Ep 333: Abby's Top 10 Tips for Fertility Patients

0:00You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

0:21Dr. Carrie Bedient: Hello and welcome to another episode of Fertility Docs Uncensored. I am one of your hosts, Dr. Keri Bedient from the Fertility Center of Las Vegas, joined by my two babical badass, truly, hmm, I'm running out of another B word here. Truly fantastic, even though it doesn't start with a B. Co-host, Dr. Susan Hudson of Texas Fertility Center. Hello. And for this fabulous episode, highlighting Dr. Abby Evelyn from Nashville Fertility Center. Hey, everybody. This is a bittersweet episode because Abby is retiring. She is going to live a life far more exciting than certainly what Susan and I are grinding away at right now.

1:08Dr. Carrie Bedient: But we wanted to spend this episode just going through all things, Abby, like what are your top pieces of advice for patients and just kind of see how things have developed over your career and what you think and all of those types of questions. All right. Well, I got a top 10 here and I'm going to have Susan and Carrie chime in with me. I think it's hard to put these in order, but I think the number one is it's really important. when you pick the right person, trust your team. They really want what's best for you. If they give you advice, they give it to you because they really mean you should do it.

1:46And I don't know how many people I've had over the past, I don't know, six months that I've seen that have come up to me that are friends of mine. And they're like, my cardiologist told me I need to start on statins. Do you think I should start on statins? Yeah. If that's what he said, start on statins. Or my doctor thought I needed to have this thing removed in the OR. What do you think about that. Well, if that's what he thinks, do it. So I think in this society, a lot of people are a little bit mistrustful of physicians for whatever reason, at least speaking for myself. I mean, I feel like my heart has always been in the right place.

2:16And what I ask patients to do, I ask them because I thought that would really help them.

2:22Dr. Susan Hudson: I totally agree with that. I mean, we do this every day because in our hearts, we want to give you your best chance of growing your family and ideally growing your family as close to the way you want to grow them as possible. And it really does help if you have a level of trust in your physician and your team. And if you don't, that might not be the right home for you to be in because this is a tough thing to go through. This is a tough thing to go through. And it's really important not only to have your home-based team be included and active in your fertility journey, but knowing that your professional team is rooting for you and really trying to do the best things for you.

3:07Dr. Carrie Bedient: Absolutely. Trusting your gut's important. If you trust them enough to say, yeah, let's go through this with them, then trust that they're doing everything they can to make you successful in what your dreams are. So number two, understand the why and also kind of know why you're doing things. I think in the big picture, you want to know when your doctor plans something for you, you want to be a team member in that decision. And make sure you're honest with your doctor. If you're uncomfortable with a certain procedure, be honest. I mean, we'll try and do workarounds, but know what the plan is for the big picture for your treatment.

3:41And then know the details, too, because a lot of times patients will leave and by no fault of their own, they just get so much information. They get home and they're like, I don't even know what she just told me. It's always good to bring a piece of paper or if you're somebody that can tap on your phone really fast, just write some things down so that you know before you leave at least what the very next step is and who to call if you don't understand what you're supposed to do. And also, if they can give you a flyer about what this plan is, that can also be helpful, too, so you can refer to that.

4:11Being able to ask at the end of the visit.

4:13Dr. Carrie Bedient: But okay, so in summary, what happens next is I call you on the first day of my next period so that I can start meds or I'm waiting for your office to call me about X. It can be really helpful because it really distills down for you what happens next and how do we get there so that you make sure that if you misunderstood something or if they didn't explain something the way that they thought they did, that you guys can be on the same page before walking out the door.

4:42Dr. Susan Hudson: And Abby always says it's kind of like drinking from a fire hose when you come to see us and having an extra set of ears to make sure that you have all that information can be very helpful as well. If IVF has been living in the I'll deal with it later category, summer might be your window to change that. Schedule shift, things slow down just enough, and suddenly you've got the space to actually figure out what comes next. At Fertility.suncensored, we've spent years helping patients cut through the noise and understand IVF for what it really is. Not overwhelming, not mysterious, just a series of steps you can learn and navigate.

5:21Dr. Susan Hudson: That's exactly why we created the IVF Blueprint. It's a straightforward, no-nonsense guide to the entire IVF process. What happens, what decisions you'll face, and how to think through them without second-guessing every move. Whether you've just started to seriously consider IVF or you're already in it and want to feel more control, the IVF Blueprint helps you move from I think I should to I know what I'm doing. You can find it in print, e-book, and audio book with a bonus conversation from us at the end wherever books are sold and at FertilityDocsAndSensor.com. If you've been waiting for the right moment to get clarity, this might be it.

