Lorne Brown:

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Welcome to Conscious Fertility, this show that 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 Lorne Brown. I’m a doctor of 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 Olive Fertility Center in Vancouver, British Columbia, Canada. She is a reproductive endocrinologist, and I’ve known Dr. Beth Taylor for many years. I think we met maybe you were a resident or fellow when you were at UBC? What were you doing when I met you back in the day?

Dr. Beth Taylor:

I think it was a fellowship back in 2005.

Lorne Brown:

Yeah, okay. So-

Dr. Beth Taylor:

Long time.

Lorne Brown:

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. Now, at Olive 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, Acubalance, go on site for their IVF acupuncture, embryo transfers, and we have lots of discussions on integrative 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 an implant? Because there is kind of a handshake that has to happen. You have 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, they 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.

Dr. Beth Taylor:

Thanks, Lorne. 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’ve always talked about the seed and 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 the embryo is healthy? What that means then 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 miscarry, more likely to make a healthy baby that you have in your arms nine or 10 months later. So, the health of this seed is so important, and that’s predicted mostly by 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 embryo, but the biggest thing that means 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 done before we put the embryo in. So, it’s preimplantation 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 aneuploidy which just reflects the number of chromosomes, and we’re looking for abnormal numbers of chromosome, so it’s aneuploidy. So, PGT-A is what we’re talking about when we’re saying, “Let’s test that embryo, let’s test that seed to see its health status.” So, PGT-A 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 biopsying an embryo to see whether it’s normal or not.

Lorne Brown:

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 are some that may not even know that this is available or are about 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 in to retrieve the eggs from those follicles, and in the lab you inseminate and these eggs get fertilized and they grow into embryos over a five day period. The biopsy that you’re doing then, these embryos, so you retrieve the eggs, they’re fertilized with sperm, seminated, which in turn hopefully fertilized the egg, and they’re going to grow. You’re biopsying 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 biopsying.

Dr. Beth Taylor:

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.

Lorne Brown:

When you’re doing this biopsy, it’s at the blastocyst stage, and there’s kind of like two stages to this blastocyst, you have these inner cells 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.

Dr. Beth Taylor:

No, that’s right. So, that’s why we wait five, six, seven days to do the biopsy, because at 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 trophoblast, that trophoblast at that stage, and it’s the trophoblast we biopsy. We don’t biopsy babies. Doesn’t that sound horrible, even to say in one sentence?

Lorne Brown:

I know, but it’s important to-

Dr. Beth Taylor:

It is.

Lorne Brown:

… 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 amazed, and 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 amazing how this is beyond space and time when you look at it from a conscious perspective. So, just the idea that you’re biopsying 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 placenta and obviously not the baby because you’re not taking cells from what’s going to become the baby, but do you have ways and the science to share with them how this is okay?

Dr. Beth Taylor:

Well, firstly, as they say, the proof is in the pudding. We have tens and hundreds of thousands of babies born after PGT 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. Too large a biopsy taken or there’s an issue with 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. 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 98% chance that we’re not doing any harm at all. We’re getting really valuable information, is the upside.

Lorne Brown:

At this stage of the development, when it’s called a blastocyst around day five and six, it seems like us humans are like salamanders, these things just correct and duplicate. So, it’s not like the placenta is going to be missing anything.

Dr. Beth Taylor:

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 their lives, 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, there’s no evidence of that.

Lorne Brown:

Yeah, I’m always amazed just how we have this innate ability to regrow things and fix things at such an early stage, which what you guys have now are… We’ve seen this in salamanders, but we see this in human beings, we’re like them, at the early stages, and you’ve seen this in the science with the PGT that you guys do.

Dr. Beth Taylor:

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 as children that they can procreate. If you’re a child and you cut their arm, boy it heals amazingly, right? We’re just able as humans when we’re young, we’re just able to regenerate that, and that’s certainly happening to a manyfold in the embryo.

Lorne Brown:

So, I want to talk about the different types of genetic testing and why you would do this. So, let’s start off with just the most common one, and you talked about PGT aneuploidy, PGT-A, back in the day, that’s what it was also called PGS and also CCS. Is that the same test?

Dr. Beth Taylor:

Exactly right.

Lorne Brown:

Okay. So, it’s the same test that we’re talking about here. When do you counsel patients to do this? What’s the upside of doing this test? Why would somebody want to do this test?

Dr. Beth Taylor:

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 PGT-A, 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 in my mind to really contemplate PGT-A for everyone. Miscarriages are, besides the emotional side, physically hard on the uterus, they can leave women 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, not underplay that.

