:10.760 recurrent miscarriages, for example.

00:03:12.800 And I was also focused on the end goal, which was the child.

00:03:16.480 But as I practiced the tasks of my profession, I really began to question a number of things.

00:03:26.820 But the first part of this was, well, is this really the best approach?

00:03:30.580 Is this the panacea that we've all been told it is?

00:03:36.200 Number one.

00:03:37.260 Number two, are we actually getting to the root cause?

00:03:40.420 So I felt like I was just starting to treat women as though they were just, I was really

00:03:47.020 only treating them as ovaries in a vacuum.

00:03:49.280 And I wasn't focused on the whole person, body, mind, soul.

00:03:53.460 And so I felt there was this incompleteness in my approach to identifying what was going

00:03:59.780 on and healing it.

00:04:00.760 OK, so that was the second part.

00:04:02.160 And then the third part was really seeing the sequelae of what couples and women went

00:04:07.600 through as they went through all of these aggressive procedures.

00:04:11.060 And there are many layers to this.

00:04:13.100 There's obviously a moral and ethical component, but there's also the physical.

00:04:17.940 It's very difficult to be injecting yourself with multiple medications daily, on average for

00:04:24.320 weeks.

00:04:24.880 There's an emotional component, obviously.

00:04:27.920 There are side effects that you're battling against and procedures that you're undergoing.

00:04:31.900 And then, of course, the continued waiting game of infertility.

00:04:34.320 And so all of these factors really coalesced into, again, my decision to stop and have a more

00:04:42.880 holistic approach.

00:04:44.160 And I think that also speaks to women's health in general.

00:04:48.420 So much of women's health, we're told our fertility needs to be suppressed, that we need to 1.00

00:04:54.780 be on pharmaceuticals for a myriad of different conditions that all have one very similar

00:05:01.240 Band-Aid.

00:05:02.480 And so I questioned why I was doing that.

00:05:05.880 It didn't feel like it was as tailored as it should be.

00:05:09.240 And before we get into your kind of like awakening and transition professionally, I want you to

00:05:15.800 answer some just basic medical questions that a lot of people have about IVF, because what

00:05:20.860 I found and what was true for me is that there is a lot of ignorance and not to try to use

00:05:25.920 a pejorative term, but there's just a lack of knowledge about what IVF actually is.

00:05:30.240 And when we think about it big picture, without thinking about it too hard, it's easy to just

00:05:34.880 be supportive of it in every case, because having a baby is great.

00:05:39.200 Where I'm pro-life, and so I'm pro-baby.

00:05:42.000 I understand the desire to have a child.

00:05:44.520 And I want someone who desires to have a child to be able to do that.

00:05:49.180 And if IVF is the means by which they get to have a child, then I think it's easy for

00:05:54.180 people to celebrate.

00:05:56.240 But not everyone knows everything that goes into the in vitro fertilization process.

00:06:02.720 So I want to start from the beginning.

00:06:05.500 A 32-year-old married woman walks into your office, or not anymore. 1.00

00:06:10.860 But back when it was just this kind of IVF approach, or the old fertility methods that

00:06:18.000 you were focused on until more recently.

00:06:22.120 And she said, OK, you know, we've been trying to have a baby for two years.

00:06:25.880 We can't do it.

00:06:27.100 We want to go through IVF.

00:06:28.740 Like, what does that process look like from there?

00:06:32.260 Yes, absolutely.

00:06:33.160 And so the conventional process would be, of course, to try to diagnose the reason why

00:06:40.160 they were unable to conceive to that point.

00:06:42.260 And so that couple will undergo a slew of testing, which, of course, they still perform,

00:06:47.220 whereby we're looking at both the factors within the woman's body, such as issues regarding 0.98

00:06:53.480 her eggs, whether they're being released from the ovary, the number of eggs, the hormone

00:06:59.820 balances that exist within her body, such as thyroid, for example.

00:07:04.340 We'd also look at the structural components of her reproductive tract, which include the 1.00

00:07:10.140 uterus, the fallopian tubes, which are where the sperm and the egg meet within to form

00:07:16.620 baby.

00:07:17.380 And then finally, we'd look at the male partner, and we'd assess his sperm through a semen analysis.

00:07:24.500 And so that would be the very standard infertility workup that a couple would first undergo.

00:07:30.620 Again, knowing now what I know with the breadth of further knowledge that I've gleaned in these

00:07:39.400 last several years, I would say that, at least for myself, I can only speak for myself, that

00:07:46.400 I overlooked a lot of factors that may still contribute to infertility, which is why this

00:07:54.660 is unexplained diagnosis, meaning the woman's ovulating, at least one tube's open, the sperm

00:07:59.960 overall look normal.

00:08:01.820 We give that couple, okay, well, this is unexplained.

00:08:05.720 That diagnosis ranges from anywhere between 10 to almost 50% of the time, depending on what

00:08:13.920 study you're looking at.

00:08:15.360 And it's interesting looking now, when we actually get to the root cause of this, we can get that

00:08:21.160 diagnosis down to certainly less than 5%.

00:08:23.580 So that's just one example of why conventional treatment versus this restorative reproductive

00:08:28.440 approach is quite different.

00:08:29.880 Okay, so when someone walks in, and basically everything kind of looks good, and it looks

00:08:35.620 normal, that's when they're given unexplained infertility, because I've heard that a lot.

00:08:40.200 You even see it in the Instagram bios of some people who are chronicling their IVF process.

00:08:45.180 They'll say they have unexplained infertility.

00:08:47.960 So that's basically what they mean, that for whatever reason, they can't make a baby,

00:08:51.860 but the doctors can't pinpoint why.

00:08:54.320 And is that typically the diagnosis that someone is given before IVF is recommended to them?

00:09:01.960 Well, there's a variety of different diagnoses, which makes sense, because there are a couple

00:09:08.140 involved.

00:09:09.200 A third of the time, it's based on what we call a female factor. 1.00

00:09:12.480 There's something going on within the woman's body. 0.91

00:09:15.360 A third of the time, it's a male factor, even up to half, it's both.

00:09:19.660 There are several diagnoses that we're making.

00:09:23.620 So there is a variety of reasons.

00:09:26.900 Common reasons why people go to IVF immediately include issues with the sperm, issues with the

00:09:32.980 tube, such as the tube being closed, or low number of eggs, which is called diminished

00:09:39.280 ovarian reserve.

00:09:40.020 Okay, gotcha.

00:09:42.280 And then say that woman who walks into your office, she falls into one of those categories. 0.99

00:09:49.620 And so they move forward with IVF.

00:09:51.880 What does it look like from there?

00:09:54.080 Yes.

00:09:54.820 So from that point, what would happen is a woman typically starts an IVF cycle with her 0.97

00:10:00.280 period with that bleed, although many times women will also be given birth control pills

00:10:07.080 for varying reasons or be given injections before that projected start date of the IVF

00:10:13.660 cycle for even a couple of weeks in order for the physician to, in a way, become the exogenous

00:10:20.300 brain is the way that I kind of think of it.

00:10:22.220 Because typically what happens in our endocrine system, which is just our hormones talking

00:10:26.960 to each other, our endocrine system is comprised of hormone messengers so that the brain can

00:10:31.700 talk to whatever organ it needs to, and the organ can talk back.

00:10:34.900 Okay.

00:10:35.740 And in a woman's natural cycle, there is what I think of as a race to ovulation every month, 1.00

00:10:43.160 meaning there's a group of eggs that lines up, but only one egg at the end of the month,

00:10:51.560 the end of the cycle can be released, can be the winner of that race.

00:10:55.540 Okay.

00:10:55.800 It can be ovulated in IVF.

00:10:58.360 The goals are different in IVF.

00:11:00.300 Every, everyone's a winner.

00:11:01.940 So every follicle that's contains an egg is, is, uh, ideally will become a mature egg.

