07: Training for the Fertility Marathon with Dr. Beth Taylor

By listening to the Conscious Fertility Podcast, you agree to NOT use this podcast as medical advice to treat any medical condition and either yourself or others. Console your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast. Welcome to Conscious Fertility, to show the listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lauren Brown. I'm a doctor at Traditional Chinese Medicine and a clinical hypnotherapist. I'm on a mission to explore all the paths to peak fertility and joyful living. It's time to learn how to be and receive so that you can create life on purpose. Today on the Conscious Fertility Podcast we have Dr. Beth Taylor. She is one of the directors at All Look Fertility Center in Vancouver, British Columbia, Canada. She is a reproductive and ecanologist and I've known Dr. Beth Taylor for many years. I think we met maybe were you resident or fellow when you were at UBC? What were you doing when I met you back in the day? I think it was a fellowship back in 2005. Yeah, okay. So Beth was already curious and into integration back then because she came to my clinic with some of her colleagues to get some acupuncture. And so even back in 2005 she was quite open-minded and now at All Look Fertility Center they're offering the best of Western reproductive medicine when it comes to the technology and the care. And they're truly integrative. Evident by that us acupuncture go on site for their IVF acupuncture embryo transfers and we have lots of discussions on integrated care to help support the women and men during the fertility journey. Today I thought we're not going to talk so much about the consciousness aspect of fertility although I know with Dr. Taylor with Beth here that could come up but we're going to talk about some of the things I'm around testing for quality and in particular we're going to talk about how do we know if we have a good embryo and how do we know if the lining is receptive can we get implantation because there is kind of a handshake that has to happen. You got to have a good embryo and the uterus has to receive that embryo in order to have an ongoing pregnancy. So since these embryos are so precious I mean they're all precious but as women age to become more precious to them and if they don't have a lot of embryos in an IVF cycle wow now they're really precious because you only have so many and so we really want to make sure we're putting in an embryo that has the chance to become a baby and I thought I would ask you about some of the testing that you guys do when it comes to knowing whether that embryo or not has a chance to turn into a live birth. Thanks Lauren and there's lots of new stuff happening in this area so it's kind of fun to talk to you about it and I'll use your model you know you've always talked about the seed in the soil those are the two parts that make the plant grow or the baby grow and if we talk about the seed how do we make sure the seed is healthy how do we make sure that embryo is healthy and what that means then is is a healthy embryo is more likely to stick in the first place and give you a positive pregnancy test it's less likely to biscarry more likely to make a healthy baby that you have in your arms nine or ten months later so the health of the seed is so important and that's predicted mostly by the the woman's age more and more we're realizing the male age matters too but when we say healthy what does that really mean well it means a lot of things in an an embryo the biggest thing that means is what is is it chromosomally normal so does it have the right number and structure of the chromosomes in the embryo we can test to figure out if it does or not and that testing is it's done before we put the embryo in so it's pre-implantation and it's genetic testing so it's PGT and when we're looking for chromosomes it's got an A at the end because it's for annuploity which is reflects the number of chromosomes and we're looking for abnormal numbers of chromosomes so it's annuploity so PGTA is what we're talking about we're saying let's test that embryo let's test that seed to see its health status so PGTA is a test that's being used more and more often there's some controversy with it like any tool we have in medicine there's some controversy with it which we can talk about as well but that's what the testing is called and it involves biopsy in embryo to see whether it's normal or not well let's talk a little bit about that IVF process and getting to the biopsy because some of the listeners have gone through this but there's some that may not even know that this is available or bowed to embark on an IVF so in an IVF cycle and this is going to be a short and sweet version of IVF but you use drugs to stimulate several follicles in the ovary and you go in and retrieve those follicles go and retrieve the eggs from those follicles and in the lab you inseminate and these eggs get fertilized and they turn into they grow into embryos over a five day period the biopsy that you're doing then these embryos so you you retrieve the eggs they're fertilized with sperm disseminated which turn hopefully fertilize the egg and they're going to grow you're biopsy them on day five ideally some of them though you do have to grow I've noticed longer some take up to day six or seven right for biopsy that's right we biopsy day five six or seven which is five six or seven days after we've created the embryo through fertilization day five and six are about the same similar chance that an embryo will be normal the biopsy goes well similar success rates with those embryos day seven we start to see a bit of a decline in success rate and even just the chance that it's a healthy embryo and when you're doing this biopsy it's at the blastocyst stage and there's kind of like two stages to to this blastocyst right you have these inner cells and and then the cells that are going to become the placenta a lot of patients are like I don't want you to take any cells from my baby you're not taking cells from the baby when you do this biopsy no that's right so that's why we wait five six seven days to do the biopsy because that point the baby has separated differentiated away from the placenta and so the baby is when you look at these embryos day five six or seven it's very clear this is the baby and then there's cells that are around the baby and that's the future placenta it's called the trophoblastic that trophoblastic at that stage and it's the trophoblastic biopsy we don't we don't biopsy babies doesn't that sound horrible even to say in one sentence I know but it's important to to share that right because when they say I mean we see the people that go through this they want this to work so badly I'm always amazing we'll tie this into the conscious part right here as they're already in love with this baby before they've met this baby before it's even implanted it's it's amazing on how this is beyond space and time when you look at it from a conscious perspective so just the idea that your biops in the embryo I'm sure you guys see a lot of the patients get quite concerned quite worried that you're going to take cells from that how do you put them at rest that this is not damaging the placento and obviously not the baby is not taking cells from what's going to become the baby but do you have ways or the science to share with them how this is okay well firstly the as they say the proof is in the pudding we have tens and hundreds of thousands of babies born after PGT that that are