6:02this one I came up with something kiri said the other day and I thought this was really good we want you not to feel like you're a number in our practice we want you to feel like you're getting a plan just for you but it's really important we want to see you as a person but we want you to see us as a person as well as part of that with front desk staff with our nurses with the physicians we want we want you to be kind to them as we try and be kind to you it kind of works both ways because this is a hard job for us. We deal with lots of high emotions and lots of happy stories, but unfortunately, a lot of unhappy stories.

6:36It really kind of drains us when we see a patient who is just so unhappy and maybe it's something we don't have any control over, like ovarian reserve or something like that. It really goes a long way with your physician and your practice if you can be patient and be kind to the staff and to the physicians. It's a big team.

6:53Dr. Carrie Bedient: Yeah, I would definitely agree with that. Not that you have to be responsible for our emotions in any way, but just acknowledge that we have them too. And while we will never try and make our bad day your problem, you are dealing with the weight of the world for one person and we are dealing with, granted, a smaller weight of the world. But for potentially 100 people a day, we're trying to give everybody the grace that they all deserve. And we appreciate that in return. So this is kind of on a different note. Know your insurance and kind of know what your financial responsibilities will be. And certainly your doctor's office can do a really good job of helping you figure that out because it is challenging.

7:30I might have trouble when I'm seeing my doctor figuring out what's covered and what's not. But the more you know before you go in, I think the more confident you'll feel when your doctor recommends different treatments. I think some patients, if they don't know what their insurance covers, every time a doctor says something, they just see dollar sign after dollar sign after dollar sign. to the point where they can't really listen to what you're really trying to tell them. And it's also really difficult when you're in the doctor's office for us to immediately go, because a lot of times or sometimes patients will say, well, what does the ultrasound cost?

8:01What is this blood going to cost? What is this going to cost? And unfortunately, we can't really, we don't have a real easy way of going line by line and telling you exactly what it costs, because it depends a lot on your insurance coverage and, you know, what your deductible is and how much of your deductible you've met. So the more you know going into it, I think the more helpful it will be. And I think the less stressed you'll be about the financial part anyway.

8:23Dr. Susan Hudson: I think this is really important when we have couples coming into the practice because oftentimes the person who is not undergoing the medical therapy is often the one who's kind of taking charge of the financial parts of it just because it's something tangible and it's something that they can help with. Making sure both partners are on the same page as to what is our insurance? What is our coverage? What is our deductible? What is our co-pay? What are things that are covered? What are things that are not covered? Making sure y 'all are having conversations between yourselves. It can be very helpful.

8:59Mm hmm.

9:00Dr. Carrie Bedient: And knowing that as much as you know and you ask the insurance company what is and is not covered, sometimes they tell you different things than they tell us. And that is a source of just endless frustration when someone will say, oh, well, my insurance said that they cover X, Y and Z. And we come back and say, well, yes, but it's only if this diagnosis is in place and you don't have that diagnosis. And those things play a part because we also can't write down things that are not true because none of us look good in orange. We don't want to go to jail. Knowing how your clinic plays in with that.

9:35Dr. Carrie Bedient: And that's something where you'll need to work with that financial team because there will be specific rules, applications, principles that apply to one practice that may not apply to another, whether a lab or a surgery center is covered or is not. And how all of these things interweave makes a difference. And so when you know what your insurance covers, it allows you to ask more specific questions and really understand how that clinic interacts with that as well and document everything that the insurance company tells you. Because ultimately, you are often the one who is having to fight when they tell us, oh, yeah, everything's covered.

10:14Dr. Carrie Bedient: And they tell you, oh, yeah, everything's covered. And then they don't cover it. it ends up coming down at the patient, unfortunately, who has to really advocate over quite a long period of time. So keeping notes can be really helpful there. All right. Number five, be resilient. And this is really one of my favorite ones. This is Abby's top one. Well, actually, I kind of had it initially at the top of the list, but I try to put it in sort of a certain order. It's important for fertility, particularly because fertility treatment often is a marathon. It's not a sprint. Your mindset has to be toward that, like, okay, I'm going to be hopeful that this is going to be a quick thing, but it may take me a while.

10:53And don't let things knock you down because if you let one or two negative results or ineffective treatments get to you, then, you know, I'm just afraid you're going to fall off as a patient before you really have a good chance of being pregnant. I've found over the years, The people that are often most successful are the ones that just say, okay, I had a negative pregnancy test. What do I need to do next? As much as you can, and I know it's really hard, try and take the emotions out of it and try and just focus on the prize at the end. I'm going to keep going. I'm not going to let this get me down.

