Ep 343: Fertility & Career Planning

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 audacious, amazing co-host, Dr. Carrie Bedient from Fertility Center of Las Vegas.

1:05Dr. Carrie Bedient: Hello.

1:06Dr. Susan Hudson: How's it going? Doing good. Doing good. Good. What's new? Not much. It's just it's going to be fall and hopefully it starts getting a little cooler this year. I'm sure it's been crazy hot in Vegas, too.

1:20Dr. Carrie Bedient: Yeah, it is definitely roasty toasty. Still not a whole lot in the way of outdoor activities going on besides swimming, but we're getting there.

1:29Dr. Susan Hudson: Yes, yes. So I have a question. So when you were little, what were some of the fun things that you like to go do?

1:36Dr. Carrie Bedient: So I would say on an average school day, weekend day, afternoon, it was get on my bike and ride down to the park that was maybe a mile away. And they had a little splash pad. And one of my, really one of my favorite things is when they would irrigate the fields on the school, I would bike down to the elementary school. And all the baseball fields, because soccer was not as big then, so everything was baseball fields, would be under a couple inches of water. You take off your shoes and you go splashing through it, which in the middle of the desert, like that's the only time that that happens. And so you just kind of run around and splash and frolic in wet conditions that never, ever happen.

2:17Dr. Susan Hudson: That sounds fun. That's good memories. Yeah. What about you? Something I think about when I was little. So my parents both commuted to work. They both had like hour commutes. So I spent a lot of time with my grandparents and they always had a hula hoop for me. And so I loved hula hooping. And I know it sounds so corny, but I could go outside and spend hours doing tricks and throwing it and sliding it and then coming back to me and all kinds of stuff like that. So that's a good childhood memory.

2:49Dr. Carrie Bedient: So did you ever do anything with it in terms of becoming a baton twirler or a belly dancer or anything like that later in life?

2:57Dr. Susan Hudson: So I do have to say I did win a hula hooping contest in Wiley, Texas at one time. I have a cousin who lived out that way. And I'm pretty sure it was when I was in college. I had gone to visit her and there was like a 4th of July celebration or some sort of thing like this. And they had a hula hooping contest. So I can say that was my claim to fame with hula hooping.

3:22Dr. Carrie Bedient: I feel like that needs to be some Susan trivia in an upcoming meeting somewhere.

3:28Dr. Susan Hudson: It would be a good one. So John Stormont, if you're listening, that is my next trivia.

3:34Dr. Carrie Bedient: That is Susan trivia.

3:34Dr. Susan Hudson: Yes.

3:35Dr. Carrie Bedient: That's amazing. I am going to find a way to bring that into casual conversation at the next meeting that we go to.

3:42Dr. Susan Hudson: Just think about it. We've been doing this for six and a half years and you actually learned something new about me today.

3:48Dr. Carrie Bedient: Yeah, I like it. I like it. I feel like There should be a blue ribbon stashed somewhere, perhaps with glitter on it for your amazing win or perhaps a trophy. Maybe, maybe. Okay. Okay. Duly noted. All right. Do we have a question for today?

4:08Dr. Susan Hudson: We do have a question for today. Hi, I love the podcast. I want to get your thoughts on if I should do an egg retrieval prior to endometriosis surgery, just do IVF or just do the surgery. I really don't want to do IVF, but when I went to meet with my endo specialist, she recommended doing IVF since the surgery could damage my ovaries. I have a 5-centimeter endometrioma on my left ovary and two small ones on my right ovary. Just wanted your opinion. That is a great question.

4:36Dr. Carrie Bedient: Yeah. How do you approach your endopatients with cysts? And that's a very important qualification because not everybody who has endometriosis has endometriomas.

4:47Dr. Susan Hudson: So the way that I deal with my endopatients nowadays, which historically hasn't always been the same, this is definitely an evolving way of practicing medicine. I am a minimalist when it comes to removing those endometriomas. If the endometriomas seem to cause a whole lot of pain and the patient feels very urgently, I need to have surgical intervention. I think that's one thing. But if it's really not too bothersome, I would rather stimulate around those endometriomas and get as many eggs as I can. Because I've had people who I've removed endometriomas and that ovary just didn't stimulate in the future because you're going to lose eggs.