healthy so we don't think we're harming these children there's no evidence of that healthy babies just like any other IVF baby there is a small chance of harm to an embryo if the biopsy is done you know too large a biopsy is taken or there's an issue with you know this how the cells are handled there can be damage to an embryo which is why we don't tell everyone to do this but the risk is really small it perhaps 1% perhaps 2% is what most studies show that there's a risk that you could damage an embryo just by handling it like that but really we're not 98% chance that we're not doing any harm at all we're getting really valuable information is the upside and at this stage of the development when it's called a blastocyst around day five and six it seems like as humans are like salamanders these things just correct and duplicate so these it's not like the placenta is going to be missing anything well that's right and remember the placenta at that stage might only be 300 cells and eventually it's going to divide enough to become hundreds of thousands of cells and then that's so early on in our lives you know these cells are all we call pluripotent or totipotent like they have potential to become many many different things and many many cell divisions to become much bigger and larger so really we're not harming the future placenta IVF there's no evidence of that I'm always amazed just how we have this innate ability to regrow things and change fix things at such an early stage which what you guys have now are we seen this in like in salamanders but we see this in human beings we're like them at the early stages and you've seen this in your in the science with the PGT that you guys do well that's right and wouldn't it be nice if we could keep that healing and proliferation that happens at the embryo level and even at the you know as it's children that they can procreate if you ever if you know if you're a child and you cut their arm boy it heals amazing right like we're just able as humans when we're when we're young we're just able to regenerate that and that's sort of happening to many fold in the embryo and so I want to talk about the different types of the genetic testing and why you you would do this so let's start off with just the most common one and you talked about PGT and deploy PGT-A back in the day that's what it was also called PGS and also CCS is that the same test exactly right okay so it's the same test that we're talking about here and when do you counsel patients to do this what's the upside? of doing this test. Why would somebody want to do this test? We should be doing this test if we're interested to know the chromosome status. And if you know the chromosome status of an embryo, you know if it's healthy or not, a healthy embryo is more likely to stick. And it's less likely to miscarry. So someone who has had many miscarriages should really think about PGA, because the reason they're having many miscarriages, which everyone knows are traumatic, physically, mentally, emotionally. They're one of the hardest things, a couple and a woman in particular will go through is a miscarriage. So avoiding a miscarriage is good enough reason to my mind to really contemplate PGA for everyone. Miscarriages are besides the emotional side, you know physically they're hard on the uterus. They can leave women with with scarring of the uterus and make it less fertile in the future. So we really want to be cognizant of what it means to miscarry and not underplay that. Because most of the big studies that look at the value of PGA have shown limited value in women under 35, if you don't consider miscarriage. Okay? So, but if playing over 35, it's shown value. And the thinking there is that if you don't buy up see these numbers and you just put them in the woman one after another month after month, the outcome is the same whether you buy up see them or not. And that makes sense, right? If you had four embryos and you buy up see you knew that one of them was normal and you put it in, that person will have a baby. She got that baby from one embryo transfer though. The other person who had four embryos and only one was normal, she might have had three embryo transfers and two miscarriages and a really big delay is that takes time to have transfers and miscarry. And eventually the end of that story though is that she did have that normal embryo transfer and she had a baby from it. So the story at the end, a year later, 18 months later was exactly the same. And that's the argument against PGA that ultimately if you just use the embryos, you didn't need to do the biopsy. But I think the counter argument there is that three embryo transfers are really expensive. They're time consuming, they're emotional, and potentially putting you at risk of a miscarriage if you're putting in an abnormal embryo. So I think there's lots of reasons that don't show up in that final live birth rate data point that that suggests everyone should contemplate PGA. Now there are definitely exceptions to that. And if you look at at our centers numbers, it's about 60 to 70% of our patients are doing PGA and the rest are not for various reasons. For example, the woman under 35 who has one or two embryos, she might just opt to put them in. And the cost is probably the same and she's not putting her embryo through a biopsy, even that one or two percent and the outcome kind of has the same story whether she biopsied they're not. So there's definitely scenarios where we make the decision even later on in their treatment. We start out thinking we're going to do PGA and then change our mind as we go along, but I'll circle back. So there's some women it really, really makes sense for and there's some women it really, really doesn't make sense for, but the vast majority of people that generally make sense nowadays to do PGA. And when we think about it, like what area of medicine are we not wanting to get more information from what area of medicine are we where we're going to blind ourselves to information that we could have that could potentially help us. In this case, avoid miscarriage or just even more likely have a live birth. I want to summarize kind of what you shared because it's such a common conversation that we see with our patients that are going through IVF at your center. And so, and I like the math side of it because it's coming down to odds and as you put it so nicely, there's that individualized aspect of what's going on for the patient because not just the stats of live birth, but the emotional toll and the physical toll on the individual of having unsuccessful and financial costs of unsuccessful transfers. So when I'm understanding for my conversation is like you said, the live birth rate, if you took somebody and she has four embryos and you don't test and only one is normal, but you didn't test, but we just know this because we know things. Then that's the only one that's going to stick and we don't know if you're going to put that one in first or if that's going to be the fourth transfer that's going to work. And so when you test, you're saving that person time because now rather than wasting their time and money putting in the three abnormal embryos that won't stick or will and then miscarry, you're able to go right to the embryo that's going to work. So you're saving time and saving money by putting that in right away. But like you said, if you gave the person 18 months to do all four transfers either way, whether she did testing or not, she's going to have a live birth. It's just that it may take 18 months longer and more time and more stress and trauma around that transfer. Right? Agree. Now, when people get older and they have three or four embryos, if you don't test and you spend 18 months putting them in and say they're all abnormal, this is when it becomes individualized. Right? They may miss out on the opportunity of doing another cycle to get a normal embryo. So if they did four, if you're able to get four day five and all four abnormal, then this individual and they're in their late 30s, they right away can think about doing another IVF to see if they can get a normal embryo. Versus if they wait and put these in and they don't know 18 months later at age 38, 18 months is a lot of time for a quality to cause. That's right. 