Ep 342: Your Hormones Are Talking: What They Can Reveal About Fertility & Health

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.

0:52Dr. Carrie Bedient: Hello, everyone, 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 fantastically gorgeous, invincible co-host, Dr. Susan Hudson from Texas Fertility Center. Hello, everyone. How are you all doing today? And we are joined by Dr. Amy DeVaragna, and she is the founder and CEO of Uva. We will get into a little bit more depth about what exactly Uva is and how it can play a role in people's fertility journeys. But Amy, when you and I were talking as we were deciding to set up this episode, you were at your parents' house and you had a fabulous backdrop behind you.

1:34It was honestly that call on that trip that I realized how old my parents' house is. I can't even tell you how much pride I had that my mom made all these curtains, but she also made those curtains 35 years ago.

1:46Dr. Carrie Bedient: I mean, it was a lovely floral pattern and it looked very nice. The only reason I can laugh at this is mostly because, and I can say this because my mom doesn't listen to this podcast, but my mom's house is the exact same way of you walk into it and it's a time capsule into the 90s, which is not necessarily a bad thing. But also, can we update it just a little bit? In her defense, she did change the carpet to hardwood. Okay, it's a step. Yes, we make fun of it so much, but there's this level of comfort that you just cannot replicate without coming into your own childhood home. And if it didn't have that feel and that old, like, this is my home, it wouldn't feel like home.

2:29I'll give her a hard time, but I also don't want her to change it secretly.

2:32Dr. Carrie Bedient: I bet she would be delighted to hear that. I hope so. I will make sure she listens to this podcast. I'm going to say we should definitely send her a tiny little snippet of this so that she knows how much her hard work is appreciated and how lovely it is to go home as an adult and be taken care of. Yeah, I will say going there for a couple of days, totally. Just staying there for a week. I'm like, I don't know how I grew up in this house with these people. It's time for me to go back to my home. But still, it definitely is reminiscent. Yeah, it's remarkable how quickly you can fall into past patterns when you go back to your childhood home.

3:06Dr. Carrie Bedient: Susan, you live, what, three doors down from your mom?

3:09Dr. Susan Hudson: Two doors down from my mom, but it's not where I grew up. So it is in the same city where I grew up, but my childhood home, my mom doesn't live in anymore. After my dad passed away, it was too hard for her to stay there. But I do have to say that I do drive by that house periodically. And we had these two red park benches on our front patio, and they're still there. And the house has been sold multiple times, but these benches have just stayed with the house. And it makes me have that warm and fuzzy feeling that I'm like, it's so awesome to see a little piece of my childhood still there. They're your benches.

3:47Dr. Susan Hudson: They are. They are. That's fantastic.

3:50Dr. Carrie Bedient: All right. All benches aside, do we have a question to play with today?

3:54Dr. Susan Hudson: We do have a question. So our question for today is, can a low intervention approach ever be better? I've done two stem cycles with very low blast rates. First, 150 of all of stem, 75 of menopure, Provera. She had eight M2s, 100 % ICSI fertilization, one blast. The second, I had 225 of all of stem, 225 of menopure, Ganeralix, seven mature eggs, 100 % ICSI, zero blast. I'm 36, 2.5 AMH, everything normal. My husband had 2 % morphology, hence the ICSI, otherwise normal, with low DNA fragmentation. We are healthy and active. We have conceived naturally three times, one live birth in 2023 and a miscarriage 10 months ago.

4:39Dr. Susan Hudson: We went straight to IVF, but now no one can explain our low blast rate. I have seen multiple doctors who advise trying again, but you know the definition of crazy. Should I try ovulation induction or IUI? Or am I kidding myself?

4:54Dr. Carrie Bedient: That's a fantastic question. And I think the answer to this is, one, my inclination would be get a little bit more information in the form of a sperm QT there. You already mentioned the DNA fragmentation sounded fine. And so I think a sperm QT is really helpful. That's a test that looks at the functionality of the sperm. Is it able to break into the egg? And the way that I think about it is a semen analysis looks at, can the sperm show up to the club and line up around the block? And a sperm QT looks at, can they get past the bouncer? And they're two very important functions. You need both. I think before you can really significantly get into the, do you want to do a lower intervention, IUI type approach, you may want to consider doing that one.