00:11:11.920 Okay.

00:11:12.380 And so how does that happen?

00:11:13.660 How it happens is that a woman's given daily injections for on average, a couple of weeks

00:11:19.000 in order to cause those eggs to mature.

00:11:23.060 But before those eggs can be released again, a couple of weeks later, they'll undergo a procedure

00:11:28.700 called an egg retrieval.

00:11:30.660 Okay.

00:11:31.160 This comes after multiple visits every other day, almost on average four to five visits

00:11:36.180 with the fertility doctor, at which point she's going to undergo a vaginal ultrasound to 1.00

00:11:41.840 measure the size of the follicles.

00:11:43.560 Because as the follicle grows in size, the egg inside is maturing.

00:11:47.540 And so we're, that's being monitored very closely.

00:11:49.960 The lining of the uterus is being monitored.

00:11:52.080 And then finally, the day of that egg retrieval comes, the woman is, um, typically given conscious

00:11:58.560 sedation, meaning medicines through an IV.

00:12:00.400 So she has a twilight sleep. 0.80

00:12:03.880 And then while she's asleep, there is a needle that's placed through the vagina under ultrasound 1.00

00:12:09.960 guidance and into each of those eggs and the, um, the, into each of the follicles, which

00:12:15.980 is where the eggs are contained.

00:12:17.120 And then the eggs are suctioned out and that's done with every egg in both ovaries. 0.84

00:12:22.040 The eggs are then handed off to an embryologist in a lab.

00:12:27.480 And then the embryologist looks at the eggs, determines that they're mature.

00:12:32.060 And at that point, they'll place the egg in a dish, either surrounded by a lot of sperm,

00:12:37.520 or they will take a sperm. 0.99

00:12:40.560 They'll select a sperm that ideally is moving forward, that ideally is normally shaped.

00:12:45.640 And they'll physically place that sperm into the egg in a process called ICSI or intracytoplasmic

00:12:51.340 sperm injection.

00:12:52.640 And so then they leave those dishes overnight.

00:12:56.800 And the next day, the dishes are checked again.

00:13:00.020 And 80% of the time on average, they'll then contain an embryo, a fertilized egg.

00:13:06.680 Okay.

00:13:07.080 Gotcha.

00:13:07.480 And, and can I ask, this is, um, an uncomfortable question that we have actually never talked

00:13:13.580 about.

00:13:13.860 So we hear, okay, the sperm, they, you use the sperm and you put it in the dish or you

00:13:19.980 put it on the egg.

00:13:21.820 Um, but something that is overlooked is how you actually get the sperm.

00:13:26.680 I feel like we don't really think about that or talk about that, but that has its own like

00:13:30.680 ethical questions, right?

00:13:33.280 So are you able to talk about that?

00:13:35.240 Like, how does the father then give his sperm to then fertilize the egg?

00:13:40.520 How is that collected? 0.99

00:13:41.480 Well, the vast majority of the time it's done through masturbation.

00:13:46.440 And so, um, I think that I've certainly talked to a lot of male patients who, who have said

00:13:52.240 what a uncomfortable and embarrassing process that is because there are specific collection

00:13:57.400 rooms whereby they'll go and collect and then hand off the sample to the embryology lab.

00:14:04.640 And is pornography a part of that?

00:14:08.700 Yes.

00:14:09.960 Okay. 0.96

00:14:10.380 So a man very often is watching or looking at porn in order to masturbate, to give the 0.97

00:14:16.880 sperm to then that is used in IVF.

00:14:19.600 And you would say that's the majority of cases of IVF?

00:14:22.360 I would say that's the vast majority.

00:14:25.660 I mean, I think the other way of collecting would be to do it through the process of intercourse.

00:14:32.120 Um, and I know for, certainly for some of my couples who don't want to interrupt that

00:14:35.940 unitive and procreative act, you can use a perforated condom.

00:14:40.100 So that way that act is still, um, less set in that regard.

00:14:45.320 Um, but that is not the majority, that is absolutely the minority of the time.

00:14:49.740 Okay.

00:14:50.260 So you said that after the, which by the way, just to like pause there, I feel like that

00:14:56.120 is not talked about very much at all when it, when it comes to the ethics and the morality

00:15:01.280 of this.

00:15:02.720 But so I just want everyone to kind of like take that in if they didn't already know that

00:15:07.060 that was part of the process.

00:15:08.140 But once that egg is fertilized, you said that there is an 80% chance that after waiting,

00:15:15.260 once they're in the Petri dish, that there will be an embryo. 0.99

00:15:19.240 Um, how, well, how many eggs are typically collected, would you say in a typical egg retrieval?

00:15:24.800 You know, it depends, Allie.

00:15:26.680 It depends on the woman's egg number and it depends on the type of stimulation that's employed. 1.00

00:15:33.500 Okay.

00:15:33.760 So I'll give you a range.

00:15:34.940 Okay.

00:15:35.260 Um, what we would call a good prognosis patient would typically have eight to 10 follicles,

00:15:41.720 each of which would contain an egg in each ovary.

00:15:44.800 Okay.

00:15:45.280 And so the average number for good prognosis would be anywhere from about 20 follicles being

00:15:52.080 seen on ultrasound and measured.

00:15:53.680 I would say from those, maybe perhaps there'd be about 15 mature eggs retrieved out of those.

00:15:59.700 If we assume an 80% chance of fertilization, that's 12 embryos.

00:16:03.660 Okay.

00:16:04.660 Um, and we contrast that to someone who has something like, for example, polycystic ovary

00:16:09.840 syndrome, which is a condition whereby women have an imbalance in their male and female 0.99

00:16:14.380 hormones and they also have irregular cycles, irregular ovulation, but those women may have 1.00

00:16:22.020 many more follicles.

00:16:23.680 So I can, uh, remember, uh, reading or hearing about even up to 50 plus eggs being retrieved

00:16:34.780 in women such as a PCOS patient.

00:16:38.680 On the flip side of women who has that low egg number, they may be get, uh, there may be 1.00

00:16:45.740 only three eggs retrieved in that, in that case.

00:16:48.880 Okay.

00:16:49.200 So there's, there's a, there's a wide range.

00:16:51.740 Okay.

00:16:52.120 So say a woman has a dozen eggs that are retrieved. 0.99

00:16:55.760 All of those eggs are then fertilized.

00:17:00.760 Great question.

00:17:01.720 I would say the, again, the majority of the time, yes, all those eggs, all those mature

00:17:09.300 eggs would be attempted to be fertilized.

00:17:13.320 Correct.

00:17:13.600 There are cases, especially with higher egg number, whereby the eggs themselves could be

00:17:21.680 frozen in order not to create so many excess embryos.

00:17:27.820 Um, but that is not necessarily performed.

00:17:32.640 I mean, again, I don't know if there's a statistic on that, but I would say the majority of the

00:17:37.580 time that those would be attempted to be fertilized.

00:17:40.720 Yes.

00:17:41.240 Okay.

00:17:41.540 Um, and then you said, I know I'm kind of bouncing around a little bit as the questions

00:17:46.640 come to my mind, but then you said there's an 80% chance that an embryo will form from

00:17:50.900 those fertilized eggs.

00:17:52.620 And so then what happens from there?

00:17:55.840 So then that embryo has one of three fates at that point.

00:18:00.320 The first is for, well, I mean, regardless, let me, let me actually back up because what

00:18:06.320 happens from there, even before the determination of what happens ultimately with the embryo is

00:18:11.460 that the embryos are then watched.

00:18:13.940 They're kept in those dishes for a period of days and in an incubator in order to simulate

00:18:20.100 the temperature, the humidity, all the conditions whereby they would naturally be within the

00:18:26.480 mother's tubes, fallopian tubes.

00:18:29.180 And we watch as those embryos grow and divide.