18 months matters. Then your late 30s, that's right. Yeah. Yeah. Yeah. And so with our listeners, it's important that there's the testing. But then there's the expertise that you get when you talk to somebody like Dr. Taylor because it becomes individualized. It comes the emotional financial cost, but also the cost of time. And so stats will say you've got the same chance regardless of don't put them in. I don't know if you know Beth, but before I was in Chinese medicine, before I was in a accountant, my my degrees in math. And so my that teacher said, that's always lie. And so you can make that say anything you want. So be careful of the statistics in general. And that's where you need to have that personal individualized care, which you guys offer to ask those questions. What about the embryos that come back? So if an embryo is abnormal, you guys won't put them in because it's not going to work or you're going to create a definitely old child. Is that's the idea like you guys won't transfer abnormal embryos. We have an exceptional circumstances, but generally we wouldn't advise it's not going to give them a baby. And that's what they came for. So they're not going to get the baby and our goal is healthy baby. When you do the genetic testing, you're testing for chromosomes. So do they have the right number of chromosome? There are some conditions that this will pick up. Correct? Like I know it picks up Down syndrome. Yes, that's right. But this is not testing for some severe genetic diseases, the PGTA tests. That's right. Right. So you have another test for that. If you know there's a serious illness, a hereditary illness in the family, there's another test for that. Yeah, that's right. We'll talk about those. You want I also want to talk about just the mosaic embryos as well before we go on to those just to let people know what's available, but it's not always black and white with the testing. So you can have a normal embryo or an abnormal embryo when you do the PGTA testing, but sometimes you get a mosaic embryo. And that's where we see a lot of controversy, but whether you should transfer them or not. Can you tell us what that's about and kind of how you look at that in your clinic when you see couples or women that have mosaic embryos? Right. And you've said it right. When we get a report back on the embryos that were tested, it will be normal abnormal or mosaic. And about 20% of the time it will come back saying mosaic, you'll know that when we do the biopsy of the placenta or the trophecta derm, what we're actually biopsying those cells, there'll be a cluster of cells, 10 or 15, 20 cells. Some number of cells are coming out in that biopsy and they're sent off. And what happens is that if they're all normal, we call the embryo normal. If all of those 10 or 20 cells are abnormal, we call it abnormal, but sometimes two cells in there will be abnormal. We'll have the down syndrome number of chromosomes or some other chromosome problem, but the rest will be normal. And so they call that a mosaic. Now that's when you'll talk to your doctor here or one of our genetic counselors and say, Hey, you know, what do you think about this mosaic? Is that what does that really mean? And remember, if we didn't do this testing, we would have put that mosaic embryo into you. You know, that's an important point. I want to bring this up that before this testing was ever created, invented, but I've been practicing since 2002, since 2000, 2002 with fertility, that was IVF. You guys were putting in abnormal embryos because people get quite concerned. Oh my god, I have an abnormal embryo or mosaic. If I don't test you, that's what IVF was. You guys were putting back abnormal mosaic embryos. For the last 30 years, that's right. All the time. Yeah. And anybody you're not testing right now because you don't test everybody, they're likely putting back abnormal. It doesn't work or mosaic embryos. That's right. And we're not creating a whole bunch of genetically abnormal kids. And we know that because there's been nearly six million babies born from IVF around the world, most of those are not PGT tested and we're not, we're not causing problems. So, so we know that transferring mosaic is a fine thing to do. It does have a lower success rate though because sometimes that mosaic reflects that yeah, actually there are a lot of abnormal cells in this little, in this little one. And so probably it's actually not that healthy and it's less likely to stick. And then in other times, we know that the body's really good at healing and it will heal out or or expel or not procreate, proliferate, I should say those abnormal cells. And so you end up with a normal healthy child. I just got to bring a little Chinese medicine part because this is what I love when I see the medicines coming together is this was one of the tenants of Chinese medicine that the body has this innate ability to heal if it has the right environment. You can self correct within reason and it's that you guys, like this is something that's discussed in 2000 years old, how they've observed the body. But now with a map, you guys are actually seeing some of these embryos that you see themselves correct. Self-correct, you're absolutely right. Yeah. And if you have a healthy egg, and this is why we love doing the preconception care, I've been told that sometimes sperm's not so great, but the egg also does some repair. Like, even if it gets an average guy. So again, we have a strong female. It's kind of like how the family is raised, right? You got the strong female, that feminine energy. You create a good child. And so, and I will share with everybody that you can have divine masculine. That means there's feminine energy there. I'm not talking you have to be X, Y, chromosomes here. I'm talking about that feminine energy. But we see this with egg quality and sperm quality that the egg sometimes can sit there and take average, not so good sperm. And then it does some correcting and makes a fine embryo. That's right. Yeah. So we will see that that correction happens. The mosaics are worth considering and having a discussion about the current threshold is the 50%. So a 50% or fewer of the cells are abnormal, generally encouraging people to transfer those embryos. Okay. And you always still transfer the normal embryos first. So if you have genetic, if you buy up to the embryos, and you have say four come back three or normal and one is mosaic, you put in the normals first one at a time normally as well, right? That's right. That's right. And so the mosaic is the is the last one of your selection. You still go through the normals. That's right. And you guys are seeing pregnancies and healthy babies from these mosaic embryos that are below that 50% threshold. That's right. We are and our local data