[SPEAKER_00]: Hello and welcome to the Aquaman podcast.
[SPEAKER_00]: This is an exploration of woman kind.
[SPEAKER_00]: Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit.
[SPEAKER_01]: Good day, everyone, and welcome back to the pod.
[SPEAKER_01]: Before we begin, I would like to acknowledge the traditional custodians of the land in which this podcast is being recorded across Luchelweta, Tasmania, and pay my respects to Elders' past, present, and future.
[SPEAKER_01]: Today, I'm joined by Dr. Rebecca McKenzie-Prockter, a fatility specialist and gynecologist at Stella Fatility in Melbourne, and a newly appointed lecturer at the University of New South Wales.
[SPEAKER_01]: She has over a decade of experience with subspecialist training in reproductive and technology,
[SPEAKER_01]: and infertility.
[SPEAKER_01]: She combines scientific rigor with a deeply patient-centered approach.
[SPEAKER_01]: We spoke about all things IVF and modern fertility care from navigating complex diagnoses to understanding treatment options and how a holistic view of reproductive health can support people on their path to parenthood.
[SPEAKER_01]: Let's get into it.
[SPEAKER_01]: Alright, thank you so much for Becker for coming on today.
[SPEAKER_01]: I really appreciate your time.
[SPEAKER_01]: Do you mind just starting out and explaining what got you into medical school?
[SPEAKER_01]: What got you into learning about physiology and specialising in IVF and being a female focused health practitioner and doctor?
[SPEAKER_02]: Well, thank you so much for having me.
[SPEAKER_02]: It's such a special opportunity to be here and be able to talk to other people about the process and what I do and how I got here, and hopefully hopefully some people will feel some help with what I say today.
[SPEAKER_02]: And answer to a question, how did I get here?
[SPEAKER_02]: What may be going to medical school?
[SPEAKER_02]: Bye.
[SPEAKER_02]: really always wanted to help people and I not sounds kind of bit tried but it's a kid I had the biggest backpack in the school I'd turn up to school with everything in my bag to help everybody.
[SPEAKER_02]: So if anyone had a problem I had it in my bag and I always was walking around helping people from a younger age but I kind of got a bit excited about life and between times and I enjoyed music, I was in a band, I wanted to be a fashion designer, I didn't really want to be at school that much
[SPEAKER_02]: three years.
[SPEAKER_02]: And so I didn't go straight to medical school.
[SPEAKER_02]: I traveled the world.
[SPEAKER_02]: I then went and explored different cultures and different environments.
[SPEAKER_02]: And finally thought, okay, no, it is what I always wanted to do in my back to my roots.
[SPEAKER_02]: But because I've already missed a sort of entry to medical school, I did a degree, which meant that I and my
[SPEAKER_02]: You know, I had to actually look twice as hard.
[SPEAKER_02]: So I had to get straight A's way plusers all throughout my degree as opposed to maybe just one year of pre-medical school.
[SPEAKER_02]: So that degree was physiology.
[SPEAKER_02]: So I did physiology.
[SPEAKER_02]: I should have did three different majors.
[SPEAKER_02]: I changed my major each year, which might have to study twice as much each year too.
[SPEAKER_02]: But that's exciting.
[SPEAKER_02]: So I got to learn so much more stuff.
[SPEAKER_02]: So I started off doing sports physiology, cardiology, then I moved on to psychology, neuropsych, neuropiance, physiology of neuropiance, physiology of the heart, everything else but fertility actually.
[SPEAKER_02]: And then through medical school, a really missed physiology.
[SPEAKER_02]: I found that medical schools, it was a little bit behind with the knowledge that I'd learned from my degree, because it was really cutting-edge science.
[SPEAKER_02]: And by the time I found women's health,
[SPEAKER_02]: from a holistic point of view, I felt that that was the best thing to be doing.
[SPEAKER_02]: I could do all aspects of surgery, scanning, looking after women, and also medicine.
[SPEAKER_02]: And it's an area of positivity, bringing life into the world as positive.
[SPEAKER_02]: It's not negative.
[SPEAKER_02]: You're not saying I've had a stroke.
[SPEAKER_02]: And so I want to
[SPEAKER_02]: You've got to look after the symptoms of it, but the rich and you've either get better.
[SPEAKER_02]: Whereas with women's health, there's a lot of times where you can improve people's lifetime and outcome.
[SPEAKER_02]: At this point in time, people are the most receptive to change.
[SPEAKER_02]: And I think really second time people are all if you need to stop smoking to stop your lung conditions.
[SPEAKER_02]: Whereas with fertility or with women's health, you can change so much of your future by changing your environment and changing your day-to-day health.
[SPEAKER_02]: So I really found that really positive.
[SPEAKER_02]: And then what brought me into fertility is that I actually missed the science.
[SPEAKER_02]: So I got through medical, I've got through OMG training of stitches and gynecology training.
[SPEAKER_02]: And realized actually, I still missed that really base physiology.
[SPEAKER_02]: And with fertility, I get to have everything its science and action every day.
[SPEAKER_02]: I'm able to help patients manipulate hormones to try to get them a bit of outcome.
[SPEAKER_02]: And I'm actually seeing the changes in their physiology day-to-day.
[SPEAKER_02]: And having had that background after all that earlier study, it was not wasted because now I get to use it.
[SPEAKER_02]: in my day to day job, and then the three years extra study on top of that, the CRI, specialist fertility trading, meant that I think got to enhance my knowledge like taking steroids on my knowledge.
[SPEAKER_02]: It's just been such the best way of being able to utilize everything that I've learned to help patients.
[SPEAKER_02]: And along the side journey of that, I've always valued the importance of travel and the importance of understanding other people's culture.
[SPEAKER_02]: And by practicing the way that I get to practice, I can utilize and help women think about what is, what are their roots of being a woman, what are our roots of our environment, how do we cycle based on the different cycles of the moon, all those sorts of things that we're way back when, what does the Indian people do, what do the Chinese people do, what do every different culture has a different sort of focus, and I think through my love of travel and my love of human,
[SPEAKER_02]: beings.
[SPEAKER_02]: I've gathered a lot of information that I can now use in this environment.
[SPEAKER_02]: So I just feel like the blackiest woman in the world that I get to do this job.
[SPEAKER_02]: And then having kids, it's even better.
[SPEAKER_02]: I was like, I've had these beautiful children that I just love so much.
[SPEAKER_02]: And every day I put them to bed, I think gosh, I'm lucky.
[SPEAKER_02]: And this is why I go to work the next day is to give other people this joy if that's what they want.
[SPEAKER_02]: And so that's what motivates me, keeps me going.
[SPEAKER_01]: Wow, what a beautiful interruption.
[SPEAKER_01]: That's yeah, incredible.
[SPEAKER_01]: And I love what you said about bringing life into the world is a positive and joyous thing.
[SPEAKER_01]: And we need to view it as that and we really need to foster that connection.
[SPEAKER_01]: And it's really unique to hear that you kind of had a life before med school.
[SPEAKER_01]: Every other doctor I've spoken to, they're like, right, I got triple A's and I went straight from high school into pre-med and then I went into med and then I specialised and I was done and dusted by the time I was 30.
[SPEAKER_01]: and then they start traveling and then they have these holistic experiences and how you speak about IVF and how we've spoken previously.
[SPEAKER_01]: You can absolutely tell that your life experiences and also the amount of study that you've done have really imbued how you view IVF and fertility as this holistic joyous space that we should be excited about and I think that's one of the many reasons I wanted to have you on today.
[SPEAKER_01]: So we're talking about IVF, what is IVF?
[SPEAKER_01]: Do you mind explaining what this is just at the asset?
[SPEAKER_02]: So IVF is a very technical, very scientific-based approach to helping people be able to conceive.
[SPEAKER_02]: It involves approximately about a two-week period of intensive monitoring and medications.
[SPEAKER_02]: So patients will use injections to stimulate their ovaries to grow little follicles.
[SPEAKER_02]: And within those follicles, we hope that they're at eggs.
[SPEAKER_02]: We do a few scans in that cycle, maybe two, sometimes three scans to see that the patient
[SPEAKER_02]: And then when they look like the follicles are big enough and we expect that to be eggs inside of them we will arrange to have an egg collection which is usually done under some form of anesthetic and depends on where you are in the country and the world how this is done.
[SPEAKER_02]: So
[SPEAKER_02]: we click the eggs into it into some fluid that is looked under the microscope by the scientists.
[SPEAKER_02]: Those eggs are then a get a chance to meet the spoon.
[SPEAKER_02]: So they have a date night after the Eclipse and day and it's either injected with a fireproof is called XC or they are allowed to fertilize overnight and the next day the scientists will be able to see how well the
[SPEAKER_02]: fertility out of the fertilization has occurred and then we watch the embryos grow and plant put them back in the body or freeze them as needed.
[SPEAKER_02]: So it's a way of enhancing people's fertility or also for those that don't have some of the necessary machinery for getting pregnant and allows them to be able to have a baby by the use of science.
[SPEAKER_01]: Mm-hmm.
[SPEAKER_01]: I love how you said date night.
[SPEAKER_01]: You must be so excited, you know, in the afternoon or sometimes, you know, late evening as doctors often work over time, you know, putting them it back in the petri dish, okay, I'm going to go to home, going to go see my kids going to come out to get to work and see what's happened in the morning and see what's happened to this petri dish and see if we have any embryos.
[SPEAKER_01]: Like, I love how you're talking about that.
[SPEAKER_01]: It's actually quite exciting.
[SPEAKER_01]: But IVF as you've just explained it sounds pretty invasive, so if I'm correct, the medication you're giving to women at the start of their cycle is going to increase FSH, or it also is FSH itself, and that's designed to increase the amount of follicles that are matured, so you can take them out and you can put them in a petri dish, is that correct?
