1
00:00:03,920 --> 00:00:07,000
Speaker 1: Welcome to the kick your Expert led podcast, helping you

2
00:00:07,080 --> 00:00:11,479
Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming

3
00:00:11,480 --> 00:00:11,879
Speaker 1: a parent.

4
00:00:12,240 --> 00:00:16,000
Speaker 2: On the podcast and our online pregnancy program grow My Baby,

5
00:00:16,160 --> 00:00:19,919
Speaker 2: we share my experience of helping more than four thousand babies.

6
00:00:19,600 --> 00:00:22,200
Speaker 1: To be born, and our experience of running a women's

7
00:00:22,200 --> 00:00:24,160
Speaker 1: health clinic and parenting for boys.

8
00:00:24,360 --> 00:00:27,360
Speaker 2: We're here to help everyone to feel empowered in pregnancy

9
00:00:27,520 --> 00:00:30,360
Speaker 2: and birth with real life, practical information.

10
00:00:32,200 --> 00:00:33,159
Speaker 1: Well, welcome everyone.

11
00:00:33,159 --> 00:00:36,479
Speaker 3: I'm Bridgid Maloney and I'm obstetrician doctor Patrick Maloney, and

12
00:00:36,479 --> 00:00:36,880
Speaker 3: we've got.

13
00:00:36,760 --> 00:00:39,040
Speaker 1: A Q and A today, Pat good. Yes, we've got

14
00:00:39,080 --> 00:00:42,640
Speaker 1: some ripper questions in so, you know, I keep saying,

15
00:00:42,640 --> 00:00:44,280
Speaker 1: as we do, we just get stuck straight into it.

16
00:00:44,280 --> 00:00:45,440
Speaker 1: All right, let's go, let's go.

17
00:00:46,040 --> 00:00:49,000
Speaker 4: Hello Bridget and doctor Pat, thank you for your wonderful podcast.

18
00:00:49,400 --> 00:00:52,199
Speaker 4: I'm Belinda. I'm thirty three from Sydney and I first

19
00:00:52,240 --> 00:00:55,080
Speaker 4: started listening in twenty twenty one when I was pregnant

20
00:00:55,080 --> 00:00:58,280
Speaker 4: with my son. I'm currently pregnant again twenty two weeks

21
00:00:58,320 --> 00:01:01,680
Speaker 4: and due in August with my second I'm calling in

22
00:01:01,720 --> 00:01:04,160
Speaker 4: today to see if you have any information on how

23
00:01:04,200 --> 00:01:07,600
Speaker 4: my previous breast cancer treatment may impact pregnancy and labor

24
00:01:07,680 --> 00:01:10,399
Speaker 4: this time around as a few months after winning my

25
00:01:10,480 --> 00:01:13,560
Speaker 4: sixteen month old in twenty twenty three, I was diagnosed

26
00:01:13,600 --> 00:01:16,560
Speaker 4: with stage two ductul breast cancer. I had a lumpectomy,

27
00:01:16,880 --> 00:01:20,560
Speaker 4: followed by chemotherapy, then radiation, and two years of hormone

28
00:01:20,600 --> 00:01:25,080
Speaker 4: blocking medication. My obstetrician, who's amazing, helped us for pregnant

29
00:01:25,160 --> 00:01:29,400
Speaker 4: via ovulation induction, and he's arranged a baseline echo cardiogram

30
00:01:29,480 --> 00:01:33,160
Speaker 4: due to the level of chemotherapy I received. As wondering

31
00:01:33,240 --> 00:01:36,000
Speaker 4: if you had any insights on potential impacts of these

32
00:01:36,040 --> 00:01:40,480
Speaker 4: treatments on pregnancy, labor, or postpartum recovery and whether any

33
00:01:40,480 --> 00:01:44,600
Speaker 4: additional monitoring or precautions are typically recommended for someone in

34
00:01:44,600 --> 00:01:47,640
Speaker 4: my situation. Thank you so much for your time.