were presenting this fall at the Canadian fertility society meeting. And also there have been other publications of thousands of mosaic embryos and no surprise. We're seeing healthy babies. And this is what I like about the integration because I feel that the preconception time. So the lifestyle, the diet, the meditation, what we're doing with the acupuncture and laser and our clinic, that preconception, we're helping the sperm and egg get to their peak potential at the time of conception. Or when you do IVF fertilization. And you guys are like you're doing the grading. You're like the report card. Did we study well enough? Did we prepare well enough for this exam? And during the IVF when you guys do what you do so marvelously with your drug protocols and going in and retrieving and how your lab just can grow such nice embryos out to day five, it's just a nice integration. And it's a nice opportunity to see how well we've been able to help prepare that body, that cellular environment to help them reach their peak potential to give them a better chance. I couldn't agree more. I think that creating a healthy embryo is a marathon. And at fertility clinic, what we do is we provide water and cheer on the embryos at the last two miles. But what you guys are doing is actually getting them ready for those last two miles. And that's so critical because we're really neglectful of that first part of the race, which I think we really lean on you guys and should more so to give us the best possible legs to get to that beautiful finish line. Well, and that's the key. So the goal is the finish line, healthy baby. And we share three groups. So there's acu balance or if you're seeing your Chinese medicine naturopathic positions, you got the fertility clinics on this case, it's all of. And then you have the person going through IVF. So there's three of us that have a shared goal of that finish line, which is a delivery of a healthy baby with a healthy mom. And if a father's involved, a healthy father, right? That's the goal. And you said it, we're at that the beginning, that big part of that race. So we help in that part of the marathon. And the way you said you're giving the water at the end, yeah, but if you don't finish the race, you didn't finish the race. So there's integration. So there is no like we just need both parts and your part is so it's sexy and exciting. The western part, the technology, I'm always so fascinated with it, which is I enjoy integration that we do with you guys. And I'm glad that you see the value in the marathon and preparing before the IVF. So what are the other and we're going to go into the receptivity side, the uterus side because not all genetically normal, chromosomely normal. So the PGDA, what's on average the success rate when you put in a normal embryo. So it's about 75% chance you'll have a positive pregnancy test. And then about 8% will be miscarried after that. So it's about a live birth rate in the mid 60s. And so again, let's just put that into perspective. And it's unfortunate, but we can't unfortunate as in there's no guarantee, right? Nobody can say and run from anybody that says if you work with me 100% success rate, because it doesn't exist at the time of this recording anyhow. But in 2002, the success rate was well under 30% I think. And now you can get up to 60%. In nature, meaning you're not doing IVF, you're in your 20s and you're having unprotected sex and trying to conceive, the chances are what, 25, 30% each cycle. That's right. Yeah. And you're saying 60% live birth rate through genetic testing. So pretty impressive then what technology can do to help us increase your chances in a cycle to get pregnant without IVF genetic screening in your prime is in that 30% range. And with the testing, it's over 60%. That's right. And you know, IVF was the first big leap. I think PGT was the next big leap. But I can't and brighter minds may be able to, but I can't see the next big 10, 15% leap myself. I can only see two and three percent leaps. And that's this receptive, you know, that sort of testing. I can't see the next 15% leap in pregnancy rates, per embryo transfer, but I can see where, you know, the low hanging fruit Chinese medicine, some new technologies like laser ultrasound, certain medications, certain testing of the endometrium, the microbiome, all those things that are kind of coming at us now. I think our each one is 2% you know, and then many 2% though we'll get us to another 10% rise. So then a year or two from now, we're sitting and talking about 75% live birth rates. Sure. And anybody who's gone through fertility treatments will take 2%, 3%, 4% increase. We will all do it all day long. It's true. It all day long. And I think, you know, we didn't see PGT really coming through either. I don't think it was super obvious. And so stem cells or somebody's going to figure something out. I'm sure it will come. But for now, we'll do the marathon. And we're going to talk about these things where you talked about the microbiome and all those things about receptivity because I remember when genetic testing started, they thought it was the solution again that we've solved the kind of infertility. And it's turned out there's a big increase in pregnancy rates doing this or saving time as you shared. And we've learned that the uterus plays a big part too because I think like back in the early 2000s, my experience was my understanding was a lot of the fertility clinics kind of dismissed the uterus. We just need to get a good embryo. They weren't so concerned about the uterus. But now you guys are very concerned about the uterus. And it makes sense because again, Yin Yang and Chinese medicine, there's always this handshake, right? One may look like it's more important, but still without the other, you don't get it, right? It doesn't happen. And maybe a circle, I know I told you guys we're going to talk about the other testing for other diseases. I think it's basically you guys just have other biopsies that you can look for diseases so we can bring that in. But when these normal embryos aren't implanting or you're seeing implantation failure, they don't make sense. You guys now are looking at the uterus in more detail for its receptivity. Can you talk a bit about that? And I think that's why we've been on site with you guys for a while is we're there to try and help with uterus. Because on transfer day, the marathon's over, we can't do anything to prepare embryo quality. It's all about uterus. So let's talk about the technology and testing that you guys are doing to find out about uterus. Right. So even when I first, well, when we both first started, we used to just blame the embryo when a woman didn't get pregnant after a transfer. Must not have been a good transfer. But then we have testing that shows no actually this is a normal embryo. It's chromosomal normal. It looked beautiful under the microscope. Geez, you know, that really sort of shifted our focus to the uterus more than ever. And that's led to some groups doing some really neat things looking at the microbiome, looking at levels of infection in the uterus and looking at what proteins are in the uterus when an embryo sticks and what are there when it doesn't stick. And are the right genes being turned on to make those proteins at the right time. And that is receptivity testing. Endometrial receptivity analysis is what it's called ERA. And there's several groups around the world. We use one from Igenomics, which is the biggest ERA testing group in the world. But there are