[SPEAKER_01]: So it's
[SPEAKER_02]: It's actually we give patients FSH, so FSH stands for follicles stimulating hormone, and that stimulates the follicles to develop, and in the development of a follicle, estrogen level is increased.
[SPEAKER_02]: So it's not increasing the FSH, it's increasing the estrogen, and as the estrogen level is increasing, that is the normal trigger response for ovulation to occur.
[SPEAKER_02]: What usually happens is that our follicle only one becomes the dominant follicle and all the rest die.
[SPEAKER_02]: So in a month cycle patients may have 10 to 100 little follicles trying to become the one that's going to ovulate.
[SPEAKER_02]: Usually only one makes it through and the rest die.
[SPEAKER_02]: And so you're always getting follicles growing and dying regardless of the on the pill, regardless of if you actually ovulate.
[SPEAKER_02]: This process is constantly happening to your constantly losing.
[SPEAKER_02]: X, but what I believe is doing is stopping those eggs from or the follicles from deteriorating and allowing the ones that we're going to be there to keep going.
[SPEAKER_02]: So we have to use a sick medication to trick the brain from knowing that this estrogen level is above the physiological expected level and then we also then have to trigger the ovulation sort of process ourselves because we've basically taken over the brain's ability to do the natural fertility processes.
[SPEAKER_02]: So yes, it's very intense because we are giving the body higher levels of hormone than they would normally expect to have in a natural cycle.
[SPEAKER_01]: Okay, so this is quite an intense process and it is interesting because IVF and IUI will talk about all of it and eat freezing as well.
[SPEAKER_01]: This is just kind of part and parcel with females and like women nowadays and especially modern women.
[SPEAKER_01]: But I think we forget how intensive it is and how invasive it can be, because we haven't even spoken about how you take the opens up, which is you put like a needle up through the cervix and into the floping tubes that correct, and that's where you extract.
[SPEAKER_01]: I don't know how do you take it out, I mean correct.
[SPEAKER_02]: Almost, but
[SPEAKER_02]: Yes, almost, but not quite.
[SPEAKER_02]: So, the first part is correct.
[SPEAKER_02]: We use an ultrasound guided probe.
[SPEAKER_02]: So, similar to what you have of a journal scan, so it's invasive in itself for a lot of people.
[SPEAKER_02]: It has a needle on the end and it goes, it's guided through the ultrasound scan.
[SPEAKER_02]: And that actually goes into the ovary that the fluid in the, in the ovary itself.
[SPEAKER_02]: And that fluid is being drained out.
[SPEAKER_02]: And we hope that the egg is in the egg is obviously microscopic, so we can't see it unless the scientists see it.
[SPEAKER_02]: So it is invasive that's going from vagina through into the kind of pelvis with the ovaries and into the ovary and then we drain the fluid out.
[SPEAKER_02]: Hopefully we avoid the tubes, we don't really want to cause any tumble damage.
[SPEAKER_02]: But it's invasive that a lot of people have that done under anesthetic, which is again an insult on the on the system if you are thinking about your the
[SPEAKER_02]: exposure to volatiles, some of those volatiles, I'm probably just using a dazzling of things to know.
[SPEAKER_02]: But if you aren't having anesthetic, it's also very uncomfortable for patients too.
[SPEAKER_02]: So the way I trained, actually, was using local anesthetic just in the vagina, which I now look back at and think, gosh, four people who have to go through that.
[SPEAKER_02]: So it's a lot.
[SPEAKER_02]: And that's the woman side of thing.
[SPEAKER_02]: Obviously, the man has to ejaculate to a device and we use that.
[SPEAKER_02]: But it's not secondly, but it's
[SPEAKER_02]: He doesn't have to have people to sleep for that process.
[SPEAKER_02]: So, I mean, the woman goes through a hell of a lot, really, to get this result.
[SPEAKER_02]: And the thing is that we never know exactly how many eggs they're going to be.
[SPEAKER_02]: Not every follicle will have an egg in it.
[SPEAKER_02]: So it can be really, it's really stressful as well.
[SPEAKER_02]: Knowing what you're outcome is potentially going to be.
[SPEAKER_01]: and IVF is skyrocketing.
[SPEAKER_01]: Every single year we're seeing it's becoming more and more and more popular.
[SPEAKER_01]: There are a lot of different theories and there are conspiracy theories around this as well.
[SPEAKER_01]: What's your perspective on this?
[SPEAKER_01]: Like what are the theory of science or social factors that you see in the rise of IVF and how that reflects in the rise of infertility, which is a hot topic at the moment, isn't it?
[SPEAKER_02]: Yes, and it's something I don't get rather passionate and excited about talking about and I think exposing some of the things that are a concern in our world, there is definitely the fact that people are driven to do Ivy if there's lots of reasons.
[SPEAKER_02]: And so from the negative side of things, yes, I think there is an idea of Ivy to the way of getting a baby, the marketing kind of doubles your chances and more likely if I do in the sorts of avoid having natural conception, you
[SPEAKER_02]: So we also know that a lot of companies make money from IELF and sadly as a doctor this is where ethics is quite difficult is that you have to have an income and that is made through helping other people potentially get pregnant but also big huge private equity companies that run fertility units will also gain equity by putting people through IVF cycle.
[SPEAKER_02]: So that's where my negative point of view comes from because that's what is the business,
[SPEAKER_02]: So from that side of things, I find it really difficult at times.
[SPEAKER_02]: My aim is to really help build families, but not in a way that's going to hinder them financially.
[SPEAKER_02]: On a flip side, the rise of IVF is probably more the fact that we are aging as a fertility population.
[SPEAKER_02]: And that's because from a wonderful feminist standpoint of you, a lot of women are out there living their life, building their careers, focusing on what they want to be doing, and the thought of family doesn't really come into the picture to later on.
[SPEAKER_02]: And also trying to find the perfect person doesn't always come into the picture, if ever, for a lot of people.
[SPEAKER_02]: And so a lot of my patients come to me like 38 and said, well, I've been looking for this perfect person to start a family where then I haven't found them.
[SPEAKER_02]: Is it too late?
[SPEAKER_02]: And thank goodness,
[SPEAKER_02]: it's hard because you don't really want to have to admit that to yourself and then the guilt that comes along with it thinking, well, if only I've done it earlier and all these sorts of things is really, really, really hard.
[SPEAKER_02]: So I think that IVF is rising for two purposes, one is the negative financial gains by the companies and the two is there.
[SPEAKER_02]: our age and our population and also the fact that there's more women going to university, more women who are in careers that require a lot more study and a lot more time taken for themselves or for the career outside of having a baby.
[SPEAKER_01]: And we're also seeing the rise of endocrine disorders like endometriosis and PCOS.
[SPEAKER_01]: I mean, you could argue endometriosis has always been static, but maybe we're just discovering it more in women because we have better diagnostic tools, PCOS, we know we're using.
[SPEAKER_01]: And we also know about falades and everything else that's decreasing fertility, but I guess that's a whole other conversation.
[SPEAKER_02]: But as I say, we need to talk about endocrine disruptors.
[SPEAKER_02]: Also, realizing for male factor too, the drop-in sperm counts has been shown to have a link
[SPEAKER_02]: our overall sperm counts had been dropping over time.
[SPEAKER_02]: And this is something to do with our environment that we really also need to look at the mail too.
[SPEAKER_01]: And that beautifully goes into the next conversation which is, can hold it holistic living and can we be holistic and also
[SPEAKER_01]: Have IVF and go through IVF cycles because these two things kind of in the zeitgeist of fertility and women's health seem to be on opposite ends of the scale But I don't necessarily think that they have to be especially if we have mothers who were starting their pregnancy journey and their motherhood journey later in life We need to have the holistic supporting the more allopathic measures of fertility and that's something that you're really passionate about is these Milding of these two worlds and using holistic living to support IVF.
[SPEAKER_01]: So can you speak a little bit more about that?
[SPEAKER_02]: that you're speaking my language, that's one of the really big drivers behind what I do.
[SPEAKER_02]: Is it allows that the body is an amazing mound of physiologist, physiologist, also spiritual spirituality, and the combination of the two.
[SPEAKER_02]: And I think
[SPEAKER_02]: I feel really lucky that we've got IVF for those that really need it, but if we are creating an embryo to put back into an environment that is in hostile, potentially for life creation, or that it's not an optimal state, then it's really useless, like I could make all the embryos in the world I liked.
[SPEAKER_02]: But if the body is not prepared to receive the embryo, then it's kind of useless.
[SPEAKER_02]: So they really need to go hand in hand at all points.
[SPEAKER_02]: Psychologically and physically, we need to be in the right state to be able to receive the embryo and receive the life to have the baby.
[SPEAKER_01]: Yes, our life is not just an embryo.
[SPEAKER_01]: I think that's really poignant, especially in my extended family right now.
[SPEAKER_01]: I have a woman in my extended family and I think she has been through, I don't know the exact number, but I think it's over five IVF cycles.
[SPEAKER_01]: And then they finally were like, hmm, maybe something is wrong here.
[SPEAKER_01]: And they found something that, you know, they could have gotten to two IVF cycles and go on like, let's do a little bit of investigating it, makes no sense why your embryo's aren't sticking.
[SPEAKER_01]: And she had something wrong with her uterus and it was a very simple keyhole surgery.
[SPEAKER_01]: And I was just thinking, you guys have paid hundreds of thousands of dollars of this poor couple.
[SPEAKER_01]: And now you've gone, now you've started to be more curious.
[SPEAKER_01]: And now you're going, oh, we maybe you should take this supplement and maybe we should do this surgery and let's talk about your diet.
[SPEAKER_01]: And I just think it's really interesting with IVF doctors specifically.
[SPEAKER_01]: That very often what we hear is that, that is not the conversation that happens to the outset.
