Send us a text with a question or thought on this episode ( We cannot replay from this link)
Joining me at the table is, Dr. Naomi Whittaker, a visionary in restorative reproductive medicine, to explore the fertile yet challenging terrain of endometriosis and its impact on fertility. Dr. Whittaker’s innovative approach marries cutting-edge research with minimally invasive surgery and bioidentical hormones, charting a course for those navigating infertility that may circumvent the need for traditional IVF treatments. Our enlightening conversation sheds light on the often overlooked symptoms of endometriosis, revealing how a deeper understanding could pave the way to improved reproductive health.
As we traverse the complexities of conditions like adenomyosis and endometriosis, we unravel the critical implications these have on fertility and the profound influence a surgeon’s skill can have on patient outcomes. Dr. Whittaker highlights the path to patient autonomy, emphasizing the value of thorough preparations for surgery, including the need to address uterine infections and inflammation. It’s a compassionate reminder of the evolving nature of these conditions and the necessity for patient-centered care, striking a chord with anyone yearning for a more comprehensive understanding of the intricate dance between surgical intervention and nature’s own fertility processes.
In our final chapters, we delve into the often-misunderstood world of hormones and their pivotal role in fertility, as well as the emotional odyssey that accompanies infertility. Dr. Whittaker’s insights into the potential of bioidentical hormones to alleviate not just physical but also emotional suffering, offer a beacon of hope. We confront the silent struggles and the imperative of emotional support, encapsulating the essence of a journey marked by resilience and the search for meaning beyond biological ties. So pour yourself a comforting beverage and join us for a heartfelt episode that promises to arm you with knowledge and fill you with hope.
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Website endobattery.com
Navigating Endometriosis and Fertility Challenges
Speaker 1
0:03
Welcome
to
EndoBattery
,
where
I
share
about
my
endometriosis
and
adenomyosis
story
and
continue
learning
along
the
way
.
This
podcast
is
not
a
substitute
for
professional
medical
advice
or
diagnosis
,
but
a
place
to
equip
you
with
information
and
a
sense
of
community
,
ensuring
you
never
have
to
face
this
journey
alone
.
Join
me
as
I
navigate
the
ups
and
downs
and
share
stories
of
strength
,
resilience
and
hope
.
While
navigating
the
world
of
endometriosis
and
adenomyosis
,
from
personal
experience
to
expert
insights
,
I'm
your
host
,
alana
,
and
this
is
EndoBattery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
EndoBattery
,
grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
me
at
the
table
.
Speaker 1
0:47
I'm
joined
at
the
table
today
by
Dr
Naomi
Whitaker
,
who
is
the
founder
of
RRM
Academy
and
is
an
OBGYN
fertility
surgeon
focused
on
women's
restorative
reproductive
medicine
,
compassionate
health
care
and
education
.
Dr
Whitaker
is
a
board-certified
OBGYN
and
a
fellowship-trained
surgeon
who
specializes
in
the
Creighton
Model
Fertility
Care
System
and
Napro
technology
,
which
works
cooperatively
with
women's
body
to
treat
the
underlying
cause
of
gynecologic
issues
and
infertility
,
such
as
endometriosis
and
PCOS
.
Dr
Whitaker
helps
women
improve
their
gynecologic
health
and
avoid
or
achieve
pregnancy
in
accordance
with
their
natural
fertility
,
using
the
latest
research
,
medicine
and
surgery
.
Please
help
me
in
welcoming
Dr
Naomi
Whitaker
.
Thank
you
,
dr
Whitaker
,
for
joining
us
today
and
taking
your
time
out
of
your
busy
schedule
to
join
me
today
.
Speaker 2
1:40
Thank
you
so
much
for
having
me
.
Speaker 1
1:42
Yes
,
you're
welcome
.
I
do
want
to
start
off
this
episode
by
saying
that
what
we're
going
to
talk
about
today
can
be
triggering
for
a
lot
of
people
.
This
is
not
an
easy
topic
to
talk
about
,
and
especially
if
you
are
in
the
trenches
of
walking
through
fertility
issues
or
infertility
issues
,
or
if
you've
had
your
fertility
stripped
from
you
in
the
past
and
are
unable
to
have
kids
.
So
this
may
be
triggering
to
you
,
and
I
just
want
to
say
that
I
hear
you
and
I
see
you
and
I
want
you
to
know
that
you
are
not
,
in
any
way
,
shape
or
form
,
looked
over
,
and
this
can
be
hard
.
But
this
can
be
triggering
for
some
and
I
just
want
to
say
that
.
But
I
do
think
it's
important
that
we
do
talk
about
it
,
because
a
lot
of
people
do
struggle
in
this
area
specifically
.
So
thank
you
for
being
the
person
to
talk
about
this
in
such
a
great
and
delicate
way
.
Speaker 2
2:34
Yeah
,
it's
such
an
important
topic
and
I'm
so
glad
that
you're
bringing
this
information
out
there
.
Speaker 1
2:39
Yeah
,
can
you
explain
to
us
what
it
is
that
you
do
,
as
far
as
what
the
difference
is
between
what
you
do
and
what
a
typical
GYN
would
do
or
typical
specialty
in
fertility
would
do
?
Can
you
kind
of
give
us
a
background
of
what
it
is
that
you
specialize
in
?
Speaker 2
2:58
Sure
,
so
it's
its
own
type
of
approach
.
Where
it's
not
quite
,
it
dabbles
in
minimally
invasive
gynecologic
surgery
.
It's
somewherebles
in
minimally
invasive
gynecologic
surgery
.
It's
somewhere
in
between
minimally
invasive
gynecologic
surgery
and
REI
Okay
,
a
combination
of
both
of
those
.
So
,
but
I
don't
do
IVF
.
I
actually
use
surgery
to
treat
underlying
women's
health
issues
,
for
example
.
Also
I
use
a
bioidentical
hormones
in
cycle
charting
and
I
combine
all
of
those
together
to
help
boost
natural
fertility
.
Timing
intercourse
instead
of
IUI
,
big
endosurgeries
,
tubal
corrective
surgeries
instead
of
IVF
that's
kind
of
my
version
.
So
women
come
to
me
who
either
failed
IVF
,
iui
or
don't
want
to
do
that
approach
,
or
they're
coming
to
me
before
they're
actively
trying
to
conceive
and
they
see
issues
.
Either
they
were
cycle
charting
and
they
saw
issues
,
or
they're
very
knowledgeable
,
either
from
a
family
member
or
friend
that
told
them
something
isn't
right
.
And
so
they're
coming
to
me
younger
and
hopes
that
maybe
one
day
they
can
preserve
their
fertility
,
maybe
even
enhance
their
fertility
,
so
that
they
can
be
ready
when
the
time
is
right
to
try
to
conceive
.
Speaker 1
4:13
Do
you
have
patients
that
walk
into
your
door
that
don't
know
that
they
have
maybe
an
underlying
condition
or
know
what
the
condition
is
,
but
they
just
know
that
they're
struggling
with
fertility
and
they
maybe
aren't
as
comfortable
with
IVF
or
they've
had
a
reaction
to
IVF
and
they're
coming
to
you
and
they're
like
what
is
going
on
with
me
?
How
often
do
you
see
that
in
your
clinic
?
Speaker 2
4:34
I
would
say
most
women
don't
know
it's
endometriosis
,
right
?
Most
women
don't
say
this
is
absolutely
endometriosis
,
where
women
are
told
things
are
normal
throughout
their
whole
life
,
either
by
their
mother
or
their
teachers
or
their
physician
,
and
so
they
come
,
they
say
something's
wrong
.
Clearly
I'm
not
getting
pregnant
and
I
want
an
answer
.
Speaker 2
4:54
Right
and
you
and
I
probably
know
quite
quickly
that
endometriosis
is
very
high
on
the
likelihood
,
even
if
only
infertility
is
the
problem
.
But
usually
when
you
dig
deeper
and
I
started
to
do
this
endometriosis
symptom
survey
to
pretty
much
any
woman
that
walks
in
with
fertility
issues
,
and
the
main
thing
that
I've
found
so
far
I've
only
been
doing
it
for
a
few
months
is
that
women
under
report
their
symptoms
.
They
have
normalized
it
to
themselves
for
so
long
that
they
kind
of
lived
with
it
,
they
put
up
with
it
or
they
work
their
life
around
it
.
And
then
,
unfortunately
,
many
of
these
women
I
mean
,
I
definitely
have
a
subset
of
women
that
are
coming
to
me
mainly
for
pain
,
but
there's
a
big
subset
that
put
up
with
so
much
pain
and
suffering
and
don't
pursue
aggressive
options
until
they're
trying
to
conceive
and
that's
the
one
final
thing
to
push
them
over
that
line
to
actually
seek
treatment
.
Speaker 1
5:54
Yeah
,
talking
about
this
survey
,
I
saw
that
you
had
recently
just
posted
something
on
your
account
about
this
survey
.
Can
you
tell
us
a
little
bit
about
what
this
survey
entails
,
what
it
is
aimed
to
do
,
so
that
we
can
get
a
better
picture
of
maybe
what
we
can
be
looking
at
or
what
people
can
be
looking
at
when
they're
thinking
about
this
in
the
sense
of
fertility
and
endometriosis
?
Speaker 2
6:16
Yeah
.
So
I
put
together
a
survey
that
is
just
my
brain
on
paper
.
When
someone
comes
to
me
for
a
surgical
consult
,
either
they're
coming
to
me
for
pain
or
infertility
or
both
,
and
then
I
ask
them
all
these
questions
and
when
they
say
these
symptoms
,
these
are
the
ones
that
really
stand
out
in
my
mind
as
specific
to
endometriosis
.
Obviously
,
it's
a
whole
constellation
of
symptoms
and
you
have
to
take
into
consideration
the
big
picture
.
Some
symptoms
overlap
with
other
issues
that
could
be
not
related
to
endometriosis
.
But
I
thought
,
well
,
if
I
put
my
brain
on
paper
,
more
people
will
have
access
to
what
it's
like
to
be
in
the
mind
of
a
surgeon
.