00:18:35.780 And it's actually remarkable.

00:18:37.720 They're dividing so rapidly.

00:18:40.040 They go from one cell to hundreds of cells just days later.

00:18:44.320 And we can watch that process happen.

00:18:46.620 They, they, they actually mature.

00:18:48.820 And the process of maturation means they actually, the embryo forms an inner cell mass.

00:18:53.100 So they're beginning to grow and develop into again, what becomes the baby and then what

00:18:59.180 becomes the placenta.

00:19:00.360 And this is all happening naturally in the fallopian tube or in these dishes.

00:19:05.720 Okay.

00:19:06.060 And so they may be graded at this point.

00:19:08.180 And so an embryologist is checking on them throughout this process.

00:19:11.000 They're being potentially manipulated because in the case of, for example, embryo biopsy,

00:19:19.620 they would, an embryologist would actually place a needle into the embryo, suction out 0.93

00:19:25.260 some of the cells, and then send that off to a lab to screen the chromosomes within those

00:19:31.120 cells.

00:19:31.780 Okay.

00:19:32.260 They may undergo.

00:19:33.700 Yeah.

00:19:33.900 So there's a lot of potential options, but that brings us to, again, the one of three

00:19:38.420 fates.

00:19:38.860 One fate is that a few days after their life, they will be transferred back into a woman's 1.00

00:19:46.620 uterus in order to see if implantation, if pregnancy occurs.

00:19:52.920 Okay.

00:19:53.180 That's one.

00:19:53.960 The second fate is that they will be biopsied, as I mentioned, in order to undergo chromosome

00:19:59.020 screening.

00:19:59.940 The third fate is that they will be frozen.

00:20:02.820 And they will be frozen in liquid nitrogen-containing canisters as well.

00:20:08.140 They'll be stored.

00:20:09.540 Okay.

00:20:09.940 And you said that the embryos are graded.

00:20:13.080 Are all the embryos graded?

00:20:14.820 And what does that mean?

00:20:17.720 So what it means is there's, well, what does grading mean?

00:20:22.280 There are different ways for the embryologist to determine the morphology of the embryo.

00:20:32.720 So that's a, let me unpack that.

00:20:34.420 What that means is an embryologist knows that there's a very typically precise set of growth

00:20:41.420 and symmetry of the cells, for example, lack of debris within the embryo, him or herself.

00:20:49.760 And those will correspond to certain grades that have been spelled out in different systems that

00:20:56.100 have been validated.

00:20:56.820 But the ultimate reason for grading is because there's been data supporting the fact that

00:21:05.600 embryos that look more symmetric, that achieve a certain number of cells or a certain stage

00:21:11.100 in development at the time that they should, may have a higher chance of leading to a live-born

00:21:18.840 baby.

00:21:19.680 Right.

00:21:20.260 Okay.

00:21:21.060 And you said that there's the biopsy possibility.

00:21:25.520 Do all parents choose to get that kind of testing?

00:21:29.300 Because you said that that looks at the chromosomes.

00:21:31.520 Does that, is that how gender is determined or, or what is being looked at there?

00:21:37.260 Yes, that is how gender may be determined. 0.99

00:21:39.880 And the reason for that is because all chromosomes are screened.

00:21:43.040 And so they'd be called either euploid, which means screened chromosomally normal.

00:21:47.760 So a 46XX, 46XY, okay. 0.83

00:21:51.880 They can be checked for specific genetic disorders.

00:21:57.680 The majority of the time though, again, it's, the embryos are screened for just chromosome

00:22:04.560 number, right?

00:22:06.580 And so again, that 46XX, 46XY would be typically looked at very commonly.

00:22:12.640 And to answer your question about how common that is, I would say the most recent data nationwide

00:22:18.700 of IVF clinics in 2021, it was the last year that they've been able to publish that data

00:22:25.000 show that at least half of all cycles are PGT, which is pre-implantation genetic testing,

00:22:33.560 which is what that biopsy is, or PGT cycle.

00:22:36.880 So it's very common now and the number has increased.

00:22:39.020 Well, because I hear very often, especially when it comes to say like two men that are

00:22:45.860 using an egg cellar and then also a surrogate is that, and even with Paris Hilton, like Paris 0.70

00:22:52.820 Hilton used a surrogate and she knew the gender of all of the embryos that she had on ice. 1.00

00:22:59.260 She was like, I have like 12 boys and I'm still trying for a girl, whatever it is.

00:23:04.000 So I guess I thought that all IVF patients know the gender of the baby before it's even

00:23:11.180 transferred, but I guess that's not, that's not the case.

00:23:14.940 They'd have to undergo that biopsy process in order to get the chromosomes from that embryo

00:23:20.420 because that embryo has a unique set of chromosomes, right?

00:23:24.520 From the mother, the father. 0.87

00:23:27.620 And so therefore that embryo would him or herself have to be biopsied in order to understand what

00:23:33.740 that embryos chromosomes reveal.

00:23:48.680 How often would you say, um, there might not be an exact statistic on this, but for those

00:23:54.920 who do undergo or their embryos undergo that genetic testing, how many then decide, okay,

00:24:03.640 if that baby has down syndrome, for example, that's a chromosomal disorder, do they decide,

00:24:09.240 okay, we're not going to move forward with transferring that embryo.

00:24:12.600 We're going to try again for a healthier embryo.

00:24:15.020 Like how often are decisions made based on any kind of chromosomal signs of some kind of

00:24:21.800 disability or disorder?

00:24:24.520 Very often, Allie.

00:24:25.780 I mean, the, the standard typically is that if that embryo is deemed, screened, chromosomally

00:24:33.760 abnormal, that embryo will not be transferred back into the uterus.

00:24:40.100 There has been, um, a move more and more towards some centers being open to attempting that transfer.

00:24:51.540 And I'll tell you the reason why that is.

00:24:54.400 It's because again, no technology is perfect.

00:24:58.200 And that also goes for pre-implantation genetic testing for the screening process.

00:25:04.360 And so these embryos, it's very interesting.

00:25:08.480 I liken it almost to, uh, this embryo is almost like a, a lots of different cells, almost like

00:25:13.680 a soccer ball, if you will, sometimes that there are, um, white areas of abnormal cells,

00:25:20.460 but also black areas of normal cells, for example.

00:25:24.200 And if you biopsy the wrong area, you might erroneously conclude that that embryo is not

00:25:32.060 chromosomally euploid and therefore would not have that embryo eligible to be transferred.

00:25:39.040 Again, the data is very new in this regard, but there is, there are case reports in, in

00:25:48.200 the literature showing that some of these embryos that then, you know, of course, informed

00:25:53.700 consents obtained, everyone agrees that we're going to go ahead and transfer this embryo in,

00:25:58.900 into the uterus. 0.83

00:25:59.820 And there have been reports of chromosomally normal babies born, um, to these, uh, abnormal,

00:26:07.960 uh, allegedly screened, um, embryos.

00:26:11.060 So.

00:26:12.100 Okay.

00:26:12.600 So do parents even have, cause you said you, you mentioned or alluded to the fact that some

00:26:18.240 centers won't even consider transferring a chromosomally abnormal embryo.

00:26:24.960 And that could mean like a baby with Down syndrome.

00:26:27.520 And of course we know that people with Down syndrome can have like fulfilled and very joyful

00:26:32.400 lives, but that could be like the kind of baby that we're talking about that they deem

00:26:37.700 almost, I don't want to, you didn't use the term incompatible with life, but it seems like

00:26:42.280 that is almost the judgment being made by saying, okay, this embryo is going to be discarded.

00:26:46.820 Like, do the parents in that case, do they have the choice?

00:26:50.280 Are they ever told, Hey, we, this baby has Down syndrome.

00:26:53.380 Um, what do you want to do or are they not even informed about what happens to those embryos

00:27:01.060 that the doctor decides are not healthy?

