Knocked Up Podcast - Why the Media Doesn't Get Egg Freezing
With elective egg freezing being so new, how we interpret the data in the context of today's population doesn't quite give the accurate story. Dr Raelia Lew explains.
With elective egg freezing being so new, how we interpret the data in the context of today's population doesn't quite give the accurate story. Dr Raelia Lew explains.
We recommend listening to the 'Beyond Expectations' podcast episode "Kate Lancaster on What They Don't Tell You About Egg Freezing"
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
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Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Jordi Morrison:
Women's Health Melbourne is an innovative, holistic fertility and women's health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals. Our handpicked expert team provides the ultimate care experience for our patients. Reach us at womenshealthmelbourne.com.au and follow us at Women's Health Melbourne and at Dr Raelia Lew. Hello, and welcome to Knocked Up, the podcast about fertility and women's health.
You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI fertility specialist. Welcome, Raelia.
Dr Raelia Lew:
Hi, Jordi.
Jordi Morrison:
How are you doing?
Dr Raelia Lew:
I'm great.
Jordi Morrison:
Thank you. Today, we're talking about pregnancy. Normally, we talk more about getting pregnant, but we're talking about pregnancy in the context of conceiving using assisted reproductive technology. Why did you think it would be a good topic to talk about?
Dr Raelia Lew:
I think that when someone has gone through having to seek treatment to get pregnant, they might be more anxious in their pregnancy. And there might be things a little bit different about their pregnancy than if they were to conceive spontaneously.
And I thought you might have some great insight. I think you're right. I think people who do conceive with help have thought about it a lot more than people who just get pregnant and then have to think about it.
So there's probably a fair bit of worry, projection, anxiety. Things haven't gone right all the way when someone's needed help to get pregnant, so they're much more aware of the fact that things can go wrong and therefore more worried about things going wrong.
And probably in their journey to seek infertility treatment, they've probably done a lot of research online or chatted to people or read some of the things that do go wrong in early pregnancy like miscarriage, ectopic pregnancy, biochemical pregnancy, and so therefore are more concerned.
It's probably also true that people—as a generalization, and not always true—but people who seek assisted reproductive treatment are a bit older.
And therefore, they're a little bit more worried about some of the things that we can diagnose in early pregnancy like Down syndrome and other chromosome abnormalities that can some people choose not to continue a pregnancy.
Jordi Morrison:
Yeah. I think there might also be some benefits because you would have prepared yourself for pregnancy in advance as opposed to spontaneously being pregnant.
So I guess to start off with, probably the biggest difference will be when and how you find out that you're pregnant.
Dr Raelia Lew:
Well, that's actually a good point. Like, you know, you've taken yourself off potentially under the guidance of your doctor, medications that are fraught with danger, that you've kind of had a good think about diet and lifestyle, that potentially you've been on a prenatal supplement to optimize your chance of having a healthy pregnancy and reduce the risk of things like neural tube disorders that can happen when you don't have enough folate, thyroid deficiencies in the baby that can happen if you don't have enough iodine.
So all of these things have hopefully been looked at and corrected.
And, you know, things like vitamin D deficiency, things like iron deficiency that are common.
Probably because you've been under the care of a fertility doctor, these things have been examined and any problems have been addressed.
So you're probably going into pregnancy really well prepared.
And, you know, we also do quite a few other investigations in fertility workup that help us optimize your chance of avoiding problems in pregnancy.
Like, we've probably figured out if you're not immune to things like chickenpox and rubella, we've probably given you the opportunity to get vaccinated.
And there's lots of different things like that that we do address just trying to do everything right, dotting every I and crossing every T for you.
So you probably are actually very well prepared going into a pregnancy compared to most people who just get pregnant very quickly without thinking about it.
Jordi Morrison:
And I know we sort of touched on it before, but is there a difference between prenatal care when you've had fertility treatment or if you haven't?
Dr Raelia Lew:
That's true. So when you do get pregnant with assisted reproductive treatment, we test at the very earliest possible time.
Anyone who's actively trying to get pregnant anyway will probably be aware that you can have home testing kits that pick up pregnancy hormone, the hCG hormone.
The full name is human chorionic gonadotropin hormone.
And in terms of doing tests at home, you can test relatively early.
It is important to understand, well, why do we have pregnancy hormone tests and what are they actually picking up?
