Ep 340: Questionable Testing: Answering All Your Questions About Fertility Testing

0:00Dr. Carrie Bedient: You'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. Susan Hudson: This episode is brought to you by Receptiva DX. What if unexplained infertility isn't actually unexplained? For many women, hidden inflammation associated with endometriosis and other uterine conditions can go undetected for years, even when everything else appears normal. For more than a decade, Fertility specialists have trusted Receptiva DX to provide deeper insight into the uterine environment, helping women and their physicians uncover answers and make more informed treatment decisions. Hello, everyone. This is Dr. Susan Hedson from Texas Fertility Center with another episode of Fertility Docs Uncensored.

0:58Dr. Susan Hudson: I am here with my sensationally snazzy co-host, Dr. Carrie Bedia. Hello.

1:03Dr. Carrie Bedient: How are you doing? I am just fine, thank you. If you see me making any spastic turnaround movements while we're talking, it's because my puppy is sitting right behind me and there's noises coming from her. I keep turning around going back and forth because the only thing that she's got there is a towel. But that should not be making the loud crunching sound that I am hearing. The number of things this dog has eaten. Oh, my God. She's cute. It's really good. She's cute.

1:30Dr. Susan Hudson: What types of things has she eaten?

1:31Dr. Carrie Bedient: She has ravaged the socks in our house. The monster that lives in the dryer must be just pissed beyond belief because it's getting starved. There's no socks for her to eat because she has already eaten them. She likes shoes. Fortunately, I am pretty good about putting my shoes up right away. So she hasn't gotten to any of mine, for which I'm grateful. She does like to eat little toys and puzzles. So we've got a fair number of brain teaser type things around our house. And I don't know if you've ever seen them, but there are these little 3D puzzle pieces. And you can fit them together somewhere between Legos and Lincoln Locks and stack them.

2:08Dr. Carrie Bedient: And they come in a nice variety of colors. So I was out in the backyard picking up her poo and I looked down and one is the colors of the rainbow. And I'm not talking muted. I'm talking bright yellow, bright pink, bright blue. And it was the little puzzle piece. She ate skittles. Yeah, it did look like she ate skittles. And it looked like they went through almost, I don't want to say completely intact because they had all been chewed in half. But yeah, it was multicolored poo. Did your dog be a little bit older than mine?

2:40Dr. Susan Hudson: yes yes my oldest dog is 12 so we are way beyond that my husband's completely deaf in one ear and he had a hearing aid at one point to help get sound from the other side and when she was a puppy she chewed up his hearing aid and then our other dog is probably about five years old but we also have a we do have a puppy in our house well she's a year old she's a year old it's it's my son's puppy she visits but sometimes she stays for a month at a time she's good we're really good at giving them bones and antlers. Antlers are amazing. Okay. Go get antlers.

3:16Dr. Carrie Bedient: All right. We've tried the various different types of bones and chew toys, and there are a couple that get traction, but...

3:23Dr. Susan Hudson: And she's a little bitty thing, right?

3:26Dr. Carrie Bedient: She started at five pounds. She's now pushing 20.

3:28Dr. Susan Hudson: Okay, but still, that's relatively small.

3:31Dr. Carrie Bedient: I mean, yeah.

3:31Dr. Susan Hudson: So go get some antlers and see how she does with that. Like either deer antlers or elk antlers. Right now, they have elk antlers at Costco. They're pretty cheap, realistically. As antlers go, it's a good deal.

3:46Dr. Carrie Bedient: I didn't realize that there was a secondary market for antlers.

3:49Dr. Susan Hudson: There is a secondary market for antlers. They're good chewing.

3:52Dr. Carrie Bedient: Okay. As long as she's not chewing on my feet. The other morning, she was chewing on one of her toys and accidentally got my toe as a part of it. And I yelped and jumped and then she yelped and jumped and went into the down position right in front of me and just gave a single little which I think was her saying, I'm sorry, because she didn't mean to do it. And I accepted her apology. That's sweet of you. I thought so.

4:16Dr. Susan Hudson: All right. On that note. So today we're going to have a question episode all about testing. There's so many tests that we do in fertility care, and we tend to do a whole lot of them at once. So we understand how it can get a little confusing and a little overwhelming at times. But I'm hoping through some of these questions, we can break through some of the barriers and understand why we look at some things, why there are some things we don't care about anymore. Because testing kind of comes and goes. Things that were popular, it changes. And we'll go from there. RMA of New York is a global leader in state-of-the-art reproductive medicine, serving as Division of Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai.