others doing this kind of work. And what we do is we know people have studied this in the 90s and in the early 2000s. What a uterus that will stick an embryo, what the protein and gene profile looks like if you take some some of the uterine lining out and look at it on the day of of implantation. And so we know what that looks like. And then if you'd biopsy someone who and say, well, actually yours doesn't look like the receptive one, how can we make it receptive. And then we can get some advice in changing progesterone dosing is the big thing we're changing right now. So ERA is involved in taking a biopsy of the lining of the uterus around the time that you were going to put an embryo in. And so saying, "Hey, this is a receptive lining." And the answer is yes or no. If it's not a receptive lining, what can we do to make it receptive? And we can adjust for just your own dosing is the big one, but I think there's gonna be more things come out over time about how we can make that uterine lining look more sticky. If you were to just take the population and test every woman walking down the street, you'd find that most women actually have a receptive lining. So only about 15% of us don't have a receptive lining, but picking out that 15% and helping them make their lining receptive, now you've upped your pregnancy rates in that group of people. You've really helped that 15% of people and overall you've raised your pregnancy rates. So again, that's chipping away, getting higher and higher and higher pregnancy rates, but you're really benefiting the 15%. And this is again going back to your stats background more and personalized medicine mixing together in a brew that can really help people and really harm people. So a lot of people take an ear angle, well, if you look at statistically then, most people don't need this test. So we shouldn't be doing it on everyone. But boy, that 15% of people who had their lining identified as not receptive and it was adjusted and made it receptive and they had a child, that was big for them. So if that person needed it. So now you've got to put a lot of people through this test without show, without a benefit to them. So I always, that's when I talk to patients, I'm saying, I'm gonna talk to you about a test that I think is important for you to do, but you probably don't even need it. Let's talk about those who could need it and we'll bring in again. So I got my math background, used to be in a accountant. Now I'm doing Chinese medicine and I really think it helps with this discussion because the policy makers are looking at the budget as they should, right? Taxpayers money and insurance money. And so if it's a small percentage, the average population, they can't recommend it, right? So just going on stats. But there is no average human being. There's just you, right? The person in front of you. But we make decision based on the population. But in this case, there's the individual in front of you. And the individual in front of you wants this thing to work. And this is where it becomes individualized. So first part is you use the statistics to help you make general ideas and it's for its general. And this is why you still wanna talk to the experts who are talking to you is where you find out where does it benefit that individual. And so thinking of somebody who is going through donor egg cycle, like I'm thinking of the cost for that individual. The donor egg cycle is much more expensive than an IVF with your own eggs, for example. And so this is where the disc, and I'm not saying donor eggs should do ERA. I'm bringing up that if somebody is doing donor eggs, in most cases, they have been on this journey for a while. That's right. And so there is a cost emotionally and financially for this person. And so now they're not looking to see if they failed one or two more cycles before you recommend an ERA. I'm sure that I was that woman in the chair and I did a donor cycle or you put in a normal PGA embryo for me and it didn't work. And then you say, well, next time we'll do an ERA, I would say, why didn't we do it the first time? That's right. And so this is the individualized side of it. So can you talk more about how you counsel and so the women can go and talk to their experts about this test and why you like it, even though only 15% of the population may benefit. - And it's tricky because if we've published some studies largely by Dr. Gary Nikuda, but we've published our experience here and a few other groups have published their experience where you take 100 women and you put them through ERA and statistically speaking, you don't see a huge benefit until you've had failed embryo transfers, right? Because on the statistic side, you need failure to show up adults, so an improvement. So we don't see a big push for ERA before the first embryo transfer. And if you're gonna be a purest and evidence based doctor based on population studies, you're actually not gonna do an ERA before your first transfer. You're gonna wait one or two failed transfers. And that's what a purest would do. But the truth is is that you look at the person in the eye and you go, you have one embryo. You've been trying to have a child for seven years. This is a test, it takes a month to do, costs about $1,800 that will allow you to walk into that embryo transfer knowing that you really did everything you possibly could that science can give you at this moment in time. I think it's worth considering this test and I'll walk through what the test involves. The harm of the test is only the cost. You do lose a month 'cause you're gonna go through the whole treatment as if you were putting an embryo in, but you don't put an embryo in instead, you sample the uterine lining. - I wanna share that with the listeners. So when you do this receptivity test, it's like what you call a mock cycle. So they're not trying to get pregnant that cycle. Just going in and your biopsy when you would want to put in the embryo and seeing what it looks like 'cause you're gonna do the same thing the next cycle. And so you wanna make sure that it's receptive. - Exactly right. And then you have the biopsy, the biopsy hurts, had one done myself, they hurt and have done thousands of them. It's much like getting your ears pierced. It's like, oh, it's like a really sharp pain and then it's done. The pain might last 20 or 30 seconds over the long of your ears pierced, I guess, but it is that kind of a sharp pain and then it's done and then we get the results. And then the next month when we go to put the embryo in, we'll react to those results and say, hey, you actually need hired also a progesterone or eight more hours of progesterone or whatever that test result comes back. And that's really helpful. And so you do, you can act on it right away. - And the reason you're doing this 'cause we didn't really talk about this, is the window of implantation when the uterus is receptive to that embryo is not indefinite. It's not like your whole luteal phase, not the whole second half of your cycle. There is a window even though you're not gonna bleed for 14 days after ovulation, or if you put in the embryo on day five, you're not gonna bleed likely for nine more days, right? But you don't have nine days for implantation to start. There is a window and that's why you're doing this to match up the window when you put the embryo inside the uterus. - That's right, sync it up, that's right. And there's times when it doesn't make sense to do that. Like the couple who has five chromosomally normal embryos and they want