Now
,
obviously
,
it's
not
a
way
to
diagnose
it
,
it's
just
a
suspicion
score
.
And
so
people
ask
me
all
the
time
what
does
the
score
mean
?
Well
,
I
can't
tell
you
much
about
it
,
except
when
the
score
is
very
high
,
like
especially
30
or
more
.
I
think
that
makes
it
very
likely
for
endometriosis
to
be
there
.
But
if
the
score
is
low
,
like
even
a
score
of
seven
or
11
,
I've
found
people
report
stage
four
endometriosis
even
.
And
of
course
,
symptom
score
is
not
correlated
to
staging
,
right
?
That's
not
surprising
,
right
?
And
this
is
all
preliminary
data
.
Speaker 2
7:38
I
would
love
to
research
it
.
It's
not
research
,
but
I
think
the
lower
symptoms
score
doesn't
rule
it
out
,
but
it's
.
It
is
something
to
bring
up
like
okay
,
well
,
you
know
which
symptoms
to
focus
on
when
you
go
to
a
provider
,
see
if
,
even
if
you
are
screening
a
surgeon
,
do
they
even
take
these
symptoms
seriously
,
you
know
.
So
that's
something
to
consider
as
well
.
So
I
felt
like
it
was
a
way
to
bring
access
to
people
who
may
not
be
able
to
see
a
surgeon
,
like
myself
,
I
only
see
patients
in
Pennsylvania
and
Virginia
,
so
I
know
access
is
a
huge
problem
and
for
me
,
I
have
endometriosis
.
I
didn't
realize
these
are
symptoms
until
fellowship
,
and
so
even
me
in
the
field
of
OBGYN
,
I
didn't
even
realize
these
symptoms
are
highly
subjective
of
endometriosis
.
Speaker 1
8:30
Which
I
mean
I
think
that's
true
with
a
lot
of
us
,
right
,
we
don't
put
our
symptoms
together
and
even
after
my
diagnosis
and
after
my
surgeries
,
there
were
symptoms
that
I
had
that
I
didn't
put
together
with
my
endometriosis
until
after
,
and
it
was
more
because
I
was
learning
about
these
symptoms
and
how
it
correlated
with
the
endometriosis
.
Speaker 1
8:49
For
instance
,
I
didn't
really
realize
my
UTIs
that
weren't
really
UTIs
were
probably
endometriosis
,
right
?
So
there's
all
these
little
tidbits
of
information
our
body
gives
us
that
we
aren't
necessarily
putting
our
pieces
together
,
and
I
would
even
say
this
is
post-operatively
symptoms
and
I'm
like
,
okay
,
could
this
have
been
because
of
endometriosis
or
is
this
in
correlation
to
because
I've
had
it
for
so
many
years
?
And
so
I
think
that's
true
with
a
lot
of
us
that
struggle
with
endometriosis
.
Are
you
able
to
speak
on
the
success
rate
for
those
patients
that
maybe
have
adenomyosis
,
because
this
is
a
big
one
for
us
in
the
endometriosis
community
,
as
far
as
a
lot
of
us
that
are
struggling
with
fertility
not
only
have
endometriosis
but
have
adenomyosis
as
well
.
Is
that
something
that
you
kind
of
deal
with
on
a
daily
basis
as
part
of
helping
those
achieve
success
in
fertility
?
Speaker 2
9:46
Absolutely
so
I
had
to
really
do
my
own
research
on
adenomyosis
because
there's
really
not
good
information
out
there
.
So
there's
technically
two
different
types
of
adenomyosis
there's
diffuse
and
there's
focal
.
So
diffuse
is
more
common
in
women
who
have
had
children
and
does
not
cause
infertility
but
can
cause
the
symptoms
like
fullness
,
heavy
bleeding
.
But
the
good
thing
is
that
shouldn't
really
affect
fertility
.
Endometriosis and Adenomyosis
Speaker 2
10:15
It's
very
often
visualized
on
ultrasound
.
In
an
article
that
I
read
analyzing
many
,
many
studies
and
summarizing
the
findings
,
it
compared
it
to
the
boy
who
cried
wolf
.
So
adenomyosis
is
over
called
on
ultrasound
because
obviously
we
know
endometriosis
is
missed
more
often
than
not
by
ultrasound
and
MRI
.
But
they
might
see
some
junctional
changes
or
whatever
the
ultrasound
findings
are
in
a
large
uterus
.
So
oh
,
it
must
be
that
right
.
Just
because
you
find
it
doesn't
mean
it's
clinically
significant
.
And
now
that
our
ultrasound
technologies
is
more
clear
than
it
used
to
be
,
we're
finding
it
more
.
And
now
we're
over
calling
it
.
Speaker 2
10:54
Based
on
what
I've
been
able
to
find
,
I
don't
see
other
signs
of
issues
.
If
it's
just
that
,
for
example
and
I
don't
consider
that
in
my
other
than
management
of
symptoms
,
I
don't
consider
that
as
a
barrier
to
conceiving
.
Now
it's
very
different
.
Someone
messaged
me
today
they
have
a
seven
centimeter
adenomyoma
.
Now
that's
very
different
.
That's
evidence
of
focal
adenomyosis
,
so
a
big
nodule
or
area
of
endometriosis
growing
into
the
muscle
of
the
uterus
,
and
so
those
do
cause
infertility
.
But
the
good
thing
is
those
are
resectable
.
You
just
treat
it
very
similarly
to
endometriosis
.
Now
it's
definitely
trickier
surgically
.
Speaker 1
11:40
But
and
from
my
understanding
and
maybe
I'm
wrong
on
this
but
doing
those
does
increase
risk
,
sometimes
with
fertility
,
depending
on
who
you
see
.
Like
you
wouldn't
want
to
see
,
just
anyone
to
see
,
no
matter
what
.
Speaker 2
11:53
Right
Period
.
If
you
are
interested
in
fertility
and
I
think
that's
something
I
really
want
to
bring
out
today
into
light
is
that
who
your
surgeon
is
matters
more
than
anything
.
Right
,
because
?
Because
not
only
finding
it
all
,
but
tissue
handling
being
very
delicate
with
tissue
I
see
people
on
social
media
even
just
grabbing
the
fallopian
tubes
.
You
don't
want
to
do
that
with
these
very
strong
instruments
.
Obviously
you
don't
want
to
take
out
fallopian
tubes
without
patient
consent
,
which
obviously
happens
a
lot
.
I'm
sure
you've
gotten
those
messages
,
like
I
have
.
I
went
under
anesthesia
.
I
woke
up
without
a
fallopian
tube
.
I've
seen
it
on
patients
who
go
to
surgeons
.
They
go
there
for
fertility
.
The
tube
is
taken
out
because
they
thought
it
was
endometriosis
.
Pathology
was
negative
for
endometriosis
on
the
tube
.
They
took
out
the
whole
tube
.
So
surgeon
choice
matters
for
someone
who's
fertility
friendly
,
who
really
respects
that
,
and
so
it's
.
There's
a
lot
to
it
.
We
could
definitely
go
into
it
more
.
That's
touching
the
surface
of
it
.
But
number
one
respecting
autonomy
.
Respecting
that
.
You
know
I
have
patients
all
the
time
.
Speaker 2
12:56
Are
you
going
to
take
out
my
tube
?
Are
you
going
to
take
out
my
ovary
?
I
mean
,
you
know
,
and
I
explain
how
often
I
do
that
,
which
is
almost
never
unless
I
think
it
looks
like
there's
a
cancer
how
often
I
do
that
which
is
almost
never
unless
I
think
it
looks
like
there's
a
cancer
,
I
pretty
much
try
to
save
every
fallopian
tube
or
ovary
.
After
you
know
,
informed
discussion
with
a
patient
.
Of
course
,
I'm
sure
there
are
exceptions
in
women
who
aren't
trying
to
.
Speaker 1
13:14
I'm
talking
about
trying
to
conceive
population
,
yeah
,
If
someone
comes
into
your
office
and
they've
already
had
excision
surgery
but
they
are
still
struggling
with
fertility
or
even
sometimes
probably
pain
,
what
are
some
approaches
that
you
take
to
help
them
achieve
their
ultimate
goal
of
either
fertility
or
pain
relief
?
Speaker 2
13:35
Yeah
.
So
of
course
I
look
back
at
their
operative
reports
to
see
what
was
done
and
I
go
over
with
them
concerns
from
what
was
seen
,
including
,
you
know
,
the
potential
or
of
adhesions
,
or
if
they
did
appropriate
adhesion
prevention
.
If
they
check
the
tubes
with
chromoprotubation
they
may
have
missed
a
partial
occlusion
of
the
fallopian
tube
,
which
is
pretty
common
with
endometriosis
,
and
so
for
that
I
do
a
selective
hysterosalpingogram
which
is
more
accurate
than
a
regular
hysterosalpingogram
.
It's
where
the
x-ray
is
put
above
the
body
and
I
have
an
actual
cania
that
goes
into
the
fallopian
tube
and
I
have
a
pressure
gauge
and
it
measures
if
there's
a
partial
occlusion
.
So
I
don't
want
to
just
see
fillage
of
dye
,
I
also
want
to
see
that
the
pressure
is
very
low
and
so
that
that
indicates
the
tube
is
wide
open
.
And
so
I
check
each
tube
individually
and
then
if
there's
a
partial
or
complete
occlusion
,
I
have
a
guide
wire
that
can
run
down
the
tube
,
kind
of
like
snaking
a
sink
to
open
it
up
.
I
just
see
tubal
occlusion
with
endometriosis
period
Okay
,
more
like
or
with
infertility
period
.
Speaker 2
14:49
You
know
I'm
not
sure
what
the
risk
factors
are
If
it's
congenital
,
you
know
hereditary
someone's
born
with
it
.
Speaker 2
14:56
If
there's
endometriosis
in
the
tube
,
if
there's
debris
in
the
tube
or
inflammation
related
to
endometriosis
or
if
it's
just
infertility
as
a
symptom
.