So when you're an embryo—whether you're created naturally through sex, whether you're created through IUI, or whether you're replaced into the womb after having been created in the IVF lab—you have an outer layer called the trophectoderm and an inner layer called the inner cell mass.
And the inner cell mass becomes the baby and all of the baby's organs and everything to do with the baby, and the outer layer becomes the placenta.
And the placenta is the tissue that makes hCG hormone.
And so it's actually amazing when you think about it. When you're an embryo and you are implanting, you are microscopic in size.
For you to make enough hCG hormone with your placenta for it to be picked up at a distant site either in the blood or in the urine, the pregnancy has to have gone quite a significant way.
Dr Raelia Lew (continued):
And just to kind of data a little bit back to where we were concentrating on—for patients who have something like a biochemical pregnancy where the pregnancy doesn't keep going, it's obviously very disappointing when that happens.
But as an IVF specialist, we learn a lot about that because it tells us actually implantation happened.
So if you're somebody along your IVF journey listening to this episode and you've had a biochemical pregnancy—say, for example, in a natural cycle for an embryo transfer—that means you were receptive.
And if you need to try again to get pregnant with a different embryo, really the environment of the first attempt was right. Otherwise, you wouldn't have had a positive pregnancy test at all.
So the fact that that happened is actually very reassuring.
And usually in that circumstance, the issue is the embryo—that it hasn't done everything right or maybe it didn't have what it took genetically.
And that means a different embryo might have a very good chance of succeeding.
Dr Raelia Lew:
Back to the topic. So hCG in the blood can be picked up a bit earlier than it can in the urine.
It's just about how we excrete hCG.
Because when it's in the blood, it's like a signal from the baby to the mother to help the mother's body hold on and support the pregnancy.
So it's like, "I'm here, mum. Look after me."
Whereas, in terms of the urine, it's a distant site, and we're actually picking up hCG in the urine that's actually been excreted from the blood as part of the clearance system of the body.
That's how our body purifies our blood—by filtering it into the urine, and the urine is where the waste products are excreted.
So some hCG gets there by virtue of the fact that it's just filtered through.So you can pick up hCG in the urine a bit later than you can pick it up in the blood.
Dr Raelia Lew:
And a lot of the tests commercially that you can do at home on urine are not what we call quantitative.
Now I'm sure that technology will come.
Already quantitative urine hormone assays are here. They're just very expensive, and people can't generally buy them over the counter yet.
A lot of the pregnancy tests that we have looking at hCG hormone in the urine, they're kind of like yes or no.
And sometimes you can have a bit of nuance in that.
If they have a line and it's a positive line, it can be darker or it can be lighter.
And the darker the line, the higher the hCG level. It just means more of the hormone molecule binding to the test.
So, you know, we can do a pregnancy test at home quite early, but we generally in IVF say, "Well, don't do it before you've had your blood test," because firstly, you can have a false negative.
You might actually be pregnant, and it just might not be picking up on the urine because the levels can start quite low, and we test quite early.
Dr Raelia Lew (continued):
We usually test from a blastocyst transfer and embryo transfer. And on day five, we test ten days later, so it's very early. It would be technically before the timing of a missed period.
So if you reference it to a natural cycle, that missed period in a natural cycle would probably come, you know, kind of a few days later. It is really early.
And also, we like to have a look quantitatively. So during the blood test—it is quantitative.
And we as a general rule in early pregnancy—and this does not actually apply to later pregnancy—so this pattern that we look for, it's a temporary pattern of early pregnancy.
But the hCG hormone tends to double every forty-eight hours as a rule of thumb if things are going normally.
There are definitely exceptions to the rule where pregnancy can start off a little bit weak and then pick up.
So it doesn't mean if it's not initially doubling, that it's definitely not okay. But if it is doubling, it's reassuring. So it's a good sign if it is.
If it isn't, it doesn't necessarily mean that all is lost, especially at the very beginning. But it is very reassuring when we see things going the way we hope that they will.
Dr Raelia Lew:
And the reason that the hCG initially doubles is purely mathematical—that the pregnancy is very tiny, it's growing fast.
And the amount of tissue making hCG is increasing exponentially.
So we see that pattern in the blood. And it's a way that we can look in on a pregnancy and make an inference as to whether things are going right at a stage where there's no ultrasound that can pick up a physical sign because things are too small.