5:33Dr. Susan Hudson: And I think there's more than just losing eggs to those surgeries. That there's something structurally, biochemically, who knows that they just don't react quite as well. and then either prophylactically giving Lupron or Oralisa for two months prior to embryo transfer in case there's BCL-6 or if they want to have BCL-6 testing. Anytime you take medications that are going to make you temporarily menopausal, it's not necessarily going to be a fun thing to do. So some people would rather have the testing, plus your insurance is more likely to cover Lupron or Oralisa if you have positive testing. I've had a lot of people who've been able to get coverage for the meds with that finding.

6:16Dr. Susan Hudson: And considering those medicines aren't cheap, it's sometimes worth the endometrial biopsy.

6:22Dr. Carrie Bedient: Yeah, yeah. I would agree with that. Your surgeon's right. Doing surgery has the potential to have a very big negative impact. And I would agree if someone's having pain and big symptoms, absolutely go get it taken out. But if we can avoid removing it before we do the stem, so much the better. Now, when we do the egg retrieval, our goal is to not hit that endometrioma at all. We don't want to go into it. We don't want to touch it. That is not always possible for two reasons. One, because sometimes they're just so big that they get in the way and you really don't have a choice but to go through them.

6:56Dr. Carrie Bedient: The other reason is because sometimes when you do a stim in somebody with endometriosis, you get follicular development or at least what looks like follicular development, but But then you go in to puncture that follicle and instead of getting that nice clear straw colored fluid out of it, you either get a clogged needle because endometrioma fluid is thick and kind of the consistency of chocolate sauce. Or you just get this blackish, greenish, brackish back that doesn't have any egg in it. And you've gone into it thinking, oh, this is a normal follicle. And then as soon as you puncture it, it is not.

7:34Dr. Carrie Bedient: And so sometimes you inadvertently puncture them because there's not really a way around that. Sometimes if it's really big, if we think it's a problem at all, we'll give additional antibiotics afterwards to prevent any sort of infection. But a lot of the time, you don't necessarily have the ability to avoid going through that endometrioma. So we try and suppress it as much as we can, go into the stim, stim harder than we would otherwise to overcome local hormonal response and environment and just see what we can get.

8:05Dr. Susan Hudson: I think we're both on the same track there.

8:07Dr. Carrie Bedient: Yeah, yeah. But I agree. I think the desire to do surgery for endometriosis is considerably lower now than it was even 5-10 years ago when it's just they're big surgeries. They don't always help. They have the active possibility of hurting. And if someone doesn't have a history of pain and other really concrete reasons to go for it, it has the potential to at best be awash and at worst cause some significant damage to fertility. Absolutely.

8:35Dr. Susan Hudson: All right. Well, today we are going to broach a subject that's near and dear to both of our hearts. And what that is, is balancing fertility care with your career. And this is something more and more women are experiencing. And we really think this is worth us sitting down kind of talking about how do you balance these things, whether you're early in your career, late in your career? How do you deal with work and having to do doctor's appointments and all that kind of mess?

9:07Dr. Carrie Bedient: I remember while I was in training, going up to meet with longtime friends of my husband's, and the woman sitting there said, oh, I don't think that age-related decrease in fertility is real. And I remember looking at her going, I have a whole career in a busy waiting room that says otherwise. And I always think it's interesting that Some women are very, very well attuned to what time and age does to fertility, and others aren't necessarily. And sometimes it's with good reason, because their mothers, their grandmothers conceived when they were in their early, mid, sometimes even late 40s. But for better or worse, there is a big impact on age and how you factor a career that may require a lot of education or training or hours logged kind of time really plays a large role in how your future is shaped.

10:02Dr. Susan Hudson: Absolutely. Absolutely. So an important thing to understand is that women are born with all the eggs we're ever going to get. So when you were in your mama's tummy, you had about three million eggs. By the time you're born, you're down to a million. by the time you went through puberty down to about 300 ,000. We ovulate or release about 450 in a lifetime, and the rest of them undergo something called atresia, or programmed cell death. They just kind of disappear. The rate at which they disappear significantly increases in the upper 30s and early 40s. So by the time you're getting into your upper 30s and early 40s, not only do you have fewer eggs because of all these things we just talked about, but they're also much more fragile.