35
00:01:47,880 --> 00:01:49,800
Speaker 1: Heye callers a brave, aren't they?

36
00:01:49,960 --> 00:01:50,279
Speaker 5: Emotion?

37
00:01:50,520 --> 00:01:50,600
Speaker 4: Like?

38
00:01:50,720 --> 00:01:52,680
Speaker 1: You know, I'd just be a puddle on the floor.

39
00:01:53,120 --> 00:01:55,800
Speaker 5: And I love how she just tells us that whole story, like.

40
00:01:57,600 --> 00:01:59,720
Speaker 1: This happens, this happens. Now, What can I do?

41
00:02:00,520 --> 00:02:01,600
Speaker 5: Yeah, so well done.

42
00:02:01,680 --> 00:02:04,800
Speaker 3: How wonderful for you that you have not only been

43
00:02:04,840 --> 00:02:08,000
Speaker 3: successfully treated for that initial illness, but that you are

44
00:02:08,000 --> 00:02:14,399
Speaker 3: pregnant again. So that's fantastic. This is obviously an unusual situation,

45
00:02:15,160 --> 00:02:18,080
Speaker 3: give or take, our peak cancer years are much later

46
00:02:18,160 --> 00:02:21,720
Speaker 3: than our peak baby years, and so we don't often

47
00:02:22,680 --> 00:02:27,320
Speaker 3: treat people for pregnancies who who've had previous chemotherapy, but

48
00:02:27,520 --> 00:02:33,040
Speaker 3: certainly there are some. So the the conditions can be

49
00:02:33,080 --> 00:02:36,000
Speaker 3: breast cancer obviously that can happen to young women, less

50
00:02:36,040 --> 00:02:38,080
Speaker 3: less common, but it can. And then there's lots of

51
00:02:38,120 --> 00:02:40,680
Speaker 3: other cancers, like blood cancers like them foma that can

52
00:02:40,680 --> 00:02:45,320
Speaker 3: happen to young people, and of course testicular cancer in men.

53
00:02:46,200 --> 00:02:49,480
Speaker 3: So those have happened to young people in the pre

54
00:02:49,639 --> 00:02:56,799
Speaker 3: fertile times, in the pre pregnancy years and potentially affecting fertility.

55
00:02:56,639 --> 00:03:03,160
Speaker 3: The treatment that this woman probably needs now is probably

56
00:03:03,160 --> 00:03:06,119
Speaker 3: reasonably straightforward. She's had an echo, which seems a good

57
00:03:06,120 --> 00:03:09,280
Speaker 3: idea to make sure that the chemo hadn't had affected

58
00:03:09,320 --> 00:03:12,720
Speaker 3: cardiac function, which would be quite relevant with the demands

59
00:03:12,880 --> 00:03:15,839
Speaker 3: of the second half of the pregnancy. On ow on

60
00:03:15,880 --> 00:03:19,560
Speaker 3: the heart rate and the what's called stroke volume, how

61
00:03:19,639 --> 00:03:22,440
Speaker 3: much your heart pumps out per beat, And is.

62
00:03:22,360 --> 00:03:24,400
Speaker 1: That a known problem that chemo can impact your.

63
00:03:24,280 --> 00:03:26,440
Speaker 5: Heart, Yes, so that's why they've checked that.

64
00:03:26,919 --> 00:03:29,560
Speaker 3: And then and then you want to make sure that

65
00:03:29,560 --> 00:03:32,160
Speaker 3: if you're going in for another vaginal birth, that the

66
00:03:32,200 --> 00:03:35,480
Speaker 3: body will be safe for the being demands on your

67
00:03:35,520 --> 00:03:38,920
Speaker 3: cardiovascular system that you might experience in labor. And so

68
00:03:39,400 --> 00:03:43,640
Speaker 3: they've done that, and with the obstetric checking those things

69
00:03:43,680 --> 00:03:47,760
Speaker 3: and perhaps in conjunction with the oncologist to say, well,

70
00:03:47,760 --> 00:03:48,960
Speaker 3: what exactly did.