Speaker 2
15:06
It's
hard
to
say
but
I
do
screen
almost
all
women
that
come
to
me
who
are
undergoing
surgery
.
I
offer
them
that
because
if
they
haven't
tried
to
conceive
it's
going
to
be
silent
and
then
they're
at
increased
risk
,
in
my
opinion
,
if
they
likely
have
endometriosis
.
In
my
opinion
,
if
they
likely
have
endometriosis
,
I
do
think
many
times
it
is
probably
congenital
and
treatable
and
it
goes
away
after
that
procedure
.
But
I
like
to
offer
it
to
most
women
undergoing
surgery
,
even
if
they're
not
actively
trying
to
conceive
,
because
I've
had
women
come
to
me
with
endometriosis
.
They
got
excision
,
they
got
a
lot
better
and
then
they
come
back
to
me
with
infertility
because
their
kids
were
occluded
and
if
we
had
just
checked
it
when
they
were
focused
on
the
pain
but
they
knew
they
wanted
children
later
,
I
regretted
not
offering
it
earlier
.
I
explained
hey
,
if
you
haven't
been
trying
,
you
may
not
want
to
do
this
procedure
,
but
I
like
to
just
offer
it
if
they're
going
under
general
anyway
.
Speaker 1
16:04
Right
.
Speaker 2
16:05
Because
it's
pretty
quick
,
it's
very
quick
.
Speaker 1
16:08
Well
,
and
it
sounds
like
it's
a
more
proactive
approach
as
opposed
to
a
reactive
approach
,
which
we
all
know
that
when
you're
reactive
,
that's
when
things
can
get
a
little
hairy
with
outcomes
,
and
so
sometimes
it's
better
to
be
proactive
when
it
comes
to
things
like
this
,
specifically
for
fertility
.
Speaker 2
16:27
Yeah
,
I
think
it
depends
on
the
woman
and
what
her
desires
are
and
where
she
is
.
And
you
know
,
some
women
really
want
to
be
on
top
of
it
,
want
to
be
ahead
of
it
and
be
proactive
,
and
that
gives
them
peace
of
mind
,
and
others
want
to
take
it
as
it
comes
.
Speaker 1
16:39
So
,
yeah
,
and
some
people
are
just
in
survival
mode
and
they
aren't
thinking
,
and
that
too
,
yeah
.
So
some
people
are
just
in
survival
mode
and
they
aren't
thinking
.
Speaker 2
16:47
And
that
too
,
yeah
,
so
when
I
bring
it
,
up
.
Speaker 1
16:49
They're
like
what
are
you
talking
about
?
Speaker 2
16:50
They're
really
blindsided
by
it
.
Like
why
are
we
talking
about
this
?
Like
,
well
,
because
I
deal
with
so
much
infertility
,
it's
always
on
my
mind
so
I
want
to
bring
it
up
.
I
say
,
and
if
you
don't
want
it
,
that's
fine
,
because
it
is
another
intervention
that
may
be
unnecessary
.
So
,
yeah
,
other
things
you
want
me
I
can
tell
you
that
that
I
see
that
are
really
unknown
with
endometriosis
include
inflammation
in
the
uterus
,
which
could
be
related
directly
to
endometriosis
,
and
sometimes
chronic
endometritis
,
which
means
inflammation
in
the
uterus
from
infection
,
and
then
,
of
course
,
polyps
as
well
.
Importance of Comprehensive Surgery Preparations
Speaker 2
17:31
It's
important
I
like
to
look
for
polyps
in
everyone
and
biopsy
everyone
and
look
with
a
camera
for
anyone
with
abnormal
bleeding
and
or
pain
,
if
they're
going
under
surgery
.
Speaker 2
17:42
Anyway
,
because
it's
again
quick
and
you
can
improve
outcomes
,
because
it's
rare
that
I
don't
find
endometriosis
at
surgery
.
But
if
if
that
is
the
case
,
then
I
usually
find
something
else
.
So
a
common
thing
that
I'll
find
is
an
infection
in
the
uterus
.
So
it
can
exacerbate
endometriosis
pain
or
infertility
or
it
could
be
the
main
cause
of
pain
for
some
women
.
That's
rare
but
I
have
had
that
.
Maybe
one
case
a
year
where
I'm
expecting
endometriosis
.
I
don't
find
it
,
and
in
those
cases
I
usually
find
something
else
,
like
an
infection
in
the
uterus
,
like
E
coli
,
which
shouldn't
be
there
.
And
again
,
that
not
only
will
help
her
outcome
of
pain
and
abnormal
bleeding
but
also
prevents
infertility
down
the
road
.
Because
what
I'm
thinking
of
was
a
teenager
.
Speaker 2
18:28
I
don't
know
how
it
gets
in
there
,
but
it
probably
is
related
to
immune
system
dysfunction
.
We
don't
really
know
.
It's
not
due
to
lack
of
hygiene
or
STDs
.
That's
a
common
question
.
But
that's
an
easy
thing
to
do
at
the
time
of
surgeries
get
some
swabs
,
check
for
infection
,
and
I
do
get
probably
a
lot
more
swabs
than
may
be
needed
because
I'm
covering
for
infertility
as
well
.
But
I
typically
get
aerobic
,
anaerobic
mycoplasma
,
ureaplasma
,
fungal
,
viral
.
We
get
10
swabs
,
but
it
covers
.
That
covers
most
of
them
.
Speaker 1
19:00
Interesting
.
Do
you
think
that
more
doctors
should
be
looking
for
things
like
that
when
patients
come
in
?
I
mean
,
I
think
maybe
across
the
board
,
but
specifically
for
those
who
are
going
in
for
excision
surgery
,
do
you
think
that
we
need
to
take
more
of
those
samples
and
swabs
to
be
able
to
really
identify
if
there's
more
going
on
than
what
you
initially
thought
?
More
than
just
an
endometriosis
?
Yeah
,
thought
more
than
just
endometriosis
.
Speaker 2
19:25
Yeah
,
I
rarely
just
find
endometriosis
.
Typically
,
you
know
,
you
have
your
pre-op
and
post-op
diagnosis
.
My
post-op
diagnosis
is
very
long
.
It's
usually
four
or
five
lines
,
not
just
different
areas
of
endometriosis
but
evidence
of
inflammation
or
polyps
or
cervical
stenosis
or
tubal
stenosis
,
adhesions
.
I
look
at
the
liver
,
you
know
,
and
I
see
if
there's
inflammation
of
liver
or
fatty
liver
.
So
I
tried
to
do
it
just
a
whole
assessment
of
everything
that
I
see
for
health
purposes
,
cause
,
as
you
know
,
women
with
endometriosis
or
pelvic
pain
or
infertility
,
they're
all
very
complicated
and
it's
usually
not
just
one
thing
going
on
.
Especially
by
the
time
they
present
10
years
later
,
after
they've
been
asking
for
help
,
things
have
usually
gotten
pretty
bad
yeah
response
.
Speaker 1
20:26
portion
of
that
is
often
overlooked
because
it's
not
always
a
definitive
picture
right
out
of
the
gate
where
people
aren't
just
thinking
,
oh
,
there's
an
immune
response
to
this
.
It's
oh
,
there's
endometriosis
,
let's
go
get
the
endometriosis
.
But
there's
,
you
know
.
I
think
maybe
that
could
be
another
key
as
to
why
some
of
us
struggle
so
much
postoperatively
as
well
is
maybe
we're
missing
a
piece
,
oh
yeah
.
Speaker 2
20:44
I
mean
there's
.
I'm
always
learning
more
about
the
immune
system
,
about
mast
cell
response
.
I
don't
know
much
about
that
.
I
was
not
taught
about
that
at
all
.
Speaker 2
20:53
And
that's
clearly
an
issue
.
Yeah
,
tons
of
rashes
postoperatively
.
That's
the
most
,
by
far
the
most
common
conflict
.
You
know
,
complication
is
significant
.
Rashes
not
just
a
little
bit
.
But
many
women
react
to
something
,
whether
it's
the
glue
,
whether
it's
the
prep
.
It's
very
common
.
So
clearly
there's
a
lot
more
that
we
need
to
be
doing
.
That
I
don't
know
about
,
but
I'm
always
trying
to
learn
.
That's
why
I
like
being
on
social
media
,
because
I'm
always
learning
from
followers
who
are
telling
me
about
their
experiences
,
what
helped
them
.
Speaker 2
21:23
I
try
to
share
their
raw
,
authentic
experiences
,
because
that's
how
we're
going
to
advance
.
Speaker 1
21:28
Yeah
,
Well
,
and
who
better
to
learn
from
sometimes
than
the
patients
?
Speaker 1
21:32
Because
you
know
,
I
think
you
know
what
I
see
a
lot
of
times
is
doctors
get
really
stuck
in
what
they
know
,
but
it's
because
that's
where
it's
comfortable
,
that's
where
they
excel
,
they
understand
it
.
Speaker 1
21:43
But
sometimes
what
the
patient
is
telling
you
contradicts
what
you
know
,
and
so
if
you're
not
learning
and
growing
from
the
patient
,
sometimes
you
become
stagnant
in
your
care
.
And
I
would
say
,
like
a
lot
of
really
good
surgeons
aren't
that
way
and
they
do
listen
to
their
patients
.
So
that's
kind
of
is
a
generalization
and
not
completely
for
everyone
,
but
I
do
see
that
happen
quite
often
,
where
I'm
really
good
at
this
one
area
as
a
doctor
but
the
patient
is
telling
you
something
completely
different
than
what
you
know
,
and
so
that
can
be
,
I
think
,
uncomfortable
for
doctors
.
I
mean
,
I'm
not
a
doctor
,
but
maybe
you
have
had
that
experience
at
times
where
you're
like
this
is
not
what
I'm
familiar
with
,
but
to
hear
the
patient
out
sometimes
and
kind
of
like
,
suss
it
out
and
see
,
okay
,
is
there
validity
to
this
?
Are
we
,
you
know
?