5:37Dr. Carrie Bedient: Knowing that you've had two prior conceptions is helpful and promising, but it's possible something's changed health-wise that could impact that. Beyond that, I would say my impression of those two cycles in terms of results is that they're the same. And unfortunately, the way that that reads to patients is not at all the same because in one you got a blast and the other you didn't. But the difference between 7 versus 8 M2s, 100 % FERT and 0 to 1 blasts, those are the same results. And although there is a dramatically different feel and an even potential outcome from the perspective of the stem, that was pretty similar.

6:17Dr. Carrie Bedient: Now, I'd be really curious, knowing that your AMH is 2.5, as good as it is, why we're only getting eight eggs. I would anticipate far more than that. And I would actually, for this one, I think about pulling out growth hormone and maybe some clomid and kind of tinkering a little bit. What would you do, Susan?

6:32Dr. Susan Hudson: Well, I would also be curious as to at what point are they triggering her? I'm concerned that it may be a situation that there are more follicles, but we're not getting more mature eggs because they're not pushing the follicles far enough. Now, back 5, 10, 15 years ago, we triggered at 18 millimeters. We don't do that anymore. Honestly, I can't even remember the time I triggered with a maximum. Like I know in the past I did that, but I've been doing it for so long that I've been pushing them that I don't know when I did that last. And really watching those bigger follicles get into that 22, 24, 26 range.

7:10Dr. Susan Hudson: And sometimes you even push them further than that, depending on where the main part of your cohort is. But I'm wondering if the cohort itself is not getting advanced enough. But I do completely agree with you. I wasn't sure where you were going with the sperm QT because I'm like, we did ICSI. But it's if we're going to do ovulation induction, making sure that the sperm have the capacity to get where they need to be without the XC. I do think that's a great idea. But I do agree with the fact that I think we've had similar results, either adding growth hormone or letting those follicles get bigger.

7:43Dr. Susan Hudson: Maybe it just feels like there just aren't as many eggs as I would have expected for an AMH2.5 as well.

7:49Dr. Carrie Bedient: I wonder if there's some form of endometriosis going on, and that's why seeing a lower yield than maybe you would expect. And so maybe sticking more with the Ganorelix and Orlissa and stronger meds like that may help a little bit, a little bit of pretreatment. But there's something else going on in here that we're just missing that piece of information of why we're only getting eight eggs from a 36-year-old with an AMH of 2.5, because there's some other piece of this puzzle that hasn't come to light yet.

8:18Dr. Susan Hudson: I also accept that, especially if you're in a non-mandated state, you've laid out the cash for two IVF cycles. That's steep. You have one live birth. We really want to have another child. Secondary infertility is just as devastating as primary infertility, so we don't want to discount that. But I have had patients who have been in a similar situation. They said, we're just going to do IUI cycle after IUI, and we're really going to have the endurance to just keep on going month after month. And we've been successful. It is positive that you've had a successful pregnancy in the past, and it was only three years ago.

8:57Dr. Susan Hudson: That's nice information. I think that there is some flexibility. But I do think getting a sperm QT makes sure you're not wasting your money on those IUIs. But if that's normal and you wanted to go down a path that's less invasive, now when we say less invasive, I do recommend ovulation induction with intrauterine insemination because the combination of those two is what actually drives up pregnancy rates in ovulatory women. If you're ovulating on your own and you only do ovulation injection, that really doesn't push the needle. You're just spending money and getting frustrated. And you may get pregnant, but it's probably not because of what was the actual intervention.

9:36Dr. Susan Hudson: But the combination, the synergy of those two actions are what drives up the pregnancy rates. So I think that would be a potential reasonable thing to consider.

9:45Dr. Carrie Bedient: Absolutely. Well, getting to our topic at hand and segueing there. So Amy, as you were creating Uva, or perhaps the impetus to create Uva, was your own fertility journey, which sounds like it had its own share of ups and downs and all of the fun emotions that everybody experiences. So how did you fall into this fertility world? What brought you here in the first place? Yeah, hearing that patient story, it's like bringing back so many things. I feel for the woman that wrote that in. but I found myself navigating a similar journey. I had several health journeys that I found myself navigating throughout life.