5:04Dr. Susan Hudson: Led by an integrated team of physicians and scientists, RMA of New York is renowned for its pioneering research in the field and for delivering high IVF success rates. With locations across Manhattan, Brooklyn, Westchester, and Long Island, RMA of New York has helped thousands to build the families of their dreams for more than two decades and counting.

5:25Dr. Carrie Bedient: All right. Okay. Carrie, you want to do the first one? Yep. Okay. Could chronic, recurring, and asymptomatic BV play a role in infertility? I've had a positive BV test during regular OBGYN checkups in the past. I'll do a course of antibiotics, never notice any symptoms, then test positive again at a checkup. I have an FET coming up and I went in for a test with my OBGYN as a precaution. Sure enough, positive. I recently got 12 euploids in a single egg retrieval and can't help but wonder if BV is the reason I've never fallen pregnant since making good embryos clearly isn't the issue. For context, my husband and I are 34, AMH 3.75, retrieved 39 eggs, no PCOS, now PMOS, unexplained, and I had progestin IUDs for nine years.

6:07Dr. Carrie Bedient: What do you think?

6:08Dr. Susan Hudson: This is kind of an example of something that used to be tested a lot in yesteryear, and I don't think that there's a huge amount of support to say, yes, BV is a problem. However, I would say that you are probably a person that I think doing a biopsy in the endometriums earlier than later to check for chronic inflammation would be a good idea. And whether it's related to the BV or not, it sounds like you may be a person who sometimes has overgrowth. So things that maybe should be at a little slower pace and maybe be on some probiotics and that type of thing. But I would more use it as a signal of, hey, what else could be similar than necessarily blaming it on the BV itself?

6:57Dr. Carrie Bedient: I would agree with that. The vagina is a pretty good self-cleaning oven in terms of maintaining itself. Fortunately, more often than not, the bacteria stays down where it's supposed to and the cervix does its job as a barrier. And that cervical mucus that we're all seeing and watching month to month is able to block out little pathogens, bacteria of various sorts from going where they shouldn't. But if there's a huge overgrowth, maybe it's creeping up where it ought not be and it's worth taking a look. I would also venture to say it is worthwhile to take a secondary look, meaning you go in and if they do find inflammation, you get the treatment and go back and make sure it cleared because about 70 % of the time it will, but that means 30 % it won't.

7:42Dr. Carrie Bedient: And I've definitely had a handful of patients over the years where we just had to go back again and again and again in order to finally clear it or at least finally make the decision of, okay, we're going to go ahead and transfer anyway, because this just is not going anywhere no matter what we do. And at least we feel good knowing we did everything we could. And if it doesn't work, it's not for lack of trying.

8:04Dr. Susan Hudson: Absolutely. All right, on to our next one. Two-part question. After an IUI and a six-week ruptured ectopic, which resulted in the loss of my only functional tube, my husband and I moved to IVF. We retrieved six eggs, but zero blasts on our first round. Our second round, we switched to a Lupron Omnitrope prep before stims and got 13 eggs, one blast. PGT showed missing chromosome number 16, aneuploid. I am a 36-year-old female. My AMH was tested in May of 2025 and it was 0.05 and then tested again in February 2026 and was 0.93. My husband has passed all sperm testing and neither of us are carriers for genetic disorders.

8:51Dr. Susan Hudson: Do you think a third round is worthwhile or should we pursue another avenue? Why are my AMH results so different? Thanks for all you do for our community.

9:00Dr. Carrie Bedient: Well, first of all, you're very welcome. So a third round being worthwhile versus pursuing another avenue. This question is not really about IVF. This question is about time and money. And your heart. And your heart and your head and pretty much every other organ besides your ovaries. I would say you're 36 years old. It is worthwhile for you to keep going and keep getting eggs and see what you get because clearly you're learning things on each retrieval, able to get more eggs. You may Maybe someone where omnitrope turns out is a very helpful thing for you and other manipulations of the cycle may be really helpful.

9:37Dr. Carrie Bedient: I think medically going in to try and get more eggs totally makes sense. But do you have the stamina for that? Do you have the coverage or financial wherewithal for that? Do you have the desire to do that? Because there comes a certain point at which you say, screw it all. I want a baby. And you move to egg donation, embryo donation, adoption. whatever it may be, to get there. A lot of this depends on what you are thinking. Absolutely.