And there's really no symptoms that might guide us in a really yay-or-nay way to tell us for sure if everything's alright.
So it's just a way of checking in and getting the most information possible.
Jordi Morrison:
And I guess that's something that's very different to a natural conception where people probably don't do that at all.
You certainly might have the opportunity to go to your GP and have serial blood tests organized if you have an index of suspicion that there might be a concern.
But most people who get pregnant might pee on the stick, get a positive, be happy, and go on their merry way and check in with their GP a bit later.
Dr Raelia Lew:
So certainly a difference with assisted reproduction is we probably do more tests at an earlier stage, which can give some reassurance, and I'm sure it can also generate some anxiety as well.
So whether it's necessary or not, at the end of the day, it doesn't make a difference to the prognosis of the pregnancy unless there's a certain type of pregnancy called a hormone-supported or artificial cycle, where we do hormone monitoring at that time just to be able to titrate how much medication a patient needs to be on for the next few weeks.
Aside from that, there's really no absolute impact of doing the test or not doing the test aside from the fact that we wanna know what's going on.
Jordi Morrison:
In terms of an IVF pregnancy, are there any specific risks or complications that need to be watched?
Dr Raelia Lew:
It really comes down to the individual.
And so I would refer a patient to someone who’s a very highly qualified maternal fetal medicine obstetrician, for example, preconception—before they get pregnant—if they have serious medical problems that require attention, optimization, and monitoring in pregnancy.
Firstly, to discuss their risk and also to discuss how treating them in pregnancy might be different to treating other people when they're pregnant.
We tend to, as obstetricians, stratify patients into categories of risk.
And having a pregnancy that's spontaneous at a young age, where there are no problems, where the mother doesn't have any health problems—that’s likely to be what we stratify into a low-risk category.
Whereas when a patient has underlying issues—and these might be part of the reason that they might have needed help in the first place to get pregnant—then they required IVF treatment, and potentially, they might be a bit older, then that would stratify into a different risk category.
Dr Raelia Lew (continued):
So, really, what I would be thinking about more so than whether someone needed IVF to get pregnant is what's their risk category.
Now you can argue that there are some people who definitely need IVF to get pregnant who are also in a low-risk category.
So an example of that would be a young woman, partner has severe sperm problem, needs IVF for the reason of male-factor infertility, otherwise fit and healthy, has a frozen embryo transfer in a natural cycle, has what's called a corpus luteum supporting her pregnancy as she would if she'd have conceived naturally—low-risk pregnancy.
She doesn't need—just because she had IVF—it doesn't mean that she's high risk.
So there is a degree of nuance. And what we do as obstetricians is we look at the picture of the person in front of us and say, "Well, what's her risk?"
And that's how we define how we treat someone in a pregnancy.
And it is a way that we focus our lens to try and risk mitigate and be able to ensure that we help people have healthy babies with the right level of intervention.
And sometimes the right level of intervention is minimal intervention, and sometimes the right level of intervention is maximal intervention.
So it really depends on the person rather than the fact that they've had assisted reproductive treatment.
Jordi Morrison:
And we know that IVF babies grow up to be normal like every other baby.
Dr Raelia Lew:
Yes. And even more nuanced than that, the type of IVF that's been used can sometimes have an impact as well.
Of course, we all know from our general knowledge that IVF has an association with multiple pregnancy.
So if you're carrying more than one baby for any reason, that’s what we call a higher-risk pregnancy. For example, that would be a reason that somebody would have a different way of being cared for in pregnancy.
In terms of the type of cycle you’ve had and the age you are, that will also impact the IVF risk that you would have.
So for example, if you’ve had a pregnancy generated in what's called an artificial cycle—maybe because you’re menopausal or maybe because your natural cycle is unreliable or maybe it’s for logistic reasons…
You might have used a donor egg or, if you're in a same-sex relationship, an egg from your partner or you might be using a frozen egg that you froze when you were younger.
And so we’re trying to coordinate it in an organized cycle coordinated within an egg thaw.
Dr Raelia Lew (continued):
So if you're getting pregnant in what's called an artificial cycle, then there's an association with that cycle type with a higher risk of blood pressure in pregnancy and preeclampsia. So we'd be looking for that.