[SPEAKER_01]: It's not, you know, your ovum's take about three months to fully mature.
[SPEAKER_01]: Let's start now, come back to me in three months.
[SPEAKER_01]: How about with your diet?
[SPEAKER_01]: How about we try and lose a little bit of weight?
[SPEAKER_01]: How about we try and put some muscle mass on?
[SPEAKER_01]: Let's talk about all the other determinants of health that really help to hold on to a pregnancy.
[SPEAKER_01]: Where's your progesterone at?
[SPEAKER_01]: I just think there's a really interesting questions.
[SPEAKER_01]: But what we hear within the IVF realm is we're just going to go through another round and another round and another round.
[SPEAKER_01]: It's just your body and it's such a mystery.
[SPEAKER_01]: We don't know why it's sticking, but you're saying like, no, let's prepare the body and then we can do IVF cycle.
[SPEAKER_01]: If you had a client come to you and they were really keen to do an IVF cycle and their body was very obviously ready, would you say you're not ready yet?
[SPEAKER_01]: Come back to me in three months after you put these things in place.
[SPEAKER_01]: Like, what does that look like if you are pretty sure that someone's not going to carry that pregnancy?
[SPEAKER_01]: to term and that might actually have risk.
[SPEAKER_02]: It's a really difficult place to be because some people aren't really to listen or hear their information and a lot of the time there's a lot of panic, a lot of stress associated with trying to get pregnant don't come to me because they're having a great time.
[SPEAKER_02]: They come to me because they're struggling already, and so often they don't want to hear when I say we need to prepare things, and often they have to go through a cycle that hasn't worked for them to listen to what I say.
[SPEAKER_02]: That doesn't mean that I don't say it on the outset.
[SPEAKER_02]: I will talk to them all about the things that are important, going through what it is to actually create a life inside of you.
[SPEAKER_02]: But three months for a lot of people seems like eternity, but I wish people would really listen to me like this.
[SPEAKER_02]: I always say, come and see me three months before you want to have the baby and that's actually what I try a lot to talk to GP's about is actually sending the patients to me before they've been trying for a year.
[SPEAKER_02]: Send them to me after six months or three months even because I can then help them prepare that time.
[SPEAKER_02]: I'll say, hey, look, I love to see you before you actually a desperate at the other end.
[SPEAKER_02]: I'd love to see you at that with that.
[SPEAKER_02]: lead in time to be, hey, look at let's look at everything, let's look at your diet, let's look at your stress levels, let's look at your hormones and all the things you've mentioned already, those things are so important and I can do all the physiological kind of the doctor, doctor speak checks, but then I like to have a supportive network, I like to have a lot of other practitioners around me that they can help me do this alongside them and if they can engage earlier on, it's much better than going back with it's like the ambulance, the bottom of the cliff, I prefer not to need the ambulance.
[SPEAKER_02]: But if you're just not to jump off the cliff either, ideally, we'll say to someone, look, I think we need to focus on egg quality here.
[SPEAKER_02]: If that's usually the thing that we need the three months for, and I'll say, look, these are things we need to do for equality.
[SPEAKER_02]: How would you feel about delaying the timing starting?
[SPEAKER_02]: And what if we do X, Y, and Z, try a few other things.
[SPEAKER_02]: We can support your natural cycle while you're doing it.
[SPEAKER_02]: You can still try naturally while we are supporting your
[SPEAKER_02]: your equality, but let's avoid the more invasive IVF until we've made some other changes in the lifestyle.
[SPEAKER_02]: So some patients are restricted to that, but most of them just want to be pregnant yesterday.
[SPEAKER_01]: Which is hard.
[SPEAKER_01]: My neck hurts from nodding.
[SPEAKER_01]: I'm nodding.
[SPEAKER_01]: So much.
[SPEAKER_01]: You brought our AMH.
[SPEAKER_01]: Let's talk about it.
[SPEAKER_01]: What is AMH?
[SPEAKER_01]: What does this actually tell us about fertility?
[SPEAKER_01]: Because a lot of women going at this test and just think it is a death sentence, or it's a veal and endle, can it change?
[SPEAKER_01]: What's the optimal level?
[SPEAKER_01]: What does it actually represent?
[SPEAKER_02]: So AMH is something that as a fertility specialist I use every day for multiple reasons, but it doesn't mean that every doctor needs to use it for multiple reasons.
[SPEAKER_02]: So what is AMH?
[SPEAKER_02]: Anti-malarian hormone.
[SPEAKER_02]: It is a marker of ovarian reserve, but it's not a marker of fertility.
[SPEAKER_02]: It doesn't tell me
[SPEAKER_02]: that if there were three series in front of me, one had a low AMH, one had a normal one, one had a high AMH, that if anything else is the same, you will all have the same monthly ability to conceive.
[SPEAKER_02]: So Yoke Fakundati per month is the same.
[SPEAKER_02]: But the person with the low AMH is going to struggle if they need to IVF.
[SPEAKER_02]: That also likely to lose their
[SPEAKER_02]: it reserve faster.
[SPEAKER_02]: We're on the flip side, the first one with a very high AMH is more likely to potentially overrespond, is more likely to have conditions such as polycystic ovary syndrome.
[SPEAKER_02]: And so there's another whole raft of things that that person may have.
[SPEAKER_02]: So I use it for sort of in a two to three-prong approach.
[SPEAKER_02]: One, it helps me with diagnosis.
[SPEAKER_02]: So if it's a very low AMH, I think, well, is there something else going on that's affecting the ovaries?
[SPEAKER_02]: Is there a process within the ovary?
[SPEAKER_02]: Be it endometriosis for one?
[SPEAKER_02]: That is causing sort of resistance in the ovary.
[SPEAKER_02]: Has there been some exposure to something in the environment?
[SPEAKER_02]: There has meant that their reserve is lower than expected for their age.
[SPEAKER_02]: If it's very high, it's the opposite.
[SPEAKER_02]: It's that PCO picture has the person that isn't releasing their eggs on a regular basis.
[SPEAKER_02]: AMH's job is to hold eggs in place, so the higher it is, the harder it is for the body to release the eggs.
[SPEAKER_02]: And then if the person's in the middle it kind of gives me another whole realm of discussion saying, well, maybe you don't need to go down that treatment path option.
[SPEAKER_02]: It also helps me decide what level of drug I'm going to give you for the safest possible approach, and also how many potential rounds of IVF you might need if you need IVF.
[SPEAKER_02]: From egg freezing, I use a lot to say, maybe you don't need to free to eggs.
[SPEAKER_02]: Or maybe you do.
[SPEAKER_02]: And if you do what's it going to look like and how much is it going to cost you.
[SPEAKER_02]: So I do find it helpful for people for planning especially on all levels.
[SPEAKER_02]: But there's not a dead sentence and it's not a guarantee of pregnancy.
[SPEAKER_02]: And it doesn't tell me anything about quality.
[SPEAKER_02]: Quality is mainly determined by age and the environment that those eggs are in.
[SPEAKER_02]: as we've already kind of mentioned.
[SPEAKER_02]: It's the, it's the house that they are living in and have lived in their whole entire existence or your whole entire existence on this planet.
[SPEAKER_01]: And so you spoke about increasing just a second there and I'd like to hold on to that.
[SPEAKER_01]: So if a woman comes to you and they have low AMH, so say if I came to you and I have PCOS or I've endometriosis and I want to have kids maybe five years but I'm not really yet and my AMH is low.
[SPEAKER_01]: Would you say yes, you probably need to freeze your eggs now?
[SPEAKER_01]: What would that look like?
[SPEAKER_02]: Yes, I usually would.
[SPEAKER_02]: If your AMH is low, so you came to me and you were 30 years old, 28, 30 years old, and your AMH was sort of 11, 12.
[SPEAKER_02]: I'm going to say, well, the chances are that your AMH is going to be lower in five years' time when you come to see me.
[SPEAKER_02]: And if you are going to be 35, the DNA within your eggs is going to be
[SPEAKER_02]: a lower quality as we age, so at 35 you're going to have a lower level and you're going to have a lower quality.
[SPEAKER_02]: So if you need it to have assistance at 35, you're going to need more eggs, which with a lower AMH, you're going to need more cycles, then you would have needed now.
[SPEAKER_02]: So you potentially, like,
[SPEAKER_02]: two eggs now would potentially be like four eggs later on.
[SPEAKER_02]: You know, one to two really.
[SPEAKER_02]: So if your 30 years old and you have you're getting one egg, that's the same as having sort of maybe two or three eggs at 35, just a rough idea.
[SPEAKER_02]: This is obviously very different per person.
[SPEAKER_02]: But what I'm trying to, the point of trying to make here is more that
[SPEAKER_02]: you need less at a younger person than you do as an older person.
[SPEAKER_02]: So if you've got to low AMH, you're better off to do the process younger than you are to get into trouble later on if that's something that you really want.
[SPEAKER_02]: Of course, do we have to remember that egg freezing isn't guaranteed?
[SPEAKER_02]: The best egg freezing for patients is once that don't actually need it, because they then get pretty naturally and it makes me very happy.
[SPEAKER_02]: that way.
[SPEAKER_02]: So, but what I do find it really helpful for people as it allows people to stop being so concerned about trying to find the perfect person and to have children with, whether or not that's a guy or girl, whatever it's going to be, it gives you the opportunities to finish your career, advance your career, travel, and find the person that you really want to have a family with, or if you decide to do it on your own, you've still got that option available to you later on down the track.
[SPEAKER_01]: Okay, recently, I'm not sure if you're aware of this, France has sent out letters to all 29-year-olds to tell them to freeze their eggs.
[SPEAKER_01]: It's an open word.
[SPEAKER_01]: It's not to take on this abomination.
[SPEAKER_01]: Trying to scare women into having babies and freezing their eggs.