71
00:03:48,800 --> 00:03:49,320
Speaker 5: This woman have?

72
00:03:49,360 --> 00:03:51,480
Speaker 3: What are the known side effects of that medication? Then

73
00:03:51,520 --> 00:03:54,520
Speaker 3: you could easily put together a plan to think that

74
00:03:54,600 --> 00:03:58,520
Speaker 3: through and that that could be done on a per

75
00:03:58,640 --> 00:04:01,800
Speaker 3: case basis, And it sounds like that's already been done

76
00:04:02,800 --> 00:04:07,720
Speaker 3: very capably for this caller. There are two other things

77
00:04:07,720 --> 00:04:11,360
Speaker 3: that I think are worthy of mentioned. One is mental health.

78
00:04:12,080 --> 00:04:15,880
Speaker 3: So this is a this is a big deal breast

79
00:04:15,880 --> 00:04:19,680
Speaker 3: cancer and are pregnant again. And I think that I

80
00:04:19,760 --> 00:04:22,320
Speaker 3: would be encouraging this person to make a plan for

81
00:04:22,360 --> 00:04:28,279
Speaker 3: their own mental health. And there are supports available through

82
00:04:28,400 --> 00:04:32,680
Speaker 3: or through through cancer networks. There are supports available through

83
00:04:32,680 --> 00:04:33,600
Speaker 3: good obstetric care.

84
00:04:34,480 --> 00:04:37,360
Speaker 5: There are psychologists and psychiatrists.

85
00:04:36,680 --> 00:04:39,240
Speaker 3: In the community. And I think that I would be

86
00:04:40,080 --> 00:04:43,840
Speaker 3: trying to manage help this woman manage her mental health

87
00:04:44,000 --> 00:04:49,480
Speaker 3: as prospectively and preventatively as possible, because it sounds.

88
00:04:49,160 --> 00:04:53,480
Speaker 1: Like you know I can totally empathize with how she's proceeding,

89
00:04:53,680 --> 00:04:55,960
Speaker 1: which is, you know, just from that one call, it's

90
00:04:56,240 --> 00:05:01,040
Speaker 1: it's sort of facts and things sinking differently at different times,

91
00:05:01,120 --> 00:05:03,080
Speaker 1: and you know, you never know when that's kind. She

92
00:05:03,160 --> 00:05:05,919
Speaker 1: might say, oh gosh, my mental health is fantastic, But

93
00:05:06,839 --> 00:05:09,400
Speaker 1: it does pay to sort of have a think about

94
00:05:09,440 --> 00:05:11,760
Speaker 1: it and have somebody else sort of reflect back to

95
00:05:11,800 --> 00:05:12,520
Speaker 1: you what you're saying.

96
00:05:12,600 --> 00:05:15,600
Speaker 3: And if we think our mental health is really good,

97
00:05:15,760 --> 00:05:19,520
Speaker 3: there's nothing quite like throwing a boby to test that deprivation.

98
00:05:19,839 --> 00:05:20,400
Speaker 2: Yeah.

99
00:05:20,520 --> 00:05:23,320
Speaker 3: Yeah, so I would be making a plan for that.

100
00:05:23,839 --> 00:05:25,320
Speaker 3: And the other thing I thought i'd mentioned is that

101
00:05:25,720 --> 00:05:29,680
Speaker 3: is that some of these cancers that affect young people,

102
00:05:29,760 --> 00:05:32,600
Speaker 3: especially if it happens before their first baby, there are

103
00:05:32,640 --> 00:05:38,360
Speaker 3: services around for emergency fertility preservation that can be done

104
00:05:38,440 --> 00:05:41,440
Speaker 3: before the chemo is given. So if we've got a

105
00:05:41,480 --> 00:05:46,599
Speaker 3: young woman who's got breast cancer, for example, then before