00:27:04.480 I would say that typically I, I can only speak for myself.

00:27:12.500 Okay.

00:27:12.960 And so I will tell you that in my prior practice, you know, there, I had such a blindness, Ali,

00:27:20.160 um, that, and there's a lot of reasons for that.

00:27:23.520 But with that being said, you kind of just think, okay, this is a aneuploid and you, it's

00:27:30.480 true.

00:27:31.260 There are plenty of situations, not just Down syndrome.

00:27:33.880 I think trisomy 18 is another one that there are children with trisomy 18.

00:27:38.740 I personally know of one that are able to lead lives that are, it's not, it is compatible

00:27:47.340 with life, this diagnosis.

00:27:48.800 There are plenty of others like Turner syndrome and, um, but there's this blanket thought

00:27:53.440 that, oh, aneuploid means not transferable.

00:27:57.240 Yeah.

00:27:58.580 Okay.

00:27:59.120 So for the embryos that are deemed healthy or the ones who don't go through genetic testing,

00:28:06.180 um, well, how many, how many healthy embryos would you say someone typically ends up with?

00:28:12.120 I know there's so many factors that go into that, as you've already explained with the number

00:28:15.540 of eggs and the age and all of that, but what is like the average number of embryos created

00:28:21.240 in the IVF process?

00:28:23.700 So let's use that, um, kind of middle of the road, good prognosis patient example again,

00:28:28.800 right?

00:28:29.300 And so remember we, there were 12 embryos that were created, right?

00:28:33.600 Out of those, they'll be watched.

00:28:35.700 Not every one of them will continue to mature.

00:28:39.140 And so about six embryos, I would say on average, will make it to blastocyst stage, which is

00:28:45.440 typically day five of their life and is what we consider a mature embryo.

00:28:51.380 And so again, out of those, if that, um, couple chooses to have chromosome screening performed,

00:28:58.800 perhaps about half of those will yield euploid chromosome screen, normal embryos.

00:29:05.500 Okay.

00:29:06.640 Um, and so that would be then three embryos if biopsy was done.

00:29:12.260 If it's not, then there would be about six embryos, um, of which depending on the woman's 1.00

00:29:19.220 age, anywhere from one to even potentially up to three or more would be transferred back

00:29:25.560 at a time.

00:29:26.380 Okay.

00:29:27.000 So at a time.

00:29:28.340 Um, so she could have three of those embryos transferred simultaneously. 0.95

00:29:37.060 Potentially.

00:29:37.700 And that has their set of criteria depending on the woman's age and different prognostic

00:29:42.520 variables.

00:29:43.340 But what's interesting is that they actually published again in this most recent CDC report

00:29:48.300 of us clinics, the average number of retrievals of egg retrievals needed to achieve a live born

00:29:53.940 baby and Allie, even in the best prognosis age group, which we consider less than 35 years

00:29:59.480 of age, the average number of egg retrievals, remember all that whole process that, that,

00:30:03.940 that couple and that woman have to undergo the average is two.

00:30:07.700 And in a woman who's over 40, the average is, I believe over nine and perhaps even 12,

00:30:13.860 but definitely over nine, which is just, just, you think about these women, um, really it, 0.99

00:30:21.680 it, it, again, it takes, it can take a toll on many, um, couples and women as they're undergoing

00:30:26.860 this, um, for many reasons.

00:30:28.660 On the woman's side of this, you said before the egg retrieval, she has to inject herself 1.00

00:30:45.960 with, what is it that she's injecting herself with?

00:30:49.300 There's different type of, first of all, hormones that are used.

00:30:53.160 Okay.

00:30:54.120 As well as other injections designed to prevent premature ovulation.

00:30:59.700 And then, um, so those are the main type of injections used.

00:31:03.260 Okay.

00:31:03.700 So she's injecting herself typically at home with these shots. 0.93

00:31:07.200 And I've seen pictures and videos of that.

00:31:09.120 As you said, she's got the multiple doctor's appointments to make sure that the eggs are 0.99

00:31:13.580 maturing.

00:31:14.380 She goes through the egg retrieval and she's kind of put under, like you said, a twilight sleep

00:31:19.080 for that.

00:31:20.060 Um, there was that, I don't know if you saw that.

00:31:21.840 I think it was New York times podcast, this horrible story of these women who were being 0.96

00:31:28.020 told that they were being put under or being told that they were given fentanyl and they

00:31:32.040 actually weren't.

00:31:33.340 And the nurse was stealing the fentanyl and putting something else in there. 1.00

00:31:36.580 And they were completely awake for all the egg retrievals.

00:31:38.900 So that was like a whole big story.

00:31:41.100 There's just so much that happens in this reproductive industry that a lot of people don't know.

00:31:45.660 But anyway, so they get the egg retrievals, then they start the, uh, fertilization processes.

00:31:51.220 You just explained, but what does the woman do while that fertilization process, that growing 1.00

00:31:57.560 process into the blastocyst is happening?

00:32:01.820 Yes.

00:32:02.300 It depends again on what the plan is.

00:32:05.100 If there is a, what we call a fresh embryo transfer to be performed, meaning five days

00:32:10.860 later, for example, the embryo is going to be placed back into that woman's uterus. 0.64

00:32:15.180 Then the woman will undergo, uh, just preparation of her uterus is what it's called. 1.00

00:32:21.580 And that's by giving hormones as well in different ways.

00:32:26.560 And so that might include more injections that will include pills, um, as, as well as potentially

00:32:32.660 antibiotics.

00:32:33.320 So that would be her preparation and then more, um, scans, uh, to make sure that the uterus is 1.00

00:32:40.700 prepared to receive the embryo.

00:32:42.640 Okay.

00:32:43.260 So, yeah, getting the uterus ready to receive that embryo so that it's hospitable for the 0.95

00:32:50.260 embryo to implant, for the placenta to grow and all of that.

00:32:53.780 And what is the transfer process like both for this, uh, embryo and for the woman?

00:33:01.440 And so the transfer process, I'll start with the embryo.

00:33:07.960 So what will happen is it depends as well.

00:33:10.780 Again, if embryo, if the transfer is happening with a embryo that has not been frozen, then

00:33:17.700 what will happen is the embryologist will take the embryo and what we, that's what it's called

00:33:22.600 is load, place that embryo into a long transfer catheter.

00:33:27.040 And then at the same time, what the woman is experiencing is that she'll be, um, on a table,

00:33:34.760 there will be typically an ultrasound on her abdomen in order to watch as, um, the, the catheter 0.98

00:33:42.340 is placed through the vagina, through the cervix and into the uterine cavity. 0.89

00:33:46.420 Um, and then, um, you actually can see the air bubbles surrounding the embryo being placed

00:33:54.920 into the uterine cavity.

00:33:56.860 Afterwards, the embryologist will then take the catheter to ensure that the embryo was indeed

00:34:01.780 placed, um, within the cavity or is no longer in the catheter.

00:34:06.200 Um, but typically that transfer process is done while the woman's awake, the, the couple 0.99

00:34:12.960 is together in the room, um, and is, is quite comfortable typically.

00:34:18.200 Okay.

00:34:18.600 Not always the case.

00:34:19.840 Sometimes if it's difficult to enter the uterus, um, then it can be uncomfortable for that woman. 1.00

00:34:26.980 But I would not say that the cervix, so the cervix doesn't have to be dilated at all.

00:34:32.260 It just not, not typically, but sometimes yes.

00:34:37.140 And in those cases that, that could be very uncomfortable.

00:34:39.580 It could be uncomfortable.

00:34:40.440 Okay.

00:34:41.000 So at that point though, she doesn't really know if she, yes, the, there is a living embryo,

00:34:46.240 which as you've already said is scientifically its own individual that is inside her uterus, 0.81

00:34:51.600 but we haven't gone to implantation yet.