10:27For my first period, I struggled with irregular cycles and then after college, I was misdiagnosed with polycystic ovarian syndrome. I was put on metformin. I was put on birth control to help regulate the cycle. Neither really worked for me and I had every side effect in the book. I became incredibly anemic, was bleeding pretty profusely, I became depressed, had a lot of struggles that were ultimately due to the medication, only to find out three years later that I actually didn't have PCOS and just had irregular cycles and just choose to live with it or be on birth control if I wanted to. So it was a very flippant dismissal that I got of that diagnosis and no explanation.

11:04So it put this mistrust in me when it came to my fertility with the medical community. I didn't really want a doctor to tell me how I could or could not get pregnant. When I found my partner and we decided to start trying to have a baby, we decided we're going to try to pursue this naturally. And if it didn't happen, then being a parent just wasn't in the cards for us. And it was honestly a very easy decision to make day one, but one of the toughest pills for me to swallow. Nothing could have prepared us for the journey that we ended up embarking on that day. We did everything right. I timed it, of course, as we should.

11:36It was very exciting in the beginning. Both of us were on board. It got old real fast. And a test that was negative month after month just became even more of a loss. And I found myself grieving something I never had. And it became worse and worse every subsequent cycle. But the worst part was that the tests themselves were kind of broken for me because I didn't have a regular cycle. So I was barely getting highs or peaks. That smiley face never blinked for me in my journey. And it felt a little odd that I wasn't ovulating for so many months because whatever irregular I was, I was still bleeding.

12:10And only to find out that all these tools were designed for women that had regular cycles. And if you had an irregular one, the technology was kind of not meant for you. So I really was starting at a loss. It was this one day when I really thought I was pregnant. Mind you, at this point, I have now isolated myself from everybody. I'm not even kind of keying my partner into the discussion with me. I don't tell them what I think we're pregnant. But this one morning, I really thought we were. And I went in to take that pregnancy test and it was negative. And I was devastated. I mean, I was sitting on the floor looking for a ghost line with my dad's magnifying glass.

12:45There was nothing there. But I was so sure it should have been there. And I realized that there was this moment that clicked for me that I'm sitting here with this like 60-year-old magnifying glass trying to find a line. But technology is moving forward so fast. My PhD work was in such cool science and such cool analytics that I was doing. Yet none of that was being applied here. And I'm still sitting here with a 60-year-old magnifying glass trying to find a line. So this is ridiculous. It has to change. I felt I didn't have the data or the information to really understand what was going on with my body.

13:16And I wanted to change that. That's really what the foundation for Uva came about. I realized that the foundation of all of our health is hormones. And if we could translate that language into something that a lay person can understand, all of a sudden she could start advocating for herself and asking the right questions. And in my eyes, a patient walking into your office informed is very different than somebody walking in defeated. And so I wanted to figure out how do we empower women to be more informed patients so they could get the care they deserved. And that's really the foundation for Uva.

13:46Dr. Susan Hudson: That's amazing. So what is UVA? So we at the core of it, we're at home hormone testing platform. We currently measure three hormones, luteinizing hormone, progesterone, and estrogen through urine. The test is designed to be used daily. It's a simple urine-based test. You pee in a cup, you dip the appropriate hormone test in, and then you scan it with your phone. There's no devices, there's no attachments, there's no Bluetooth. We're using these amazing cameras that we're holding in our hands all day. And you get your quantitative results within seconds. You've done a lot of work to clinically validate this, but the key thing is that we're also HIPAA compliant.

14:19So if you're working with a clinician, you can also share your data with your clinical team in real time. So everyone's having the same conversation at the same time.

14:29Dr. 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.

15:13Dr. 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.

15:27Dr. Carrie Bedient: That's fantastic. So when someone goes to buy a kit, just in a very practical approach, what are they getting? Are they buying like the little hormone strips? How does this work? Do they get the app first? How do you do this? So you buy a kit. The kit comes with 30 test strips. I know it's the podcast, but I'll show it to you and I'll describe it a little bit. It looks like this. So every test strip is basically a urine-based test in a plastic cartridge with a QR code on it. And there's a window where the lines will appear. So when you get your kit, you get 15 test strips that measure estrogen and 15 that measure luteinizing hormone and progesterone.

16:00Those are together on one test or multiplexed, as we say. When you download our app, you go through a pretty extensive onboarding process. We learn a lot about your cycle, if you have any reproductive conditions, what your health journey is, are you trying to conceive or something else? And then we will help you navigate which hormone to test on which day. And on those days, you would collect the urine sample, dip the test in, everything is labeled. We know exactly which hormone by this QR code, and you get your results within seconds.