Because most of the big studies that look at the value of PGT-A have shown limited value in women under 35, if you don’t consider miscarriage. Okay? But, in over 35 it’s shown value. The thinking there is that if you don’t biopsy these embryos and you just put them in the woman, one after another, month after month, the outcome is the same whether you biopsied them or not, and that makes sense. If you had four embryos and you had a biopsy, 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 because that takes time to have transfers and miscarry. But, eventually, the end of that story 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 PGT-A. That ultimately if you just used 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 suggests everyone should contemplate PGT-A.

Now, there are definitely exceptions to that, and if you look at our center’s numbers, about 60 to 70% of our patients are doing PGT-A 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 2% and the outcome has the same story whether she biopsied or 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 PGT-A 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, for the vast majority of people, it generally makes sense nowadays to do PGT-A. When we think about it, what area of medicine are we not wanting to get more information from? What area of medicine where we’re going to blind yourself 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.

Lorne Brown:

I want to summarize what you shared because it’s such a common conversation that we see with our patients that are going through IVF at your center. So, I like the math side of it because it’s coming down to odds, and as you put it so nicely, is 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, and financial costs of unsuccessful transfers. So, what I’m understanding from our 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.

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. Correct?

Dr. Beth Taylor:

Agree.

Lorne Brown:

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?

Dr. Beth Taylor:

That’s right.

Lorne Brown:

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 thirties, 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 30, 18 months is a lot of time for egg quality to decline.

Dr. Beth Taylor:

That’s right. 18 months matters in your late thirties. That’s right.

Lorne Brown:

Yeah. 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 costs, but also the cost of time, and so stats will say you got the same chance regardless, so don’t put them in. I don’t know if you know, Beth, but before I was in Chinese medicine, before I was an accountant, my degree is in math, and so my stat teacher said, “Stats always lie.” So, you can make stats 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 deathly ill child.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

That’s the idea. You guys won’t transfer abnormal embryos.

Dr. Beth Taylor:

We have exceptional circumstances but generally we wouldn’t advise. It’s not going to give them a baby, and that’s what they came for.

Lorne Brown:

So, they’re not going to get the baby, and our goal’s healthy baby.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

When you do the genetic testing, you’re testing for chromosomes. So, do they have the right number of chromosomes? There are some conditions that this will pick up, correct? I know it picks up Down Syndrome.

Dr. Beth Taylor:

Yes, that’s right.

Lorne Brown:

But, this is not testing for some severe genetic diseases, the PGT-A test.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

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.

Dr. Beth Taylor:

Yeah, that’s right.

Lorne Brown:

Well, we’ll talk about those. I also want to talk about just the mosaic embryos as well before we go onto 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 abnormal embryo when you do the PGT-A testing, but sometimes you get a mosaic embryo, and that’s where we see a lot of controversy about whether you should transfer them or not. Can you tell us what that’s about and how you look at that in your clinic when you see couples or women that have mosaic embryos?

Dr. Beth Taylor:

Right. 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 trophectoderm, what we’re actually biopsying at 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. 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, what do you think about this mosaic? What does that really mean?” Remember, if we didn’t do this testing, we would’ve put that mosaic embryo into you.

Lorne Brown:

Yeah, that’s an important point, I want to bring this up. 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, a mosaic.” If I don’t test you, that’s what IVF was. You guys were putting back abnormal mosaic embryos-

Dr. Beth Taylor:

Put in mosaics for the last 30 years, that’s right.

Lorne Brown:

All the time.

Dr. Beth Taylor:

Yeah.

Lorne Brown:

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.

Dr. Beth Taylor:

That’s right, and we’re not creating a whole bunch of genetically abnormal kids, and we know that because there’s been nearly 6 million babies born from IVF around the world, most of those are not PGT tested, and we’re not causing problems. So, we know that transferring mosaics 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 one, and so probably it’s actually not that healthy and it’s less likely to stick. Then in other times, we know that the body’s really good at healing and it will heal out or expel or not procreate, proliferate, I should say, those abnormal cells, and so you end up with a normal healthy child.

Lorne Brown:

I just got to bring a little Chinese medicine part because this is what I love when I see the medicines coming together. This is one of the tenets of Chinese medicine that the body has this innate ability to heal. If it has the right environment, it can self correct within reason, and it’s neat that you guys… This is something that’s discussed in 2000 years old, how they observed the body. But, now with the lab, you guys are actually seeing some of these embryos that you see themselves, correct?

