Hi friends and welcome back to the As a Woman podcast. I'm your host, Dr. Natalie Crawford. And today is one of your favorite episodes. This is a bonus fertility Q&A.

Joining me today is Emily Whitlock, who is going to be asking some of your top fertility questions that you submitted online at natalie CrawfordMD.com hey m thanks for being here hey happy to be here all right

let's see this okay first one says she is 30 years old she is in a same-sex couple and they are ttc

with donor sperm she has an ovulatory PCOS that she manages with 1,500 milligrams of metformin

she eats well has low bmri doesn't drink alcohol. All blood work has

been normal and her AMH is 14. She's done four failed IUI cycles. So now they're moving on to IVF.

They did their first IVF cycle and got 19 eggs, but only four fertilized. The sperm was good and no

notes from the embryologist on egg quality. Where do we go from here? Okay, a lot of questions about our IVF cycle. So obviously it's a fine balance with PCOS. So with PCOS, we know we have a lot of eggs, especially with an AMH this high. And we can't always get every single egg to maturity with PCOS. One of the biggest issues I see, though, is people being so afraid of

ovarian hyperstinulation that they trigger somebody when many of the eggs are immature. And then this is

going to lead to really low fertilization rates because you can only fertilize mature eggs. So of these 19

eggs, I have a question of how many are mature, and I'm worried that we'd have low maturity on that

aspect of it. So I wonder how many total eggs that we got, and then of these, how many are mature, and I'm worried that we'd have low maturity on that aspect of it.

So I wonder how many total eggs that we got, and then of these, how many the 19 are?

Was there a lot that we lost in the maturity range?

Also asking, did we do conventional fertilization, or did we do Ixie for fertilization?

Because as we talked about before, Ixie can be really advantageous. One thing that I see is sometimes

people say, oh, it's donor sperm, so this sperm is great. So we'll just do conventional fertilization.

And then we see really low fur rates. We have to remember that a lot of times donor sperm is

unproven. We don't really know that it's great. We don't know the lifestyle of the guys who donated sperm.

And so being more conservative with Ixie can be advantageous, especially because we're already spending so much money to get pregnant. We had to buy donor sperm for each round, go through all these IUIs, and now we're on IVF. This is where I like to have a WTF appointment with your doctor. So this is where you sit down and here's how I lead mine because I know everybody's different.

I'm going to sit down and go through each metric. This is how many eggs those measuring. This is how many mature I got. This is how many were immature or overmature. This is the fertilization we did and how many fertilized. Of those, this is how many made it to blasts, and then try to look at where I can make improvements.

Sometimes it's on the protocol type, the timing of the trigger shot. I will say this.

...