16:26Dr. Susan Hudson: Very nice. When do you suggest someone to start looking at something like this? I mean, is this something that somebody should start doing if they're not even considering trying for pregnancy or only after they've been trying for a while? When is it recommended? Yeah, sure. I think the conversation has shifted a bit in the past few years since Uva's been in market. Initially, it was designed for women that were actively trying to conceive, and they were basically at the step before going through ART. They've gone through the drugstore tasks, haven't been able to conceive, and now Uva is really designed for those that need some personalized data and to understand their unique cycle.

17:02But now what we're starting to see is that a lot of women are coming to us when they're not even ready to conceive yet, but they want a family plan. Is my cycle regular? I'm thinking of coming off of birth control. Has my cycle returned? What's the lay of the land before I actively start trying to conceive so they could be a bit more mentally prepared for it?

17:19Dr. Carrie Bedient: How does it work when you do have someone who's got really irregular cycles? Maybe they go out two months between cycles and they've got these 15 test strips. How does the app navigate that when you truly may have no idea when to even start testing without having to go through a monster pile of strips? Yeah, absolutely. And I like to say with UVA, we capture all the problem children, which is really majority of the population. It's everyone that has something going on, an irregular cycle or hormonal imbalance or reproductive condition, which is honestly like a pretty decent chunk of this population.

17:56We are really good at personalizing the experience for you. Of course, cycle one, we might have to go through some strips, especially if you have an extended cycle or really a regular cycle. We recommend that you buy our extended kit, which is basically 30 estrogen and 30 LH progesterone. So you're getting 90 hormone measurements in that. But for the most part, we're really good at helping you hone in on what days to test so we can really understand where you are. And because it's quantitative, we can learn what your baseline levels are and then detect fluctuations by comparing to that. So we're not comparing you to that textbook curve.

18:29We're waiting for a threshold like the blinking smiley faces. We're doing something a lot more where we're learning your baseline and waiting for a certain differential on a day-to-day basis to tell you, yes, you're ovulating or yes, you're in your luteal phase. Let's wait until the next cycle. It gets pretty smart pretty quickly.

18:44Dr. Carrie Bedient: How many cycles do you have to go through in order to build that baseline? We are great from cycle one because let's say you just had a bleed and then you start testing. We know that your hormones are just bumping up from baseline. so we can test from there. But if you have a really irregular cycle or regardless, we often recommend that you test for two months or two cycles because women ovulate differently from both sides. We want to capture both of those cycles so we can help navigate you on that third or fourth or whatever maybe.

19:08Dr. Susan Hudson: Is there a group of people that you think this maybe is not a great idea for? Anyone that's actively in hormonal birth control, the data won't be as meaningful because if the birth control is working, it's actually subduing a lot of the hormones. You're not going to see the fluctuations that you would expect. And then also if a patient is actively going through IVF, we would recommend that they don't use UVA because their hormones are going to be substantially higher than what our tests can measure. So they'll get very false. Well, not false, but it will be representative hormone patterns that they're going to detect from UVA.

19:40Dr. Susan Hudson: And how do urine measurements of these type of hormones vary from blood measurements? Yeah, great question. So we've put a lot of our emphasis and our funding and everything into validating the test. We know for clinicians, for example, the gold standard is serum. So if I'm going to tell you you can use Uva instead of blood tests, I need to at least meet the bar that you consider to be the gold standard. We get to a 99 % correlation to serum or the biomarkers that we measure. We put a lot of emphasis on sensitivity and accuracy and all of our tests go out to two decimal places. So it's a very precise test, I guess we could say.

20:15Dr. Carrie Bedient: What other information do patients get from putting together these hormone profiles? And let's say they do those two cycles back to back. Is there other information that they're getting beyond just the, I ovulated on day 26 this month and day 14 that month? What else are they picking up? There's a lot. So hormones are just a piece of the puzzle. There's so much more to this. Your symptoms matter a lot. Your symptoms are your body's way of saying this is what's happening inside. Let's translate that into is this good or bad. What we do with UVA is yes, we capture your hormone levels. We show you your hormone trends, but we also translate it into a language that you understand even if you're not a medical professional.