Dr. Beth Taylor:

See it self correct. You’re absolutely right. Yeah.

Lorne Brown:

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 even if it gets an average guy. So, again, we have a strong female, you can still… It’s kind of like how the family’s raised, right? You got the strong female, that feminine energy, you could create a good child. 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 have XY chromosomes here, I’m talking with that feminine energy. But, we see this with egg quality and sperm quality that the egg sometimes can-

Dr. Beth Taylor:

Can heal.

Lorne Brown:

… sit there and take average not so good sperm, and then it does some correcting and makes a fine embryo.

Dr. Beth Taylor:

That’s right. Yeah. So, we will see that that correction happens. So, mosaics are worth considering in having discussion, but the current threshold is 50%. So, if 50% or fewer of the cells are abnormal, generally encouraging people to transfer those embryos.

Lorne Brown:

Okay. You’ll always still transfer the normal embryos first. So, if you have genetics… If you biopsy the embryos and you have, say, four come back, three are normal and one is mosaic, you put in the normals first, one at a time normal is well, right?

Dr. Beth Taylor:

That’s right. That’s right.

Lorne Brown:

So, the mosaic is the last one of your selection, you still go through the normals.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

You guys are seeing pregnancies and healthy babies from these mosaic embryos that are below that 50% threshold.

Dr. Beth Taylor:

That’s right. We are, and in our local data we’re 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.

Lorne Brown:

This is what I like about the integration because I feel that the preconception times, so the lifestyle, the diet, the meditation, what we’re doing with the acupuncture and laser, and our clinics, at preconception we’re helping the sperm and egg get to their peak potential, 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?” 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.

Dr. Beth Taylor:

I couldn’t agree more. I think that creating a healthy embryo is a marathon, and at the 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 are really neglectful of that first part of the race, which I think we really lean on you guys and should moreso to give us the best possible eggs to get to that beautiful finish line.

Lorne Brown:

Well, and that’s the key. So, the goal is the finish line, healthy baby. We share three groups. So, there’s Acubalance, or if you’re seeing your Chinese medicine, naturopathic physicians, you got the fertility clinics, so in this case it’s Olive, 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?

Dr. Beth Taylor:

That’s correct.

Lorne Brown:

That’s the goal. You said it, we’re at 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… We just need both parts and your part is so exciting, the western part, the technology, I’m always so fascinated with it, which is why I enjoy integration that we do with you guys, and I’m glad that you see the value in the marathon in preparing before the IVF.

So, what are the others… We’re going to go into the receptivity side, the uterus side, because not all genetically normal, chromosomally normal, So, the PGT-A, what’s on average the success rate when you put in a normal embryo?

Dr. Beth Taylor:

So, it’s about a 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.

Lorne Brown:

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 a hundred percent success rate-

Dr. Beth Taylor:

That’s right.

Lorne Brown:

… because it doesn’t exist at the time of this recording, anyhow. But, in 2002 the success rate was well under 30%, I think.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

Now, you can get up to 60%. In nature, meaning you’re not doing IVF, you’re in your twenties, and you’re having unprotected sex and trying to conceive, the chances are what? 25, 30% each cycle?

Dr. Beth Taylor:

That’s right, yeah.

Lorne Brown:

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%.

Dr. Beth Taylor:

That’s right. 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 3% leaps, and that’s this Receptiva, that sort of testing. I can’t see the next 15% leap in pregnancy rates per embryo transfer, but I can see where 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, each one is 2%. Then many two percent will get us to another 10% rise. So, then a year or two from now, we’re sitting here talking about 75% live birth rates.

Lorne Brown:

You’re right. Anybody who’s gone through fertility treatments will take 2%, 3%, 4% increase, because-

Dr. Beth Taylor:

We will all do it all day long. It’s true.

Lorne Brown:

We’ll do it all day long, and I think we didn’t see PGT really coming through either. I don’t think it-

Dr. Beth Taylor:

No, no.

Lorne Brown:

… was super obvious, and so stem cells, or somebody’s going to figure something out, I’m sure it’ll come, but for now we’ll do the marathon. 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 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 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?

Dr. Beth Taylor:

Isn’t that true?

Lorne Brown:

It doesn’t happen. Maybe we’ll 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, right?

Dr. Beth Taylor:

That’s right.

Lorne Brown:

So, you 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 little bit about that? 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 uterine receptivity-

Dr. Beth Taylor:

Receptivity.