10:05Dr. Susan Hudson: I totally agree with that. And as to the AMH result, I would like to say that we generally think of AMH as being relatively static, meaning not having a huge variability from one testing date to another. I have to say in practice, I do see some degree of variability, and I think different medications that you could be on or different stressors that are going on in your life can sometimes have a factor. Now the reality is you went from one value that was extremely low to another value that I would still consider low. We did not go from 0.05 to 4.5. I think it shows that you do still have a level of quantity of eggs.

10:56Dr. Susan Hudson: And I think it shows that things aren't necessarily getting worse quickly, which is a bonus. And it kind of goes along with what we saw in your egg retrievals, going from six eggs to getting 13 eggs. There is going to be some variability. I think there's more variability than we like to think about. But again, we didn't go from super low to super high. we went from super low to still low but not as bad. I would take it as we take all of our testing with a grain of salt. I mean there's a reason why a lot of us do antral follicle count, we do AMH levels, and we still do FSH and estradiols because not one of those in itself is a perfect test and really the best strength we have is when we have all three of those put together and be able to have some conclusions about quality and quantity.

11:48Dr. Susan Hudson: And quite honestly, your IVF cycles are the ultimate test when it comes to ovarian reserve. Absolutely.

11:54Dr. Carrie Bedient: A lot of patients live and die by those numbers. And I 100 % get it. I am very much a numbers person and I appreciate when we have data. But it's one of those things where the statistics don't matter for the individual. You want to get as many as you can get. And if you get lucky with one embryo or you get lucky because you had 25 embryos, it doesn't matter. You still got lucky.

12:20Dr. Susan Hudson: And we're hoping you get the lucky one on the next one. Very much so.

12:23Dr. Carrie Bedient: Third time's the charm. Absolutely. Next question. Hi, ladies. Thank you so much for all the invaluable information you provide us. Oh, you're welcome. My question is, after two FETs with one embryo each time, one biological and one with a donor, Should I be pushing my clinic to do more testing like a hysteroscopy? I'm 44, and I've been trying with this clinic for four years, doing many tests, many stimulation rounds, and ultimately with insurance funding running out, was guided to use donor eggs. I had four day five embryos created with my husband's DNA and now have three left. We were not allowed to do PGT testing on the donor eggs, but we're told they looked great.

12:58Dr. Carrie Bedient: I also have Hashimoto's thyroid disease, so could there be any more my clinic is missing to help with implantation issues? Thank you for your help.

13:04Dr. Susan Hudson: So I would say anytime that somebody has had two embryo transfers and they are relatively good prognosis embryos, which it sounds like you have had those, that is definitely a time to be looking at more testing. There was a study done probably about 10-15 years ago that showed after two embryo transfers of untested embryos, hysteroscopy revealed some abnormality in the endometrium 30 % of the time. That's a pretty high percentage. So I definitely think hysteroscopy is a reasonable thing. I would also suggest Receptiva. Receptiva is a test that looks for a chemical called BCL-6 within the lining of the endometrium.

13:50Dr. Susan Hudson: BCL-6 has a relationship to endometriosis, but not everybody with BCL-6 has endometriosis. Not everybody with endometriosis has BCL-6, but we know if BCL-6 is present and is not treated by some mechanism, it can decrease chances of pregnancy and increase risk of miscarriage. I am still a partial believer in ERAs, endometrial receptivity assays. I think that there is a segment of the population that it can be helpful. Do I think it's everybody? No. Do I think somebody who's failed two FETs? I think it's probably worth a try. You've tried out a decent amount of genetic material so far. I think that might be a good thing to do.

14:29Dr. Susan Hudson: I would also check you for antiphospholipid antibody syndrome. APLS, which is what we generally, or APS, what we call it for short, is an acquired blood clotting condition that's usually related to recurrent pregnancy loss. However, I think it's something relatively simple to do. A lot of times insurance companies will cover it for a screening test, and I've discovered a good number of people who are positive for it, and those are the people who actually really need blood thinners. I'm stingy when it comes to blood thinners. Now, aspirin, that's one thing. Giving you injectable blood thinners like Lovenox or Heparin, those I give if there's a true indication.