10:45Dr. Susan Hudson: And when we think about baseline, if you're in your young 20s or mid-20s and creating embryos, in that situation, we expect half of the embryos to be chromosomally abnormal, not have the right number of chromosomes to result in a happy, healthy, normal baby. And as we get into probably the late 30s, you're maybe looking at 60 plus percent, early 40s, 70. And by the time you get to around 45, probably 90 to 95 percent of those embryos are going to be chromosomally abnormal. It's not that you can't get one. It's that statistically, your odds are getting lower and lower. So thinking ahead of what you may want to be doing if you're thinking about delaying

11:35Dr. Carrie Bedient: childbearing is an important thing. How do you think that women who are in their perhaps early early college careers, think late teens, early early 20s, maybe they're in graduate school, let's start with college. What do you think those women should be thinking about? Do they have to do something in college or in that 18 to 22 range to protect or preserve their fertility at all?

12:02Dr. Susan Hudson: Say the vast majority of women do not need to worry about this when they're in their young 20s. It's mainly because realistically, if we're thinking about things like egg cryopreservation, that we want you to cryopreserve eggs at a time that your eggs are still, quote, nice and young, but also at a time that you're more likely to use them. And as much as we are more than happy to help freeze eggs for a 22-year-old, statistically, a 22-year-old is going to be one of those numbers you hear about in the news of, oh, all these people are freezing eggs and they're never going to use them. It's kind of a situation where it's a good thing to start thinking about, but not necessarily do.

12:42Dr. Susan Hudson: Now, if you have any major health issues, you have endometriosis, you have autoimmune disease, you are somebody that I would go back on what I just said and say possibly freezing eggs sooner than later is a better idea. Because whether you may need to have surgery or your body may fight off your ovaries and you don't even know it, Those things can happen. And what you want to make sure is if you're 22 and say you have celiac like me and you are going to be like, oh, I'm not going to worry about having babies until I'm in my early 30s. Well, your early 30s may translate to somebody else's mid to late 30s.

13:24Dr. Susan Hudson: Not knowing exactly how many children you may want to have, that might be a good time to think about egg freezing. realizing that the younger you are the more eggs you're likely to get and the fewer of those eggs

13:38Dr. Carrie Bedient: it takes to yield a baby exactly and some of the limitations that of course someone in their late teens early 20s is going to hit is all the financial impacts of this as well as some of the mental and emotional impacts of it because when you're going through this you're giving yourself injections every day and you're getting lots of vaginal ultrasounds which most people at 18, 19, 20 have not had the opportunity to experience GYN care. They haven't had a pap smear. They haven't had a vaginal ultrasound. They haven't had that more regular exposure. And while it's not bad if you need it, it's something that oftentimes people handle a little bit better when they're a bit older.

14:20Dr. Carrie Bedient: And the mystique of the vagina in the gynecologist's office is not quite as great because they've got more personal experience and more accumulated experience with just their friends and family members and hearing stories and just kind of having an idea there. There is one thing that I do think that younger women need to be very aware of with respect to their fertility. And that is the impact of what having unprotected intercourse can do. And it's so interesting that all of us spend years and years and years going, oh my God, I can't get pregnant because if I do, I'm going to derail all my life plans.

14:55Dr. Carrie Bedient: and then you get to your desiring fertility years and you can't get it. But the reason I say be aware of unprotected intercourse, it's not just the ability to get pregnant, it's the ability to avoid disease. And gonorrhea and chlamydia do have very real impacts on tubes and nobody ever voluntarily gets those. Nobody is just randomly sloppy and gets it. But it's one thing to really consider because it does have such an impact later on. And it's a relatively minor thing. It's unlikely to jeopardize your health as a whole, but it really will have an impact on what happens later in your ability to have kids on your own.

15:37Dr. Susan Hudson: People are trying to figure out when in their professional life they're wanting to have children. And they're thinking about things like freezing eggs versus freezing embryos. What are some of the things that you should think about when making that decision?

15:55Dr. Carrie Bedient: So stability presence of a partner is really the biggest thing between eggs and embryos. And if you have someone who is a known life partner where you're in it for the long haul together, that is one of the cases where creating embryos can oftentimes make more sense. Because once you create embryos, you can't go back. You can't hit the reverse button, rewind button. You can't undo everything that has already been done. Even though you get a lot more information about embryos, about what's going to happen in the future, there's no going back from that. And so oftentimes relationships that are occurring in that point, they are still in the formative years.