We’d be putting some institutional elements into your care, like, for example, putting you on aspirin from the beginning to stop preeclampsia from happening if we can.
And we would also be monitoring you closely for that issue in pregnancy and planting a seed that it might be an issue.
Now the reality is that most patients who have that cycle type never get preeclampsia, but it's a relative risk increase so we're aware of it.
Likewise, if you have a fresh embryo transfer—so you've had an egg collection and we have an embryo transfer fresh—that's associated with poor placental function.
We know that puts you at an increased risk of placental insufficiency and intrauterine growth restriction as a baby. So we’ll be watching for that.
If you have a frozen embryo transfer, that actually doesn’t happen. And it's to do with the environment of implantation rather than the IVF itself.
Actually, frozen embryo transfer—if there’s an association—it’s with the opposite, with being a bigger baby, a larger-for-gestational-age baby, and that means you’ve got a healthier placenta.
So it’s one of those things that the way that you get pregnant in IVF also influences the risk.
The important thing to say is that most IVF babies are born normal in every way without complication.
Jordi Morrison:
Yeah. And in terms of an IVF pregnancy, are there any specific risks or complications that need to be watched?
Dr Raelia Lew:
That’s right. So there is an increased risk of fetal abnormalities in IVF, particularly in some subsets of IVF compared to natural conception.
We actually think that a lot of that’s more to do with the patient population than it is the IVF itself because it's not seen across the board.
And in terms of that, we do look for things and we do document things. But in general, there’s about a 2% background risk of fetal abnormalities.
In IVF, it’s more like 3 to 5%. It is increased, but it’s not seriously increased to the point where a lot of IVF babies are affected.
95% plus of IVF babies are completely normal, and that’s very reassuring.
Jordi Morrison:
Is it at a different stage that a patient who's had fertility treatment would move to the care of an obstetrician, or is it the same?
Dr Raelia Lew:
Look. I think, you know, I can speak from my practice and also acknowledge the fact that practice of IVF is different around different places in Australia and around the world.
So as a CREI subspecialist, I'm a tertiary referral person for IVF. I treat the hardest cases. I've done the most study, subspecialized my practice into fertility management.
And I always say I get so many patients pregnant that I could not possibly deliver their babies because looking after them in pregnancy—there's just not enough hours in the day for that.
And I’m blessed with a beautiful network of obstetricians, many of whom don’t do any fertility treatment at all, who are very happy to care for patients in pregnancy and do a wonderful job.
Some of whom have actually sub-specialized into areas of obstetrics like the maternal fetal medicine doctors that I mentioned.
And those are the doctors to whom I would refer my highest-risk patients because they have the expertise at managing complex medical conditions in pregnancy as well as pregnancy care and delivery of the babies.
Dr Raelia Lew (continued):
So, look, it's one of those things that I personally refer my patients for obstetric care at quite an early stage.
What I do is I make sure that everything is okay. I make sure that there's a baby and a heartbeat and everything going well and make sure that my patients know what to do if they have any residual need for IVF medications to support early pregnancy.
For example, some patients stop progesterone support at about six weeks, and others will continue progesterone support to the end of the first trimester.
And sometimes in IVF, there are other medications that we use to support implantation as well that I might have prescribed on an individual case-by-case basis.
So managing that—I make sure that they know what to do and they've got a plan.
And of course, I say don’t be a stranger if you have any problems. I’m here for you.
But it’s usually at around the six- to seven-week mark that I would pass their care—or discharge, I guess—patients from my care as the primary care provider and pass their care to their chosen model of antenatal care.
Dr Raelia Lew (continued):
Now in our practice at Women’s Health Melbourne, we also do have a shared care program within our practice.
So sometimes for patients who are keen to deliver in the public hospital, they might choose to continue at Women’s Health Melbourne in our obstetrician-led shared care program.
Some patients will want to have a private obstetrician, and I would refer them to a private obstetrician.
And I see my role as a bit of a matchmaker actually, because I really do know my patients very well by this stage.
I know their personality. I know their medical context, and I know their, I guess, desires for pregnancy, birth, and beyond—because they've communicated that to me.
So I’m actually very—I feel very well placed to choose an obstetrician or guide them to choose an obstetrician who’s going to be a good fit.
There are patients who want to have other models of care like hospital-based care, midwife-led care.