20:55So we will correlate your symptoms with your hormones. When you talk about your cycle, not only are we telling you if you're ovulating or not, but giving you details about your follicular phase and your luteal phase. I mean, the basic knowledge that a lot of patients have is pretty minimal. Oftentimes, I will ask patients, how long is your cycle? And they'll say three days because that's how long they bled. And I'm like, no, that's not what a cycle is. Let's get down to the basics. You really want to try to make sure, again, that the patient walking into your office is a lot more informed. We'll break down what our follicular phase is, how long it is, what does this mean, luteal phase, so on.

21:28And then what I think it starts getting more exciting is when we start looking at the hormone pattern over time. We define a hormonal archetype. It's kind of a fun thing, but we will describe what pattern that we're seeing and what symptoms are associated with that. What are some lifestyle modifications you can make to regulate some of the patterns that we detect? We don't provide clinical care. So I will never say, oh, you need to go get progesterone or you need to go get a script for something. But we may say you may want to add some dietary supplements into your diet. And not supplement by pill.

21:58I mean, let's add some greens or let's add some chia seeds to get some fiber. into your diet, whatever it may be. We would make those kinds of recommendations to help regulate some of the imbalances that we detect.

22:09Dr. Carrie Bedient: Do you get any extra information about the quality of ovulation by monitoring these long-term progesterone levels? Yes, we do. We don't share that with the patient, but that is something that we can offer through our clinical portal because we're very careful about what we tell a patient versus what we share with clinicians. From the clinician side, yes, you can start to detect that a patient's progesterone is quite erratic. We call it the progesterone zigzag. And in those cases, it's very clear that the ovulation wasn't, the egg isn't forming a proper corpus luteum. There's something that's happening here.

22:39And then as a clinician, you can intervene and do as you wish. But UVA won't make that recommendation. We'll show you the pattern and highlight it.

22:46Dr. Susan Hudson: How is this information shared with patients? Is it through an app? Is it through a conversation with somebody? How do they get to understand what my body's doing? It's immediate. So you scan your test and then you get your results within seconds in the app. And then we provide the context right there. So it's all within the user app.

23:03Dr. Carrie Bedient: If somebody has questions, can they talk to a real person or do they just have to take the data to their doctor and say, here, this is what I have. Tell me what it means. We do offer clinical consults with our clinical team so they can always come to us with questions. Again, we won't provide the clinical care, but what we can do is arm you with the questions and discussions to have with your doctor. And then, of course, they would come to you with those specific questions and ask them to have the data to back it up. But yes, we're happy to talk to patients about what the data means, what patterns we're seeing and things that they can do.

23:32Dr. Carrie Bedient: What other types of things do you pick up for people who maybe do have normal cycles where every roughly 28 days they bleed, it's very routine, and then maybe they start doing this more intense monitoring? Is there other information that's valuable to them that can get picked up in that time, even though they have those quote unquote normal cycles? There's a lot. Again, hormones, I think, are just a piece of it. But when you start tracking what's your hormones, then you layer on additional data. Like, for example, you can track your symptoms in our app. You can also integrate wearables into our platforms where we can monitor wearable data with our hormone patterns.

24:07You start to see some really interesting behaviors that associate with the hormone patterns that you may not have really paid attention to beyond track. One of the big things that we see quite often is there's a strong correlation between estrogen patterns and sleep quality. And so we've been publishing about this quite a bit. We presented this at a few conferences last year and this year. But we see a really strong estrogen decline happen on nights that women experience poor or irregular sleep. That might be something you might kind of shrug away. But when you start to see this hormonal underpinning as to what's causing that lack of sleep, it starts to raise additional questions and things that you may be able to address on those specific days.

24:47We also see a strong correlation with migraines and progesterone patterns. A lot of women see this dramatic decline in progesterone happen in their luteal phase, and that leads to migraines. There's things that can be done there too. It doesn't always have to be medical. It could also be diet and the good habits that you can improve on those days. So I think just getting that awareness has been really helpful for our users.