[SPEAKER_01]: You just said it's not a guarantee.
[SPEAKER_01]: So, what is your opinion on this?
[SPEAKER_01]: What's your take on this?
[SPEAKER_02]: Well, I think it's pretty harsh.
[SPEAKER_02]: I personally don't think that I would subscribe to that and I feel really disappointed on a personal level for the women of France being told this because it's not, I am age is not an indication of your fertility, so we don't exactly know if you had a low level in your told you need to raise your eggs tomorrow.
[SPEAKER_02]: Freezing your eggs is not guaranteed it's gonna work for a pregnancy.
[SPEAKER_02]: I don't know much about the fridge market for IVF in the financial side of things and the government side of things and what's going on there either to really make a comment around what the economic costs would be.
[SPEAKER_02]: But the physical costs are huge because IVF is not without risks.
[SPEAKER_02]: You've got a huge high levels of hormones.
[SPEAKER_02]: You've got to undergo a procedure to take them out, which has got risks of
[SPEAKER_02]: You know, potentially damaging blood vessels, causing bleeding, causing infection, causing pain, over stimulation, you could be an ICU.
[SPEAKER_02]: There are all these things that could be negative.
[SPEAKER_02]: It's not, it's not taking a pan at all.
[SPEAKER_02]: And, you know, going for walk.
[SPEAKER_02]: They are things that are high risk.
[SPEAKER_02]: And I think it's terrible.
[SPEAKER_02]: Also for women to feel like,
[SPEAKER_02]: you have to freeze your eggs.
[SPEAKER_02]: Otherwise you're going to be barren in the future.
[SPEAKER_02]: I don't know, maybe it's the government is trying to stop aging processes.
[SPEAKER_02]: I've done it really difficult as a female mother of females to think that a government would put that in place and that's just really my personal opinion.
[SPEAKER_02]: It makes me really sad.
[SPEAKER_02]: I'm France, it does a lot of really good things for health, but this is probably not one of them.
[SPEAKER_01]: It's incredibly archaic and it is something that we're seeing a lot is that we have mostly many governments and they're going, oh, birth rate is falling.
[SPEAKER_01]: This isn't good for the economy.
[SPEAKER_01]: Let's just try and call us women into having more babies and this is just another example of that.
[SPEAKER_01]: But I think we're going to keep seeing in the next few years as fatility is a main concern of most governments.
[SPEAKER_01]: but going back to the individual and if women are wanting to improve their fertility outcomes, the best thing they can do is improve their egg quality.
[SPEAKER_01]: And so AMH is out the window that's not really a great indication that's just a biomarker that tells IVF doctors what they can and cannot do.
[SPEAKER_01]: What does egg quality respond to?
[SPEAKER_01]: What are some things that you would recommend to your clients when they come to you to improve their
[SPEAKER_02]: equality.
[SPEAKER_02]: We have to remember going back to basics at the eggs were in your body when you were in utero inside your mother's tummy.
[SPEAKER_02]: And as we go through life, we're not getting new eggs, that is, you know, we're just losing eggs throughout the matter life.
[SPEAKER_02]: So if you're thinking that we can't kind of make them better, but what we can do is reduce the toxic load on the system to help prepare any DNA make breaks or any DNA concerns that might result
[SPEAKER_02]: in egg breakdown or genetic abnormalities in the offspring.
[SPEAKER_02]: So the way I look at it is I think, well, if you overload in the system with toxins, the body is going to spend its time detoxifying to maintain homeostasis, that's a level physiology from the heart and the brain and the liver, all those other kind of life essential things.
[SPEAKER_02]: Reproduction is not considered in the life essential thing, so it's kind of
[SPEAKER_02]: goes off the back burner.
[SPEAKER_02]: So, you know, if you're mitochondria are not functioning so well, but they're busy doing other things to provide energy and other parts of the body, the ovaries miss out.
[SPEAKER_02]: And so, if our liver is trying to process all the chemicals in our system, the pollutants, everything from the foods that we're eating to the air that we're breathing, to the here-dye that we're using and make up the list goes on without scaring you.
[SPEAKER_02]: scaring people, then it can't function on trying to protect that egg.
[SPEAKER_02]: The egg and its energy system is so important for fertility because it actually helps the sperm to fertilize.
[SPEAKER_02]: So the sperm don't have as robust energy systems within them and they rely heavily on the
[SPEAKER_02]: with its job to fertilize or to implant into the egg.
[SPEAKER_02]: And so again, if that egg is not working, then the sperm, if the sperm is a little bit dodgy as well, you've got a compounding problem.
[SPEAKER_02]: So if I look at it, if you think that is the problem, how do I say the patients to fix the problem?
[SPEAKER_02]: So I go back to the lifestyle again and I say, well, what are the endocrine disruptors in your life?
[SPEAKER_02]: What are you doing?
[SPEAKER_02]: What products are you putting on your skin?
[SPEAKER_02]: What are you doing?
[SPEAKER_02]: What are you doing with the clothing that you wear?
[SPEAKER_02]: I'm usually about careful about how I brooch this topic.
[SPEAKER_02]: It's not you the first thing I'll say to somebody because often the patients or people who're going through this journey are really highly stressed and have so many other little voices in the head going, don't do this, don't do that, don't do this, don't do that and so
[SPEAKER_02]: I don't want to overwhelm them too much, but I start off with simple things like, say, don't heat your food up in plastic containers, so that leeches the plastics out of them when you heat them up the plastic molecules will go into your food.
[SPEAKER_02]: The same with using glad rep, drinking out of hot plastic bottles.
[SPEAKER_02]: Especially the one that sits in your car that's had the heat of the sun on it all day, that's leased its plastic out into the water that you'd then drink.
[SPEAKER_02]: Same with coffee cups, anything that's heated with the plastic has an opportunity for those molecules to separate, release some toxin and then form reform again.
[SPEAKER_02]: The swapping out of chemicals within your environment, so I don't say go through everything out of your house, that's a very expensive
[SPEAKER_02]: environment full of toxic waste.
[SPEAKER_02]: So I say we knew finish one thing, make a better choice the next time.
[SPEAKER_02]: So thinking about your cleaning products, go back to more natural products that you can use.
[SPEAKER_02]: Face products, don't have things that say have lots of numbers you don't understand at the back of them.
[SPEAKER_02]: And the worst one I think is one that says perfume.
[SPEAKER_02]: And I don't know anything called perfume.
[SPEAKER_02]: perfume is a description of the smell.
[SPEAKER_02]: It doesn't say anything.
[SPEAKER_02]: So companies can get away with saying at the word perfume or and it can have anything in it that they like so that's something I'm really do get a bit concerned about for people because it's known that those some of those perfume compounds can affect the indecrime.
[SPEAKER_02]: or potentially fit the indecrime system.
[SPEAKER_02]: So it's making better choices.
[SPEAKER_02]: And if the people who really, I don't want to say if I don't, if I do your nails ever again, also they will don't do them as regularly.
[SPEAKER_02]: So maybe just do your toes and if your toes for a bit.
[SPEAKER_02]: And so you don't want to become a time cave woman or a cave person, you also need to live live life a little.
[SPEAKER_02]: And so you don't want to be totally devoid of any.
[SPEAKER_02]: any of those nice things that you might like.
[SPEAKER_02]: The same with alcohol, I say to people, it's celebration drink so really important.
[SPEAKER_02]: Rating is really important, and if having a glass of wine means you're not avoiding a celebration event, then that's also important because you don't know how long the student is going to be if it's 10 years for you, and you've spent 10 years avoiding going to anything social because you don't have one glass of wine.
[SPEAKER_02]: It's probably a lot worse.
[SPEAKER_02]: The breakdown of this fact that these cycles aren't working for you.
[SPEAKER_02]: That's another thing.
[SPEAKER_02]: Environment aside, what are the things that you can take?
[SPEAKER_02]: Obviously, I'm not an entrepreneur.
[SPEAKER_02]: I'm not a nutritionist.
[SPEAKER_02]: It's not something that I've, my expertise, apart from having a strong interest in this area.
[SPEAKER_02]: But I'll talk co-q 10 is something that I use a lot for patients.
[SPEAKER_02]: In AC, in AD, are things that can be useful too.
[SPEAKER_02]: In AD, you're going to be careful.
[SPEAKER_02]: It has to be an infusion, not a oral supplement because it doesn't actually have that.
[SPEAKER_02]: good research about its oral availability, vitamin, so high dose antioxidants, vitamin C, vitamin E, zinc, selenium, it can all be really helpful just to boost the system.
[SPEAKER_02]: I think call it if you've got, if we think oxidative stress, the breaking down of the DNA in the ovary or in the egg, sorry, is the problem if we can counterbalance this by supporting the oxidation system then that's that there are things that can be really helpful for patients.
[SPEAKER_01]: Thanks to this week's podcast Sponsor temperature for keeping this podcast free for you to listen to.
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[SPEAKER_01]: Okay, wonderful.
[SPEAKER_01]: Let's move on to IVF and IUI.
[SPEAKER_01]: What is IUI and how does it compare to IVF and which one will you usually recommend first and when will you switch between the two?
[SPEAKER_02]: So,
[SPEAKER_02]: IUY stands for Intute Rine and Simination.
[SPEAKER_02]: So that is where we follow someone's cycle to the point where they're about to ovulate.
[SPEAKER_02]: We either give them medication to make them definitely have a follicle to ovulate and trigger their ovulation of into a cure to time and insemination process.
[SPEAKER_02]: Insimination is where a male gives sperm sample.
[SPEAKER_02]: The sperm is washed so all the prosthetic fluid and some of the other fluid that helps get to the cervix is taken away and it's just the pure sperm sample left and that is then inseminated, felt tiny catheter into the uterus of via the vagina through the cervix.