00:34:55.040 Correct.

00:34:55.600 That's just the transfer.

00:34:56.620 So she wouldn't necessarily get a positive read on a pregnancy test yet, right?

00:35:02.160 No, she wouldn't at all because, um, yes, you're correct.

00:35:05.880 Implantation still has to happen.

00:35:07.820 And during that process of implantation, that's when the embryo actually, um, and the, the placenta 0.71

00:35:13.740 and the uterus, it's actually quite beautiful because there's a very specific window of implantation

00:35:22.600 that occurs whereby there are these special called peanut pods.

00:35:25.680 They're almost these suction cups that, um, from the endometrium and there's a crosstalk

00:35:30.320 between the embryo and the endometrium in any time, you know, spontaneous or through this

00:35:36.880 process.

00:35:37.200 And that the embryo, the embryo is then drawn up into the endometrium and this starts the process

00:35:41.800 of implantation.

00:35:42.580 And then after that, the hormone HCG or human chorionic gonadotropin begins to be produced.

00:35:49.600 And that's the pregnancy hormone that you can measure in the urine or in the blood. 0.96

00:35:53.860 Yeah.

00:35:53.980 As you're explaining all of this, it's, it just makes me like wonder at God about how

00:35:59.160 he created the human body and the female body, really like pregnancy and natural conception

00:36:08.260 and childbirth is all such a miracle.

00:36:10.720 Like all of the mechanisms and all of the effort that has to go into, if you're doing it through

00:36:16.360 this process to create a child, it's really just the fact that anyone is here is really

00:36:22.320 just beautiful and miraculous and speaks to God's design.

00:36:25.320 Go ahead.

00:36:26.400 Yes.

00:36:26.640 I have to tell you one other part that I just love hearing because it just always makes me

00:36:30.820 think of, of, of God as well.

00:36:33.420 It's so interesting when couples are having intercourse and the woman's almost going to 1.00

00:36:39.880 ovulate.

00:36:40.380 Okay.

00:36:40.620 And so she's a few days before ovulation.

00:36:42.540 In fact, there's only a six day period of time where a woman can become pregnant that cycle,

00:36:47.920 whereby men are always fertile.

00:36:49.880 Women are not necessarily always fertile, even within that month. 0.99

00:36:54.100 But anyway, when they're having intercourse during the time of her fertile window, they've

00:37:00.260 done these very interesting studies looking at labeled particles that get deposited into

00:37:07.020 the upper vagina. 1.00

00:37:08.380 And they'll see that like sperm within minutes, within two minutes, those particles along with 0.63

00:37:15.900 the sperm are in the fallopian tube already after ejaculation.

00:37:20.420 And it's so interesting is that they're on the side that the egg is on.

00:37:26.160 Wow.

00:37:26.240 And so there's like, isn't that funny?

00:37:28.480 Yes.

00:37:28.840 I know.

00:37:29.800 Yes.

00:37:30.220 There's a, there's a lot of chemotactic signaling.

00:37:32.180 There's a crosstalk going on though.

00:37:33.640 You know, it's just so amazing.

00:37:35.800 Yes.

00:37:36.140 So amazing.

00:37:37.240 And okay.

00:37:37.900 So back to the transfer process.

00:37:41.260 Um, how, what, what is the percentage?

00:37:44.760 I forget the number.

00:37:46.160 I'm pretty sure it was lower than I realized.

00:37:48.400 What is the percentage of transfers that will end in a successful implantation?

00:37:57.400 Well, okay.

00:37:58.140 So let, I just want to set the stage for this because I think that it's hard to parse apart

00:38:04.360 the numbers.

00:38:06.060 And the reason for that is because, um, there's several factors.

00:38:10.360 The first part of this is just to understand what is the baseline chance of pregnancy per

00:38:15.200 cycle, right?

00:38:16.060 And that's kind of the baseline we should be comparing things to regardless.

00:38:19.140 And so when we think about couples in their twenties, do you think of as almost like best

00:38:22.900 prognosis, right?

00:38:24.500 Um, high egg quality and quantity, um, no fertility issues, just trying for the first time.

00:38:30.860 Their average chance of pregnancy per cycle is about 25 to 30%.

00:38:34.480 So just FYI, that's just important to kind of set that stage.

00:38:38.040 Okay.

00:38:38.960 Um, with that being said, the way that, um, the data is presented, uh, that I think is

00:38:46.100 helpful to understand it better is how many of intended retrievals are going to yield a

00:38:53.000 live birth?

00:38:53.560 Because that's actually what we care about is the baby, um, you know, being born and,

00:38:59.240 um, not born ideally.

00:39:00.600 Right.

00:39:00.960 And so, um, when we think about best, again, best prognosis, um, there are even all comers,

00:39:08.820 let's just talk about all comers, all comers.

00:39:10.840 It's about a 37% chance of live birth.

00:39:14.600 And so, again, it's not quite as high.

00:39:17.260 I know that that can feel surprising, right?

00:39:20.460 Um, so, so that's just the live birth rate.

00:39:25.860 When we compare that to just, there's different ways of looking at the data, but you can compare

00:39:30.940 it to, again, some restorative reproductive medicine measures. 0.96

00:39:35.180 There's an interesting study looking at couples who, um, were by all accounts, what we would

00:39:42.100 call, um, hate using these terms in some ways, but poor prognosis, meaning the woman was advanced 0.98

00:39:47.960 maternal age.

00:39:48.580 I think the average age was 37 years of age.

00:39:50.740 They've been trying for over five years.

00:39:53.160 Um, and when they looked at a series of a thousand couples who then went into, again, this deeper

00:40:01.420 dive by these restorative reproductive medicine approaches, they found that the, um, cumulative

00:40:09.780 live birth rate was over 15%, which is pretty amazing.

00:40:14.540 So, again, there, there's other options available.

00:40:18.540 But to answer your question, that's a look at some of the numbers.

00:40:21.560 I think that people assume that IVF is like the guarantee that you're going to have the

00:40:39.740 baby, that that's just what you do if you're 37 or you're 45, even that you just go through

00:40:45.700 IVF and you're guaranteed to have a live birth out of that. 0.96

00:40:48.820 And that's just not the case.

00:40:50.640 There are some embryos that don't, they don't survive the transfer process.

00:40:54.520 Of course, there are some embryos that won't implant.

00:40:57.000 And that's true in natural conception too.

00:40:59.520 And then of course, there is the risk of, um, a miscarriage, which again is also a risk,

00:41:05.180 whether you naturally conceive, um, is the risk of miscarriage higher in the IVF process?

00:41:14.280 Well, you're asking compared to spontaneous conceptions is what I'm assuming, right?

00:41:22.280 I would say that's a hard, that's a little bit hard to evaluate.

00:41:25.760 And the reason for that is because we think of women who it's a different population is 1.00

00:41:30.140 the kind of term we use, meaning that those women who are experiencing difficulty consumer,

00:41:35.920 that couple may have different risk factors that might change that risk of miscarriage.

00:41:40.560 Okay.

00:41:40.860 That's the first part.

00:41:42.380 Um, and so the second part is, is that if they, uh, do proceed with pre-implantation genetic

00:41:49.540 testing with that chromosome screening, you can imagine that that's going to, again, decrease

00:41:54.400 the number of embryos.

00:41:56.780 Like I said to you, that will even be used or, or tried, you know, attempted to be transferred,

00:42:02.580 but then it does, uh, have a decrease in miscarriage rate is what the studies show, which makes sense

00:42:10.500 because the vast majority of first trimester miscarriages are due to just random chromosome

00:42:16.000 errors on the part of, of the embryo.

00:42:18.660 Okay.

00:42:19.480 Gotcha.

00:42:20.600 Um, is it true that this is common?

00:42:24.820 I know that this happens.