16:35Dr. Carrie Bedient: Is this the person we're going to hang out with forever and ever on then? Or is this a relationship that's likely going to change if for no other reason than you both move to different cities to pursue whatever dream you have next? Most of the time, we're thinking about freezing eggs in this category. Now, there are some situations where if you have someone who knows that they are not going to have a male partner ever, then great, get the sperm. Use a donor, pick someone who has whatever attributes are most important to you, and you can make an argument for any number of different ways to choose that, whether you choose someone who's got attributes that are more like you in terms of how you look so that any future partner doesn't feel like they're being neglected in the sense of maybe you choose a donor who looks exactly opposite to what a future partner ends up looking like.

17:24Dr. Carrie Bedient: But in those cases, choosing a sperm donor and going that route may make a lot of sense. But even then, you still may come across somebody in your life, whether it's a brother of a future partner or other family member or friend or someone who there's an extra connection to using their sperm that would overrule wanting to use a donor. Those are some of the things to think about. So especially in those younger ages, most of the time it's eggs rather than embryos for those reasons.

17:51Dr. Susan Hudson: Also know you don't have to do all one versus the other. Some people may do a split cycle or even do two cycles, which I usually recommend people doing instead of splitting their cycles. But having one cycle dedicated to eggs and one cycle dedicated to embryos. If you're kind of in a gray zone of, hey, I really want to have an idea if I have chromosomally normal embryos, but I also want to leave my options open to do other possibilities in the future.

18:25Dr. 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.

19:10Dr. 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. but available now wherever books are sold.

19:24Dr. Susan Hudson: What do you think about when people are like, my career is too busy for whatever reason, travel, dedication, climbing the corporate ladder, whatever it may be, and they're just like, I'm not going to carry the pregnancy. I'm going to use a gestational carrier whenever that happens. What are some of your thoughts and potential concerns in that situation?

19:44Dr. Carrie Bedient: That is a complex, very complex question. And the first thing that comes to mind is just the practical impact of using a surrogate or a GC, so gestational carrier, which is the more accurate term in the sense of surrogacy often implies that there's a genetic relationship between the person carrying the pregnancy and the embryo, the fetus, the baby. And in the vast majority of cases, that is not the case. There is complete genetic separation. And so gestational carrier GC is the more correct term there. but number one using a gc is exceptionally expensive and you are not only having to reimburse the surrogate for her time and for all of the medical expenses but also for the risk that she is undertaking because pregnancy is an event that can kill you and it can irreversibly change your life someone who is willing to do that unless it's an altruistic surrogacy where a friend, family member is caring for you, it ends up being a very expensive experience because there's agencies to work with.

20:47Dr. Susan Hudson: And when Carrie says expensive, she's talking about$150 ,000 to $200 ,000 minimum, not including your IVF cycle. So it's a house.

20:57Dr. Carrie Bedient: Yes, it is. It is absolutely a house, down payment for a house, maybe a semester's worth of college at this point. And it adds up very quickly. That is one concern straight off the bat that while yes, you can do it, you have to think about it very, very carefully because it is such a big financial decision and impact. That is by no means the major reason, but it is a very significant reason to think about it. Besides financial, what else can factor into this decision?

21:29Dr. Susan Hudson: So where you live can factor into that decision. So number one, gestational carriers are not necessarily legal in all states nor all countries. And since we have lots of international listeners, we completely want to acknowledge that. But also in certain states like Texas, we have lots of gestational carriers. I see gestational carriers all the time for monitoring. But you have to have a reason for using a gestational carrier, like a health reason. It can't be just what I would call social gestational carrier agreement where I just don't want to carry a pregnancy. You may or may not have that ability depending on where you reside.

22:14Dr. Carrie Bedient: The other thing to consider is that someone whose career is important enough to them to say, I don't have the ability to carry my own pregnancy because I am too busy and too wrapped up in all of this. Typically, those people are what you might call type A, have perhaps obsessive compulsive personality traits, not disorder, but traits because traits are absolutely functional in that realm. And you are used to a level of control and perfection and excellence. And all of those things rolled in together. other. When you have a GC, you don't have any of that. And people will say, oh, but there's a contract.

22:57Dr. Carrie Bedient: Oh, they're going to agree to, oh, they're blah, blah, blah, blah, blah. And yes, there is a contract. Yes, you're going to vet the situation, your agency, because most people are using an agency, they're going to vet it. And ideally, you and your surrogate very much are on the same page, but your surrogate is not you. And that is a very important distinction because there are things that all of us will go through for ourselves that you won't necessarily go through for a job. And the level of precision control and having an exact precise knowledge of everything that happens, you will not have that with a surrogate.