[SPEAKER_02]: So it's got like having a smear.
[SPEAKER_02]: It's not done under anesthetic.
[SPEAKER_02]: It's a speculum in the vagina.
[SPEAKER_02]: The cervix is visualized.
[SPEAKER_02]: A little catheter is heated through the cervix and the sperm is released there.
[SPEAKER_02]: And the idea is that just gives the sperm a little bit of a head start to wait and still go.
[SPEAKER_01]: I've got that, you know, a little bit of a handicap.
[SPEAKER_02]: Exactly, right.
[SPEAKER_02]: Finally, if we could give them little maps as well, so that they knew where they needed to go.
[SPEAKER_02]: But unfortunately, we can only do so much.
[SPEAKER_02]: So when would I use this process?
[SPEAKER_02]: So I use this process of a male, has a few sperm issues.
[SPEAKER_02]: So his sperm is not terrible, but it's also not great.
[SPEAKER_02]: And mainly, motility is a big thing, or a lot of concentration.
[SPEAKER_02]: The Susan Cushops that we have, that I'd say, no, this is not going to be working for you.
[SPEAKER_02]: But generally, if it's just a small kind of a mild male factor,
[SPEAKER_02]: If it's someone who also can't have physical intercourse, if we really use people who have bad genus mess or any other reason, why ejaculation inside the vagina is not a possibility, then this is also a really useful way of being a bit more natural in that process.
[SPEAKER_02]: Patients who don't want to go under the YVF, it's useful for.
[SPEAKER_02]: And also those patients who are doing really poorly at IVF also go back to IVY.
[SPEAKER_02]: If you're only making one egg at IVF and you're paying a ridiculous amount of money for it,
[SPEAKER_02]: hard.
[SPEAKER_02]: And so if you're only making one egg through that process, making one egg through IUI is also probably a lot of a bit of cost savings for not that much improved benefit.
[SPEAKER_02]: Yes, the success rates are a lot better with IVF and it's also depending on awesome patients age.
[SPEAKER_02]: You are wise probably between
[SPEAKER_02]: You know, 10 to 15, 20% per cycle.
[SPEAKER_02]: We're as you're looking at a lot higher rate per embryo transfer, depending on age and quality and things, theirs.
[SPEAKER_02]: The advantage of IY is that it doesn't involve taking those huge levels of injections and having this massive epistrogen spikes really.
[SPEAKER_02]: So it can be a lot more gentler on the body for a patient to an extent.
[SPEAKER_02]: But still, the still foot, the foot utilization is still natural.
[SPEAKER_02]: It's not like we're doing it in the lab.
[SPEAKER_01]: And do women prefer that because it feels a little bit more natural, and they usually will go for IUI first, and then if that doesn't work, will they move on to IVS, if that doesn't work for them?
[SPEAKER_02]: It really depends on the person and their mindset when they're coming into it.
[SPEAKER_02]: Those that really want to avoid IVF at all costs will want to keep things as natural as possible.
[SPEAKER_02]: Yes, they'll do IVF first.
[SPEAKER_02]: Those that have sort of been trying for, sometimes, six to 12 months.
[SPEAKER_02]: And it just been like, no, I'm the sick of having to wait each month.
[SPEAKER_02]: I'm finally really hard.
[SPEAKER_02]: Those want to go straight for IVF.
[SPEAKER_02]: Because with IVF, we can make potentially the same amount of embryos you may have made in a whole entire year in one month.
[SPEAKER_02]: So it saves a lot of time for patients.
[SPEAKER_02]: There's something that just like, I'm over this.
[SPEAKER_02]: I just need to take.
[SPEAKER_02]: that away from me and I don't want to do that anymore and I want to make sure I've definitely got the goods and that's I've got the embryo and the embryo is going where it needs to go.
[SPEAKER_02]: So there's still unknowns with an IUI process.
[SPEAKER_02]: All we know about is that we've put the spoon in the right place at the right time.
[SPEAKER_02]: We don't know if it's managed to fertilise, we don't know if it's managed to travel down the tube and develop all we have.
[SPEAKER_02]: So there's these still things that we have, yeah, that are unknown.
[SPEAKER_02]: So I think I'd be if for some people
[SPEAKER_01]: Yes, and because fertility is such an individuated process, I guess it's really hard to compare the success rates between IU and IVF, is that correct?
[SPEAKER_02]: Yes, yeah, and we've also been each each month, that's also going to be different for every patient, because every month you've got a new egg, and every month you've got a new sperm.
[SPEAKER_02]: So it's hard to always compare cycle to cycle two, because in one month that might it might have had a really bad viral illness, which may have affected your sperm quality, and your sperm count the same with your eggs.
[SPEAKER_02]: There's lots of things that we can't always control for, so it is hard to compare between the two of them.
[SPEAKER_02]: But junior guidelines would suggest that a patient who's sort of under 35 is a good prognosis.
[SPEAKER_02]: Three IUIs if it's not working, I may let them do go to six for me saying, and I let this is kind of think about shifting and changing now.
[SPEAKER_02]: If someone is older than 35, I'd be at that three IUIs we're saying now, let's move on.
[SPEAKER_02]: Because I really want to get, if they're going to need IVF, I want to do it before the AMH drop see further and it becomes even harder.
[SPEAKER_02]: So you kind of, sometimes I go either of first and then say, I can come back to IUY if it's not working, because I want to utilize your equality and give as much as I can out earlier, rather than later.
[SPEAKER_01]: So on that, what can we do?
[SPEAKER_01]: And what would you recommend to women to have a successful IVF or IUY round?
[SPEAKER_01]: Is it kind of the things that you said previously, prepare the body to become a really beautiful host for pregnancy and become calm?
[SPEAKER_01]: But like, what are some specific things that you feel like you repeat a lot to your clients before they have their rounds?
[SPEAKER_02]: So to prepare for IVF is really important to have nourished yourself physically and mentally and to your relationship too.
[SPEAKER_02]: So they are like people to have thought about these things.
[SPEAKER_02]: And so nutritionally, Mediterranean diet is probably the best diet.
[SPEAKER_02]: I say eat the rainbow so eating all the colors.
[SPEAKER_02]: colourful foods at a natural colours, not artificial colours, of course, are high in antioxidants in many cases and they're going to be really helpful naturally because nutrients, the way that we process it is the way that it was grown in nature.
[SPEAKER_02]: So taking all the supplements in the world is actually not as good as eating the food with the war ingredients because there's so many other things other than just.
[SPEAKER_02]: the essential vitamin or mineral, it's the whole package of the food.
[SPEAKER_02]: So whole foods is really important.
[SPEAKER_02]: Movement, we can exercise not overexcising, but keeping yourself moving, allowing sort of lymphatic drainage and lymphatic flow is really good.
[SPEAKER_02]: Sleep is an interesting one.
[SPEAKER_02]: So a study that's recently came out showing that the mouth of sleep and the type of quality of sleep doesn't affect embryo transfer, but we know that sleeping affects melatonin levels.
[SPEAKER_02]: and melatonin as an antioxidant also, and having a good man asleep allows you to be more resilient to take over through the process too.
[SPEAKER_02]: It helps reduce the cortisol, and stress responses in your body, so allows you to also detoxify your system and reset, so I think sleeping is really important.
[SPEAKER_02]: The toxins we've already spoken about, so reducing the disease, stops smoking, vaping, and other big one, high alcohol intake, excess of plastics, endocrine, as well as all those things, really important to get out of your system.
[SPEAKER_02]: And also for those patients or those people who have jobs that are highly toxic environments, farmers, exposure to different chemicals, that's also a consideration for people.
[SPEAKER_02]: Check, I think it's important to check all your other indirect systems as well.
[SPEAKER_02]: Make sure I and labels be 12, fall late, vitamin D is good to be on a good prenatal, falloc acids are very important for fertility, so we need to make sure we've got the right fall late for you.
[SPEAKER_02]: And a lot of places are iodine deficient, so making sure you've got a good supplement for your iodine as well.
[SPEAKER_01]: Hmm.
[SPEAKER_01]: Okay.
[SPEAKER_01]: This is somebody in the entire spirit of that woman and see if she's actually ready and has an abundance of nutrients to support that pregnancy.
[SPEAKER_01]: Yep.
[SPEAKER_01]: Absolutely.
[SPEAKER_02]: And it's that.
[SPEAKER_02]: Supporting the pregnancy physically and also psychologically because
[SPEAKER_02]: If you are going down the process of IVF, for most people it's not just easy one-round and done.
[SPEAKER_02]: You've got to have the resilience to be able to keep going if that's what you need and that's what you desire.
[SPEAKER_02]: But your relationship also has to have that.
[SPEAKER_02]: So I talked to people about in a relationship you have the man and the woman and then you've got the fertility.
[SPEAKER_02]: Taking away the thought that fertility is not who you are, fertility is something about the two of you coming together.
[SPEAKER_02]: No one person should be blaming themselves for this process.
[SPEAKER_02]: If you can de-personalize it and take it outside of your selves, then you've got a lot less stress upon each other and you don't get the blame over it's your fault.
[SPEAKER_02]: It's my fault you're doing this and I'm doing this and you're not doing that.
[SPEAKER_02]: That doesn't help anybody.
[SPEAKER_02]: Because you're in the situation because you want to start a family together.
[SPEAKER_02]: Going back to why you here in the first place and not losing sight of that.
[SPEAKER_02]: And if it doesn't work, what have you got at the end of the day, you've still got each other.
[SPEAKER_02]: And so having each other and having quality with each other is important.
[SPEAKER_02]: So sometimes I'd have it with a stop doing IV for a bit and just had some time out together.
[SPEAKER_02]: look at yourselves.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: So going on from that if you could speak to male partners or partners not even male partners partners too women who are going through an IVF journey or even people who are not binary going through an IVF journey.