00:42:26.080 I just don't know if it's common that I've talked to women who really wanted to go about

00:42:31.580 IVF in a way that is more ethical in the sense that they only wanted to create the number of

00:42:39.200 embryos that they knew they were willing to implant or transfer rather.

00:42:44.220 Um, and that some doctors are very hesitant to do that, to only create like fertilized three

00:42:52.500 eggs, for example, just because the chances of then a successful life birth from that can

00:42:58.360 be lower.

00:42:58.900 If you had say, you know, fertilized six eggs, like, is that, have you seen that at all?

00:43:05.280 Like, is that the case that some doctors are hesitant to fertilize a lower number of eggs?

00:43:11.820 Yes.

00:43:12.260 I mean, I think that there are certain, what I've heard is that there are certain centers

00:43:16.700 who, for example, won't even consider, um, moving forward with fertility treatments if

00:43:24.700 the, a PGT, if that chromosome screening isn't performed, for example.

00:43:29.300 And so I've certainly heard of that.

00:43:31.760 Yeah.

00:43:32.780 And I also have listeners, cause I talk about this a lot.

00:43:36.440 And so I get a lot of stories from a lot of moms who have gone through IVF.

00:43:40.040 They have regrets about it.

00:43:40.920 They love their children, but they realize, wow, there was just so much I just didn't know.

00:43:45.040 And then some who went through IVF, they didn't actually end up getting pregnant that way.

00:43:50.120 They got pregnant later.

00:43:51.060 They adopted later.

00:43:52.200 So many different stories, even on this podcast that I've had.

00:43:55.600 Um, and one story that I've gotten is a woman who got pregnant with triplets and she was

00:44:01.340 encouraged by her doctor, um, this was after the IVF process to reduce.

00:44:07.020 Um, it does seem like it's more likely to be pregnant with multiples in the IVF process because

00:44:12.440 you could be transferring more than one embryo at once.

00:44:15.780 Um, is that something that happens that you have heard of, of doctors saying, Hey, if you

00:44:20.720 get pregnant with twins or get pregnant with multiples, we can always do a selective reduction,

00:44:25.480 which is aborting one of the babies, um, in the hopes that it will lower the risk to the mom.

00:44:31.220 Yes, Allie.

00:44:33.680 So I think that, um, the reason why is because in IVF, remember the baseline chance of twins,

00:44:40.820 for example, in the general population is about 2%.

00:44:43.920 Okay.

00:44:44.500 In IVF, there's about a 30% chance of multiple pregnancies.

00:44:48.280 Okay.

00:44:49.260 If this is another reason why there's such a push for that chromosome screening, uh, is

00:44:55.260 because with chromosome screening, one embryo is transferred back at a time, thus decreasing

00:44:59.840 number of, um, multiple or just chance of multiple pregnancies.

00:45:05.340 Okay.

00:45:05.920 But in those patients who do have triplets or more, the standard would be absolutely to say

00:45:13.480 that due to the risks of the risk to the mother and to the, and to the children, which

00:45:20.940 I know sounds very ironic that selective reduction would be recommended.

00:45:25.880 I think that's something that a lot of people just don't think about.

00:45:29.640 I've actually seen, I saw recently an Instagram post from someone saying that she did this,

00:45:35.080 that she went through selective reduction and that it was something that she was happy about

00:45:40.620 that, you know, she said kind of like that it saved her life, but also saved the life

00:45:45.600 of her other children potentially.

00:45:47.320 And you just kind of choose the baby that's easiest to get to and then abort the baby that

00:45:54.260 way.

00:45:54.800 And that is also, uh, sometimes an unforeseen consequence of purposely transferring multiple

00:46:01.480 embryos at once is that you could end up with triplets or, I mean, oh, it's not probably

00:46:07.280 often, but you could end up with quadruplets or something like that, and then have further

00:46:12.260 pressure after that.

00:46:13.660 Um, and so there's just a lot there.

00:46:15.660 Go ahead.

00:46:16.140 No, I agree.

00:46:18.340 And I think that's, what's so hard is that couples are then faced with these excruciating

00:46:23.240 choices.

00:46:23.940 Maybe not for everyone, as you mentioned, but I would say for, uh, for, for many couples

00:46:29.400 that either at that moment or even in the future, right after it's already occurred.

00:46:35.620 And I think another common one that many couples are dealing with these days are when they've

00:46:41.060 completed their family, right?

00:46:42.760 But they still have embryos frozen.

00:46:45.400 Yes.

00:46:45.660 There's over 1 million embryos estimated to be frozen in the United States right now,

00:46:49.860 indefinitely, potentially.

00:46:51.860 And, um, they, I think they, these couples struggle so much with what to do with these

00:47:00.280 embryos.

00:47:01.120 And I think that's because inherently in, for me, I think that it's because they inherently

00:47:06.980 realize that this is my child.

00:47:08.820 And so I don't know if I feel comfortable, uh, you know, giving away this embryo for adoption,

00:47:13.580 for example, or donating this embryo to research where the embryo will be destroyed or just

00:47:22.260 undergoing Frank destruction.

00:47:23.520 It's a lot of very profound and difficult moral and ethical situations that people are

00:47:30.660 placed in.

00:47:31.140 And we just aren't talking about it enough.

00:47:33.220 Yes.

00:47:33.760 So I imagine that all of these questions played a role in you quitting, um, your IVF practice.

00:47:40.220 So can you talk about that transition?

00:47:43.760 Oh, absolutely.

00:47:44.880 I mean, for me, yes, like I said to you, I, I love what I do.

00:47:49.020 I think it's such a honor to, to be able to walk alongside the couples that I, that I care

00:47:57.160 for.

00:47:57.920 I, I always knew I wanted to be a doctor.

00:48:00.240 It was kind of one of those callings.

00:48:02.360 And so I just love my job.

00:48:06.340 Um, with that being said, once my eyes were opened, once I finally started again, I was

00:48:14.200 so involved in everything.

00:48:15.740 And I said to myself, like, this is, I'm dreading going back into work.

00:48:19.380 I, I was dreading going into work.

00:48:21.280 And that's why I decided, um, again, to stop, to leave it all behind.

00:48:27.800 I just felt like for me, my soul was at stake.

00:48:31.160 And I say that, like your eyes were opened kind of in what way?

00:48:36.640 That this embryo is a human being and that human being deserve, has inherent dignity and

00:48:46.460 should be protected as the most vulnerable of all.

00:48:53.280 Again, this is, it makes sense.

00:48:55.780 It just makes sense scientifically.

00:48:57.440 There's, there's no question about that.

00:48:58.960 Um, number one, number two is that all of these technologies, just because we can do

00:49:06.160 something doesn't mean we should.

00:49:07.900 And what's the ultimate, we're seeing this now almost, it just feels like the, it's

00:49:12.580 snowballing more and more is the fertility industry.

00:49:16.760 Again, there's a lot, there's just not a lot of regulation compared to, for example,

00:49:22.680 the adoption, um, industry where you really have to undergo a very rigorous screening process

00:49:30.300 to understandably become the parents of this, of this child.

00:49:35.340 And I don't think that that's present.

00:49:37.660 And I also think that this is starting to be used in ways, again, that, uh, are, have

00:49:45.120 significant ethical and moral, um, questions surrounding them.

00:49:51.840 So that was one big part of it for me.

00:49:54.720 And then, um, I would say also that I just felt, as I told you before, that we're putting

00:50:01.680 these very expensive band-aids on these issues that are going to persist.

00:50:05.380 And is that actually the best way to do medicine?

00:50:07.880 Shouldn't we instead try to identify the root cause and heal it?

00:50:11.960 And then we're going to be having healthier mothers with healthier babies and helping them 0.99

00:50:17.720 in the long run so they can have the longest life possible to care for their family.

00:50:22.880 And we haven't even touched upon that, but there are risks to moms and children that are

00:50:28.800 conceived with IVF.