23:33Dr. Carrie Bedient: And it is a very unreasonable expectation to think that you will. I would venture to say in one of the things that is going to be probably the most important thing that most of us are going to do, there's absolutely exceptions to that. But this is the biggest impact you're going to have on somebody. To be able to have that control and discipline and do it the way that you want to do it is very important because you're not going to hire a private detective to follow your surrogate around to make sure that she only has four ounces of pulp-free orange juice from an organic food store. It's just, it's not going to happen.

24:09Dr. Carrie Bedient: And there are really things that you're going to want to control that you're not going to be able to. And knowing that is important because oftentimes the people who are in a position to say my career is so important that I can't do that, considering those other things will factor into your decision.

24:24Dr. Susan Hudson: Okay. So to change our angle a little bit, let's talk a little bit of how to navigate fertility care with your career. So we're trying to do making babies and we're trying to do our job and do all the things we love doing. So what's one of the first things that you think about in this scenario that would be helpful for somebody who's about to jump into fertility testing, treatment, etc.?

24:50Dr. Carrie Bedient: We live and die by your menstrual cycle. And knowing when you get your periods factors in hugely. Now, a lot of patients in this scenario are on birth control pills and have been for quite some time, which is fantastic because it gives us a measure of control over when your appointments are going to fall. The potential issue with that is that birth control pills when used for a long period of time are suppressive. Now, suppressive is different than damaging. I didn't say damaging, but when your egg count is suppressed, we're not going to get as many. And so oftentimes we will have you come off of your birth control pills.

25:24Dr. Carrie Bedient: And typically you can leave IUDs in place, you can leave the arm implants, those types of things, all of those in place, but birth control pills, NuvaRing, those types of things are going to come out. And so you need to factor in how your menstrual cycle is going to key into what you are doing. And if you have a ton of travel, for example, it's worth having a discussion with your clinic of, okay, which one of these things have wiggle room and which one of these appointments do not have wiggle room? Because in the testing phase, there's oftentimes ways that we can work around it. Once you get into treatment, we get a lot more rigid and defined because, again, we are all control freaks as well.

26:07Dr. Carrie Bedient: And we want to make sure that we've got the data that we need to make the best decisions for your cycle to go forward. Knowing that we live and die by your menstrual period and your menstrual period does not care when you have a big meeting is important.

26:20Dr. Susan Hudson: Also know that as we live and die by your menstrual period, your ovaries generally are what are calling the shots. So whether you're doing inseminations or you may be doing IVF, we're going to say, hey, it's go time at the time that is ideal for your ovaries. And that is not going to be based on a calendar day. It's not going to be based on weekend, weekday, what time is convenient. It's going to happen when it's going to happen. So understand that there are going to be some times that you need to pivot relatively quickly or your partner may need to pivot relatively quickly is important. I mean, I have quite a few patients whose partners work offshore or travel long distances.

27:09Dr. Susan Hudson: And it's important for me to know, hey, is your partner about to be deployed?

27:13Dr. Carrie Bedient: Like, yes, you need to know these things.

27:16Dr. Susan Hudson: We need to know these things. We're really good at planning and manipulating, but there is a limit to what we can do. And also know that generally speaking, if you work for a larger company, so a larger company that has to work by federal statutes like FMLA and that type of thing, what you are undergoing is a health care encounter, which means if you need your FMLA forms signed, you can do that. Now, a lot of people like to keep everything very close to their chest, and I completely understand that. However, I do think because as often as you have to be seen for fertility care, if you're just randomly taking off half days or a couple hours here and there, if your employer at some level doesn't have a glimpse of what's going on, it can look a little, I don't want to say shady, but it can look suspicious that you may be looking for another job.

28:17Dr. Susan Hudson: I mean, quite frankly, but that's kind of what it looks like oftentimes. And so sharing just enough information of, hey, listen, I'm going to be going through some medical treatments, whether you say it's fertility or not, it's a very personal decision, but sharing a tiny bit of information will often make your life easier because even though you You don't want everybody and their brother knowing your business. Having a little bit of knowledge makes people a lot more understanding. Sometimes people will be like, oh, well, I need to schedule all my days off two or four weeks in advance. That is not practical in our world.

28:55Dr. Susan Hudson: It's not going to happen. And so if you can explain enough that they have enough information to know, hey, there's something else going on here that's medical, you're likely to have an easier go of it. And you're not going to get some of those negative effects that a lot of people experience at work.