106
00:05:46,680 --> 00:05:50,279
Speaker 3: that first lot of chemo is given, even if they're

107
00:05:50,279 --> 00:05:53,840
Speaker 3: not in a relationship, even if they're very young, they

108
00:05:53,839 --> 00:06:00,359
Speaker 3: can be offered emergency appointments for fertility preservation, clear and

109
00:06:00,400 --> 00:06:03,039
Speaker 3: IVF cycle and egg freezing, or if they've got a

110
00:06:03,080 --> 00:06:05,760
Speaker 3: partner embryo freezing, and then you go off and have

111
00:06:05,800 --> 00:06:07,840
Speaker 3: the chemo and everything, and then if that chemo has

112
00:06:07,880 --> 00:06:13,479
Speaker 3: a significant impact on your ovarian function, then it's less

113
00:06:13,520 --> 00:06:16,039
Speaker 3: of a drama if you've got some frozen eggs or embryos.

114
00:06:16,480 --> 00:06:18,719
Speaker 1: Yeah, it sounded like she had ovulation induction.

115
00:06:19,160 --> 00:06:20,920
Speaker 5: Yes, but it's not clear whether that was because of

116
00:06:20,960 --> 00:06:21,760
Speaker 5: the chemo or not.

117
00:06:21,960 --> 00:06:22,239
Speaker 4: Yeah.

118
00:06:22,320 --> 00:06:24,160
Speaker 3: Yeah, I suspect not that might have been a pre

119
00:06:24,200 --> 00:06:32,440
Speaker 3: existing A pre existing a problem relates causing an ovulation.

120
00:06:32,920 --> 00:06:38,320
Speaker 1: Yeah, and maybe we could also put a tip in

121
00:06:38,520 --> 00:06:43,520
Speaker 1: about breast checks. So your breasts are changing so much

122
00:06:43,560 --> 00:06:48,719
Speaker 1: after pregnancy and during pregnancy that it's hard actually to

123
00:06:48,800 --> 00:06:51,000
Speaker 1: be able to detect lumps and bumps in the first place.

124
00:06:51,120 --> 00:06:53,559
Speaker 3: Yes, I've diagnosed a couple of cases of breast cancer

125
00:06:53,600 --> 00:06:55,960
Speaker 3: and lactating women and they've thought that it was just

126
00:06:56,160 --> 00:07:00,600
Speaker 3: lactational changes, but when I've examined them clearly to it wasn't.

127
00:07:01,160 --> 00:07:06,039
Speaker 1: Yeah, is it routine? Who's checking women's breast?

128
00:07:06,480 --> 00:07:06,640
Speaker 6: Well?

129
00:07:06,680 --> 00:07:10,239
Speaker 3: I think that that self checks are a good idea,

130
00:07:10,640 --> 00:07:13,120
Speaker 3: and the lactational tissue should at least feel roughly the

131
00:07:13,160 --> 00:07:16,200
Speaker 3: same in each breast, and if some if one's clearly

132
00:07:16,240 --> 00:07:18,240
Speaker 3: different to the other that should be checked out and

133
00:07:18,240 --> 00:07:22,400
Speaker 3: then off the family doctor for some imaging. And you know,

134
00:07:22,520 --> 00:07:26,120
Speaker 3: ultrasound can be used if if a mammogram is not suitable.

135
00:07:26,400 --> 00:07:27,040
Speaker 5: Yeah.

136
00:07:27,200 --> 00:07:29,360
Speaker 3: So if you if you're actually breastfeeding the and the

137
00:07:30,600 --> 00:07:33,160
Speaker 3: and all that breast tissue is full of for of milk,

138
00:07:33,200 --> 00:07:36,920
Speaker 3: then then ultrasound can be better than X ray.

139
00:07:36,800 --> 00:07:39,520
Speaker 1: Mammography certainly less painful, wouldn't it be.