25:07Dr. Susan Hudson: Is there any information, say, with somebody who has a regular menstrual period or even irregular menstrual period that you see something and you're like, wow, you need to go see a doctor now? Like, do y 'all ever have that piece of advice or is it just these are some modifications you might want to do? We won't raise an alarm like that. And honestly, there isn't that much that we would see that would say like, oh, my gosh, you need to go see a doctor today. I think the only thing that I would really raise a flag for, but we don't do it in product, is we can detect pregnancy pretty quickly in our platform because you start to see an LH and a progesterone behavior.

25:43It's not actually LH, it's beta HCG. That's only present if you're pregnant. And so we have nonspecific binding with that hormone. If you see a certain pattern, then we will flag like, oh, this patient may benefit from getting a pregnancy test. Our support team may reach out to them and be like, hey, everything cool? Do you want to go get a pregnancy test? and then we usually get very happy news.

26:03Dr. Susan Hudson: Do you ever note people who have very high baseline LH levels, whether it's from things like PCOS, or sometimes you have people who have severe diminished ovarian reserve who have those crazy high LH levels? Do you ever see that type of situation? All the time. And for those patients, we actually don't ping a false positive in that sense because we learn that their baseline is actually elevated. So again, that goes back to that differential that we're looking for on a day-to-day basis, we wouldn't flag ovulation for this user unless if you see a proper rise happen in that LH and the proper estrogen pattern beforehand.

26:39There's a lot of checks in this. It's not just one hormone that we're focusing on.

26:43Dr. Susan Hudson: Are users aware of a high baseline LH level in that type of situation? Or is it just that it's something that it's like, oh, we're not noting ovulation? They would see the actual levels. And so they may, when they look at our reference range, they're going to be like, oh, this is really high. but we don't flag it as like this is the negative in any way. So we're quite careful about the messaging in our platform. We're very conscious of the mental state that a patient's in when she's going through a fertility journey with us. And we're really careful about what we say and how we say it. After living through it, like you know how sensitive women can be.

27:16And I'm really cautious about how we message things to those users.

27:20Dr. Carrie Bedient: What kind of interventions can people do before they go to the doctor with all this information? I mean, there's a lot. We provide a lot of guidance on lifestyle modifications that you can make. And then we also provide them with a list of questions that they can go to their doctor with. So they're not just coming blind. We try to arm them a little bit. From those questions, it also starts to elicit, okay, maybe I can address this. Like, should I add more iron to my diet? Or should I add more fiber to my diet? And why? And so we try to provide some education there. But we focus more so on lifestyle changes that you can make versus jumping into something that's very therapeutic.

27:55Those could all be done before you go see the doctor for sure.

27:57Dr. Carrie Bedient: What kind of questions are useful for patients to have once they have this data in hand and they're preparing for their first doctor visit where they're going to say, here, look, this is what I've got. What questions are helpful for them to ask to get the most out of both the data and the doc that they're seeing? It depends on how much data we're talking about. So let's assume you've done two months of baseline and you see that there's irregularities in your cycle. They're not equal lengths. Very common, but often that can be kind of alarming. We see from our research that patients often think they have a 28-day cycle and they actually start measuring with UVA.

28:3295 % of patients didn't, and they're actually quite off. You just don't realize it unless if you're actually tracking it every single day. And so I think starting even at the basics, my cycle feels a little irregular. Is this okay? Am I ovulating regularly, it starts to stem those questions of what is my egg count? Should I get my AMH tested? And I think you're walking in not scared when you say you should get your AMH tested. All of a sudden the patient's like, wait, what does this mean? Now they're like, okay, I understand why. And what we've heard from our clinical partners and from patients is that those discussions have felt a lot more well-received and two-way versus the doctor just kind of speaking to avoid and the patient trying to remember everything or putting their sound recorder on, trying to capture every note.

29:16Now it's like, okay, I understand why you're saying this to me. Here's another piece of information. Does this feed in or explain why this is off? And it all of a sudden becomes a very interesting conversation for both parties.

29:25Dr. Susan Hudson: If someone's interested in using Uva, how do they get it? Do they go to a store? Do they buy it online? How does that work? It depends. We are available online, so you can buy us, go right to our website. You don't need a prescription or anything. You can just get it directly there. A lot of our clinical partners also keep kits in stock. So if your doctor is one of our partners, they may offer it to you as part of a protocol. But I think the fastest way is probably just getting it from our website. And how much does the kit cost and does insurance cover this? It's not covered by insurance yet.