[SPEAKER_01]: Anyone who is going through an IVF journey they're partners.
[SPEAKER_01]: We're speaking to you.
[SPEAKER_01]: What would you say to them?
[SPEAKER_01]: Like let's separate this maybe.
[SPEAKER_01]: Maybe you can speak to the male partners who are supporting their sperm quality.
[SPEAKER_01]: what would you say to them and we'll talk to all partners and what they can do to support a woman going through this.
[SPEAKER_02]: Perfect.
[SPEAKER_02]: So from a sperm quality, this is another topic that I love to talk about.
[SPEAKER_02]: But to improve your sperm quality, look at your lifestyle again, look
[SPEAKER_02]: exercise and how much you are drinking, how much you are eating.
[SPEAKER_02]: Are you smoking?
[SPEAKER_02]: All those other things are spoken about.
[SPEAKER_02]: The supports you can have is if you've got sperm issues, we look at vitamin C, vitamin D, against zinc, selenium, other really big ones.
[SPEAKER_02]: Frequent ejaculation if there's a issue because the longer the sperm is sitting around and the epidermis before gets to ejaculate the risk of it having sort of microbrakes or DNA fragmentation increases slightly.
[SPEAKER_02]: If you've got a sperm issue, then you need to get those dodgy sperm out before we think about doing IVF.
[SPEAKER_02]: So looking at your own whole self, a funny thing that I set up patients is if you are a big cyclist, be careful sitting down on your fight for too long, increases your heat and your testicles and also puts foot of pressure on the perineal area, which can make things worse.
[SPEAKER_02]: I think guys go having no sperm at all after.
[SPEAKER_02]: doing long bike, right?
[SPEAKER_02]: So really look at what is it that's happening in that heated area, cell phones, all the sector and that statistical region.
[SPEAKER_02]: So for yourself, if you're a man and you're supporting an IVS cycle, don't forget that you also have a part to play, you need to be eating well, you need to be reducing toxic load on your system, you also need to de-stress and you need to think about ejaculating before your IVF, if that's what you're doing.
[SPEAKER_02]: If you are supporting the woman from a psychological point of view, be kind, just be kind.
[SPEAKER_02]: The number of women I just see are so stressed because the hormones are out the door.
[SPEAKER_02]: The students, the highest ever been.
[SPEAKER_02]: It's like having a whole years with a period and one go.
[SPEAKER_02]: It's a lot that you're tolerating.
[SPEAKER_02]: You're going to cry at the puppy dog or come across the road.
[SPEAKER_02]: You're going to get angry the fact that the toothpaste is sitting on the left side of the right side.
[SPEAKER_02]: There are things that you are just not going
[SPEAKER_02]: the hormones speaking here and so be kind, be tolerant and be loving would be the big things I'd say.
[SPEAKER_02]: You're in this for the loving reason and the initiation, remember that if you're going through this process.
[SPEAKER_01]: Yes, beautiful.
[SPEAKER_01]: Let's talk a little bit more.
[SPEAKER_01]: I would say about like special situations and like identity around IVF and queer identity around IVF.
[SPEAKER_01]: So like what does IVF procedures and IVY procedures look like to queer couples and like are there any extra
[SPEAKER_01]: Without, without legislation in Australia, is there any loopholes for queer people?
[SPEAKER_01]: Is there any places in Australia that are not welcoming to queer couples as well?
[SPEAKER_01]: Like, what's the history of IUI and IVF for queer couples as well?
[SPEAKER_02]: So, for some states, it's really difficult.
[SPEAKER_02]: And some places being a queer person undergoing fertility desires is really hard, typically speaking,
[SPEAKER_02]: Western Australia has been the hardest state, but I think things are changing and it's hard to know because the governments will change all the time about what they, what their legislations are.
[SPEAKER_02]: But being a queer couple or person who doesn't have the other gametes, so a gametes or eagle, your sperm, you need to get it from somewhere else.
[SPEAKER_02]: So there are a lot more loopholes from that regard as you don't have the necessary things to make an embryo.
[SPEAKER_02]: So you need an egg, you need a sperm, and you need a uterus.
[SPEAKER_02]: So for guys, it can be a lot harder because not only do you have to find an egg donor,
[SPEAKER_02]: He also defined a surrogate or uterus to carry that in.
[SPEAKER_02]: And the legislation in Australia and some of the parts of the world are the same.
[SPEAKER_02]: So you can't actually advertise for a surrogate.
[SPEAKER_02]: It's illegal to do these things.
[SPEAKER_02]: And as a particularly suspicious, I'm not allowed to help you do that either.
[SPEAKER_02]: You have to find this person on your own.
[SPEAKER_02]: You also have to prove that you've developed this relationship with them so it does takes time.
[SPEAKER_02]: In Australia, Laura also sees all different states a little bit different here, but in Victoria, where I practice the law sees that if you are the gestational carrier or the surrogate, you are actually the parent of that baby until it's born in 21 days after.
[SPEAKER_02]: the fact.
[SPEAKER_02]: So you almost have to adopt your child back and every state's a little bit different and this may have changed depending on what the government's do because the government does change these policies.
[SPEAKER_02]: But it's really tricky.
[SPEAKER_02]: So you need to have a good lawyer involved and luckily we have some wonderful lawyers in Australia that support this process because it's a very unique, a very specialized area and there's a lot of people working really hard at the moment to reduce
[SPEAKER_02]: for people.
[SPEAKER_02]: But so obviously and traditionally here has been hard and I do have a lot of patients who end up traveling overseas to reduce some of the stress in the burden of this process, which is hard in itself.
[SPEAKER_02]: But back to queer couples.
[SPEAKER_02]: So
[SPEAKER_02]: If you're a female and needing sperm, it's often a lot easier, and so people will either come to see me because they want to do it through the channels of an either known donor, they know somebody that wants to come and help them, or they want to go into a sperm or use a specialized sperm bank to go through the process.
[SPEAKER_02]: If the sperm donor has lots of sperm, we can consider IUI, which we've already talked about, and that can be a lot more cost-effectively invasive for the person.
[SPEAKER_02]: Or if the person's got less sperm, we can do IV for make embryos.
[SPEAKER_02]: Some people also like to who's one from persons egg, the donor sperm, and then put their egg back into the other person and their relationships, uterus, and so then it's kind of like a shared situation.
[SPEAKER_02]: That can be really a beautiful way of doing it for a lot of people.
[SPEAKER_02]: Again, the state's laws and legislation has different roles around the counselling that's needed for this process, the consent forms, and many of the consent around this process is really quite strict, and every state will be different.
[SPEAKER_02]: I think it's really important for IV specialists to realize that a lot of people who choose to either parent alone have a partner of the same sex, they're only way they can get pregnant is by the assistance of a fertility team.
[SPEAKER_02]: And so,
[SPEAKER_02]: I take that on or on really really carefully because these people ideally wouldn't want to have to go under go IVF but they have to or they have to go IVY because they cannot do it on their own.
[SPEAKER_02]: So I think it's really important that we as a special team.
[SPEAKER_02]: are so inclusive and so caring for this really important group of our community to try to help people have families in all different ways shapes and forms and so I really take this part of my job really seriously and I have some beautiful couples that I look after and that the journey is long a lot longer than those that just have their sexual organs firm already so.
[SPEAKER_02]: My heart goes out to them and I'm saying, keep going.
[SPEAKER_02]: If you're doing it, it's hard.
[SPEAKER_01]: Yeah, absolutely.
[SPEAKER_01]: And I'm also thinking about it same-sex women couples as well.
[SPEAKER_01]: They are the most likely to have the least amount of money out of couples.
[SPEAKER_01]: And it's also going to cost them more money to have a family.
[SPEAKER_01]: And they also have all this legislation they have to get through.
[SPEAKER_01]: And then male male couples in Australia at least, they will probably have to go overseas to do this because we are so strict.
[SPEAKER_01]: And I guess there are some benefits that protect surrogates in Australia for that.
[SPEAKER_01]: And I think that's good in some parts, but I can't help but think that some of these legislations are just time of phobic and just not really kind to those groups of people.
[SPEAKER_01]: So, so grateful that we have the of doctors like you who take it really seriously.
[SPEAKER_01]: and use this very carefully and know that this is a really important space for these people that probably have been saving up and thinking about this their entire lives if they wanted to have kids because this is such a huge decision for them, especially moving on from that.
[SPEAKER_01]: I want to talk a little bit about PCOS and enemy triosis.
[SPEAKER_01]: What does PCOS and enemy triosis look like in your clinic with IVF and IUY?
[SPEAKER_01]: Let's just start with PCOS.
[SPEAKER_01]: What does that look like in your clinic?
[SPEAKER_01]: How does that present and what does that journey look like?
[SPEAKER_01]: And I know it's incredibly variable.
[SPEAKER_02]: So PCOS SZA, you know, this is like a rather large question rather large answer.
[SPEAKER_02]: So PCOS is often an ovulatory dysfunction and that means that people are not ovulating every month.
[SPEAKER_02]: And without going into all the details, we do a whole entire podcast on PCOS itself.
[SPEAKER_02]: form of fertility for what do I do?
[SPEAKER_02]: Well, I want to help the woman ovulate.
[SPEAKER_02]: To help the woman ovulate, we've talked about holistic things in the really important.
[SPEAKER_02]: A lot of women can do things within the own environment to help reduce some of the things that are creating the ovary and issues the resistance in the ovary, but if they can't, the treatments that I use as ovulation induction.
[SPEAKER_02]: So, first of all, I would use a medication called vitriazole.
[SPEAKER_02]: To the tablet you take
[SPEAKER_02]: Then do a scan, maybe two scans that might see if your follicle is growing in your ovary, and then we would trigger that follicle to be released and tell you when to go over six.