And, you know, there’s so much choice nowadays to have a safe birth in our community in different models of care, and I’m very supportive of my patients’ desires on that front.
Dr Raelia Lew:
I would also say there are some doctors in Australia who do a little bit of this, a little bit of that.
Like, they might practice a little bit of IVF, and they might deliver some babies as well and continue to care for their patients in pregnancy.
And if your IVF doctor does that, that's fine. You don't need to move on. You can stay with the same person.
One more thing to say, though, about having a new model of care when you are pregnant is it is a fresh start.
I actually think that is a beautiful opportunity for patients who’ve struggled with fertility—especially when they have a pregnancy that is now considered low risk—because they get to be normal.
And one of the things that they feel sometimes is, “Why couldn't I just get pregnant like my friends did? Why couldn't I just be normal?”
“Why did I need to have all of this help and intervention?”
And even though they're extremely grateful and happy that they had the intervention and they are now pregnant, it's an opportunity for them to have line in the sand, fresh start, no longer pathological, back to normality.
And that's very refreshing sometimes.
Jordi Morrison:
Definitely. I think it would probably feel nice to have that fresh start.
We've spoken a bit about the anxiety that might be felt for these patients.
What tools do you recommend to them to help them get through, I suppose, the psychological transition from fertility patient to expectant parent and to enjoy the pregnancy?
Dr Raelia Lew:
So when patients are anxious to the point of it being an impediment to them, we, in our practice, do have within our care network the propensity to refer to some formal counseling.
And there's some counseling programs that are actually subsidized by Medicare together with a GP care plan to have early pregnancy counseling and support.
And so that is something that we utilize in our practice for people who really need that psychological support.
And they could theoretically seek that externally through a counselor or through their GP and a psychologist in the community.
That’s something we do offer in our practice.
Dr Raelia Lew (continued):
Another element we have in our practice that is really lovely is in our holistic care opportunity is acupuncture and support through our Chinese medicine team led by Mandy Azoulay.
And that’s really beautiful, actually.
And, you know, some of our allied health team—kind of integrating them into early pregnancy—is a real opportunity for patients to just retain connection actually at Women’s Health Melbourne, but also to use that time, which can be an anxious time, really productively.
So they can have a nutritional assessment. They can have some lovely acupuncture, which is known to reduce stress, as well as having that extra support person on their cheer squad.
And it can lead into what’s—what can be really helpful during the pregnancy itself as women develop symptoms and other concerns during pregnancy.
I would say build your tribe, build your team, and build your support network.
And it's actually really important to point out that this is at a time where people might not have told anyone in their closer knit circles that they're pregnant yet.
And I think that’s quite normal.
It doesn’t really hold as true as it used to. It used to be fairly ubiquitous that nobody would tell anyone they were pregnant until they were at least twelve weeks pregnant.
And that’s because people felt there was like a stigma if they had a miscarriage or if they had a baby with a problem and chose to have a termination, and they just didn’t want to have to explain that to people.
And also, when sometimes their network knew they were on an IVF journey, they didn’t want to kind of, like, announce to the world that that journey was over only to have to—if there was the situation where there was a catastrophe with a pregnancy—pull themselves up by their bootstraps and get back on that IVF train.
So in terms of that time being a time where patients don’t necessarily want to divulge and, you know, they don’t really have anyone to share and half that burden with—
Integrating the professionals is a really beautiful way to have that support in a very confidential and protected private manner.
And I think it’s really useful and helpful.
Jordi Morrison:
Yeah. Definitely. Would your prenatal care be impacted by previous fertility treatment?
Is it possible that there’ll be different medications, or would anything be different if you’ve had fertility treatment?
Dr Raelia Lew:
Look. Obviously, like, if you have a regimen that needs to continue throughout the first trimester because that’s how we got you ready to conceive—like an artificial cycle—that would need to continue until the placenta was autonomous or running off its own kind of juices, making enough progesterone to support the pregnancy autonomously by itself.
But otherwise, no.
I mean, sometimes you’ve been on a supplement regimen leading up to IVF that’s been more egg-quality-focused or sperm-quality-focused.
I guess the guys are off the hook once you are pregnant.
But in terms of the supplements that we prescribe in the prenatal period—I mean, there’s a commonality.
You will have been taking things like folate and iodine moving into the preconception zone.