29:56We are working on it, but it is HSA FSA eligible. And it costs$129 a month if you do the subscription and you'll get 45 more measurements.

30:05Dr. Carrie Bedient: So after all of this, how did your fertility journey go? It went great. Uva is one year older than my son. It had a happy ending, but man, that was a journey we went through to have him. And the great thing is that he's aware of the journey. I think it's important for him to know why Uva exists and how he came to be. I think it's actually quite beautiful that he sees what we're trying to build here and what we're trying to do. That's fantastic. What kind of research have you guys done with Uva? So we've done a lot. And I think what's really cool is because we get all the so-called problem children, we get these really cool subgroups that are often ignored in a lot of the larger studies that are published.

30:45So for example, we've done a lot of work looking at advanced maternal age and looking at ovulatory patterns there. We've tried to debunk a lot of the myths around women's cycles. So for example, thinking that 28-day cycles are the norm, we find that that's actually not. And 95 % of women don't have a 28-day cycle. So we should really be building for a non-28-day. We also think that ovulation happens right at the 50 % point of our cycle. It is not true. It changes, especially as we age. What we're trying to do is back up a lot of the assumptions that we have about the women's reproductive system with data and really educate everyone on what is happening in our body instead of just doing all these assumptions.

31:27Dr. Carrie Bedient: What do you find about luteal phases? I have a lot of patients who come in doing the traditional OPKs where you pee on a stick, pick up that one surge, and then just start counting the days till the next period. And they're completely agonizing over the fact that it's not 14 days. What kind of patterns do you pick up and other information do you get? I was in that boat and I totally sympathize with those women because it's not the case. So I can speak from personal experience. Like my cycle, I barely got highs and peaks on the LH test because after using Uva, I learned my LH surge is just on the lower side.

32:03So my peak just never hit those thresholds, but I was ovulating. Those tests also didn't measure progesterone, so I didn't know if I was actually releasing an egg. What we see in our data is quite interesting. One, the length of the luteal phase changes as women get older. So it does get longer and we shouldn't be anchoring on that 14-day luteal phase. It could be longer and that could be very much normal for you. But it's good for you to be aware of it so you can time intercourse effectively. It also can take up to 72 hours for that corpus luteum to form after that LH surge to emit enough progesterone.

32:34You can still conceive in that time. But a lot of women think like, oh, I had my LH peak. Let's go get a pregnancy test. Am I pregnant? It doesn't happen overnight like that. There's still more time. There's a lot more that needs to happen. So there's a lot that can happen in the luteal phase. And then what's also interesting is that we see a lot of luteal phase defect. I know clinicians don't like that word, but we will often see that the progesterone just doesn't stay stable after the LA surge. And it's because the corpus luteum didn't form well. So forget the term luteal phase defect for a second.

33:04The key message here is that the progesterone isn't in that steady stream or plateauing as we expect it to. And we should address that because that could be a bigger problem. There's a lot in the luteal phase.

33:14Dr. Carrie Bedient: Yeah, that's fantastic. All right, perfect. Well, thank you for all of the extra information. We appreciate it and our listeners very much appreciate it because when women come to us, they're just at their wits end and so many rely on data. It helps them to feel comforted. It helps them to feel like they understand what's going on. And so getting that extra boost of information is very valuable. So thank you so much for creating this and I'm so glad that it worked for you. Thank you so much.

33:46Dr. Susan Hudson: Great to have had you here today.

33:48Dr. Carrie Bedient: Thank you. This has been Dr. Amy DeVaranya from Uva. And if you're looking for those products, look online, go to their website, and hopefully they can be helpful to you along your way. And thank you so much for spending part of your day with us. Thank you so much for having me.

34:04Dr. Susan Hudson: It's great speaking with you guys. Absolutely. We're glad to have had you. And for our listeners, if you have enjoyed this episode, subscribe, leave a review, and send us your questions at FertilityDocsAndSensor.com.

34:15Dr. Carrie Bedient: 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.

34:24Dr. Susan Hudson: Before we go, remember, this podcast is intended for education and entertainment only.

34:29Dr. Carrie Bedient: While we are fertility doctors, we are not your fertility doctors.

34:33Dr. Susan Hudson: Nothing we discuss should replace medical advice from your own physician who knows your individual history and circumstances.

34:39Dr. Carrie Bedient: Thank you for listening. Bye.