00:50:30.820 And thankfully in the overall scheme of things, these risks are rare, but there are relative

00:50:35.180 increases in risks that, that again, I don't know if there's enough attention put on those.

00:50:40.040 And in my opinion, oh, um, yeah.

00:50:43.580 So for moms, uh, the maternal risks include an increased risk of 26% of preterm birth, which

00:50:51.680 is, can be devastating because if the babies are born early, they can have problems with

00:50:56.320 every organ system, including cerebral palsy or even death.

00:50:59.280 It includes, um, uh, over doubling of the risk of hypertensive issues in pregnancy, as well

00:51:06.140 as what we call severe maternal morbidity, which is basically a condition that's where

00:51:11.260 the woman gets, the mom gets so sick, she may die. 0.99

00:51:14.680 She's close to death.

00:51:15.640 And that could be life-threatening hemorrhage or what's called preeclampsia, which is high

00:51:20.100 blood pressure of pregnancy, where they can even have a, uh, eclamptic seizures or sepsis,

00:51:25.460 which is a back, which is an infection of the body.

00:51:28.280 Um, these things can increase significantly.

00:51:31.020 There's an over five times increased risk of placental problems again, which can lead

00:51:35.480 to life-threatening hemorrhage at delivery.

00:51:38.180 That's the mom. 0.99

00:51:39.280 For the babies, there is an up to 40% increase in non-chromosomal birth defects that may be present.

00:51:48.140 There is an increase in autism as well as a four-time increased risk of stillbirth.

00:51:54.060 I mean, that is awful.

00:51:55.460 Again, thankfully, these numbers are overall low, but I do believe that that may play a

00:52:01.200 role in couples deciding what to do.

00:52:03.620 And like I said, my personal opinion is that part of that is because we need to do a better

00:52:09.320 job, again, understanding the reasons why people are struggling with this, um, and healing

00:52:17.400 that.

00:52:17.840 And like you said, it's a very expensive, costly in more ways than one, as you just said,

00:52:24.440 costly financially, but also can be costly for your health, can be costly for the child's

00:52:29.780 health.

00:52:30.680 Um, there are women who go through rounds and rounds of IVF. 0.73

00:52:34.380 I mean, that can really wear on your body and on your emotional state.

00:52:40.020 I mean, what you described for IVF, it's very invasive.

00:52:43.620 I've had three kids myself and even just like the, like ultrasound and then, uh, then when

00:52:52.120 you deliver like the cervical check process, like all of that is invasive and like leaves

00:52:57.920 a mark on your brain that you're like, that was not fun.

00:53:01.560 So glad I had this baby, but that was not fun.

00:53:03.580 I would love to never have another cervical check in my life.

00:53:06.740 Like, and so, but you, I listened to IVF and I'm like, well, that's a lot of that.

00:53:10.960 Like, that's a lot of very invasive stuff that someone is going through potentially many

00:53:17.660 months in a row.

00:53:18.640 That's not nothing that can really wear on your body and mind and, and your heart too.

00:53:25.940 Absolutely.

00:53:26.900 Yes.

00:53:27.320 And even for like, again, the finances, there was an interesting study that showed that

00:53:31.320 the average cost to have a live born baby, um, was anywhere from 60 to $72,000 with IVF

00:53:38.140 or the higher end was with donor egg.

00:53:40.500 So this is, uh, it's just, um, it's a, it's a crazy, exhaustive process in so many levels.

00:53:48.740 So for you, these revelations, these realizations about, you know, everything that wasn't being

00:54:08.240 talked about and was kind of just like pushed to the side as far as the ethics and morality

00:54:13.000 of how we treat these women and how we treat these little children, the earliest stages

00:54:19.240 of their life.

00:54:20.660 I'm guessing your, your faith had something to do with this kind of awakening, right?

00:54:27.780 Yes, absolutely.

00:54:29.020 It did.

00:54:29.500 I like to, I like to talk about it in both ways, because again, I think there's a clear

00:54:33.940 medical and scientific argument for this, but for me as well, personally, of course, I, um,

00:54:39.300 the Holy spirit for me, just, he, God is so good.

00:54:42.960 Thanks be to God that he did not give up on me.

00:54:45.600 And I felt best his call more and more and more.

00:54:50.100 And to me, I really, it was, it was, I talked about being blind and anything sin blinds, your

00:54:56.700 heart gets so hardened and to have that, um, my heart really just broke open.

00:55:02.680 And, and the, you know, I always think of that verse of, of being washed away and realizing

00:55:09.200 what I was involved in.

00:55:11.900 So, um, yes, I, I'm so grateful to God for his mercy.

00:55:17.120 Um, absolutely.

00:55:18.640 That goes without being said.

00:55:20.020 Yeah.

00:55:20.400 And now talk about, I, you already have a little bit, but more about what you do now, this holistic

00:55:26.840 approach to fertility is someone who, for whatever reason, it took three to four months for us

00:55:33.600 to get pregnant.

00:55:34.220 Every time we didn't have any kind of medical intervention or health, but I remember the

00:55:38.040 first time I was 20, 26 when I got pregnant, I guess we probably started trying when I was

00:55:43.340 25.

00:55:44.860 Um, and I remember my doctor telling me, oh, if you don't get pregnant, you know, y'all are

00:55:50.420 in your twenties, you're healthy.

00:55:51.780 If you don't get pregnant within six months, then we probably need to see about getting you 1.00

00:55:55.700 some kind of, you know, just seeing what's going on.

00:55:58.500 I don't know if you would agree with that or not, but that kind of scared me.

00:56:01.440 I remember thinking, oh my gosh, if I don't get pregnant in six months, something's wrong

00:56:05.040 with me.

00:56:05.500 And we did, we did get pregnant within six months, but I have friends who it took them

00:56:11.280 longer than six months and they didn't really have anything wrong with them.

00:56:14.680 It just, I don't know, whatever it is.

00:56:17.000 I think people don't realize there's not, you can't get pregnant every single day of the 0.55

00:56:20.860 month.

00:56:21.220 Um, and so there's just a lot of misunderstandings and a lot of scary.

00:56:25.700 We talk, um, when it comes to trying to get pregnant.

00:56:28.440 And I think some people think that if they don't get pregnant the first time, because

00:56:32.280 everyone also has a friend like that who gets pregnant as soon as they have unprotected 1.00

00:56:35.720 sex, um, you think there's something wrong with you.

00:56:38.220 And that's just not always the case, right?

00:56:41.140 Not at all.

00:56:42.040 I know.

00:56:42.320 I always kind of say that the people who get pregnant the first time are the only ones 1.00

00:56:45.120 that talk about it very openly.

00:56:46.860 It seems like, but, um, you know, first of all, I would say that knowledge is power.

00:56:54.200 It's one of my mantras.

00:56:55.480 And so if you're concerned, whether you've been trying for three months or certainly the

00:57:01.880 technical definition of, of subfertility is trying to conceive without being able to for

00:57:07.940 12 months.

00:57:09.220 Um, it can be earlier with risk factors, but I always tell my patients, if there is something

00:57:15.660 that you are concerned about, what it's always an opportunity to go in and speak to a professional

00:57:23.080 because they may have some insights to be able to do some testing, whatever you want

00:57:28.200 and feel comfortable with.

00:57:28.980 And you decide together that will allow you to optimize your health.

00:57:32.620 Okay.

00:57:32.760 So that's very first and foremost.

00:57:34.060 The second point I would say, um, which kind of speaks to the misconceptions is that goodness,

00:57:40.600 we just aren't taught.

00:57:41.520 We aren't taught about our bodies.

00:57:43.100 I feel like I would have no idea about any of this, um, unless I did what I did.

00:57:48.160 And I'll tell you, Ali, as the purported expert in women's health, I realized after I started 0.87

00:57:54.760 digging deeper into fertility awareness-based methods that I was learning some things for

00:58:01.260 the first time.