Lorne Brown:

… because on transfer day, the marathon is over, we can’t do anything to prepare embryo quality, it’s all about uterine receptivity. So, let’s talk about the technology and testing that you guys are doing to find out about uterine receptivity.

Dr. Beth Taylor:

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, “That must not have been a good transfer.” But, then we have testing that shows, “No, actually this is a normal embryo,” it’s chromosomally normal, it looked beautiful under the microscope. Geez, that really sort of shifted our focus to the uterus, more than ever. 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? 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. 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 of the uterine lining out and look at it on the day of implantation. So, we know what that looks like, and then if you’d biopsy someone, and say, “Well, actually yours doesn’t look like the receptive one, how can we make it receptive?” 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 saying, “Hey, is this 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. Progesterone dosing is the big one, but I think there’s going to 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, Lorne, and personalized medicine mixing together in a brew that can really help people and really harm people.

So, a lot of people take an ERA and go, “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, that person needed it. So, now you’ve got to put a lot of people through this test without a benefit to them. So, when I talk to patients, I’m saying, “I’m going to talk to you about a test that I think is important for you to do, but you probably don’t even need it.”

Lorne Brown:

Let’s talk about those who could need it, and we’ll bring in, again, so I got my math background, I used to be an accountant, now I’m doing Chinese medicine, and I really think it helps with this discussion-

Dr. Beth Taylor:

Sure.

Lorne Brown:

Because the policymakers 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?

Dr. Beth Taylor:

That’s right.

Lorne Brown:

Because they’re 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 decisions 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 this, the statistics, to help us make general ideas, and it’s general, and this is why you still want to talk to the experts. So, talking to you is where you find out where it does benefit that individual.

So, thinking of somebody who is going through a 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. So, this is where the… 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.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

So, there is a cost emotionally and financially for this person, and so now they’re not looking to see a failed one or two more cycles before you recommend an ERA. I’m sure that if I was that woman in the chair, and I did a donor cycle, or you put in a normal PGT-A 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?”

Dr. Beth Taylor:

That’s right, yeah.

Lorne Brown:

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.

Dr. Beth Taylor:

It’s tricky, and we’ve published some studies largely by Dr. Gary Nakhuda, but we’ve published our experience here and a few other groups have published their experience where you take a hundred 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 statistics side, you need failure to show a delta, to show an improvement. So, we don’t see a big push for ERA before the first embryo transfer, and if you’re going to be a purist, an evidence-based doctor based on population studies, you’re actually not going to do an ERA before your first transfer, you’re going to wait one or two failed transfers, and that’s what a purist 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 because you’re going to 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.”

Lorne Brown:

Yeah, I want to 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.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

You’re just going in and you’re biopsying when you would want to have put in the embryo and seeing what it looks like because you’re going to do the same thing the next cycle, and so you want to make sure that it’s receptive.

Dr. Beth Taylor:

Exactly right, and then you have the biopsy. The biopsy hurts. Had one done myself, they hurt, and I’ve done thousands of them. It’s much like getting your ears pierced. It’s like, “Ugh.” It’s a really sharp pain and then it’s done. The pain might last 20 or 30 seconds, a little longer than your ears pierced, I guess, but it is that kind of 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 higher dose of progesterone or eight more hours of progesterone,” or whatever that test result comes back, and that’s really helpful, and so you can act on it right away.

Lorne Brown:

The reason you’re doing this, because 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 going to bleed for 14 days after ovulation, or if you put in the embryo in day five, you’re not going to bleed likely for nine more days, 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.

Dr. Beth Taylor:

That’s right. Sink it up. That’s right. There’s times when it doesn’t make sense to do that. The couple who has five chromosomally normal embryos and they want one child, maybe you put it, you do one or two transfers before going through that testing. But, for most people, making sure the soil is being optimized and really looked at before a transfer, does make sense.

Lorne Brown:

Again, it becomes that individualized care where I often say this in my practice, “There’s no right way to do this.’ If there was, everybody, we’d have the same thing done, 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?

Dr. Beth Taylor:

That’s right.

Lorne Brown:

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?

Dr. Beth Taylor:

Agreed.

Lorne Brown:

There’s a reason… We don’t let our patients do whatever they want. There’s a 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?

Dr. Beth Taylor:

That’s right.

Lorne Brown:

What about… This is where I’m interested in, I think, the EMMA test, the endometrial microbiome test. Is that the one you’re using? Is that the name for everybody or are there different companies now doing the uterine biopsy for the microbiome?