Is
this
something
I
need
to
look
at
even
further
?
Maybe
our
quality
of
care
would
even
increase
if
patients
spoke
honestly
and
openly
to
doctors
about
these
scenarios
.
Speaker 2
22:46
Yeah
,
I
think
,
and
there's
a
couple
things
contributing
to
that
.
I
mean
.
Number
one
as
a
surgeon
and
a
physician
,
we
need
to
be
in
control
of
the
situation
as
much
as
possible
.
That's
how
we
have
safe
and
good
outcomes
Right
,
and
so
we
need
to
be
in
charge
of
the
operating
room
.
We
need
to
be
in
charge
of
the
labor
and
delivery
room
if
we're
doing
obstetrics
,
and
part
of
that
includes
a
confidence
in
our
knowledge
to
be
able
to
be
in
control
.
Speaker 2
23:12
But
,
on
the
other
hand
,
with
endometriosis
,
there
is
some
humility
that
it
takes
to
be
good
at
what
you
do
,
because
endometriosis
will
constantly
humble
you
.
You
cannot
predict
where
it
will
be
.
It'll
go
on
an
organ
in
a
new
way
every
time
.
No
two
cases
are
the
same
,
and
so
,
especially
in
the
beginning
of
your
career
,
when
you
have
no
idea
what
you're
going
to
encounter
next
,
it's
very
scary
.
That's
one
thing
you
learn
with
endometriosis
and
I
tell
patients
that
all
the
time
.
I
wish
I
could
tell
you
if
you're
stage
one
or
stage
four
or
what
organs
are
involved
.
But
that's
one
of
the
hardest
things
about
endometriosis
is
I
can't
really
predict
your
case
when
I'm
seeing
you
for
a
surgical
consult
.
So
there's
a
balance
there
of
trying
to
handle
that
growth
and
humility
and
confidence
together
.
There
is
a
way
to
do
it
,
but
that's
not
something
that
can
really
be
taught
,
right
?
I
?
Speaker 1
24:03
do
think
patients
appreciate
when
doctors
sit
there
and
say
that's
an
interesting
perspective
.
I
hadn't
thought
about
that
,
and
it
feels
validating
to
the
patient
to
hear
a
doctor
say
you
know
,
that's
a
really
good
point
Because
they're
so
used
to
being
dismissed
.
A
lot
of
times
,
specifically
when
it
comes
to
endometriosis
and
probably
infertility
issues
,
they're
so
used
to
being
dismissed
or
,
you
know
,
doctors
aren't
sure
what
to
do
so
they
just
kind
of
you
know
,
move
them
on
along
,
I
can't
help
you
anymore
.
So
when
a
doctor
is
learning
more
or
willing
to
learn
more
and
say
you
know
,
that's
a
really
interesting
point
of
view
.
I
really
appreciate
that
perspective
.
There
might
be
something
to
that
,
and
so
thank
you
for
taking
that
time
to
listen
and
hear
the
patients
and
hear
the
people
who
have
walked
through
this
day
in
and
day
out
and
are
struggling
,
because
sometimes
that
can
be
the
most
healing
for
sure
.
Speaker 2
24:57
Yeah
,
I
also
have
been
on
the
end
of
being
dismissed
,
even
recently
when
my
husband
needed
back
surgery
on
the
end
of
being
dismissed
.
Speaker 2
25:05
Even
recently
,
when
my
husband
needed
back
surgery
,
I
had
researched
the
advancements
of
back
surgery
and
the
history
of
it
for
10
years
before
we
decided
to
move
forward
with
a
more
invasive
option
for
my
husband
and
we
went
to
someone
local
,
which
is
,
I
was
pretty
confident
we
probably
weren't
going
to
go
with
.
But
it
was
one
of
those
things
.
You
need
to
do
that
step
before
you
go
out
of
network
,
because
I
was
hoping
to
maybe
get
the
more
advanced
treatment
covered
.
It
was
kind
of
like
the
excision
of
back
surgery
.
You
know
,
yeah
,
the
excision
version
of
surgery
.
I
mean
,
if
you
had
to
compare
it
to
endometriosis
,
and
so
it's
hard
to
find
someone
that
does
that
kind
of
care
,
had
to
compare
it
to
endometriosis
and
so
it's
hard
to
find
someone
that
does
that
kind
of
care
.
And
in
some
ways
I
knew
more
about
the
advancements
of
spine
surgery
than
the
surgeon
and
he
was
so
off
foot
by
that
it
didn't
go
very
well
.
You
know
,
I
would
have
.
It
would
have
been
just
really
good
for
him
to
say
he
actually
called
the
next
day
and
apologize
Not
directly
about
the
way
he
approached
it
.
Speaker 2
26:06
But
I
agree
,
I
don't
think
physicians
realize
that
because
they
think
we
the
perspective
of
a
physician
is
,
if
we
admit
our
weakness
,
you're
going
to
lose
trust
in
us
.
I
think
that's
part
of
it
and
so
it's
that
confidence
that
you
want
to
bring
.
But
,
again
,
physicians
sometimes
forget
what
it's
like
as
a
patient
.
To
live
with
a
disease
is
very
different
than
to
treat
a
disease
.
Yeah
,
and
that
patient
experience
is
very
unique
and
you
can't
outdo
that
with
clinical
experience
.
Yeah
,
you
just
you
can't
.
And
and
the
mode
that
you
get
in
when
your
life
has
been
completely
changed
by
a
horrible
disease
,
the
motivation
and
the
hours
and
the
commitment
to
reading
and
learning
and
understanding
is
just
so
different
than
someone
who's
doing
surgery
.
Speaker 1
26:57
Yeah
,
it's
so
true
and
I
think
.
But
it's
also
good
for
the
patients
to
hear
that
perspective
too
,
because
we
can
get
stuck
in
our
journey
and
not
see
the
perspective
of
the
doctor
sometimes
of
like
I
don't
think
they
intended
to
hurt
you
,
I
think
they
just
didn't
understand
,
and
so
we
can
compartmentalize
that
and
we
can
internalize
that
and
it
can
affect
how
we
navigate
our
future
care
,
and
so
I
think
that's
kind
of
a
twofold
thing
,
right
.
Just
as
much
as
we
want
the
doctors
to
continue
learning
and
to
continue
growing
as
patients
,
it's
valuable
for
us
to
be
able
to
do
the
same
and
have
better
understanding
of
our
providers
.
And
if
something
doesn't
sound
right
,
ask
the
question
.
Speaker 1
27:45
I
don't
know
a
provider
that
is
a
good
provider
that
won't
sit
there
and
answer
your
questions
.
If
it's
a
bad
provider
,
they
may
not
wanna
answer
your
questions
,
so
that
may
not
be
the
doctor
for
you
.
But
I
do
think
that
it's
a
relationship
and
you
have
to
foster
that
relationship
responsibly
and
with
integrity
on
both
sides
.
And
I
think
to
foster
that
relationship
responsibly
and
with
integrity
on
both
sides
and
I
think
that
if
we
do
that
,
then
the
partnership
gets
stronger
.
I
mean
,
that's
just
my
take
on
that
.
Speaker 2
28:17
Yeah
,
and
the
surgeon
.
Not
to
knock
on
this
surgeon
,
I
think
he
meant
well
,
I
do
.
Speaker 2
28:22
I
think
he's
a
very
good
doctor
with
,
but
his
toolkit
is
different
than
what
I
needed
and
what
I
was
asking
for
and
so
I
got
him
out
of
his
comfort
zone
and
then
he
wasn't
used
to
that
and
so
I
don't
think
he
knew
how
to
handle
that
.
I
don't
think
it
was
anything
personal
against
me
or
my
husband
,
and
I
think
he
meant
well
and
I
actually
know
he's
a
very
good
surgeon
from
people
I
work
with
who've
worked
with
him
in
the
operating
room
.
He's
very
respectful
to
staff
.
So
it's
a
complicated
topic
,
you
know
it's
complicated
.
Again
,
it
doesn't
mean
that
it's
personal
or
that
they're
a
bad
doctor
.
It's
a
place
that
we
need
to
grow
.
Yeah
.
Speaker 1
28:58
But
I
think
that
,
just
as
to
say
,
is
like
we're
always
continuing
to
grow
in
our
knowledge
and
understanding
of
endometriosis
,
surgical
technique
approaches
,
and
I
think
what's
interesting
is
you
know
,
I
went
to
the
Endometriosis
Summit
and
this
is
part
of
the
Endometriosis
Summit
is
they
have
these
panels
and
they
kind
of
debate
this
,
and
it's
interesting
to
see
that
even
some
of
the
top
excision
specialists
in
the
world
are
learning
from
other
doctors
that
walk
into
the
room
because
they're
having
this
.
I
wouldn't
even
call
it
a
debate
necessarily
,
but
I
would
say
a
discussion
on
different
techniques
and
different
approaches
,
and
it's
all
keeping
in
mind
the
patient
outcome
.
And
if
you
can
find
a
provider
that
has
the
patient
outcome
in
mind
,
I
think
you
have
a
better
chance
.
Speaker 2
29:45
I
think
the
key
is
patient
driven
in
mind
.
I
think
you
have
a
better
chance
.
I
think
the
key
is
patient-driven
,
patient-centered
I
think
you
nailed
it
right
there
.
Truly
patient-centered
,
which
is
hard
to
know
sometimes
when
you
don't
.
For
example
,
if
a
surgeon
doesn't
understand
excision
is
the
best
right
,
then
how
do
they
even
understand
what's
best
for
the
patient
out
there
?
That's
the
challenge
.
Speaker 1
30:08
That's
a
whole
other
topic
.
We
could
probably
talk
for
hours
on
that
topic
.
Speaker 2
30:13
But
if
you
want
me
to
get
into
a
few
other
things
,
that
go
wrong
with
endometriosis
.
Speaker 2
30:19
you
know
,
if
a
woman
comes
to
me
and
her
main
issue
is
endometriosis
,
even
if
it's
advanced
stage
,
I
mean
that's
she's
very
she
has
a
very
high
likelihood
of
success
.