11:25And those are the people who are usually successful in the end one way or another. May not be with their own eggs, but eventually those patients will have a baby at one point.

11:33Dr. Susan Hudson: Every adventure begins with a dream. And for many, that dream is growing a family. At IVF Florida, we understand that the road to parenthood can take unexpected turns. Our team is here to guide you with expert care and advanced fertility treatments designed to support you at every milestone. With convenient locations across Jacksonville and South Florida and flexible monthly payment plans, IVF Florida makes it easier to move forward with confidence. Visit IVFFlorida.com to schedule your consultation because every great adventure deserves a trusted guide. Start yours with IVF Florida. Okay, so moving right along.

12:15Number six on my list is seek support. That can be from friends. That can be from neighbors. That can be from clergy. That can be your girl group from college or whatever. But seek support. I think that it's really important to have a village of people around you. And you may want to keep this quiet and not tell many people. But I think it's really important to confide into a really good friend. And I think ultimately that may mean also that maybe you need some true therapy where you see a counselor, because this is a hard, hard time for many people in their lives. It's often really puts a stress on your marriage because it may be one of the early things that you face in your marriage.

12:54That's a hurdle that you both have to overcome. And men and women oftentimes look at things differently and approach things differently. it's always good to have neutral third party or pseudo third party who can you know be there to

13:06Dr. Carrie Bedient: support you emotionally absolutely this is this is putting people through the ringer in many respects and usually it started long before you ever come to see us so any extra bonus support help you can get take it and run there is no extra prizes given in heaven for suffering by yourself when you didn't have to there's a whole world out there of people who want to help and who've been there and you You just have to tap into it. And sometimes that takes a little bit of work to find your people, but you can absolutely do it.

13:37Dr. Susan Hudson: And one thing I also think about is we think about friends and family. And a lot of times people want to be very private, especially at work. But sometimes sharing with your immediate supervisor or that type of person can actually make things a little bit easier. Because if you're having to take off of work and they don't know what's going on, people are always like, oh, no, are they interviewing for another job or other things like that, especially at the intervals that we see you. It's one of those things that you don't necessarily have to let everybody know your business. I know when I went through my IVF, like having to deal with my work stress was actually probably one of the highest stresses of the whole thing.

14:17Dr. Susan Hudson: And that was me traveling across the country. Just another little piece of advice. So kind of a corollary to that is, I think, as a general rule, think about practicing mindfulness. And if you don't know what that is, you can get lots of books on Amazon. It's just it's really a way of thinking. It's a way to train your thinking. That's kind of what happens when you see a therapist. They give you sort of these different tools to kind of help you get out of this rut of thinking really negatively. Mindfulness is a situation where you focus on the present. You don't worry about the future. You don't worry about the past.

14:48When negative thoughts come through, you think about them like a cloud floating by and you acknowledge that they're there and let them go. And because oftentimes when you're stressed, you think about things over and over and over, and there's really no solution for all these things you think about. And it just uses a lot of mental energy. It increases your stress load. So I just I think that's been really helpful for a lot of my patients is mindfulness.

15:11Dr. Carrie Bedient: Your brain shapes an awful lot of what you do if you can take care of it. It's just like getting a massage for your muscles that are sore. Get a massage for that brain muscle too. So along the lines of the same thing we're talking about, number eight is don't put your life on hold. I see patients sometimes who come to see us and they're so focused on infertility. They have notebooks about their treatment and they have all these plans and all these things that they've looked up on the internet. It's kind of like it's become their second job. And I think to a certain degree, it's perfectly healthy to want to understand what's going on and try and figure out what you can do.

15:46But I think it becomes an obsession for some patients. They become isolated from their family, their friends, particularly their friends who have children. If you enjoy exercising or if you enjoy going to art museums or you enjoy painting or traveling or whatever, try to keep those things in your life because you and your partner need something positive to look forward to and to do together potentially. So don't put your life on hold and any hobbies that you've had, try to keep doing those to a certain extent because obviously those things feed your soul and you want that to continue. You are more than just your fertility.

16:17Number nine, avoid comparison. Do you guys ever see patients who bring up their sister, their friend, their uncle's third cousin, their like every single day?

16:29Dr. Carrie Bedient: In every single way. Sometimes it's comparisons with people that you wonder, how did you even find that information out on your uncle's third cousin's mother's sister's brother's best friend from kindergarten? Yeah, so So you're a unique individual and we see you. We try and treat you as a unique individual. You can certainly tell us what happened to your sister or to your friend. But a lot of times that doesn't apply to you because not only is it you, but your spouse is also involved too. And his sperm count matters and his testing matters as well as your testing. That makes you guys unique. So I would try and hold back on trying to compare to someone else and what their doctor did for them.