But, you know, switching more to a supplement choice that is more pregnancy and nutrition, baby-building-block focused is likely—either through diet or through choosing a supplement that is just more of a nutritionally focused multivitamin.
That can be very important if somebody is having symptoms that prohibit eating normally.
So hyperemesis gravidarum—if you’re vomiting all the time, you’re really nauseous, you’re maybe not eating—then being on a prenatal that’s nutrition-focused is a very good idea.
Usually, we do have that conversation before handing over care, and I tend to switch patients from any prenatal supplement that they’ve been taking that’s more egg-quality-focused to being more baby-nutrition-focused when they get their positive pregnancy test.
Jordi Morrison:
And for the last question, what do you wish more people understood about pregnancy after fertility treatment?
I think my biggest takeaway, just to interject, is that actually you might be in a better position having had fertility treatment because you got prepared beforehand.
Dr Raelia Lew:
I certainly think you're in a more educated position, and you've had the opportunity to have somebody who's got your back and knows what they're doing get you ready.
Probably a lot of the things that people have to think about at that time—you’ve already thought about. Those boxes are ticked.
You've been offered preconception genetic screening. You've probably done it.
You might have even had an embryo transfer that had been genetically tested so you can find out, you know, what the sex of the baby is quite early—earlier than anyone else.
So sometimes what happens is if I've had a patient who's gotten pregnant and we've tested their embryo, I can then write to the genetics lab and ask for a reissue of the report with sex reported.
I can generally find out within a matter of days, sometimes, what the sex of the baby is—if they want to know.
Dr Raelia Lew (continued):
Now, obviously, it's one of the greatest and most precious surprises to find out when your baby is born, and not everybody wants to know, but sometimes people do want to know—and so we can find out really soon.
We also with genetically tested embryos are pretty certain that things like Down syndrome are not an issue.
So sometimes people worry about that moving later.
Although many IVF embryos are not genetically tested, and I certainly don't advocate for ubiquitous genetic testing of every embryo.
So lots of my patients will have had embryo transfers, and they'll still have to find out—like everyone else—if they're desperate to know the sex of their baby, doing the noninvasive prenatal test at about ten weeks of pregnancy.
Dr Raelia Lew (continued):
Look, there’s—a lot of those things, you know, that perhaps patients who just get pregnant haven’t had the opportunity to have a preconception consultation even with their GP are doing for the first time during pregnancy.
And they might find out for the first time that they're not immune to chickenpox and then have to have that discussion about avoidance.
So they might have the opportunity and want to opt in for genetic screening for cystic fibrosis, spinal muscular atrophy, fragile X or more, and then have to wait six weeks to get a result.
And then if they have a carrier status identified, then have their partner tested in another six weeks.
And so none of that happens for IVF patients. Everything’s done upfront.
So in some ways, medically, they're sorted, and it’s just about the pregnancy.
Dr Raelia Lew (continued):
I think in that way, it can be better prepared.
In the way of moving forward into the pregnancy, I think it's true for many IVF patients that they—especially those who have come to IVF after a journey that's significant and long and have tried other things first.
You know, they've necessarily had a thought, "Is this going to happen for me? Will I ever get pregnant?"
And sometimes even into pregnancy, it's like, “Well, yes, I’m happy—but is it real? What’s going to go wrong now?”
“So many things have gone wrong for me.” So it can be quite anxious.
So I think that anxiety is definitely something that is more common in the assisted reproductive treatment population.
Because when something's gone wrong, you know that something can go wrong. It's been brought to your attention that not everything goes right in life when it comes to getting pregnant and having babies.
And there is a lot to be said for blissful ignorance. If you get pregnant easily, you think, “Oh, well, things will be fine. Pregnancy will be normal. Everything’s been normal.”
And it can, you know, a lot of the time be fine and go that way.
And so some of that worrying concern is just something that's just not on the radar.
Dr Raelia Lew (continued):
So I think it is a hard time. The first trimester is a hard time for patients who have conceived through assisted reproduction.
It’s also a joyous time. They’re very appreciative.
I find patients have a lot of joy. They have a lot of appreciation. They’re very grateful.
They’re grateful to the team. They’re grateful that their body has come through.
It’s a very emotional time. It’s a loaded time.
Jordi Morrison:
Thank you, Raelia.
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