[SPEAKER_02]: So that's sort of like an ovulation induction cycle.
[SPEAKER_02]: And having monitoring, it's really important because we don't want to make sure you're over stimulating.
[SPEAKER_02]: We don't want to give you twins.
[SPEAKER_02]: It's twins is something we'll love to have twins, but twins is really not a great thing to get from fertility treatments.
[SPEAKER_02]: Comes with the whole order risks.
[SPEAKER_02]: So we monitor people for that reason.
[SPEAKER_02]: And also, if someone's doing really well on a Appulation Dr. Concycle Monitor, also, and I'm saying, well, let's go to our Monitor, go and see if you don't have to utilize us.
[SPEAKER_02]: And so, a really common time I do this as a round Christmas.
[SPEAKER_02]: So people who have had a few monitored cycles, ending up to Christmas, then I say, we'll just go take the medication for yourself over the Christmas break, and have a bit of autonomy over your journey.
[SPEAKER_02]: And so it allows people to have a bit of space at the time without having to come and see me so regularly.
[SPEAKER_02]: With PCOS, say, typically,
[SPEAKER_02]: Their higher AMH means that they're likely to respond quite significantly to the medications if it's age that we talked about already.
[SPEAKER_02]: And their risk is something called ovarian hypostimulation syndrome.
[SPEAKER_02]: So it'd be really careful how we dose the drugs on these patients and how we monitor them throughout the porousies.
[SPEAKER_02]: So, there are also different strategies, different specialist will use to try to minimise this risk.
[SPEAKER_02]: But it's really important that this is addressed before a patient starts the treatment.
[SPEAKER_02]: They understand that they're likely to need what's called a freeze or all cycle to freeze.
[SPEAKER_02]: All the embryos let the body's hormones settle before we end up going into putting any bread back on the body.
[SPEAKER_02]: Because if you think about it, if we are stimulating all these follicles to grow, that amount of estrogen that's growing,
[SPEAKER_02]: is huge.
[SPEAKER_02]: The lining of the uterus wasn't designed to have that higher level of estrogen in it and we don't really know what that impact is on the embryo.
[SPEAKER_02]: The thoughts are it's not good, but in terms of embryo implantation in the window of implantation.
[SPEAKER_02]: So there's definitely a shift in a move to consider freeze-all cycles, especially for patients who have high estrogen levels.
[SPEAKER_02]: and so that's would be sort of my strategy of these patients, but generally speaking, oh I, ovulation reduction would be my first line and I would really hope that they don't need to get to IVF, but if they do, they'll often get a good number of eggs.
[SPEAKER_02]: Unfortunately, with that high number of eggs, doesn't always mean a high number of embryos, which is the
[SPEAKER_02]: eggs, but of those may be only half of them when mature, and you may still still end up with a low embryo number.
[SPEAKER_02]: And again, that's what we do with the metabolic issues, the metabolic health, and there is associated with PCOS.
[SPEAKER_01]: Okay, thank you for explaining that and moving on to endometriosis.
[SPEAKER_01]: What does that usually look like?
[SPEAKER_01]: I think the question that a lot of women with endometriosis have is, do I do all the prascapy before?
[SPEAKER_01]: Do I do it after?
[SPEAKER_01]: Should I sort out everything to do with my endolating up to this?
[SPEAKER_01]: Because we are seeing a lot of women who have endometriosis are entering IVF and IUI clinics to help with infatiality.
[SPEAKER_01]: So what does that look like?
[SPEAKER_01]: Again, very open and question that can be very hard to answer.
[SPEAKER_02]: actually question that I come across all the time and it is a discussion again realizing that as a fertility specialist I'm not here to tell you what to do I'm here to talk to you about the options and help guide you and help you understand why I'm coming to these decisions and also advise you what I think you should do but at the end of the day it is your choice a lot of the time so what do I say to patients with intimate choices?
[SPEAKER_02]: The concern about endometriosis is that often these patients have a lower AMH.
[SPEAKER_02]: They are systems highly inflammatory or witty, and even though IVF is shown to have a significant increase in your chances of successful pregnancy, it is still harder patients with endometriosis often will struggle even with IVF.
[SPEAKER_02]: So when to do a laparoscopy, we're not to do a laparoscopy, that is the million dollar question.
[SPEAKER_02]: And it will also, for me, I decide around the AMH level, the age of the patient, and sort of their family desires, because if they've got a low AMH, I'm going to really want to
[SPEAKER_02]: get on and do some embryo creating before things get even lower.
[SPEAKER_02]: If it's sort of a medium AMH or say, well, you might be able to do a few cycles of IUI potentially to keep trying naturally, or do a laparoscopy, clear out any window, try for six months, and then if it's not working then we're going to IVF.
[SPEAKER_02]: The research shows that for those that have either stayed one or stayed two endometriosis, that a leproscopy may improve natural fertility outcomes for the six months after the leproscopy.
[SPEAKER_02]: But it doesn't improve IVF outcomes.
[SPEAKER_02]: So if you're going to go down the IVF route already, there's no point in doing the leproscopy then.
[SPEAKER_02]: The caveat of that is that a patient has significant pain, what is struggling for whatever reason, then an laparoscopy may be a benefit for the patient at that time.
[SPEAKER_02]: The other time I do a laparoscopy, is that if they're having lots of failed embryo transfers, and I think is there too much information in the pelvis?
[SPEAKER_02]: Is there something we can't overcome by all the other things we're spoken about to reduce inflammation?
[SPEAKER_02]: Do they need me to go in there and clear out any of that inflammatory tissue was much as I can to help improve their outcomes and not only in terms of stimulation, but also in terms of embryo Resectivity I discuss this with patients earlier on to say well, what are we going to do?
[SPEAKER_02]: Are we going to do the lepros to be now or or be something we might consider in the future and the really reason why I do this a lot is that there's so much guilt that goes involved in
[SPEAKER_02]: the decision-making that people have through the IVF cycle.
[SPEAKER_02]: If we put the options on the table to start with, at least people know where they could be going, what the directions might be, helps reduce that anxiety helps to kind of understand where I'm coming from, and also helps them plan for their financially and physically for the next six to 12 months.
[SPEAKER_02]: So electroscopy is useful, only if it's low-grade indoor in order to try naturally.
[SPEAKER_02]: If it's significant like stage three stage four indoor, we only do it for pain.
[SPEAKER_02]: It doesn't really, it doesn't improve fertility outcomes by doing electroscopy prior to IVF or a natural conception.
[SPEAKER_02]: So we've been mainly doing that just for pain.
[SPEAKER_02]: Intimitriomas is another e-big one, so if a patient has huge ovarian cysts that look like by an Intimitriosis related, then there's a bit of a question about whether or not we should remove them or not.
[SPEAKER_02]: Obviously removing them is going to reduce the AMA, so I decide that based on what the AMA should able would be, but removing them can be useful if patients have undergone IV of cycles and they're not releasing it in that well.
[SPEAKER_02]: Just being aware that if you do an IV of cycle with Intimitriomas, there's a little bit of a higher risk of infection.
[SPEAKER_01]: But I guess we're going to admit, endometriosis have to also think that endometriosis is sticking different organ systems and fascia together.
[SPEAKER_01]: And so that's going to make the experience of pregnancy very uncomfortable.
[SPEAKER_01]: So even if it doesn't improve the outcomes of IVF, I can imagine that women would probably still with those very exaggerated stages, you know, you're four and five of endometriosis are very, very extreme.
[SPEAKER_01]: They probably might still opt for the microscopy and then go for IVF, just to manage pain, is that kind of what you usually see, that even though it doesn't improve fertility outcomes, they might still opt for it.
[SPEAKER_02]: It's a really good logical thought, but actually, from an obstetric point of view, we don't often see patients having that huge response in the pregnancy.
[SPEAKER_02]: The worst one is actually fibroids.
[SPEAKER_02]: So we've often offered you patients who have fibroids who start to do degenerate in pregnancy.
[SPEAKER_02]: That can cause quite a lot of pain.
[SPEAKER_02]: If someone's going to pain, syndrome, it's a different story.
[SPEAKER_02]: So they've already got the pain syndrome.
[SPEAKER_02]: Yes, that can be worsened to sometimes in the frequency depending on the hormone levels.
[SPEAKER_02]: But actually, those for the stage, if you've freaked out and you've got stage 4 window, it doesn't actually get significantly worsened in terms of pain in the actual pregnancy itself.
[SPEAKER_02]: So I wouldn't be advocating for surgery just to reduce potential pain and pregnancy.
[SPEAKER_02]: I'd be advocating for surgery for pain right now.
[SPEAKER_02]: because we don't know how long it's going to be until you end up getting pregnant.
[SPEAKER_02]: And if you're having significant issues now, if it's six months down the track a year down the track, but we want to make sure you're not going through that much pain because the more pain you're in, the more your nerves are getting activated and the more your likely to have a chronic pain syndrome later on in life.
[SPEAKER_01]: Absolutely.
[SPEAKER_01]: Okay, thank you for answering.
[SPEAKER_01]: That's so beautifully.
[SPEAKER_01]: I just wanted to close up with a few myths and perhaps truths around the risks of IVF.
[SPEAKER_01]: So when you look on holistic reddit threads and, you know, different Facebook groups in holistic mama groups, I've done my research before this.
[SPEAKER_01]: There's so many myths.
[SPEAKER_01]: There's so much misunderstanding around what IVF actually does.
[SPEAKER_01]: So does IVF increase the rate of cancer development in mother and baby?
[SPEAKER_01]: is the first one that I'd like to ask you.
[SPEAKER_01]: No.
[SPEAKER_02]: No, not directly in itself.
[SPEAKER_02]: So the answer is no.
[SPEAKER_02]: There's been a lot of research in this area.