17:07Because they may have a totally set of issues that maybe you're not even aware of. and that's why they got the treatment that they did. And then number 10, and this is very important, be brave and keep an open mind. I'm kind of a scaredy cat a little bit by nature and I think taking the leap to do something as terrifying as seeing a doctor about this problem that you're really worried about, sometimes for some patients can really be huge. If you're listening and you haven't seen a fertility doctor yet, I think this is your sign you need to go see one. If you're in the midst of things and you know the next step, which for everybody is daunting to think about IVF, at least keep an open mind and listen to your doctor and try to understand why they're recommending you for this and how they think you can benefit from it.

17:53Because oftentimes, and this is part of the reason we put our book out, The IVF Blueprint, is because people are so scared of IVF and they've heard so many different stories about IVF, they're afraid to even get started. And you'll find from friends and from the book that we wrote that if you, you know, that many people are very successful with IVF. And there's, yeah, there's a lot of steps involved, but it's kind of a marathon. You start with one foot in front of the other and eventually you get to the end of it. So same thing with IVF. I've had many patients over the years that do that. And after they're at the very end of it, they look back and they're like, wow, that really wasn't so bad.

18:27I might do it again. And if I need to, it's okay, you know. So be brave because it's a scary process, but we will walk you through it and handheld you to get you through it.

18:36Dr. Susan Hudson: That was beautiful, Abby, and very, very, very true every step of the way. So, Abby, I want to know what's the biggest thing that you have seen change? Oh, gosh. The biggest thing by far is genetics. I mean, when I started out, we did transfers on the third day of embryo development for IVF because we didn't have the capability to do genetic testing. We would thaw embryos on day three, and we would usually thaw three embryos or so because at day three, they have a really low cell count, and many of them didn't survive. So you might have one that survived. You might have none that survived. You might have three that survived.

19:17And then you have to go, okay, do we want to transfer all three of these? But back then, the success rates were not as good, particularly with day three embryos. Then we made the transition where we started looking at day five embryos that had two more days to grow in the lab and select. And then 15 years ago or so, we started doing genetic testing on embryos, which really was a big, big game changer for a lot of people because now if we can tell which embryo is genetically normal, again, it helps us select the best embryo for transfer. And that's really what contributed to really high success rates that we have now.

19:50I think they're high success rates of about 65 % for a genetically normal embryo.

19:54Dr. Carrie Bedient: So what were they when you first started? Like when you graduated from residency fellowship? We were gunning for probably 25 % pregnancy rates. Maybe 30 would be great, but 25 % probably. We had lots of negative, lots of consults because more times than not, now we can say it's like flipping a coin, but you have a 65 % chance of getting heads up. Whereas back then it was like flipping a coin like five times. And one of those five times you would have a good outcome. And that's really changed pretty dramatically.

20:27Dr. Susan Hudson: So I have a two-sided question. So what is something that you are hopeful for in the fertility field for the future? And what is something that maybe makes you a little nervous? So I really hope that going forward, we'll be able to develop some sort of model, maybe an animal model, to really get more information about implantation. That's the one thing in my career that, you know, I really would have thought over 25, 30 years, we would have had lots more information about things. Are we going to ask for the uterus by now? Yeah. That things were upregulated and which things are downregulated. I mean, we know that a lot of things happen at the time of implantation, but, you know, for people who are listening, you know, we obviously can't just do a biopsy on your uterus when you're pregnant.

21:11So I think either maybe AI models or maybe an animal model someday will give us more information about what needs to be upregulated and what needs to be downregulated. because along with that, I think the thing that frustrates all of us is when you see a patient who you've done for an IVF embryo transfer on them, the embryo looks great. Their lining looks great. They're completely healthy. There's all the metrics that we look at in terms of the way the endometrium looks and how thick it is, all are great. And yet you continue to do these easy transfers and they continue not to get pregnant time after time after time.

21:43I really believe there's something in the endometrium that's either not there and should be or the other way around. We just don't have data, really very good data or very good information about that or tests to look at that. So the thing that makes me a little nervous is, and I think Carrie and Susan might have been in this meeting too, a couple of years ago, someone talked about biopsying the forearm and getting fiber blasts from the forearm, which is basically skin cells, and being able to take those in a Petri dish and mix a bunch of stuff up in there and basically make them go back and regress to a stem cell.