Dr. Beth Taylor:

There are other companies but we’re doing it all through genomics. So, when we put a woman through the biopsy, as I mentioned, it does hurt, they’ve spent a fair amount of money to get to that point, they’ve taken medications. What it was five years ago is it was tested for receptivity with that sample. But, then the scientists were like, “Wait, okay, so we can look for that. Now, what else can we look for? What else can we learn in that biopsy sample?” So currently 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 a hundred different things, but as it stands today, we’re looking at three different things in the uterine lining.

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 woman has. So, those parts are looking at bacteria, and it’s funny, when I trained in the ’90s in medical school, we were taught that the uterine lining was sterile, and it’s only been in the last 10 years, I think, people have really appreciated, “Hey, wait, it actually has lots of bacteria in it. 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, and people have shown this, if you’ve got the bulk of bacteria in your uterus is lactobacillus, you’re more likely to get pregnant, and so if people are low in that number, then we’ll give them vaginal lactobacillus probiotic which will then migrate up through the cervix into the uterus and repopulate it with the right bacteria, and that, again, so I say as it stands now, is lactobacillus,

Lorne Brown:

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 at Acubalance balance, because I’ve heard Dr. Beth Taylor used the term microbiome and probiotics and lactic bacteria a couple times, which back in the day in the early 2000s, was considered craziness. But, it’s neat to see how the integration’s 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 or doing it independently and often disagreeing, which is very stressful for the patient.

Dr. Beth Taylor:

It was. I agree.

Lorne Brown:

Now, just to see how things are evolving, and that openness and that the science is there, because you practice evidence-based medicine. Back then, you just didn’t see the evidence for it, and now you’re seeing the evidence. 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 different. 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. So, we believe one day we’ll see and understand how the gut microbiome is communicating with the vaginal and uterine microbiome, right?

Dr. Beth Taylor:

Yes, I’m sure of it.

Lorne Brown:

Like anything, sometimes you treat downstream as if 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 going to make the pain in my foot go away?” The pill just knows where to go, 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, going back to the beginning of our conversation, the body has this innate ability to heal. It can be 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.

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, we’ll use the probiotic vaginal suppositories 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 Acubalance, we’ll still address the gut microbiome with the speculation that that inflammation and that gut microbiome, if it’s out of balance, it’s 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 gut microbiome in balance as well.

Dr. Beth Taylor:

I’d like to see that even extended out through a better focus on the biome through pregnancy.

Lorne Brown:

Yes.

Dr. Beth Taylor:

I think what you guys are doing is important. We have blinders on. We want to get the positive pregnancy test 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 linked to preterm birth and early ruptured membranes and second trimester pregnancy loss.

Lorne Brown:

Yeah. 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.

Dr. Beth Taylor:

So do I.

Lorne Brown:

Okay? Because I know, it’s 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, they save lives. But, if 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, the joking here, but the serious part is I just want to share with what Dr. Taylor and what Beth’s 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 didn’t use the word health blueprint, they said prenatal Jing and postnatal Jing. 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. Then the health of the mother up to birth is creating the prenatal Jing. So, you’re influencing the health blueprint of the child, and then after the child is born, they call it postnatal Jing, 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. Then once a child’s born, how you raise your child, feeding, that’s how you’re impacting it. We know telomere lengths, so the little plastic tips on the end of chromosomes, they’re not plastic tips, but we know how-

Dr. Beth Taylor:

We know, exactly.

Lorne Brown:

… that’s all epigenetic factors. So, it’s neat how we’re seeing that in science. So, going back to the implantation, because this is an important part, this is the finish line, in a sense, of the IVF process. If you have a normal embryo but the uterus isn’t receptive, then we don’t get a pregnancy or we get a chemical pregnancy. So, when you guys do the biopsies now, you’re doing three things then, because you can do it all in one test.

Dr. Beth Taylor:

One sample. That’s right.

Lorne Brown:

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 is you may adjust the timing and dosage of progesterone, and then you put in the embryo.

Dr. Beth Taylor:

Correct.

Lorne Brown:

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 of that probiotic is important at this stage.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

You’ll do that, and I see you guys doing that a lot for your frozen embryo transfers.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

In our clinic, we’re starting to just tell women to start to do it just-

Dr. Beth Taylor:

No harm.

Lorne Brown:

… whether you’re doing an IVF, or 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 benefits. 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?

Dr. Beth Taylor:

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 absolutes. So, if you’ve got endometritis, and that’s treated with antibiotics.