When
you
do
thorough
excision
surgery
,
find
it
all
,
even
a
bowel
resection
,
it
really
improves
fertility
rates
when
needed
.
And
then
adhesion
prevention
,
especially
with
advanced
disease
.
But
these
women
often
have
a
lot
of
other
issues
going
on
,
especially
if
they
tend
to
have
other
risk
factors
,
like
if
they're
older
,
if
they've
had
a
lot
of
abnormal
bleeding
,
if
they
are
married
to
like
a
man
with
severe
male
factor
,
and
so
that's
what
I
talk
about
in
my
discussion
with
these
patients
.
First
we
do
need
to
find
answers
.
So
endometriosis
is
exciting
to
find
because
it's
a
big
answer
,
and
then
it's
a
big
process
to
overcome
.
That
Outcomes
are
really
good
,
especially
if
that's
your
main
thing
.
Evaluating Hormonal Factors in Fertility
Speaker 2
31:16
But
it's
important
that
we
look
at
everything
,
including
do
they
have
an
ovulation
defect
?
So
we
screen
for
women
who
have
ovulation
defects
,
and
so
that
means
the
follicle
doesn't
grow
and
collapse
.
The
key
is
to
watch
it
collapse
as
well
and
rupture
to
make
sure
that
they're
actually
ovulating
and
releasing
an
egg
,
because
there
are
conditions
that
make
it
look
like
she's
ovulating
but
she's
not
really
,
and
so
we
do
an
ultrasound
series
to
confirm
that
she's
actually
ovulating
.
But
she's
not
really
,
and
so
we
do
an
ultrasound
series
to
confirm
that
she's
actually
ovulating
.
Ovulation
defects
where
they
don't
actually
collapse
,
the
follicle
called
luteinized
,
ruptured
follicle
syndrome
,
is
increased
in
women
with
endometriosis
and
again
that
can
be
silent
because
their
hormones
can
go
up
and
make
it
look
like
she
ovulated
after
that
.
Hormone
dysfunction
super
common
where
they
have
low
progesterone
especially
.
Speaker 2
32:04
very
common
,
which
makes
sense
why
they're
especially
if
they
have
low
progesterone
especially
very
common
,
which
makes
sense
why
they're
,
especially
if
they
have
pain
,
why
they're
more
symptomatic
or
maybe
why
their
disease
is
more
severe
because
they
have
an
imbalanced
ratio
of
estrogen
progesterone
.
Progesterone
is
anti-inflammatory
and
likely
helps
offset
the
inflammation
fueled
by
estradiol
.
Other
things
like
insulin
resistance
are
important
to
optimize
because
that's
going
to
worsen
inflammation
and
fertility
issues
.
Women
tend
to
age
their
ovaries
faster
,
so
have
high
FSH
,
may
have
low
DHEA
.
These
are
things
that
are
very
treatable
most
of
the
time
,
as
long
as
you
know
.
We
know
that
.
So
giving
DHEA
,
kind
of
fueling
this
tank
,
kind
of
like
similar
to
I
look
at
it
,
similar
to
ferritin
and
low
iron
,
which
is
also
a
common
issue
.
You
can
do
a
similar
thing
with
hormones
to
kind
of
help
optimize
hormones
If
you
study
that
and
you
can
work
with
the
body
to
help
support
the
hormone
health
.
And
then
we
often
see
low
cervical
mucus
and
so
probably
related
to
inflammation
.
That
can
be
improved
with
excision
sometimes
or
other
times
we
do
give
mucus
enhancers
or
low
dose
naltrexone
can
help
with
ovarian
function
for
women
who
are
going
through
quicker
aging
of
the
ovaries
because
it
helps
reduce
the
autoimmune
component
,
inflammatory
component
.
So
women
feel
better
on
low-dose
naltrexone
and
their
fertility
can
be
improved
on
that
medication
.
Speaker 2
33:29
Thyroid
fatigue
from
maybe
blame
on
endometriosis
,
there
could
be
thyroid
issues
,
there
could
be
low
iron
issues
.
And
then
something
simple
that
may
be
overlooked
is
just
poor
timing
of
intercourse
too
.
Knowing
there's
one
main
day
of
peak
fertility
the
whole
month
,
and
so
we
educate
women
on
thatcourse
too
.
Knowing
there's
one
main
day
of
peak
fertility
the
whole
month
,
and
so
we
educate
women
on
that
main
day
,
so
that's
kind
of
an
overview
of
everything
.
I
mean
it's
a
lot
more
complicated
than
I
can
probably
get
into
right
now
,
but
Right
,
but
at
least
there's
a
starting
point
,
there's
something
to
look
at
.
Speaker 1
33:59
It's
interesting
that
the
low
dose
naltrexone
is
helpful
for
fertility
,
because
I
know
a
lot
of
people
are
starting
to
use
that
for
like
pain
and
pain
response
,
to
help
our
body's
systems
essentially
calm
down
,
because
we
are
always
in
that
fight
flight
mode
,
you
know
,
and
so
a
lot
of
times
that
will
help
kind
of
ease
the
pain
,
kind
of
get
us
out
of
that
heightened
state
.
So
it's
interesting
that
that
works
for
fertility
as
well
.
I
hadn't
heard
that
before
.
Speaker 2
34:30
Yeah
,
it's
phenomenal
,
very
safe
,
very
effective
,
very
affordable
.
It
is
compounded
,
though
,
so
it's
not
going
to
be
marketed
by
big
pharma
.
In
fact
,
it
appears
that
the
research
has
kind
of
been
suppressed
by
big
pharma
.
Interesting
so
,
because
the
research
can't
be
published
in
mainstream
journals
,
because
it
is
a
huge
competitor
for
medications
that
cost
tens
of
thousands
of
dollars
for
Crohn's
disease
,
medications
that
cost
tens
of
thousands
of
dollars
for
Crohn's
disease
.
It's
been
shown
to
really
improve
remission
of
symptoms
in
Crohn's
disease
for
like
30
bucks
a
month
versus
$15,000
.
And
so
these
same
drug
companies
are
advertising
in
the
same
medical
journals
that
would
be
otherwise
publishing
this
data
,
and
so
they
don't
like
that
.
They're
going
to
lose
their
revenue
with
these
journals
.
Speaker 1
35:27
Wow
,
that
is
interesting
.
See
,
these
are
the
things
that
,
as
a
patient
,
we
wouldn't
be
privy
to
without
.
No
,
and
it
was
hard
for
me
to
find
this
out
.
Speaker 2
35:35
But
yeah
,
the
huge
,
the
researcher
that
was
mainly
doing
all
of
this
,
I
believe
she
was
at
Penn
State
in
Pennsylvania
.
She
had
tons
of
research
,
she
was
doing
the
Cuddy
Ignite
research
and
she
cleaned
her
website
of
her
research
.
So
I
heard
from
a
physician
who
follows
this
really
closely
.
Speaker 1
35:51
Interesting
.
That's
fascinating
.
I
just
I
know
that
a
lot
of
people
in
my
inner
circle
have
benefited
significantly
from
doing
it
and
it
seems
to
really
help
with
the
pain
more
than
you
know
any
other
drug
that
they've
taken
.
Speaker 2
36:08
So
I
personally
have
benefited
from
it
.
Yeah
yeah
,
I
had
nerve
pain
from
Lyme
disease
and
it
went
away
in
three
months
,
which
is
when
the
amount
of
time
it
takes
for
it
to
work
optimally
is
three
months
.
Speaker 1
36:21
Interesting
.
Okay
,
well
,
this
is
a
whole
nother
topic
we're
going
to
have
to
come
back
to
at
another
time
.
Speaker 2
36:30
I
mean
,
the
risks
are
mainly
vivid
dreams
is
the
most
common
risk
side
effect
.
I
should
say
yeah
,
and
then
some
might
have
decreased
appetite
,
which
can
be
a
problem
with
women
with
low
BMI
you
know
,
which
can
happen
with
endometriosis
.
Speaker 2
36:45
So
that's
something
to
talk
about
.
But
really
you
can
stop
it
anytime
if
there's
an
issue
.
There's
no
problem
with
that
.
We
go
up
slow
just
to
make
sure
women
can
adjust
,
just
because
women
with
endometriosis
tend
to
be
very
sensitive
to
medication
.
So
you
don't
have
to
taper
up
slowly
,
but
we
just
tend
to
do
that
.
It's
the
most
well
tolerated
that
way
.
Speaker 1
37:07
Interesting
.
Okay
,
something
else
that
I
think
would
be
interesting
to
understand
and
know
is
do
you
see
a
lot
of
patients
that
come
in
that
maybe
don't
have
any
pain
but
are
just
struggling
Because
you
know
,
we
know
that
with
endometriosis
specifically
,
they
don't
always
have
pain
and
so
they
go
in
,
but
they're
just
struggling
for
fertility
and
that's
how
they
find
they
have
the
endometriosis
.
Do
you
see
that
often
,
or
is
that
not
as
often
as
the
pain
?
Speaker 2
37:36
I
see
it
pretty
often
more
often
than
you
would
expect
where
the
pain
is
less
than
you
would
think
for
the
amount
of
disease
that
they
have
.
When
you
finally
do
look
,
it's
amazing
.
I
don't
understand
.
I
know
if
you
talk
to
any
experienced
endosurgeon
,
no
one
is
going
to
say
I'm
super
confident
in
predicting
endometriosis
stage
based
on
symptoms
,
because
it
makes
no
sense
.
It
has
a
mind
of
its
own
.
It
does
.
It
makes
no
sense
.
I've
seen
some
of
the
worst
cases
with
minimal
pain
.
Speaker 1
38:12
Yeah
,
but
I've
talked
to
many
people
who
are
like
I
didn't
have
a
ton
of
endo
,
but
my
pain
was
severe
and
debilitating
and
that's
why
you
know
those
are
the
best
right
.
It's
never
wording
You're
like
oh
,
straightforward
for
me
.
You're
like
this
was
a
walk
in
the
park
for
me
today
I
love
it
.