22:16And from there, you take that stem cell and you either make it become an egg or make it become sperm. And it could be, regardless of gender, you could make it go either direction. There's all kinds of crazy possibilities, plus the fact, which maybe would be good, we would have probably a lot of egg cells, sperm cells to choose from. Particularly in older women that are having more difficulty, 38, 39, getting pregnant, the advantage may be we may have a lot more egg sales to choose from when that technology or if that technology becomes state of the art. But it's kind of a scary, scary new world, I think, when that happens.

22:53Dr. Susan Hudson: To say that was the only ASRM I walked away from with like a, my goodness, like it's just, it's so far, like there are some really amazing things that that would help us bypass. past, but it opens up a whole nother world of possibilities. I think we need to have the ability to deal with those situations. Yeah, I think the thing about this field of medicine that keeps it so interesting for all of us, our field is one of the fields, and I know a lot of other areas of medicine have a lot of changes too, but it seems like we're always on the cutting edge of technology. And we also have AI that can look at embryos in the lab to see how they develop.

23:30And And that's still not a proven beneficial thing to do yet, but we're always looking at new things. Our field has never been dull by any means. There's always something going on.

23:41Dr. Carrie Bedient: If you could wave your magic wand and make one thing true for every patient who comes through our doors, what would it be? Well, I wish every patient could get pregnant. That would be number one, but I think that would be too big of an ask. So I would say at least help us guide the patients to the correct treatment more effectively and more quickly so that they can have the best chance of getting pregnant. But yeah, one wish would be let everybody get pregnant that comes to see us.

24:10Dr. Susan Hudson: That would be beautiful.

24:11Dr. Carrie Bedient: So what are you most excited about for your next step? Like, what do you have planned? And Abby, for our listeners, Abby is far and away the most interesting of the three of us in terms of what she does. because she's a painter and she's an artist and she travels and she does all these cool things that I don't know about you, Susan, but I just look back and go, I want to do that.

24:34Dr. Susan Hudson: I want to be creative. She is a very, very talented, beautiful person. And I'm so excited to hear what the new adventures are. Well, thank you. I've always tried to keep up my hobby of drawing and painting, and that's really kept me focused and centered. And that's one of the reasons why I said, don't put your life on hold when you're going through this. Do the things that make you happy because that's going to be overall beneficial for your mental health. I'm planning to try. The exciting thing is, and I think Carrie and Susan can relate to this, our lives are so structured. And even when we go on vacation, we have to look up patient records and we have to do labs.

25:10And that follows us no matter where we go. Seven days a week, basically, we're all we always have something in the back of our mind, a patient. I have one right now that I'm always worried about. And, you know, when I go on vacation, I'm like, oh, gosh, if I go away, is something going to happen? And I'm worried about this person. I think probably every one of the hairs on my head have changed colors because of all the patients I'm worried about. So maybe my hair will start going, becoming darker after this, but I won't miss that. I mean, I've really, really had a wonderful career. I've had wonderful patients that I'm so grateful for.

25:42You have truly enriched my life, no question about it. And I'll miss all of you guys, but having that worry all the time, kind of chronically, I'll kind of be happy not to have that. I'm glad that yoke is kind of off my shoulders and onto the younger doctors in my practice that will be taking care of my patients down the road.

25:59Dr. Susan Hudson: And you've got an amazing team back there in Nashville. Absolutely. We've got an amazing team. Well, thank you for hanging out

26:05Dr. Carrie Bedient: with us for the past six years to do this. I'm going to miss you guys. It's going to be pretty weird on a Sunday. I'm going to be like, wait, are we podcasting today? But hopefully you guys will have a great person to take my place. I know you will. And it'll be it'll hope it goes on for many, many years. We still get to do book stuff. We still get to do good things. Yeah, I hope so. Yeah. So I look forward to things that are upcoming for Fertility Docs Uncensored. I'll certainly check you guys out on Instagram and Facebook and all that good stuff. And hopefully many, many continued years of success.

26:39I don't think any of the three of us ever dreamed when we started out six years ago in this way. I thought it would end. We just stopped doing it after a while. But it's really grown and now has a life of its own, which is great. Well, thank you.

26:51Dr. Carrie Bedient: We will miss you. And we still want to get pictures and photos and updates and all those things. But thank you for all of the hours you have spent with us and for being part of a lot of hours together. Yeah. Yeah.

27:05Dr. Susan Hudson: Lots of beautiful memories over the past six years.

27:08Dr. Carrie Bedient: Yeah. Thank you. All right. Well, to our listeners, thank you so much for listening. Subscribe to Apple Podcasts to get next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

27:26Dr. Susan Hudson: Visit fertilitydocsandcensor.com to submit your questions and sign up for our email list. Pick up your copy of the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore. Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes. As always, this podcast is intended for entertainment. It's not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we'll talk to you soon. Bye.