one child, you know, maybe you do one or two transfers before going through that testing, but for most people, you know, making sure the soil is been optimized and really looked at before a transfer does make sense. - So again, it becomes that individualized care where I often say this in my practice, there's no right way to do this. Like if there was, we, everybody, we have the same thing done, right? And there is no right way to do this. And these things aren't free. So I often say if money wasn't an issue, here's what we can do, right? - That's right. - But it's important that we're not making the decisions for the people that we're seeing. We're there to inform and guide counsel and make sure they're safe, right? - Agreed. - You know, there's within reason, we don't let our patients do whatever they want. There is within reason, safety, but it's their body and they have to make that decision. And so they can't make a decision unless they have the information to make the informed decision. And that sounds like what you're providing. So I'm glad we've talked about, this is the ERA test, the endometrial receptivity array, right? Is that what this one's called? - That's right. - What about, this is where I'm interested in, I think the, the MET test, the endometrial microbiome test. Is that the one you're using, is that the name for everybody? Do different, are there different companies now doing that? You're a biopsy for the microbiome. - There are other companies, but we're doing it all through Igenomics. So when we put a woman through the biopsy, as I mentioned, it does hurt. They've spent fair amount of money to get to that point. You know, they've taken medications. What it was, you know, five years ago is, it was tested for receptivity with that sample. But then these, the scientists were like, wait, okay, so we can look for that. You know, now what else can we look for? What else can we learn in that biopsy sample? And then so currently now, the test doesn't just look at ERA. It now looks at the microbiome, and it looks for endometritis. So looking at bacterial content in the uterine lining. Look, I think in five years from now, it'll be looking at 100 different things. But as it stands today, we're looking at three different things in the uterine lining. And you're right, Emma is the check for the microbiome. And there's an Alice is the third part. So ERA, Emma Alice, and the Alice part is to look for infection, which is detected up to 10% of the time, depending on the underlying diagnosis the one has. So those parts are looking at bacteria. And it's funny, you know, when I trained in the 90s in medical school, we were taught that the uterine lining was sterile, you know, and it's only been in the last 10 years. I think people have really appreciated, hey, wait, it actually has its, actually, it has lots of bacteria. And it's got a, in fact, it's got a microbiome. And this is what the microbiome should look like if the lining's receptive. Because it's so new, I don't think we have a very sophisticated knowledge yet of the endometrial microbiome. It's right now the feeling is that lactobacillus, dominant endometrial environment is probably good. So that's an end people have shown this, you know, if you've got the bulk of bacteria in your uterus is lactobacillus, you're more likely to get pregnant. And so we, if people are low in that number, then we'll give them vaginal lactobacillus probiotic, which will then migrate up to the cervix into the uterus and repopulate it with the right bacteria. And that, again, so I say, as it stands now, is lactobacillus. Those can't see, but I have a little bit of a smile on my face. And I'm thinking of my naturopathic positions in my clinic and acubisance 'cause I've heard Dr. Beth Taylor used the term microbiome and probiotics and lactobactylia a couple of times, which back in the day in the early 2000s, that was considered craziness. But it's neat to see how the integrations coming, and neat from the public's perspective, because back in 2000 and 2002, there was a left hand and right hand, and we were kind of doing different things, we're doing it independently and often disagreeing, which was great stressful for the patient. - It was, I agree. - And now, just to see how things are evolving and that the openness and that the science is there, 'cause your practice evidence based medicine, back then you just didn't see the evidence for it, and now you're seeing the evidence, and we've been looking at the microbiome for a long time, the gut microbiome in particular, and like you said, we thought the uterine environment was sterile and now we're seeing it's a little different, and I know in our clinic, we still like to address the gut microbiome, because it's just the way Chinese medicine, naturopathic medicine understands the body of systems, that there is nothing separate, even though they look separate, everything's always communicating and impacting, and so we believe one day we'll see and understand how the gut microbiome is communicating with the vaginal uterine microbiome, right? - Yes. - And so I'm sure of it. - And like anything, sometimes you treat downstream, as in you don't always have to go to that place that you want to target. It's the story I like to hear where the little boy asks the doctor, how is me swallowing this pill, gonna make the pain in my foot go away, right? The pill just knows where to go, right? And so it's the same thing that sometimes when we just work with the soil, the environment, the cellular environment, through diet, lifestyle, exercise, sleep, supplements, the things that we do, then they start to communicate and have a systemic effect. And so we don't always have to look for the source of where the symptom is, we can treat holistically, knowing that that, going back to the beginning of our conversation, the body has this innate ability to heal, it can self-correct. If we just give the plant analogy here, so if we just pull out some weeds and give proper sunlight fertilizer and water to the plant, it can thrive. And that's the same thing with the cellular, the body. And so it's great from the patient's perspective that we're seeing the integration come together where the left and right hand are green and they're working together, right? They're working together, which is what we're seeing here. So this is fantastic. With the testing, I know you guys, and us will use the probiotic vaginal suppository, especially for those frozen embryo transfers. In our clinic, I know the West hasn't quite got there, the IVF clinic so much, but the naturopathic and our clinics and acubisants will still address the gut microbiome with the speculation that that inflammation and that gut microbiome, if it's out of balance, is probably impacting all parts of the body. And we know this through how it affects skin, how it affects mood. And so we just know that it's probably in the best interest for the organism being the human being to make sure that that microbiomes in balance as well. And I'd like to see that even extended out through a better focus on the biome through pregnancy. I think what you guys are doing is important. We have blinders on, we want to get the positive pregnancy destined through that first trimester. But so many second trimester, third trimester complications, I think we're going to realize one day, as you guys already have, though that there's a microbiome link to preterm birth and early ruptured membranes and second trimester pregnancy loss. Yeah. And we know vaginal birth versus