15:08Dr. Susan Hudson: And this is one of those times that it can actually reveal a true indication.

15:12Dr. Carrie Bedient: Would agree with all of those things, hysteroscopy, blood work. I think that it's worth checking your thyroid function if that hasn't been done recently to see if there's anything off the wall about that. If you have Hashimoto's, I would expect you to have positive antibodies. I wouldn't necessarily automatically treat if your labs are in the normal range, but if they're on the high end, for sure I would treat. And if they are on the high end of normal, so if they're definitively high, absolutely treat. If they're on the high end of normal, you can make a case for treating that as well. Levothyroxine, especially in low doses, tends to be tolerated pretty well for subclinical hypothyroidism.

15:53Dr. Carrie Bedient: There's been a bunch of papers out about whether or not it makes sense to treat that. And different doctors will have different opinions because there is some wiggle room there. Although there's more and more coming out that treating subclinical may not make as much of a difference as we might hope. I think that's worthwhile. The other thing is that if you have any other inflammatory conditions going on, get it treated. If there's anything else in your general health that might need a little bit of love and attention, I would pay attention to that too because you never know how some other body system is going to impact your ability to get pregnant.

16:29Dr. Susan Hudson: Let's play a game. How many tabs do you have open right now about IVF? One says your chances are great. Another says they're terrible. Reddit has one opinion. TikTok has another. Facebook is full of horror stories. And somehow, after two hours of searching, you have more questions than answers. Sound familiar? That's exactly why we wrote the IVF Blueprint. This isn't another fertility book filled with opinions or miracle cures. It's an evidence-based guide that walks you through every stage of IVF, from understanding your fertility evaluation and choosing a treatment plan, to medications, egg retrieval, embryos, genetic testing, transfers, and the two-week wait and beyond.

17:14Dr. Susan Hudson: Because the last thing you need during IVF is more noise. Close the tabs, put down your phone, open the IVF blueprint instead. Available now wherever books are sold.

17:28Dr. Susan Hudson: Hello, hello. Love the show. Thank you for listening or watching. I have PCOS and my husband has about 10 million sperm count. My AMH is high and at the first checkup at the fertility doctor found 35 follicles via ultrasound. We are going to do IVF with ICSI and rapid PGTA. The doc wants to do a fresh transfer. What are the pros and cons of rapid testing versus normal PGTA?

17:52Dr. Carrie Bedient: This is an interesting question. We don't usually get questions like this. The fresh versus frozen transfer. The big thing that catches my attention about your case in particular is that you have 35 follicles. That means you are likely to have a really robust stim, and that's fantastic news. The problem with that is that that means you have a much higher likelihood of having ovarian hyperstimulation syndrome if you have a fresh transfer and get pregnant. It means that they probably cannot do a Lupron trigger, or if they do, you've got a lower chance of pregnancy after doing a fresh transfer. It means that in doing the HCG trigger, you've got a higher chance of having hyper-STEM.

18:38Dr. Carrie Bedient: And it means that the physiologic environment of your body following STEM is not terribly normal. You are likely to have very high levels of estrogen and more likely to have higher levels of progesterone and all of that contributes to a lower chance of pregnancy. While I do think that there are some places where doing a fresh transfer can make sense, I'm worried because you've got some risk factors that are very real. And I remember from back in the day when I went uphill both ways in the snow, when we didn't really do Lupron triggers, that rounding on people in the hospital with hyperstimulation syndrome, especially if they got pregnant where it persists for weeks, those patients are miserable.

19:20Dr. Carrie Bedient: And in those severe cases, hyper stim is a very real risk. And a lot of people these days talk about, I was so uncomfortable. I had a ton of nausea. We're talking about potentially life-threatening risks with an intensive care unit type of sick. Yeah. And not in and out overnight, but intensive care unit for a week or longer. And the electrolyte abnormalities where your salts go bonkers, They're very real. Just hearing some of this makes me a bit anxious about it, not because of the rapid versus normal PGTA, but more for the safety profile of doing a fresh transfer in someone who's likely to have a really good stim, which is great news, but just be very cautious of that.

20:03On the flip side, if they don't stim you quite as hard, it means you may not get as many as you otherwise would.