00:58:03.480 And this is actually supported by literature.

00:58:05.700 In fact, only, I believe about 6% of OBGYNs and family medicine physicians, um, were able

00:58:12.400 to answer correctly regarding fertility awareness-based methods and their efficacy in both achieving

00:58:18.420 pregnancy and avoiding this.

00:58:19.880 And so even though patients are clamoring for a more natural and empowered approach to understanding

00:58:27.100 their own bodies, their own fertility as a couple as well, um, you know, again, I think

00:58:32.560 the data shows that anywhere from 23 to 60% of patients want to use a more natural approach.

00:58:39.140 These fertility awareness-based methods to either achieve or avoid pregnancy, only 1% end up

00:58:45.820 doing so because they didn't feel like they understood it well enough or received proper

00:58:49.560 counseling to do so from their, um, medical providers.

00:58:52.960 And so there is a gap right now.

00:58:56.740 And I think that there are gaps on multiple levels, but that's exciting because that means

00:59:00.420 we can address this, right?

00:59:02.600 And so what it means to me is that a basic education, um, of again, in middle, middle schools,

00:59:09.500 right?

00:59:09.720 I feel like the system, when we think about sex ed, there could be of, uh, in my opinion,

00:59:18.640 a much more comprehensive way of understanding what a woman's body is doing and why, and that

00:59:26.420 it all makes sense.

00:59:27.700 And it's part of this beautiful, again, miracle and in complexity that works so perfectly.

00:59:34.100 And if it's not working, you can seek help for that.

00:59:36.320 And it'll give you again, the empowerment to understand that that's one level.

00:59:39.820 The second level is educating those of us who care for others.

00:59:44.960 And so, uh, facts about fertility is a wonderful program, um, by my dear friend, Dr. Marguerite

00:59:51.520 Duane, who seeks to help medical students and residents nationwide to understand different

00:59:58.160 fertility awareness-based methods and their efficacy.

01:00:01.020 And then finally, I think that, you know, there needs to be continued calls from patients

01:00:09.240 themselves.

01:00:09.780 And so I always tell my patients, I love when they're proactive.

01:00:13.620 I love when they come.

01:00:14.360 Someone was telling me the other day, she said, oh, I don't want to come with the big

01:00:16.740 notebook.

01:00:17.020 And I said, no way.

01:00:17.900 I love it.

01:00:18.920 I have learned so much from my patients, quite honestly, because people do great research

01:00:22.960 and that's how you should be.

01:00:24.320 You should be proactive, be your own best advocate.

01:00:26.920 It is so important.

01:00:28.060 Speak up.

01:00:29.080 If there's something you don't understand or something else you want to consider, make sure

01:00:33.540 that this is your life, right?

01:00:35.140 It's how I always tell people you have to be able to feel at ease and comfortable and at

01:00:40.480 peace with the path that you are going on.

01:00:43.340 Mm-hmm.

01:00:44.160 And that alone, I think, sets you apart as a doctor because so many of us have had that

01:00:48.980 experience with the doctor who just makes you feel like you can't ask questions.

01:00:52.340 And if you do ask questions or you question their authority at all, or if you say, I did 1.00

01:00:56.340 research, then they look at you like you're an idiot. 0.99

01:00:58.420 And then you're like, okay, well, I guess I'll just do whatever you say. 1.00

01:01:01.080 So even a doctor saying, no, I want you to come in with your questions and with your

01:01:05.660 research, I think that's great.

01:01:08.000 And because you're right, like it took me probably until my third pregnancy and third

01:01:13.400 birth to realize, no, I can speak up.

01:01:17.120 And like I, at this point, I feel kind of confident that I know what I'm talking about,

01:01:21.400 not about everything, but when it comes to my own body.

01:01:24.420 Um, and so, yes, I totally encourage women to feel confident in that.

01:01:30.480 So you help women with normalized cycles, optimized fertility and miscarriage prevention,

01:01:37.420 hormone transition, uh, integrative, integrative tools, um, that a lot of people just don't

01:01:43.980 think about, including like mood issues, heart health, like the body really just works

01:01:49.960 together and everything affects something else.

01:01:53.640 And so often we, we, we have such an isolated approach to medicine today that we just don't

01:01:58.840 realize how all of these little things work together.

01:02:02.560 Right.

01:02:03.920 That's exactly right.

01:02:05.760 And that's part of the principles of the integrative fertility that I am honored to be able to

01:02:10.420 practice is that we are whole people, right?

01:02:13.560 As I mentioned before, um, their mental, emotional, physical, and, um, spiritual parts of

01:02:19.880 us and that we're, it's a whole systems approach.

01:02:22.780 And so the interconnectedness of organs, exactly the importance of our microbiomes, for example,

01:02:28.460 the importance of lifestyle changes and how that can truly make an impact.

01:02:33.140 And this has been well studied as well as the role of inflammation.

01:02:36.920 Um, and, and again, seeking to understand those hormone balances and correcting them.

01:02:42.160 I've seen just, it's been so fulfilling.

01:02:44.960 Um, and again, my career has been very fulfilling in different ways throughout its 20 year course

01:02:50.820 or whatnot, but, um, this current chapter has been really exciting because I truly feel

01:02:58.440 again, that I'm healing, helping heal these issues and women are reporting, um, just such

01:03:04.200 market improvements and how they're feeling.

01:03:06.040 And then of course we see the fruit of that.

01:03:08.440 It's very, it's just wonderful.

01:03:10.100 Yes.

01:03:11.040 And praise God.

01:03:12.340 And it's just, I mean, God created our body so perfect purposely and with such intention

01:03:19.780 and there's so much that we can learn about them.

01:03:22.540 And I love it.

01:03:23.800 Like, I'm so fascinated by everything that you do and everything that you've talked about

01:03:27.980 today.

01:03:28.600 Even as someone who opposes IVF, I'm fascinated by that process because, you know, like we already

01:03:34.920 mentioned, it just shows how intricate the design of our reproductive systems is, um, and how 0.99

01:03:42.380 miraculous bringing life into the world is.

01:03:45.480 And so the fact that you are giving couples that power and that knowledge and also just

01:03:51.260 helping us get healthy in the process really is amazing.

01:03:54.220 Um, yes, absolutely.

01:03:57.600 Um, is there a place where people can, maybe they're in your area, but where they can hear

01:04:03.760 more from you or learn more about what you do?

01:04:06.360 Where would, where would they go?

01:04:08.600 I think the best place right now would be at my website, which is laurenrubalmd.com.

01:04:15.680 And so that is a great way to reach out to me.

01:04:19.200 There's a contact page there.

01:04:21.480 Perfect.

01:04:22.000 Um, gosh, there's just, there's so much more, even I could ask you, there's so much

01:04:27.680 more that we could talk about.

01:04:28.900 We'll have to have you back on, but I just so appreciate you.

01:04:31.680 Thank you for using your testimony for good.

01:04:34.020 Yes, all glory to God, but I love how he uses people's callings, people's passions, people's

01:04:39.360 own revelations about medicine, the body, the ethics of it all for his glory and to help

01:04:45.460 other people.

01:04:46.020 So thank you so much, Dr. Rubal.

01:04:47.980 I really appreciate you.

01:04:49.520 Oh, thank you, Allie, for having me.

01:04:51.260 And I appreciate you and your hard work as well.

01:04:53.700 It's just, again, all for God's glory, but it's good to be an instrument of his will.

01:04:58.220 Yes.

01:04:58.600 And amen.

01:04:59.300 Thank you so much.

01:05:00.800 You're welcome.

Relatable with Allie Beth Stuckey - June 12, 2024

Ep 1018 ｜ Former IVF Doctor Blows the Whistle ｜ Guest： Dr. Lauren Rubal

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