Lorne Brown:

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 and her partner on 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.

Dr. Beth Taylor:

That’s why we were just treating it without the test, right?

Lorne Brown:

Yeah. Yeah.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

Sorry, I interrupted you.

Dr. Beth Taylor:

That biopsy can… Yeah, I was going to extend the thought because 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 Bcl-6. So, that is expressed in women with endometriosis. So, that’s different from endometritis. Endometritis 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’s put inside the woman to diagnose it, or now you can potentially diagnose it with this biopsy of the uterine lining looking for Bcl-6.

Lorne Brown:

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. Endometriosis can lead to infertility, so this is another reason to check for-

Dr. Beth Taylor:

To consider that test. We’re 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.

Lorne Brown:

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, because I know in some places 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 that they do for that test.

Dr. Beth Taylor:

Right. Yeah.

Lorne Brown:

So, what you’re doing is amazing because you keep going forward with the technology and you keep finding those two percents, four percents, 50% jumps, 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 head of the curve for so many things at Olive 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 in IVF, and the diagnostics that you get to offer.

Going back to the genetic screening, I know we’re going to wrap here for our listeners and for your time too, Beth, the other question I want you to help put their hearts to rest. Some people are quite concerned and protective of 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?

Dr. Beth Taylor:

That’s right. We should clarify that. We are just sending those cells. The embryo stays here at Olive.

Lorne Brown:

Right. So, it’s lovely because they’re so ready to parent and love this baby and it’s just 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.

Dr. Beth Taylor:

That’s right. They want to know where their embryos are going.

Lorne Brown:

I find that amazing because I’ve had people cross from me, and they’re quite upset and worried, and the question I ask 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, “There’s cells going that will never become part of your baby, it’s been sent away to test, but your embryo is safe and sound locked up in this little freezer packet.”

Dr. Beth Taylor:

That’s right. People ask will they get dual citizenship or something? They don’t. The embryos they’d never left here.

Lorne Brown:

All right, let’s wrap up a little bit about the integration, where you guys are at with Olive, and how Acubalance and Olive are 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, so 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.

Acubalance goes on site to do the acupuncture and laser acupuncture on transfer day, help with uterine receptivity, and we get to talk a lot, our teams get to talk a lot-

Dr. Beth Taylor:

It’s been terrific.

Lorne Brown:

… about the integration, and you are now a proponent of preconception care is what I heard. There’s a marathon here.

Dr. Beth Taylor:

That’s right.

Lorne Brown:

You’re so modest or you’re 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 workup, and all the things that you do 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 in fertility. What I mean bidirectional, I mean it on two levels. The mental emotional impacts the physical, and the physical impacts the 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 and emotional that I mentioned. But, we need the integration of the east and west here as well.

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. This is the part that you do with diet and lifestyle and supplements and stress reduction and mindfulness. We offer 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 involved, healthy dads as well.

Dr. Beth Taylor:

Thanks so much, Lorne. I couldn’t agree more. I think when all the best aspects of all types of medicine are working and pulling on the oars in the same direction, the patients benefit and we benefit with more babies.

Lorne Brown:

We’re there guides. So, what I got from our conversation today is the individualized medicine that you’re looking for, the listeners, the doctors are there to inform and educate, and so come with questions, right?

Dr. Beth Taylor:

Come with questions, come with ideas, talk to them in Acubalance, and because those patients come to us best armed with the right questions, the right direction, 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 understanding the rationale for our treatments. Yeah, I couldn’t agree more. I jumped onto your same [inaudible 00:54:45], because I knew where you were going with that, and I just wanted to… I’m echoing it before you say it.

Lorne Brown:

Like the marathon, the analogy you used, 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, but a lot of people do them and enjoy them, and so the fertility journey is not easy. With preparation, so, being educated, Beth said, go 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 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 about the integration at Acubalance, we’re happy to coach you around that.

But, it’s not like the IVF clinics like at Olive, 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, and hopefully we get you across that finish line.

Dr. Beth Taylor:

Thanks, Lorne.

Lorne Brown:

Beth, thank you very much, and I’ll see you on my next transfer day there. I’m on call on Friday.

Dr. Beth Taylor:

Excellent. We’ll see you Friday. Take care.

Lorne Brown:

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 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 @drlornebrown. That’s Dr. Lorne Brown. Or, visit my website, lornebrown.com. Until the next episode, stay curious, and for a few moments, bring your awareness to your heart center, and breathe.