a C-section, for example, going through the vaginal that microbiome, what that's doing for the child in its immunity. So there's a benefit to that. Now, I have C-section babies. So I'm not saying C-sections are bad, OK? Just because I know-- so easy to offend people. There is a time and place for C-sections. But if it's because you want to go on a trip, personally, I don't think that's a good reason to have a C-section if you're trying to focus on the health of your child. If you're doing it just because it's convenient. But if it's going to save the life of the child or the mother, I think C-sections are safe lives. But you can have a vaginal birth. And again, I'll never go through a birth. So it's easy for me to say that. If you can have a vaginal birth, you should do it. But if we take away the pain and all the other stuff that goes with it, joking here. But the serious part is I just want to share with what Dr. Taylor and what Beth saying here is the pregnancy is key as well in that microbiome. And it's interesting because the Chinese idea or understanding of health, we're also knowing with science how it's being confirmed. For example, they say the health blueprint of your child in Chinese medicine, they use the word health blueprint. They said prenatal ging and postnatal ging. So the health of the child is based on the health of the parents at the time of conception. But they said that conception is based on three months before on average. And then the health of the mother up to birth is creating the prenatal ging. So you're influencing the health blueprint of the child. And then after the child's born, they call it postnatal ging. And in the West now, we call that your genetics. And so you get your genes and then epigenetics. So what we would call how you're living leading up to conception and throughout the pregnancy in Chinese medicine, they say you're constantly impacting the health of your child good or bad based on how you eat, sleep, stress, all that stuff. You're constantly impacting it. And then once a child's born, how you raise your child feeding, that's how you're impacting it. And we know telomere lengths, so the little plastic tips on the end of chromosomes, they're not plastic tips. But we know how-- - I know, exactly. - That's all epigenetic factors. So it's neat how we're seeing that in the science. So going back to the implantation, because this is an important part. This is the finish line in the sense of the IVF process. If you have a normal embryo, but the uterus isn't receptive, then we don't get a pregnancy rate or we get a chemical pregnancy. So when you guys do the biopsies now, you're doing three things then, 'cause you can do it all in one test. - One sample. - So you're testing for uterine receptivity. So that's the window of receptivity. And if it doesn't look like it's the right window, then the treatment on your side, as you may just, the timing and dosage of progesterone and when you put in the embryo. - Correct. - The microbiome test, you're looking to see what the microbiome looks like. And based on that, you may recommend a course of vaginal probiotics. And there is the concentration with the ingredients that probiotic is important at this stage. So-- - That's right. - And you'll do that. And I see you guys doing that a lot for your frozen embryo transfers. - That's right. - And our clinic, we're starting to just tell women to start to do it. Just, you know, whether you're doing an IVF, we're trying to do it naturally, right? Just again, you're costing yourself money is what you're costing, but other than that, we see some benefit. And then you're looking for chronic endometriosis. So is this inflammation just from an infection? Or is it looking at other forms of inflammation or endometriosis? Or is it just looking for inflammation from a bacteria infection? - It's just looking for a bacterial infection. And what's interesting is that the people that have it, they don't have symptoms, but they will not implant absolute. So if you've got endometritis, and that's treated with antibiotics. - Yeah. People probably have cases. I have a relative who had infertility. And this was before this test existed. And her doctor just put her in her partner antibiotics for a month, saying there could be an underlying infection, and then she's had kids after that. And now you can test for that. - That's what we were just reading without the test. - Yeah. - Yeah. - Sorry, I interrupt you. - Now, biopsy can, yeah, I was gonna extend the fuck 'cause you said endometriosis. So that biopsy can also test for endometriosis. The sample goes to a different lab, and it's looking for a protein called BCL6. So that is expressed in women with endometriosis. So that's different than endometriosis. Endometriosis is infection. Endometriosis is a different condition that can cause infertility. And it can be diagnosed if it's bad endometriosis, it can be seen on ultrasound. If it's mild, it generally needs a surgical procedure where a camera is put inside the woman to diagnose it. Or now you can potentially diagnose it with this biopsy of the uterine lining looking for BCL6. - Rather than putting through a laparoscopic procedure to look for the endometriosis, that's the surgery you were talking about where they'll diagnose it. You can do a biopsy as well looking for a certain marker. And endometriosis can lead to infertility. So this is another reason to check for-- - Consider that test. - We're not doing that test as much because the evidence is not as strong for it. But I think again, it's a very early onset test. So I think as it gets better refined, we might have a better role. But that is a way for women who are wondering if they might have mild endometriosis to be diagnosed. - And just to show that we're kind of up to speed here, I just want to give a nod to the endometrial function test, which we talked off camera that the evidence is growing, but it's a fairly new test. But it's another receptivity test just to let our listeners know 'cause I know in some place in the state, some clinics in California are using it more often. And that's looking again at the uterine receptivity and that's two biopsies they do for that test. So what you're doing is amazing 'cause you keep going forward with the technology and you keep finding those 2% 4%, 50% jumps. And so, and again, you guys have your process and the evidence has to grow as well. And I like how you guys bring in the technology or you've been the pioneers and headed the curve for so many things at all of fertility that you've brought in at your clinic before other clinics started embracing them in Canada. So it's always great to be working with you guys to know that our patients are getting the best of technology to help increase their pregnancy rates that they're going through an IVF and the diagnostics that you get to offer. Going back to the genetic screening, And I know we're going to wrap up here for our listeners and for you. your time too, Beth. The other question I want you to help put their hearts to rest, some people are quite concerned about their embryos, and they're concerned that when you do the biopsies, you're sending their embryos away. But that's not the case, right? That's right. We should clarify that we are just sending those cells. The embryo stays here at all. Right. So, you know, it's lovely because they're so ready to parent and love this baby. And it's just, you know, we forget that because in the medical side, you can get so into the medical side, but there's a person