20:09Dr. Carrie Bedient: That's a tradeoff, too. Looking at the rapid versus normal PGTA, I don't do rapid PGTA at this point, mostly because the PGTA that I like tends to be the stippery, and that is not something that can be done rapidly. And most of my patients are getting frozen embryo transfers because I think in our hands that's more effective. But we don't do rapid PGTA because most of the time we're doing FETs and we're looking for other things. And so it's just not something we do a whole lot of. Have you done it?

20:40Dr. Susan Hudson: Actually, I did rapid PGTA when I did my personal IVF cycle like 16 years ago. In that type of situation, we thought fresh was better than frozen. And so it all made sense. Besides the fact I had diminished ovarian reserve. So I was not in this individual circumstance where I was going to have a bajillion eggs and hopefully embryos. I totally agree with you, Carrie, that there's so many things that makes me worried about a fresh transfer in this person that, I mean, I personally have never practiced in a place where I had rapid PGTA testing available. It has to be at a pretty big center. But honestly, I think most of the really good big centers are sending off their labs nowadays and not doing them in-house.

21:27Dr. Susan Hudson: So I just think that safety-wise, it might not be the best option for you.

21:32Dr. Carrie Bedient: With rapid PGTA, are they still biopsying them on day five or are they doing a day three biopsy in order to build themselves an extra couple of days?

21:41Dr. Susan Hudson: I can say that when I did it, we did it on day five. Like we biopsied on day five, got the answer on day six. If you had a day six embryo, it was biopsied and cryopreserved. So RAPID was only available for embryos available on day five going into day six.

21:58Dr. Carrie Bedient: Interesting. I would be interested to hear how this patient did and what they ultimately decided.

22:04Dr. Susan Hudson: Yeah, absolutely. Let us know.

22:07Dr. Carrie Bedient: All right. So next question. What would be the recommended tests and treatments when sperm analysis results indicate severe oligospermia, 3 million per mil sperm concentration, and transvaginal ultrasound discovered swollen fallopian tubes? Is IVF the only option to get pregnant?

22:23Dr. Susan Hudson: All right. So we'll start off with the sperm. So if a guy has a single semen analysis that shows low sperm counts around 3 million, which there's kind of a break of what we do above a million and below a million. We can talk about that a little bit. But when it's low, first of all, never make any big judgment calls. Always get a second semen analysis because sometimes guys have a bad day. It's okay. All right. So one, make sure the test is truly what's reflected in his physiology. Then I would look at some basic hormonal tests. So just like women get FSH, men, I would get an FSH, the hormone the brain produces that tells the testicles what to do.

23:12Dr. Susan Hudson: And I would get the testosterone level to see how much testosterone is being produced. I would check the thyroid. I would check prolactin. I usually get an estradiol just in case we're going to be putting the gentleman on Clomid. So I have a baseline of where that is. If we had a really diminished sperm parameters, so less than a million, I would add some chromosome testing. I would do chromosomes or karyotypes so that we have the whole array of what his chromosome makeup is. And I would also look for something called a Y chromosome microdeletion test. So on the Y chromosome, there's a little area that can have one of three different types of mutation, and these mutations are called microdeletions, and that can make us have very low sperm parameters.

24:03Dr. Susan Hudson: Realistically, if sperm parameters stay the same and they're this low without interventions, things like Clomid or HCG, those types of things, then IVF is probably going to give you your best chances of pregnancy. No one's ever going to say never. I've seen people get pregnant with IUIs with really low sperm counts on that day because you only need one good one. But statistically, do we think it's going to work? Probably not. Carrie, what are your thoughts on the swollen fallopian tubes?

24:33Dr. Carrie Bedient: If we can see swollen fallopian tubes on just an ultrasound, it's a bad sign because that means that there's enough damage that it can show up. And you're never supposed to see tubes. If you are seeing tubes, it's pretty much universally a bad thing. Even if those tubes are open, and I'm assuming that you're going to have tubal testing in here at some point, Even if those tubes are open and let's say you get the sperm count up higher, you're running a much higher risk of an ectopic pregnancy or a tubal pregnancy. And those are one of the few life-threatening conditions, along with severe hyperstimulation syndrome, that actually have the potential to do serious bodily harm to a patient in the fertility world.

25:14Dr. Carrie Bedient: We are very, very uptight and compulsive about watching pregnancy tests in somebody who has damaged fallopian tubes. Personally, I would much rather that those tubes be fully blocked off. I think that is safer for you. And at that point, you can make the argument that you can leave them in place if there's no communication between the tube and the uterus. But if they're open and there is a communication, you're running the risk of ectopic. You're running the risk of having negative pregnancy tests despite whatever treatment you're doing. Even if you do IVF, it's probably a good idea to get those tubes taken out.