140
00:07:39,560 --> 00:07:41,720
Speaker 3: Well, yeah, so there's times we can do to help,

141
00:07:41,760 --> 00:07:45,680
Speaker 3: but we want people to have things checked out.

142
00:07:45,920 --> 00:07:49,760
Speaker 1: Yeah, so I hope everybody is checking their boobs basically. Good.

143
00:07:49,800 --> 00:07:52,840
Speaker 1: All right, Well, good luck with your pregnancy and your birth,

144
00:07:52,920 --> 00:07:55,680
Speaker 1: and I hope everything goes super well for you. All right,

145
00:07:55,760 --> 00:07:57,960
Speaker 1: doctor Pat, let's listen to this one.

146
00:07:58,320 --> 00:08:03,320
Speaker 6: Say doctor Pat and Bridgard, just a quick question. I

147
00:08:03,360 --> 00:08:09,480
Speaker 6: found out that I was having an ectopic pregnancy middle

148
00:08:09,560 --> 00:08:15,840
Speaker 6: of April this year. The whole lead up to this pregnancy,

149
00:08:16,000 --> 00:08:21,960
Speaker 6: I was taking the multi vitamins the fold eate and

150
00:08:22,320 --> 00:08:29,120
Speaker 6: because of the methotrexate injection that I received, I can

151
00:08:29,160 --> 00:08:34,480
Speaker 6: no longer be on those multi vitamins until three months

152
00:08:34,559 --> 00:08:42,199
Speaker 6: post injection. Just wondering when about I can restart those vitamins.

153
00:08:42,440 --> 00:08:44,800
Speaker 1: Thank you, all right, Patty, Maybe we could start first

154
00:08:44,840 --> 00:08:47,559
Speaker 1: with what's methatrix. What's methatrix?

155
00:08:47,640 --> 00:08:51,079
Speaker 3: A yeah, So, if someone's got an actopic pregnancy, there's

156
00:08:51,200 --> 00:08:53,120
Speaker 3: the pregnancy that's in the wrong place, it's stuck in

157
00:08:53,160 --> 00:08:56,880
Speaker 3: the in the cervix, in a caesar scar, or in

158
00:08:56,920 --> 00:09:00,960
Speaker 3: the tubes. Most commonly the tubes are then Traditionally the

159
00:09:01,000 --> 00:09:05,560
Speaker 3: treatments were surgical, but if it's small and unruptured then

160
00:09:05,800 --> 00:09:09,880
Speaker 3: and found on an ultrasound, then it can be treated

161
00:09:09,920 --> 00:09:14,520
Speaker 3: with a medication called methatrex eate and methatrex AID is

162
00:09:15,440 --> 00:09:19,560
Speaker 3: probably best thought of as a like a chemotherapy type drug.

163
00:09:20,600 --> 00:09:25,800
Speaker 3: It interferes with folate metabolism and stops and stops the

164
00:09:26,559 --> 00:09:31,640
Speaker 3: pregnancy from growing. It causes it to miscarry and hopefully

165
00:09:31,720 --> 00:09:37,520
Speaker 3: resolve without surgery, and it's suitable for small, unruptured ectopics

166
00:09:37,720 --> 00:09:42,559
Speaker 3: where the woman is safe, feels fine, but the diagnosis

167
00:09:42,600 --> 00:09:46,120
Speaker 3: on ultrasounds really clear. If you're going to use methatrex

168
00:09:46,160 --> 00:09:48,440
Speaker 3: that you give it as an injection and then you

169
00:09:48,720 --> 00:09:53,000
Speaker 3: have to monitor quite carefully that it's working, because if

170
00:09:53,040 --> 00:09:56,320
Speaker 3: it's not working properly or quickly enough, then the ectopic

171
00:09:56,360 --> 00:10:00,320
Speaker 3: pregnancy could continue to grow and then rupture. So there's

172
00:10:00,320 --> 00:10:05,200
Speaker 3: a whole protocol where you calculate the woman's body surface area.