29:14Dr. Carrie Bedient: A component of that is when you go to your appointments. Most of our appointments are falling in the early morning because we need to get results on your labs and ultrasounds, usually by midday, so that our teams can turn around, make the decision. The staff can reach out to you and say, OK, here's what happens next. And that means that many clinics open early. So, for example, we open our doors at 6 a.m. That means for a lot of people, they can get in and out before their day truly starts, or they can talk with their work wife, their boss, their whomever to say, hey, I'm going to need to be about a half an hour late on these days.

29:52Dr. Carrie Bedient: and maybe you just strike up a deal that says, okay, I'm gonna stay an extra half an hour those days and I'm just gonna shift my hours a little bit or give a little bit of that explanation so it doesn't look like you are interviewing somewhere else or being disrespectful of arrival times, things like that. And maybe you get a little bit of coverage so that you don't have to go into FMLA because the other component of the FMLA is you don't really wanna take off two full weeks at a time for most people if you can avoid it to do your stims. At best, you want to take off just the time you need because ultimately you want to keep that FMLA for when you really need it, for a family member who's sick, for when you decide to have a baby yourself, all of those types of things.

30:35Dr. Carrie Bedient: You don't want to burn it if you don't have to. Knowing where you can work it is very helpful, and getting some folks on your side is very helpful. Your clinic can also help with that. We know who our early starts are, the nurses who have a 7 a.m. shift start or the docs who have 7.30 surgery start, whatever it may be. We know who our early start folks are and who's got to be in and out as fast as possible. And while we don't always control that clinic is as busy as the clinic is, we try and help you out as much as possible because we know going through this is stressful. And part of what makes that stressful is work.

31:12Dr. Susan Hudson: A little bit of a tangent from this, but definitely related, are our educators. And one thing that I want anybody who's an educator, who's a teacher, or has some other type of seasonal work, is that if you were thinking about getting fertility care, establish care well ahead, like months and months and months, before you're going to have some sort of break that you want to be very intentional on having treatments during. And this is the reason why. If you show up on May 31st after school is out, it is highly unlikely that I am going to have you pregnant by August 1st. It can happen. It's just not likely to do so.

31:58Dr. Susan Hudson: We generally need at least one menstrual cycle to get all of your testing done. And if there's anything that needs intervention, whether it's a surgery or maybe your partner's sperm count isn't as good as it needs to be, and we need to be working on that amongst lots of different things. If we're boxed in a corner, we know you want to be pregnant yesterday. We're going to move as quickly as we can, but giving us two months to make everything happen, it's a bit of a stretch. Exactly.

32:28Dr. Carrie Bedient: And we, again, we want to help you as much as we possibly can. We get as much as the next girl. We understand what career drive and ambition and busy schedules can do. We absolutely want to work with you. But knowing that it takes usually a couple of menstrual cycles to get all this stuff put together is helpful. And the other component of that is it's not just the physical requirements of call on the first day so we can get day three egg testing. It's the we need to get our medications together. And most people have not had to deal with meal or pharmacies to the extent that we do. And they haven't had to deal with the kind of financial impact that an IVF cycle, an IUI cycle has.

33:11Dr. Carrie Bedient: And prior auths take some time. If you're so fortunate to have insurance that covers fertility care, please know that for us, it's going to take a couple weeks to get that prior off. And even though the insurance company will tell you, have the clinic put ASAP urgent important on it, when we ask for that from the insurance companies, they might as well be flipping us off. And there are no emergencies in the fertility field from their perspective. You might get lucky and you might find somebody who's willing to make it fly through quickly, but that is not the experience, especially not of a fertility clinic where we are submitting dozens of those auths a day.

33:48Dr. Carrie Bedient: And the insurance companies, they don't particularly care whether you start this month or next month. And it's probably not going to make an impact on your ultimate outcome, but it will absolutely make an impact on your life. The more you can plan ahead for this, the better.

34:02Dr. Susan Hudson: It's going to vary a lot depending on how you have your coverage. So if you have coverage and it's through one of what I would consider kind of a third-party entity like Progeny or Maven, those auths generally go through very quickly because fertility is all they do. If you have your IVF coverage or other fertility coverage through conventional insurance, United, Blue Cross, Blue Shield, Aetna, those take a relatively a solid two weeks.