attached to that embryo. That's right. That want to know where their embryos are going. And I find that amazing because, you know, I've had people across from me and they're quite upset and worried. And I, you know, the question I asked is, what's the worry about? And I'm just worried about my embryo because it's being shipped and what happens to this and that. And I have to reassure them. Their cell is going that will never become part of your baby. It's been sent away to test. That's right. Your embryo is safe and sound locked up in the little freezer pack. That's right. You can last while they get dual citizenship or something. They don't. The embryo is never left here. All right. Let's wrap up a little bit about the integration where you guys are at with all of them. How acutepalms and all of our doing that integration. So you guys have some amazing diagnostics and procedures that you're doing and some great research. You are practicing integration. I noticed that you guys have like teams now. You really are embracing that patient-centered care approach, which is so well received by patients. They've really been looking for that over the decades and you guys are offering that. Acute balance goes on site to do the acupuncture and laser acupuncture on transfer day. Help with the uterus activity. And we get to talk a lot. Our teams get to talk a lot about the integration and you are now a proponent of preconception cares. What I heard, there's a marathon here. It's so modest or you humble how you downplay. Like you're at the end of the race with the water. I mean, you guys are there at the beginning, middle, throughout the whole process because you're doing the testing so much of the work up and all the things that you do this outside of the IVF cycle. And so that's where the integration is great. We're doing the conscious aspect, which is what this podcast is really about. But I do believe that it is bidirectional health and fertility. When I mean bidirectional, I mean it on two levels. The mental emotional impacts the physical and the physical impacts of mental emotional. So we need to address both and it's my personal opinion that it's the conscious work, the mental emotional, the mindfulness is the missing link for some women and men on this journey. It can be the tipping point. But also the idea of this physical body needs the integration, the mental multilimension, mental and emotional that I mentioned. But we need the integration of the East and West here as well. And so there's stuff that you can be doing to help optimize your fertility. And the stats show that age is still the biggest determinant of egg quality. So that doesn't mean if you're 40 or 42 that you do all this preconception work and you'll have eggs of a 30 year old. You can only have eggs of a 40 year old if you're 40. But some people biologically are behaving 46, 47, 50 at age 40. And so can we help you get to be biologically 40? And this is the part that you do with diet and lifestyle and supplements and stress reduction of mindfulness. We offer the acupuncture and laser as well. And I think it's a really nice fit when the high technology that you offer and the hands that we offer come together for these couples. So I hope we help together make many more babies and in that healthy babies, healthy moms, fathers of all healthy dads as well. Thanks so much Lauren. I think when when all the best aspects of all types of medicine are working and pulling on the ores in the same direction, the patients benefit and we benefit with more babies. And we're their guide. So what I got from our conversation today is the individualized medicine that you're looking for listeners is the doctors are there to inform and educate. And so come with questions. Come with questions. Come with ideas. Talk to them and acu balance. And because those patients come to us best armed with the right questions, the right direction, you know, rather than going off in all directions, wondering what to do next. They come more focused. Ask questions, advocate for yourself. Bring up a new idea you heard about on Facebook and let's talk about it because that's going to help you be a better patient in terms of understanding what's best for you and and understanding the rationale for our treatments. Yeah, I couldn't agree more. I jumped on to your same their lungs. I knew you were where you were going with that. And I just want to echoing it before you say it. And like the marathon, the analogy you use, you have to prepare. You don't just start a marathon, right? It's not going to end well. It's going to be difficult. Marathons aren't easy, right? But a lot of people do them and enjoy them. And so the fertility journey is not easy with preparation. So being educated, so best said, go on on Facebook. And if you hear something, ask, right? Sometimes it's not a good idea. Sometimes it's interesting. So being educated and doing the stuff that you prepare beforehand and those all, there's so many things that you can do through diet, lifestyle, sleep, exercise community. There's so many things that are still undervalued in our society because it's hard to measure, although we're starting to measure the benefit of them, that is in your control that you can do. We're happy. And I know I told you earlier, the integration at acu-balance, we're happy to coach you around that. But it's not like the IVF clinics, like it, all of that, they only know the technology. They know about the supplements now too. They're talking about probiotics. They're aware. They may not offer everything like that, but they're aware of who does and that what's available to you. And so you got to prepare for that marathon. And it's the same thing for trying to conceive if it's not happening easily. There's prep that you can do to make the journey smoother and more enjoyable because it is a challenge here. And hopefully we get you crossed that finish line. Thanks, Lauren. Thank you very much. And I'll see you on my next transfer day there. I'm on call and for our next video. Thanks a lot. We'll see you Friday. Take care. Thank you so much for tuning into another episode of Conscious Fertility. The show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you. So please direct message me on Instagram at Lauren Brown official. That's Instagram Lauren Brown official. Or you can visit my websites Lauren Brown dot com and acu balance dot CA. Until the next episode, day curious and for a few moments, bring your awareness to your heart center and breathe. You know, I've been seeing more women in clinics saying to me, I do not feel like myself. They're sharing that their sleep is off. They have brain fog. Their mood or anxiety feels really different and even things like joint pain and itchy ears are showing up. And they're wondering, is this just stress or something more? If you're in your 40s or early 50s, this could be the period menopause phase for you and it often comes with no clear explanation. And that's why acu balance is hosting the M factor 2 speaker summit. It's an online event on Tuesday, June 16th. We'll be screening the M factor 2 followed by a panelist, consisting of naturopathic doctors, Chinese medicine doctors, a medical doctor, a pharmacist, a fitness and nutrition expert and pelvic floor therapist. And I'll be moderating. So if you've been wondering what's going on with your body and more importantly wanting to get real answers, please go to acu balance dot CA and register for this online event. All right. Let's get back to the conversation of this podcast.