25:47Dr. Carrie Bedient: I would err on the side of IVF here. But again, like Susan, we've all seen people who have beat the odds. It's just you're playing a much more dangerous gambling game with damage tubes like this because ectopic pregnancies are dangerous.

26:02Dr. Susan Hudson: All right. Our next one. Hello. I am a 26-year-old female. Husband is 30, trying to conceive for three and a half years. No pregnancies along the way. History of PCOS and stage one endometriosis, which was resected. Have tried letrozole 6 cycles, letrozole and IUI 4 cycles. Now on letrozole trigger ultrasound monitoring cycles and IUI with 2 unsuccessful cycles. HSG times 2, both normal. Estrogen, progesterone, AMH levels all normal. And we have seen 2-3 good-sized follicles on the mid-cycle ultrasound. I have celiac disease. Husband's sperm count is normal. Sorry about the celiac, girl. I'm with ya.

26:41Dr. Susan Hudson: At this point, we are ready to move towards IVF, but are still hesitant and scared as I have never had a positive pregnancy test. Would this be a good time to move to IVF, or is there more testing things that can be done prior to moving to IVF? Thank you for your podcast. Thank you so much for listening.

26:57Dr. Carrie Bedient: You have already made a really solid, fantastic effort in doing everything leading up to IVF. I think maybe the only thing that you haven't done is ITI, and that is tubal insemination where you go up a little bit closer. Even then, I would only plan to do one, maybe two of those. It's not offered, not even everywhere. It's not offered most places. And it is an incremental increase over the IUI. And so I think at this point, it is worthwhile to go for the IVF because you're burning daylight. And the more you do these other cycles, the more you are likely to wear yourself down, wear your patients down, and be spending a lot of time and resources on something that's got a very low likelihood of working.

27:44Dr. Carrie Bedient: Now, if you wanted to, could you? Sure. But the return is not going to be very high at this point. And I think going to IVF makes sense. And if anyone is watching this on YouTube, my dog is being a spaz. She has since picking her up to stop her trying to eat through the wall. She has tried to eat my pen, my notepad, and my keyboard. What do you think about this question, Susan?

28:06Dr. Susan Hudson: So I have a couple of thoughts because we know she's had endometriosis in the past. The bad thing about endometriosis is endometriosis tends to recur. So if you're trying to uncover all things before going through IVF to maximize your chances or to figure out what do I need to do, I think doing a receptiva test in this situation might be a reasonable thing to do. Okay, see if you have any problems with the endometrium. I would also, if you're thinking about doing anything else with his sperm before doing IVF, I would do sperm QT. So sperm QT is a test looking at the genes within the sperm that can become dysregulated or abnormally turned on or off.

28:53Dr. Susan Hudson: And if there's a high amount of dysregulation, essentially the sperm can get to the egg. There can be millions and millions of them, but they don't know how to press the doorbell. They don't know how to get in. In this type of situation where I have two individuals who've been trying for three, four years, they've been young, they have really tried a heck of a lot of stuff. Is there something under the surface that we haven't been able to find? Which the answer is probably yes. It's just do we have a test to be able to delineate that? And that's one reason why I'm thinking about the Receptiva, thinking about the sperm QT.

29:30Dr. Susan Hudson: if the sperm QT is normal, that gives you reassurance if you wanted to try one or two ITI. Or if when you're going to IVF, you're wanting to use conventional insemination, it gives you reassurance that it's got the genetics to do the job, even though you haven't had a pregnancy in the past.

29:49Dr. Carrie Bedient: And the other thing that I would consider in all this is, yes, you can do more testing, but is it going to ultimately change what you do? And I don't know that there's a whole lot of impact that will change what you do and say, I need to do more inseminations. There might be some things that push you to do IVF a little bit faster or maybe make you more comfortable with that decision. But whenever you're doing a test, think about what will this answer do for me? Absolutely. Okay. Next question. Hi, love your podcast and I've learned so much from all of you. My question is about abnormal pap smears and how they may or may not impact IVF and implantation.