34:31Dr. Carrie Bedient: Yes. And knowing, having fully explored what your benefits are beforehand is really helpful because most fertility clinics are going to help you know, okay, your insurance covers this, they don't cover this. But there are things that sometimes patients will identify of, oh yeah, I was talking to my coworker and I have to do X, Y, and Z to activate this benefit that your standard insurance company isn't going to know and we're not going to know unless you tell us. that I do have progeny or, oh, I do have Maven or one of these other things. Talking to HR and finding out, hey, what are these benefits can be really helpful for two reasons.

35:12Dr. Carrie Bedient: One, because you'll find out what the benefits are. And two, because if you don't have great benefits or if you do, that's giving them extra reinforcement that this is important and that their employees are using it because employer retention is a big deal and fertility is a large portion of it.

35:27Dr. Susan Hudson: And as just another helpful hint when it comes to insurance, if you are a female and you have a male partner and your male partner is the one who has the quote IVF or IUI insurance and you are not on that policy yourself, that insurance policy is not going to cover all the things it would if you're actually covered under that policy. A lot of times we have women who have the great policy and the guys really don't have much of anything or they may not have insurance, that is a much less bigger deal than the male partner having the fantastic fertility insurance and you not being under that policy, whether it's a primary or secondary policy for you.

36:12Dr. Carrie Bedient: So open enrollment periods are key for this because they usually only roll around once a year or with major life-changing events. And knowing when that open enrollment period is in relation to when you want to go through treatment is huge. The other thing to know and consider is if you are considering a job change and the job that you're leaving or the job that you're going into has great fertility benefits, some people will say, I've got great fertility benefits now and I'm going into a job that also has great fertility benefits. It doesn't matter. It does because there's a cap on all of those benefits in the vast, vast majority of places.

36:49Dr. Carrie Bedient: It is very rare that we get unlimited anything. And if you know, okay, my current job is going to cover X, maybe they cover an IVF cycle and my next job is going to cover an IVF cycle. If you can maximize that first IVF cycle and the position that you're leaving, that gives you more wiggle room later. And you may find that's beneficial to get COBRA or to get at least an egg retrieval with the first insurance, sometimes it's actually more beneficial to pay cash for an embryo transfer because those are less expensive and then use upcoming insurance for another IVF cycle to get more embryos. And these are all nuances that are going to vary highly depending on what your situation is.

37:32Dr. Carrie Bedient: They're going to vary highly based on what insurance coverage you have and what plans you have. So you can elect to choose oftentimes PPOs versus HMOs versus this, that, and the other thing, higher premiums, lower premiums. All of those things have an impact and being able to get into that and know, yes, I can access that even if I had my tubes tied voluntarily or my partner had a vasectomy. Those kind of details matter. If you happen to have a job that's got great benefits right now, take it and run because they may not have those next year.

38:05Dr. Susan Hudson: All right. I think we've given a lot of good advice today. What do you think, Keri?

38:09Dr. Carrie Bedient: Yeah, I think these are all things that are super helpful. One of the biggest overarching tips that I would say is think about your fertility, if it's important to you, think about your fertility early and come up with a tentative plan that leaves you runway. And this is not something you want to be diving into at 35 or 37 or 38 if you can help it. You want to have looked into it, had the conversations and been planning for it because like everything else in life, operations tend to go better. Plans tend to go better when you get prepared for them in advance. And that is very true of fertility.

38:47Dr. Carrie Bedient: Seeing someone who's already seen us at 32 and maybe they don't come back until 34 for whatever their next step is, is much better than someone who's rushing in at 37 at the last minute, having never thought about this, where the stakes are higher, the results maybe aren't quite as good. And having that planning is helpful.

39:06Dr. Susan Hudson: Absolutely. Well, thank you so much for spending part of your day with us.

39:10Dr. Carrie Bedient: If you enjoyed this episode, subscribe, leave a review and send us your questions at fertilitydocsoncensor.com.

39:15Dr. Susan Hudson: And if you want even more fertility information, pick up a copy of the IVF Blueprint, our practical guide to understand fertility treatment, IVF, and the decisions you'll face along the way.

39:25Dr. Carrie Bedient: Before we go, remember, this podcast is for education and entertainment only.

39:29Dr. Susan Hudson: While we are fertility doctors, we are not your fertility doctors.

39:32Dr. Carrie Bedient: Nothing we discuss should replace medical advice from your own physician who knows your individual history and circumstances.

39:38Dr. Susan Hudson: Thank you for listening. Bye!