173
00:10:05,200 --> 00:10:07,960
Speaker 3: It's like at the dose, give the methatrax ad, and

174
00:10:07,960 --> 00:10:11,000
Speaker 3: then very carefully watch the pregnancy hormone levels until they're

175
00:10:11,000 --> 00:10:15,880
Speaker 3: back to zero. Because the way methotrexate works, it interferes

176
00:10:15,920 --> 00:10:21,360
Speaker 3: with the metabolism of folic acid or folate. Then it

177
00:10:21,440 --> 00:10:24,880
Speaker 3: means that if you're taking folate, then the folate it's

178
00:10:24,880 --> 00:10:26,960
Speaker 3: not gonna work very well, and you might be taking

179
00:10:26,960 --> 00:10:30,200
Speaker 3: that folate to prevent abnormalities in a subsequent baby. And

180
00:10:30,240 --> 00:10:32,640
Speaker 3: there are there are actually it's not just not just

181
00:10:32,720 --> 00:10:34,800
Speaker 3: that the follow doesn't work so well, but there's actually

182
00:10:34,840 --> 00:10:38,319
Speaker 3: some rare interactions with methatrex ad that could actually be dangerous.

183
00:10:38,360 --> 00:10:42,480
Speaker 3: So you're best off stopping that altogether, making sure you

184
00:10:42,480 --> 00:10:46,199
Speaker 3: don't get pregnant again, right up until the whoever's monitoring

185
00:10:46,240 --> 00:10:49,280
Speaker 3: your act topic tells you that the pregnancy hormone levels

186
00:10:49,320 --> 00:10:52,160
Speaker 3: have gone right back to zero and it's safe. Two commence.

187
00:10:52,640 --> 00:10:55,360
Speaker 1: So I mean, this woman was told three months, which

188
00:10:55,360 --> 00:10:55,840
Speaker 1: is interesting.

189
00:10:56,080 --> 00:10:57,840
Speaker 3: It might not be as long as that. Yeah, yeah, yeah,

190
00:10:57,920 --> 00:11:01,160
Speaker 3: So let's say, for example, she's minus over that time

191
00:11:01,440 --> 00:11:03,920
Speaker 3: and it's clearly gone right back to zero, then they

192
00:11:03,960 --> 00:11:07,400
Speaker 3: would say, okay, find that that pregnancy has gone. You

193
00:11:07,480 --> 00:11:10,920
Speaker 3: can restart your run prenat or fol aid and get

194
00:11:10,920 --> 00:11:11,520
Speaker 3: pregnant again.

195
00:11:11,960 --> 00:11:14,000
Speaker 1: Obviously we don't know what model of care she's in,

196
00:11:14,000 --> 00:11:15,760
Speaker 1: but let's say she's in a public unit and the

197
00:11:15,760 --> 00:11:18,559
Speaker 1: public unit's just gone. For safety sake, it's going to

198
00:11:18,600 --> 00:11:20,760
Speaker 1: be three months by then your hCG is going to

199
00:11:20,760 --> 00:11:21,720
Speaker 1: be normal or zero.

200
00:11:21,920 --> 00:11:23,400
Speaker 5: Yeah, they should still be monitoring it.

201
00:11:23,559 --> 00:11:26,920
Speaker 3: So when we you know the thing in the inner

202
00:11:27,360 --> 00:11:30,160
Speaker 3: private practices that you've got sort of one doctor looking

203
00:11:30,160 --> 00:11:33,960
Speaker 3: after these things. But in public unit, if any if

204
00:11:33,960 --> 00:11:36,800
Speaker 3: anyone's been given methatrecs eight, then the doctor of the

205
00:11:36,840 --> 00:11:38,360
Speaker 3: day on that unit will have a little folder to

206
00:11:38,360 --> 00:11:39,840
Speaker 3: look at it and it'll say missus blogs has had

207
00:11:39,840 --> 00:11:41,760
Speaker 3: a methatrex state and you need to check out blood's today,

208
00:11:42,160 --> 00:11:45,319
Speaker 3: and then as a team they would follow that through

209
00:11:45,480 --> 00:11:45,959
Speaker 3: to zero.