30:24Dr. Carrie Bedient: I recently had an abnormal pap positive for HPV E6 and E7. I had a colposcopy about 15 years ago, but everything's been normal since. Dr. Google says about 80 % of the population will have some type of HPV in their lifetime. Is there any evidence to suggest HPV impacts fertility, IVF, or implantation in any way? Thanks for what you do.

30:43Dr. Susan Hudson: I think you can rest assured that HPV is not interfering with your fertility.

30:48Dr. Carrie Bedient: Yeah, I would agree with that. I do think it's worthwhile to make sure that it's not an ongoing problem because if you need a colposcopy and it comes back abnormal, you really want to know that before you get pregnant. Because once you are pregnant, there's really not a whole heck of a lot that we can do because the cervix is the door locking that baby in and you don't really want to break down the door halfway through the gestational period because that does not end well. So, and you do what you got to do. However, I would definitely make sure that you get a clean bill of health and that the follow-up paps are normal.

31:21Dr. Carrie Bedient: Most HPV clears on its own, but not all of it. That's where cervical cancer, much of it comes from. So worthwhile to check. Absolutely.

31:29Dr. Susan Hudson: All right, let's do one more. My husband and I are both 31, no prior pregnancies. We have been trying to conceive for six months with no success. Before that, I was on birth control for 10 years. I am now having regular cycles every 29 to 31 days. I have tested with OPKs and basal body temperatures for the past three months and appear to be ovulating with a consistent 13-day luteal phase. My question is, is it too early to see an REI and start fertility testing? I know the guideline for us is based on age, would be to wait a year. We are both healthy, healthy diet, weight, no smoking substances.

32:03Dr. Susan Hudson: I have an autoimmune disease, but it is well controlled and on pregnancy safe meds.

32:10Dr. Carrie Bedient: I tend to think that if getting fertility testing has crossed your mind, especially if you're at that six month point, just get it. Because it means you can take your sweet time. You don't have to feel rushed and do everything in one cycle. So if it's not convenient for work for you to get the tube testing done this month, maybe you wait till next month. And that way you've got somebody else who's going through your history with you who may be able to pick up things that you're not thinking about. I had a patient earlier this week who said, I'm totally fine. We're here because of my husband's genetic condition.

32:44Dr. Carrie Bedient: And then after talking to her, there were four separate things that we had to address that were actually hugely serious for her that she just didn't pick up because this isn't what she does all day. I think it's worthwhile to talk to somebody, have them go through your history, get the basic testing. Worst case scenario, you get the testing and don't need it. And if it gives you peace of mind, take it and run. And that way, if you do hit the one year mark and decide, all right, we want to do something, your testing is done and you can move forward. relatively quickly.

33:15Dr. Susan Hudson: And we're more than happy to be our good luck charm to come in, talk to us, and then a couple weeks later find out you're pregnant because that does happen.

33:23Dr. Carrie Bedient: More than you might think, actually. I can't count the number of new patient consults where someone said, I missed my period, I'm pregnant today, or their follow-up consult where that happened to the extent that I had staff members who would not sit in my chairs in my office because they were the pregnancy chairs in the office and they didn't want to be pregnant at that point in times. Getting your information is rarely a problem.

33:43Dr. Susan Hudson: Absolutely. Get information. And I think people are very intuitive. If there's something that you're just like, hmm, this just doesn't feel right, get it checked out. It's not going to hurt anything. It's a little time. There's some tests involved, but you can do it at your pace and it's not a hurry at this point in time. So it's a good time to be thinking about it. So, well, I think this was a fantastic episode. I loved talking about all the nuances of these little bitty things that we, there's no way you can talk about all these in a single episode without doing it like this. So thank you for spending part of your day with us.

34:15Dr. Carrie Bedient: If you enjoyed this episode, subscribe, leave a review, send us

34:18Dr. Susan Hudson: your questions at fertilitydocsuncensored.com. And if you want even more fertility information, pick up a copy of the IVF Blueprint, our practical guide to understanding fertility treatment, IVF, and the decisions you'll face along the way.

34:29Dr. Carrie Bedient: Before we go, remember, this podcast is for education and entertainment only.

34:33Dr. Susan Hudson: While we are fertility doctors, we are not your fertility the doctors.

34:37Dr. Carrie Bedient: Nothing we discuss should replace medical advice from your own physician who knows your individual history and circumstances.

34:43Dr. Susan Hudson: Thank you for listening.