So
this
is
just
a
good
reminder
that
pain
doesn't
necessarily
mean
a
ton
of
disease
and
no
pain
means
no
disease
.
That's
why
,
again
,
having
a
specialist
on
your
team
makes
the
biggest
difference
.
Speaker 2
38:36
Yeah
,
just
the
other
week
I
had
someone
that
came
to
me
just
for
a
Dermoid
,
but
I
had
no
pain
before
the
Dermoid
.
It's
definitely
just
the
Dermoid
.
I
have
nothing
else
going
on
.
She
scored
seven
,
I
think
,
on
the
survey
,
but
mainly
because
of
the
dermoid
.
She
thought
she
had
very
advanced
stage
four
and
the
dermoid
was
actually
mixed
in
with
an
endometrioma
.
It
was
together
.
Luckily
.
I
consented
her
for
it
,
but
I
don't
think
she
really
mentally
was
prepared
for
that
diagnosis
and
she
really
wants
a
family
.
That's
so
.
That
was
a
tricky
situation
.
Speaker 1
39:07
Yeah
,
you
had
talked
a
little
bit
about
hormones
and
the
part
that
they
play
in
your
practice
.
Can
you
explain
that
a
little
bit
more
and
the
use
that
you
have
for
them
and
how
you
utilize
them
?
Speaker 2
39:22
Sure
,
one
of
my
favorite
treatments
hormonally
is
progesterone
.
What
I
do
is
a
full
hormone
profile
based
on
a
woman's
ovulation
.
So
the
reason
why
most
doctors
don't
do
tests
is
because
doctors
assume
all
women
ovulate
on
psychedate
14
,
and
that's
maybe
10%
of
women
who
actually
do
that
.
So
you
can't
really
test
hormones
based
on
that
assumption
.
Right
how
to
really
test
hormones
is
to
know
when
a
woman
ovulates
,
which
changes
on
any
given
cycle
,
and
be
able
to
.
I
get
hormones
three
,
five
,
seven
,
nine
and
11
days
after
that
and
I
watched
the
rise
and
fall
of
progesterone
and
estrogen
and
I
often
see
a
progesterone
deficiency
,
sometimes
in
conjunction
with
estrogen
deficiency
,
sometimes
with
high
estrogen
,
frequently
with
low
progesterone
.
They
have
a
very
truncated
second
half
of
the
menstrual
cycle
.
That's
pretty
frequent
,
or
premenstrual
spotting
is
another
frequent
symptom
of
low
progesterone
Fertility, Hormones, and Emotional Support
Speaker 2
40:19
.
So
cooperatively
working
with
the
cycle
,
giving
body
identical
progesterone
,
helps
tremendously
with
bleeding
,
pain
,
inflammation
and
fertility
.
It's
a
very
cheap
option
and
it
helps
with
implantation
.
You
know
,
if
a
woman
was
trying
to
conceive
it
can
even
help
with
PMS
symptoms
.
We
often
see
a
correlation
of
hormone
fluctuations
with
the
onset
of
PMS
symptoms
.
So
I'm
actually
doing
a
study
right
now
based
to
prove
that
,
because
that's
not
even
proven
.
You
would
think
that
basic
event
of
PMS
and
hormone
fluctuation
would
be
a
proven
correlation
,
but
it's
not
at
all
.
It's
not
researched
,
mainly
because
researchers
don't
really
understand
the
female
menstrual
cycle
,
because
it's
so
different
between
woman
to
woman
in
cycle
to
cycle
.
And
so
I'm
working
with
cycle
charting
and
hormone
testing
that
patients
would
be
undergoing
anyway
and
just
correlating
that
with
the
survey
based
on
symptoms
,
and
then
we're
going
to
treat
them
and
watch
them
improve
.
Now
you
may
know
that
there's
often
a
progesterone
resistance
with
women
with
endometriosis
,
and
so
for
those
we
can
try
going
up
on
more
capsules
.
So
we
not
only
treat
the
numbers
but
we
treat
the
symptoms
right
.
They're
both
important
.
And
so
some
women
we
need
to
be
more
aggressive
and
get
the
progesterone
shot
,
and
I've
had
women
say
that
that
changed
their
life
.
Speaker 2
41:41
I
had
one
.
She
was
thinking
about
coming
back
for
endosurgery
again
.
She
really
didn't
want
to
,
but
she
didn't
know
what
else
to
do
,
and
then
we
started
on
progesterone
.
I
said
let's
just
try
these
shots
.
They're
not
fun
,
but
for
women
that
are
suffering
,
to
try
these
progesterone
shots
,
you
know
,
instead
of
surgery
it's
been
much
less
invasive
.
So
she
said
she
had
the
best
period
of
her
life
.
Her
husband
noticed
and
now
she
doesn't
want
to
do
repeat
surgery
.
I
really
think
it
helped
me
rule
out
that
the
recurrence
of
endometriosis
for
her
,
I
think
.
So
it's
really
neat
,
it's
really
tailored
protocol
that
we
can
work
with
the
patient
and
then
we
can
check
when
she's
on
these
hormones
to
see
if
she's
at
a
good
level
.
And
you
know
this
should
be
very
helpful
for
her
whole
health
of
her
brain
,
of
her
bones
,
for
her
whole
health
of
her
brain
,
of
her
bones
breast
tissue
.
Speaker 1
42:30
All
of
that
is
supported
by
bioidentical
hormones
.
That's
an
interesting
.
I
haven't
really
heard
that
before
,
so
that's
interesting
.
Speaker 2
42:34
Yeah
,
we
monitor
it
because
we
don't
want
estrogen
to
be
super
high
and
we
want
the
ratio
of
estrogen
progesterone
to
be
in
balance
,
because
progesterone
should
be
in
a
natural
setting
and
the
second
half
of
the
cycle
very
dominant
over
estrogen
and
that
technically
,
I
think
,
has
an
effect
on
this
next
couple
of
weeks
.
Even
so
,
it's
technically
,
I
believe
,
protective
.
I
have
to
do
more
research
for
the
whole
cycle
.
Um
,
we
definitely
see
improvements
in
pain
and
blood
flow
for
the
menses
after
that
.
Speaker 2
43:04
But
one
thing
that
I
do
when
I
review
charts
and
I
see
women
who
went
through
IVF
,
their
estrogen
I
never
should
see
it
really
above
300
.
And
that
should
be
around
ovulation
,
maybe
400
max
,
just
for
a
day
After
ovulation
.
It
really
shouldn't
get
much
higher
than
well
.
Our
goal
is
120
plus
from
you
know
,
maybe
up
to
170
.
I
don't
like
to
see
it
higher
.
They
don't
typically
check
after
stimulation
in
IVF
very
often
,
but
when
they
do
there'll
be
over
a
thousand
estrogen
and
that
I've
seen
it
many
times
.
And
not
to
mention
,
some
of
these
women
still
have
endometriomas
and
then
they're
going
to
be
doing
egg
retrievals
while
the
estrogen
is
through
the
roof
and
so
they're
poking
these
ovaries
and
causing
bleeding
and
so
those
are
the
pelvises
that
I
dread
going
in
.
Speaker 1
44:02
That's
a
hard
discussion
to
have
,
too
going
in
.
That's
a
hard
discussion
to
have
too
.
How
do
you
talk
to
your
patients
when
there
are
possibilities
of
not
having
the
outcome
that
they
want
?
How
do
you
address
those
?
Speaker 2
44:13
Yeah
,
I
mean
,
I
think
it's
important
to
be
upfront
from
the
beginning
.
First
of
all
,
I'm
very
optimistic
from
the
get-go
.
I
always
try
to
point
at
the
positive
things
.
But
then
I
also
say
no
one
can
ever
promise
you
a
baby
,
right
,
and
I
think
everyone
knows
that
,
Right
.
But
and
if
anyone
says
that
or
says
,
if
you
give
me
enough
money
,
I'll
give
you
a
baby
,
you
know
,
doctors
have
said
that
.
I've
heard
patients
have
told
me
that
.
You
know
they're
red
flags
that
you
should
run
away
from
anyone
guaranteeing
a
baby
after
infertility
.
Speaker 2
44:44
But
what
I
do
say
is
at
least
in
the
process
you're
going
to
find
answers
and
you're
going
to
find
healing
.
In
the
end
you
won't
be
broke
.
I
do
take
insurance
.
I
know
not
all
endometriosis
surgeons
are
able
to
do
that
so
hopefully
you
won't
be
broken
emotionally
,
physically
,
financially
.
In
fact
you
should
be
at
least
feeling
better
at
the
end
,
and
that's
one
thing
we
have
more
control
over
.
We
don't
have
total
control
of
the
outcome
.
And
then
we
also
I
try
to
invite
,
you
know
,
discussion
of
being
a
mother
now
and
other
non-biological
ways
,
and
there
are
beautiful
ways
of
doing
that
.
And
so
many
women
have
this
beautiful
calling
of
volunteering
somewhere
or
whatever
their
calling
is
,
and
I
really
encourage
them
to
not
let
infertility
rob
them
of
that
.
So
we
talk
about
that
and
try
to
really
focus
on
other
ways
of
being
a
mother
today
and
not
letting
infertility
rob
someone
of
their
life
or
bring
desperation
in
,
because
that's
when
we
get
into
problems
right
,
Both
physically
in
our
health
and
financially
.
Speaker 1
45:50
And
it's
interesting
that
you
say
that
,
because
I
do
know
there
are
a
lot
of
people
who
put
a
lot
of
weight
into
becoming
parents
.
And
right
,
I
mean
,
if
you
have
that
desire
and
that
passion
to
become
a
parent
,
it's
so
deep
rooted
and
if
you're
unable
to
,
you
grieve
and
you
grieve
hard
and
it
is
,
it's
a
stressor
in
a
relationship
,
it's
a
stressor
in
your
mental
health
and
your
emotional
health
.
Do
you
have
a
counselor
on
your
staff
or
people
that
you
refer
to
through
this
process
?