210
00:11:46,480 --> 00:11:48,720
Speaker 1: So if she was super keen to get back on

211
00:11:49,360 --> 00:11:52,320
Speaker 1: to trying for another baby, could she go before that

212
00:11:52,400 --> 00:11:56,520
Speaker 1: three months and have a blood hormone test at a GP.

213
00:11:57,520 --> 00:11:59,640
Speaker 3: No, it should all it should not be done through

214
00:12:00,200 --> 00:12:03,160
Speaker 3: multiple people. It should be done through the unit that

215
00:12:03,200 --> 00:12:07,240
Speaker 3: gave the methatrex eight in a protocolized, organized way. All right, yeah,

216
00:12:07,240 --> 00:12:08,640
Speaker 3: so no one falls through the cracks.

217
00:12:08,720 --> 00:12:10,640
Speaker 1: Yeah, so she could go back there and say, look,

218
00:12:10,960 --> 00:12:13,160
Speaker 1: I'm keener than the three months, can you please check?

219
00:12:13,360 --> 00:12:15,120
Speaker 3: Well, potentially if it got if it went all the

220
00:12:15,160 --> 00:12:17,840
Speaker 3: way back to zero and they were happy, then yes, good.

221
00:12:18,360 --> 00:12:21,800
Speaker 1: All right, Well, I've got this one which is going

222
00:12:21,840 --> 00:12:23,480
Speaker 1: to be a big one. So I think that probably

223
00:12:23,520 --> 00:12:25,800
Speaker 1: will take us up to the end of our session.

224
00:12:25,880 --> 00:12:27,440
Speaker 1: So let's have a listen.

225
00:12:28,640 --> 00:12:31,520
Speaker 7: Hi, pattern Bridget, I'm imagen and I absolutely love your

226
00:12:31,520 --> 00:12:34,360
Speaker 7: factual based podcast based on all things we're in health

227
00:12:34,440 --> 00:12:38,079
Speaker 7: and pregnancy. You're part of the movement in creating awareness

228
00:12:38,080 --> 00:12:41,640
Speaker 7: for all of the complexities associated with frankly just being female.

229
00:12:41,920 --> 00:12:45,280
Speaker 7: So please put yourself on the back. For a brief

230
00:12:45,320 --> 00:12:48,440
Speaker 7: history of myself. I'm twenty four, my BMI is about

231
00:12:48,480 --> 00:12:53,720
Speaker 7: twenty three. I've had PCOS and stage three ENDO surgically diagnosed.

232
00:12:53,960 --> 00:12:57,520
Speaker 7: I've currently got a marino in situ, and my husband

233
00:12:57,520 --> 00:12:59,480
Speaker 7: and I are starting the journey of trying for a

234
00:12:59,520 --> 00:13:03,280
Speaker 7: baby's partially out of our own desire to do so

235
00:13:03,920 --> 00:13:06,040
Speaker 7: and also just the awareness that it probably is going

236
00:13:06,080 --> 00:13:08,280
Speaker 7: to be a little bit harder given my history and

237
00:13:08,320 --> 00:13:11,319
Speaker 7: my mum also required a full hysterectomy of thirty due

238
00:13:11,360 --> 00:13:15,840
Speaker 7: to severe endometriosis. I recently had a public ult just

239
00:13:15,840 --> 00:13:18,199
Speaker 7: howd to visualize where my marina is so we could

240
00:13:18,280 --> 00:13:22,800
Speaker 7: have it removed and start our TTC journey. Endomeutriosis was

241
00:13:22,880 --> 00:13:27,200
Speaker 7: visualized again, particularly on my left kidney. I've got forty