[SPEAKER_02]: And yes, figure some studies that show, maybe there's a little correlation.
[SPEAKER_02]: But often that's because of the patient that's going in for the fertility reason is different.
[SPEAKER_02]: And then maybe they hit the cancer risk already.
[SPEAKER_02]: And so it's yeah, the answer is unapopulationable, no.
[SPEAKER_01]: And I guess the question following that is to IVF babies face any higher long-term health risks in association with children who are naturally conceived.
[SPEAKER_02]: The answer here again is unlikely.
[SPEAKER_02]: It's not completely not true.
[SPEAKER_02]: Again, the reason why the patient might have been undergoing fertility in the first place may affect the outcome.
[SPEAKER_02]: So if it's a male factor, for instance, that could be to do with the genetic problem, that child may also have a genetic issue.
[SPEAKER_02]: What we don't know is we don't know about testing of the embryos, is this some sort of long-term effect of taking a few cells away from an embryo and seeing the life of
[SPEAKER_02]: There's a thought that maybe there's some impact in the future, but we still don't know, as probably they've answered that.
[SPEAKER_02]: But there's no risk of increasing childhood cancers or anything else that we know of from IVF at the stage.
[SPEAKER_01]: It's an expression that I think a lot of people are like, okay, this has to be true because it's so plausible.
[SPEAKER_01]: And there are a few different types of IVF that we actually haven't spoken about.
[SPEAKER_01]: There is one type of IVF where you put the oven and the sperm in the petri dish you leave for the night you come back and you see if an embryo is there.
[SPEAKER_01]: And there is a second type where we put the over in a picture dish and you get a tiny little needle, the tiniest needle on earth and you put the sperm inside of the egg.
[SPEAKER_01]: And so this type of IVF, what is that one called?
[SPEAKER_01]: What's the name of that when we get the needle and put the sperm inside of the oven?
[SPEAKER_02]: It's called XC, InterSighted Plasmix Spurm Injection, and which is a robot, it's very cool watching it.
[SPEAKER_02]: So it'll be robot on this piece, and it's micro movements to one paper, hold the egg, and the other one will help put the sperm into it.
[SPEAKER_02]: So it's very exciting.
[SPEAKER_01]: Okay, so there's a lot of conspiracy around this because we're forcing this to happen.
[SPEAKER_01]: This means that because the ovum has this kind of shield around it in a way and it chooses the sperm.
[SPEAKER_01]: And because the ovum is it choosing the sperm, this might increase the risk of genetic mutations because the ovum did choose the correct sperm.
[SPEAKER_01]: Can you please talk about this and like what the likelihood of a baby being born from exe has an increased likelihood of having genetic mutations?
[SPEAKER_02]: So we have to be clear that just by putting a sperm into an egg doesn't mean it's fertilised.
[SPEAKER_02]: So the fertilisation still has to occur.
[SPEAKER_02]: So you're actually just enhancing the natural potential system.
[SPEAKER_02]: Yes, there's a potential that we're selecting the sperm that wasn't going to be the best sperm swimmer.
[SPEAKER_02]: But the reason why we do it exceed is because they aren't very many sperm to choose from.
[SPEAKER_02]: So the options are that you don't get pregnant because no sperm is going to get to their egg or we index into the egg.
[SPEAKER_02]: A lot of the studies that have shown slight changes with the exe is actually because a lot of the concerning features around mean who have problems with producing sperm may be genetic and maybe that's the reason why they offspring are affected.
[SPEAKER_02]: But are we forcing it?
[SPEAKER_02]: No, we can't force the egg in the sperm to come together and fertilize.
[SPEAKER_02]: We really, really can't.
[SPEAKER_02]: If there's going to be a problem with the genetic material of any quality too many or too little chromosomes occurs, you've still got no difference in rates of that with IVF or XE because you're still going to end up with a miscarriage if that happens.
[SPEAKER_02]: And yes, you may have some subtle changes by doing the XE process.
[SPEAKER_02]: But really, we can't make a baby occur.
[SPEAKER_02]: We can only sort of lead the horse to the water really, but we can't make the fertilization happen.
[SPEAKER_02]: So that would be my bottom line there, to say no.
[SPEAKER_02]: I think that that is actually a little bit too extreme and that for patients who don't have sperm, this is the only way that they can conceive.
[SPEAKER_02]: And we're actually really helping in heart and support their journey.
[SPEAKER_02]: And I don't think that we are forcing genetic mutations
[SPEAKER_01]: So that practice of XE doesn't change the genes that we have already.
[SPEAKER_01]: And if that pregnancy happened, it would have the same genetic mutations if we had XE anyway.
[SPEAKER_01]: So thank you for that.
[SPEAKER_01]: And I guess the other one that I really want to talk about are the IVF hormones used harmful or risky.
[SPEAKER_01]: in the long or short term for women.
[SPEAKER_02]: So if we look at the level of hormones that we're using, so if you say it's the reason to stimulate short half life doesn't turn the body that long, not a concern.
[SPEAKER_02]: The estrogen is probably what a lot of people talk about, and estrogen is at high levels within the cycle.
[SPEAKER_02]: The cycle lasts approximately two weeks, and the highest able of estrogen is round to the couple of days for your egg collection, and it's only a couple of days.
[SPEAKER_02]: The level of estrogen and producer-owned and a pregnancy is far higher, and it's lasting for the whole.
[SPEAKER_02]: So really, if you really broke it down to the nitty gritty in the basics of physiology again, and not to be too pigeonholed with the IVF, you compare it to the actual pregnancy, then no, it's no real difference.
[SPEAKER_02]: But yes, for a short period of time, you are having super high levels of estrogen.
[SPEAKER_02]: And I maybe if you did them, I'd be of cycle every month for five years in maybe it is a problem because you're not being pregnant every month for five years.
[SPEAKER_02]: But there's actually, there's no studies that have shown that there's clear harms for the fertility drugs.
[SPEAKER_02]: From a physical point, you could not say that psychologically, I feel like a lot of women feel pretty crazy on that high level of hormone because they're not used to it and when you're pregnant, there's a whole lot of other stuff going on as well.
[SPEAKER_02]: So, but no, do no research shows that that high level of hormone does have a long-term negative effect on women.
[SPEAKER_02]: But just to carry it to that, there are some conditions that have issues with estrogen and some of the clotting factors issues migraines with aura, so the intimate show has a high BMI.
[SPEAKER_02]: These patients really require very specific addictions of their protocols.
[SPEAKER_02]: So it's important that if you are doing IV for fertility, you are talking to someone who understands those differences, that understands the intricacies of hormones, that understands that not every body is the same as not cookie cutter medicine, that they understand you and your couple in your situation.
[SPEAKER_02]: So I think, yeah, that's really another important point about kind of
[SPEAKER_01]: Yeah, like if someone already has a higher subset of estrogen, it's being aware that we're going to increase that again.
[SPEAKER_01]: And so how can we support your exit pathways and how can we support your liver and your adrenals?
[SPEAKER_01]: Are you constipated?
[SPEAKER_01]: Okay, cool.
[SPEAKER_01]: We can't really do an IVF cycle until everything is ready to move out.
[SPEAKER_01]: What's your progesterone level?
[SPEAKER_01]: What can we support for that?
[SPEAKER_01]: I think it's just such an individuated process.
[SPEAKER_01]: Thank you so much for your time.
[SPEAKER_01]: How can people find you?
[SPEAKER_01]: It's very exciting.
[SPEAKER_01]: You've opened up your own independent IVF and IOI clinic now.
[SPEAKER_02]: tell us all about it.
[SPEAKER_02]: So super excited.
[SPEAKER_02]: We have a doctor run in owned clinic so it's fully supported by ourselves, it's called Stellar Fatility.
[SPEAKER_02]: So we're based in Melbourne but we also have a lot of telly health so we look at a couple of patients all over Australia and we also have a unit in River Arena IVF and New South Wales.
[SPEAKER_02]: So amazing exciting.
[SPEAKER_02]: We are based in two beautiful
[SPEAKER_02]: That's where you can find me here physically or online.
[SPEAKER_02]: And I also do gynecology.
[SPEAKER_02]: So I look after patients from adolescents all that through should remain a causal time.
[SPEAKER_02]: If fertility is my main love and care.
[SPEAKER_02]: I operate.
[SPEAKER_02]: twice a week, sometimes, sometimes more because I love to also look after every aspect of the woman.
[SPEAKER_02]: When asked about me, you can contact me through my website, I'm sure you can put in there, I'm at Instagram, at m.doctorabicatmp.wipsitesurbicatmp.com.
[SPEAKER_02]: And find me there, share it out to me.
[SPEAKER_02]: Any questions?
[SPEAKER_02]: Anything you want to know, do find us also at StealthAtility.com.au.
[SPEAKER_02]: We would love to help you on your journey if you need help.
[SPEAKER_02]: Also, if you don't need help, I'd also tell you that too.
[SPEAKER_02]: So be aware that if you come and see me, I'll give you a really honest and heartfelt approach to your care.
[SPEAKER_02]: So I look forward to meeting any of you out here.
[SPEAKER_01]: That's exactly what IVF needs.
[SPEAKER_01]: Thank you so much.
[SPEAKER_01]: Thank you so much for taking the time out of your busy day to listen to this episode.
[SPEAKER_01]: If you loved it, please remember to like, subscribe, and send to a loved one.
[SPEAKER_01]: If you want to learn more from our quaman, please check out the website at arquaman.com.au where you can find a pothora of offerings like charts, masterclasses, courses, and organic clothing.
[SPEAKER_01]: You can also head over to patreon.com slash arquaman.
[SPEAKER_01]: or sub-stack.com slash our comment to join the community.
[SPEAKER_01]: I hope you have a really beautiful morning, afternoon or evening wherever you are in the world, and I will see you on the next episode.