Speaker 2
46:21
I
wish
,
I
wish
,
we
would
love
to
have
one
on
staff
.
So
unfortunately
we
me
and
my
nurses
end
up
doing
counseling
that
we're
not
qualified
to
do
.
We
do
try
to
encourage
support
groups
and
books
and
therapists
,
and
we
do
have
people
that
we
do
recommend
.
We
would
love
for
someone
in
our
clinic
to
be
there
on
the
premises
because
it's
so
needed
.
Every
single
woman
facing
infertility
goes
through
trauma
,
like
you
said
,
and
the
problem
is
it's
so
drawn
out
,
it's
invisible
.
Women
look
healthy
on
the
outside
and
couples
and
so
they
feel
so
alone
.
Yeah
,
and
just
that
long
grieving
process
right
Of
your
dreams
of
this
life
that
you
envisioned
for
so
many
years
,
that
maybe
no
one
warned
you
you
know
you
thought
it
was
guaranteed
so
many
years
.
Speaker 1
47:08
What
is
your
advice
to
those
people
who
are
trying
to
seek
out
whether
to
do
IVF
or
what
the
next
stage
of
trying
for
a
family
should
be
,
if
they
know
that
they
have
endometriosis
or
even
if
they
don't
know
,
if
they
have
something
that's
prohibitive
physiologically
?
Speaker 2
47:27
I
think
everyone
deserves
answers
Understanding Infertility
Speaker 2
47:29
.
With
going
through
infertility
,
the
least
someone
deserves
is
knowing
why
.
My
least
favorite
diagnosis
is
obviously
unexplained
infertility
,
because
that's
not
really
a
diagnosis
,
right
?
Well
,
the
doctors
gave
up
or
they
stopped
.
You
know
conventional
tests
,
the
basic
test
didn't
find
an
answer
.
So
I
think
knowing
why
is
extremely
important
for
healing
emotionally
and
physically
.
Right
,
because
knowing
for
example
,
I
found
cancers
in
patients
with
infertility
not
,
you
know
it's
not
common
,
but
you
know
there
are
serious
issues
that
lead
to
infertility
,
and
so
someone
is
worthy
to
know
why
.
Speaker 2
48:09
Is
it
?
Male
factor
,
is
it
?
And
if
it's
a
male
factor
,
he
has
an
increased
risk
of
a
shorter
life
expectancy
.
So
there's
abnormalities
on
SFA
,
it's
often
a
sign
of
underlying
health
issues
,
and
so
it's
a
predictor
of
future
health
.
And
so
I
think
it's
important
to
find
answers
for
emotional
and
physical
healing
,
first
and
foremost
,
and
being
empowered
with
what
is
going
on
and
having
a
sense
of
support
from
each
other
or
faith
or
friends
or
other
people
going
through
infertility
,
support
groups
when
navigating
these
decisions
and
not
going
from
that
place
of
desperation
because
that's
when
people
have
a
report
first
mortgage
on
their
house
,
and
then
they
have
no
baby
and
no
money
,
or
no
money
for
adoption
and
I
had
a
patient
that
failed
IVF
three
times
and
they
were
like
just
do
it
again
.
And
she
was
very
smart
,
she
and
her
husband
were
very
,
very
intelligent
and
they
were
like
why
would
I
repeat
the
same
thing
?
And
so
they
came
to
me
.
I
said
,
oh
,
and
she
was
older
too
,
you
know
,
for
trying
,
you
know
like
30
,
late
30s
or
40
.
Speaker 2
49:17
And
I
said
you
know
this
is
probably
endometriosis
and
we
were
going
to
do
a
full
,
thorough
surgery
and
her
pre-op
labs
she
had
a
positive
ACG
.
Speaker 1
49:28
Oh
my
gosh
.
Speaker 2
49:29
So
just
through
time
to
intercourse
and
maybe
we
get
a
few
little
like
maybe
hormone
support
like
a
couple
of
little
things
time
to
intercourse
hormone
support
and
and
that's
true
20
of
couples
that
fail
ivf
will
go
on
to
conceive
naturally
.
Speaker 2
49:44
Yeah
,
so
clearly
,
to
me
that's
proof
that
too
many
patients
are
told
to
do
ivf
.
Right
,
if
20
conceived
naturally
,
naturally
,
that's
proving
that's
without
any
intervention
.
Imagine
how
much
higher
we
get
that
when
we
actually
work
and
treat
endometriosis
,
treat
hormone
dysfunction
,
treat
ovulation
disorders
,
improve
the
seminal
fluid
analysis
and
then
in
the
process
of
I
also
help
men
to
,
the
couple
feels
better
and
and
they're
excited
to
feel
better
.
And
there
are
milestones
,
because
often
with
a
long
journey
of
infertility
,
you
don't
have
a
lot
of
wins
.
Right
,
because
you're
looking
for
the
one
win
of
the
test
.
That's
positive
.
But
what
I
say
is
you
should
look
for
your
biomarkers
on
your
chart
to
be
better
as
far
as
abnormal
bleeding
,
pain
,
energy
.
All
of
that
should
be
improving
as
we're
optimizing
your
health
.
And
so
in
the
end
,
let's
get
you
feeling
better
.
We're
going
to
get
there
.
Bonus
,
if
we
can
have
a
pregnancy
and
a
healthy
pregnancy
.
Speaker 1
50:42
Most
often
they
are
healthy
when
we
get
them
to
that
point
oh
,
so
good
to
hear
for
a
lot
of
people
and
you
know
,
and
I
have
heard
from
other
patients
who
have
done
ibf
and
it's
affected
them
negatively
with
their
health
,
and
so
I
I
want
to
encourage
people
,
before
taking
drastic
steps
,
to
really
look
at
a
big
picture
,
to
consider
,
and
it's
so
hard
because
,
just
like
with
endo
,
if
you
just
trust
your
neighborhood
OBGYN
,
you're
told
you
do
this
,
you
take
this
pill
,
you
do
this
IUI
,
you
do
this
quick
fix
Right
.
Speaker 2
51:20
And
the
OBGYN
themselves
they
mean
well
,
it's
not
that
it's
not
always
the
best
option
,
but
they
don't
know
what
they
don't
know
.
Speaker 2
51:27
When
you
look
at
all
the
options
,
they
don't
exactly
.
It's
so
different
when
someone
does
all
their
research
right
,
because
they
may
avoid
heartache
,
they
get
answers
.
Just
being
a
self
advocate
is
just
so
important
,
you
know
,
and
just
knowledge
and
awareness
before
any
decision
is
made
.
Because
the
algorithm
is
okay
try
to
conceive
for
12
months
,
random
intercourse
if
you're
not
pregnant
.
Next
step
ovulation
medication
for
three
months
,
which
I
don't
like
to
give
blindly
either
.
Right
,
if
someone
has
an
endometrioma
I'm
not
going
to
throw
high
dose
ovulation
meds
.
I
usually
just
stop
all
treatments
and
say
I
really
recommend
.
I
mean
it's
up
to
the
patient
.
You
know
we
talk
about
risks
but
most
patients
I
don't
want
them
to
rupture
that
because
that
if
they
rupture
their
endometrioma
that's
going
to
really
cause
adhesions
and
long-term
hurt
their
success
.
So
we
talked
about
they're
more
expedited
on
the
surgical
list
to
talk
about
risk
benefits
.
So
we
try
to
avoid
ovulation
.
Medic
post-pig
support
is
fine
,
but
ovulation
medications
we
try
to
avoid
overstimulating
or
even
minor
stimulation
of
the
ovaries
.
But
typically
patients
are
doing
three
rounds
of
ovulation
meds
,
just
some
random
dose
,
not
even
knowing
if
they
need
it
they
may
be
ovulatory
.
Then
three
rounds
of
IUI
,
then
three
rounds
of
IVF
and
then
,
if
it
fails
,
oh
,
do
more
IVF
.
Speaker 2
52:41
So
there's
some
fertility
doctors
that
people
have
messaged
me
where
they
do
look
for
endometriosis
and
treat
it
.
Some
REIs
do
.
I'm
very
impressed
when
they
do
.
There
are
definitely
some
exceptional
ones
that
are
very
good
surgeons
.
Now
the
problem
with
REI
as
far
as
endometriosis
is
concerned
from
that
perspective
is
that
most
of
them
admit
that
they
haven't
had
enough
surgical
training
.
Their
focus
is
IVF
.
So
you
have
to
think
about
it
.
As
I'm
going
to
this
doctor
,
their
main
specialty
is
IVF
.
They
have
some
knowledge
of
endometriosis
.
For
me
,
I
frequently
look
in
these
pelvises
of
women
going
through
infertility
and
I'll
even
repeat
surgeries
on
patients
I've
done
surgery
on
if
they
haven't
conceived
in
18
months
and
we
feel
like
you
know
we've
gotten
ovulation
and
all
these
other
.
We
don't
see
any
major
obstacles
.
Speaker 2
53:31
I
will
offer
a
second
look
to
potentially
see
if
there
are
adhesions
or
an
amyotriosis
.
And
so
you
know
I've
really
been
able
to
through
this
experience
and
having
a
lot
of
continuity
of
care
of
patients
really
helped
me
understand
the
disease
and
what
to
expect
in
patients
,
and
obviously
it
varies
depending
on
the
patient
.
But
REIs
,
they
don't
typically
have
that
continuity
.
They
don't
really
have
training
in
tubal
corrective
surgery
almost
at
all
Most
of
them
,
I
think
.
I
mean
it's
an
exception
if
they
do
.
Speaker 2
54:03
And
so
you
have
to
think
about
the
bias
of
and
I
tell
patients
this
I
say
I
am
a
surgeon
,
that
is
my
bias
.
I
don't
do
this
procedure
.
So
I
just
want
to
let
you
know
and
be
transparent
that
when
you
walk
in
my
clinic
,
I'm
going
to
probably
think
of
endometriosis
more
than
others
,
of
endometriosis
more
than
others
,
and
that's
my
tool
.
So
if
you
go
to
another
doctor
,
just
think
about
what
tools
they
have
.
It's
going
to
lead
their
bias
into
their
treatment
,
and
so
it's
important
when
you
know
what
treatments
are
and
what
are
the
causes
of
infertility
,
you're
empowered
to
understand
okay
,
not
only
what
do
I
need
,
but
why
is
this
doctor
offering
this
?
And
so
it
just
helps
with
that
informed
consent
process
,
absolutely
.
Speaker 1
54:45
Can
you
explain
what
an
REI
is
for
those
who
maybe
don't
know
what
that
is
?
Speaker 2
54:50
Yeah
,
so
it's
a
reproductive
endocrinologist
and
infertility
specialist
,
so
they
have
an
additional
board
certification
.
They
do
a
fellowship
in
infertility
.
With
the
advent
of
Flomid
in
the
60s
and
IVF
in
the
70s
,
rei
really
that
subspecialty
really
changed
its
focus
to
those
type
of
procedures
and
IUI
,
which
is
actually
from
the
17th
century
Instead
of
before
that
time
,
before
the
1960s
,
they
were
really
endocrinologists
looking
at
root
cause
.
They
were
more
looking
for
those
types
of
things
.
Looking
at
root
cause
,
they
were
more
looking
for
those
kinds
of
things
,
and
when
these
technologies
came
about
,
like
clomid
,
they
thought
oh
,
there's
a
quick
pill
,
it's
going
to
get
everyone
pregnant
.
10
,
20
years
later
we
realized
clomid
doesn't
have
that
high
success
for
pregnancy
alone
.
So
then
after
that
though
,
so
then
they
were
doing
less
surgery
.
Speaker 2
55:41
When
Clomid
happened
and
then
with
IVF
,
that
again
happened
,
where
they're
like
okay
,
this
is
the
fix
,
we
don't
need
to
put
patients
through
all
this
surgery
.
It
sounded
so
great
and
it
sounded
so
promising
that
it
would
have
super
high
success
.
Unfortunately
,
it
didn't
have
high
success
,
especially
for
women
that
are
older
.
So
women
that
are
infertile
tend
to
be
older
and
women
with
endometriosis
have
lower
success
rates
,
especially
deep
infiltrative
.
But
the
problem
is
it
takes
10
,
20
years
to
see
the
success
and
in
those
decades
skills
,
surgical
skills
are
lost
forever
potentially
.
And
so
the
art
of
surgery
is
pretty
rare
,
especially
for
tubal
surgery
and
endometriosis
surgery
.
Obviously
no
,
tubal
surgery
is
even
harder
,
unfortunately
,
to
find
surgeons
to
do
that
.
So
that's
kind
of
the
evolution
.
Speaker 2
56:31
I
don't
think
it's
by
anyone's
fault
.
I
think
it
was
through
.
Oh
,
this
is
going
to
be
easier
,
less
invasive
,
quicker
.
It
gets
the
outcome
we
want
,
right
.
I
mean
it's
very
appealing
because
,
especially
for
patients
to
and
doctors
,
because
it
sounds
great
you
just
put
the
embryo
in
and
you
have
a
baby
,
right
.
Well
,
it's
obvious
doesn't
work
out
that
way
.
Speaker 2
56:51
So
yeah
,
that's
,
there's
a
history
behind
that
,
and
so
,
unfortunately
,
rei
fellowships
focus
mainly
on
IVF
training
,
and
they
do
.
It
depends
on
the
training
program
,
but
there
was
a
survey
a
few
years
ago
and
I
think
over
50%
said
I
wish
I
had
more
surgical
training
.
So
that's
again
.
I
think
it
speaks
to
the
REI
.
As
far
as
,
do
they
talk
about
endometriosis
?
How
upfront
are
they
about
the
different
diagnoses
?
Do
they
try
to
avoid
IVF
?
Do
they
try
to
do
it
as
last
resort
?
We
definitely
see
those
.
They're
just
more
rare
.
The
one
I
trained
under
he
didn't
have
a
diagnosis
.
He
actually
based
his
treatment
on
ability
to
pay
,
so
for
me
my
experience
is
biased
.
It's
not
great
,
because
that
definitely
was
not
a
good
introduction
to
me
as
to
his
approach
.
Speaker 1
57:45
It's
interesting
how
history
affects
the
trajectory
of
a
disease
.
Speaker 2
57:49
The
pill
was
around
the
same
time
in
the
60s
right
,
so
women
are
feeling
better
on
the
pill
.
It
must
stop
the
progression
.
Speaker 1
57:56
Right
,
of
course
,
that's
what
they
know
.
It's
an
easy
solution
,
so
easy
,
of
course
.
Speaker 2
58:01
It's
what
they
.
You
know
it's
an
easy
solution
.
It's
all
so
easy
.
So
I
think
all
of
that
came
together
.
It's
definitely
appealing
.
It's
much
quicker
.
We
all
have
physicians
and
patients
alike
we
love
quick
fixes
and
so
it's
seen
that
way
,
and
I
mean
that's
the
hard
part
about
what
I
do
is
that
it
takes
time
.
There's
no
quick
fix
involved
.
It's
definitely
more
of
an
investment
in
time
.
So
that
can
be
really
hard
and
it's
not
for
everyone
.
Not
everyone
wants
that
.
Speaker 1
58:27
But
for
those
who
have
struggled
for
many
years
and
have
done
what
they
thought
were
all
the
right
steps
,
this
is
definitely
a
good
step
to
consider
as
well
.
So
there's
another
resource
to
put
into
your
tool
belt
in
navigating
this
journey
.
It's
so
intriguing
to
find
this
out
because
this
is
all
stuff
that
you
know
.
I
had
very
little
knowledge
on
anything
that
you
do
prior
to
really
doing
my
research
and
being
introduced
to
you
through
via
the
Instagram
.
And
if
you
want
to
follow
more
,
where
can
people
follow
you
on
Instagram
?
Speaker 2
59:00
My
handle
is
naprofertilitysurgeon
.
There
you
go
,
and
my
name
I'm
sure
it's
on
there
too
Naomi
Whitaker
.
Speaker 1
59:06
Yeah
,
so
is
there
anything
else
that
you
would
find
pertinent
for
listeners
to
hear
that
would
be
beneficial
for
them
in
this
?
Speaker 2
59:18
journey
,
you
know
,
finding
someone
who
won't
ever
give
up
.
Like
for
my
patients
,
we're
going
to
keep
looking
.
Obviously
,
within
reason
there's
a
time
and
a
place
where
we
get
to
a
point
where
,
mentally
,
they're
done
and
and
then
sometimes
they
just
want
permission
to
be
done
.
They've
been
doing
this
for
five
plus
years
and
they
,
they
want
someone
to
tell
them
they're
not
giving
up
but
that
it's
,
it's
okay
,
they
covered
all
the
bases
and
then
they're
at
peace
,
which
is
amazing
.
To
get
to
that
,
you
know
,
no
one
can
ever
guarantee
you
a
baby
.
But
to
be
able
to
feel
like
you
had
a
thorough
workup
,
you
had
support
and
you
found
all
the
answers
and
you're
healthier
,
and
then
to
close
on
that
chapter
,
you
know
,
think
about
the
end
,
Hopefully
.
Obviously
we
want
a
baby
and
that
is
great
and
it
doesn't
heal
the
pain
of
infertility
but
that's
the
best
outcome
we
would
want
.
But
what
happens
kind
of
worst
case
scenario
after
working
with
a
provider
.
Hopefully
you
at
least
got
answers
and
healing
and
peace
when
you
went
.
Speaker 2
1:00:21
Look
back
,
because
a
lot
of
closing
the
infertility
chapter
is
which
people
don't
talk
about
,
because
no
one
wants
to
talk
about
.
There
is
a
time
sometimes
when
we
close
trying
for
that
biological
baby
.
But
what
women
want
to
want
to
know
when
they
close
that
chapter
is
they
are
going
to
have
peace
.
They're
going
to
have
peace
in
the
moment
,
knowing
we
tried
so
hard
to
cover
all
our
bases
.
We
did
everything
within
reason
.
As
far
as
you
know
,
excision
Some
people
don't
want
excision
,
right
.
But
whatever
,
it
is
within
reason
for
them
and
they
can
look
back
in
five
,
10
years
and
say
you
know
,
we
worked
hard
and
I
don't
know
what
a
journey
that
was
,
but
they
have
a
sense
of
peace
.
I
think
that's
what
people
look
for
when
they're
closing
that
chapter
.
Speaker 1
1:01:04
Yeah
,
absolutely
.
That's
a
good
point
to
make
,
because
I
think
a
lot
of
us
,
if
we're
faced
with
that
,
it
is
a
really
hard
thing
to
kind
of
find
peace
with
.
But
if
you
know
that
you've
done
everything
that
you
possibly
can
with
a
really
good
provider
,
I
think
there
is
a
sense
of
peace
there
Not
to
say
that
there's
not
grieving
that
happens
because
I
think
that's
always
going
to
be
the
case
but
I
do
think
to
have
peace
,
knowing
that
you
did
your
absolute
best
to
fulfill
that
dream
and
that
desire
.
Advocating for a Difficult Issue
Speaker 1
1:01:38
Dr
Whitaker
,
thank
you
so
much
for
joining
me
today
and
just
taking
the
time
.
Oh
,
yeah
,
I
mean
,
this
is
not
an
easy
topic
to
talk
about
and
you
make
it
so
much
easier
to
highlight
this
in
a
way
that
gives
good
information
.
So
thank
you
so
much
for
taking
the
time
to
do
that
.
Speaker 2
1:01:56
Yeah
,
so
happy
to
help
.
Definitely
very
close
to
my
heart
this
issue
,
so
thank
you
for
talking
about
it
Absolutely
,
and
until
next
time
,
everyone
continue
advocating
for
you
and
for
those
to
help
.
Definitely
very
close
to
my
heart
this
issue
,
so
thank
you
for
talking
about
it
absolutely
and
until
next
time
,
everyone
continue
advocating
for
you
and
for
those
that
you
love
.