242
00:13:27,240 --> 00:13:32,840
Speaker 7: plus follicles between both of my ovaries. Atenemiosis was discovered,

243
00:13:32,920 --> 00:13:36,960
Speaker 7: as well as myometrial cysts. While I already knew about

244
00:13:36,960 --> 00:13:40,359
Speaker 7: INDO and PCOS, the addition of the latter two conditions,

245
00:13:40,440 --> 00:13:44,040
Speaker 7: quite frankly, has left me full of anxiety regarding our

246
00:13:44,120 --> 00:13:46,880
Speaker 7: chances of conceiving. I should also note that I've got

247
00:13:46,880 --> 00:13:50,280
Speaker 7: factor five light and I inherited from my dad, and

248
00:13:50,320 --> 00:13:54,080
Speaker 7: I'm aware that that heightens my risk of miscarriage. My

249
00:13:54,200 --> 00:13:57,200
Speaker 7: question essentially lies within what would your steps be when

250
00:13:57,200 --> 00:13:59,640
Speaker 7: implementing a plan for a couple like this when trying

251
00:13:59,640 --> 00:14:02,920
Speaker 7: to conceal eve. Would you allow them to try naturally

252
00:14:02,960 --> 00:14:05,800
Speaker 7: for a while or would you potentially escalate them straight

253
00:14:05,880 --> 00:14:10,880
Speaker 7: to assisted reproductive technology. I feel as though the decision

254
00:14:11,840 --> 00:14:14,440
Speaker 7: as to when we have a baby has been made

255
00:14:14,679 --> 00:14:17,440
Speaker 7: for me due to my body somewhat already failing me

256
00:14:17,559 --> 00:14:20,600
Speaker 7: before I even try for a family. I hope I

257
00:14:20,600 --> 00:14:22,560
Speaker 7: haven't been too much of a downer. I just feel

258
00:14:22,600 --> 00:14:24,920
Speaker 7: so lost and afraid. Thank you for taking the time

259
00:14:24,960 --> 00:14:26,600
Speaker 7: to listen to me, and I hope to hear from

260
00:14:26,640 --> 00:14:27,040
Speaker 7: you soon.

261
00:14:27,320 --> 00:14:32,120
Speaker 3: Thank you, Wow, thank you for getting in touch. That's

262
00:14:32,520 --> 00:14:35,520
Speaker 3: you know, there's an awful lot going on there. I'm

263
00:14:35,560 --> 00:14:37,320
Speaker 3: sorry to hear that you feel so lost and afraid

264
00:14:37,360 --> 00:14:39,440
Speaker 3: that we haven't even you know, I haven't even we

265
00:14:39,480 --> 00:14:40,800
Speaker 3: haven't even sort of started.

266
00:14:41,720 --> 00:14:43,400
Speaker 5: So there's there's there's.

267
00:14:43,280 --> 00:14:45,920
Speaker 3: Lots of lots we can do to help. But this

268
00:14:45,680 --> 00:14:48,480
Speaker 3: is this is somebody we can hear that we can

269
00:14:48,520 --> 00:14:51,000
Speaker 3: hear that you're struggling physically and emotionally with what's been

270
00:14:51,040 --> 00:14:51,600
Speaker 3: going on.

271
00:14:51,920 --> 00:14:55,560
Speaker 1: Twenty four to have such incredible vast knowledge of herself

272
00:14:55,600 --> 00:14:58,880
Speaker 1: and her body and the system and h you know,

273
00:14:58,960 --> 00:15:01,680
Speaker 1: making decisions now because she knows that, you know, she

274
00:15:01,760 --> 00:15:05,440
Speaker 1: might be against the clock or whatever. Yeah, amazing.

275
00:15:05,760 --> 00:15:08,480
Speaker 5: So so there's.

276
00:15:09,960 --> 00:15:12,920
Speaker 3: This person has a burden of all the stuff that's

277
00:15:12,960 --> 00:15:15,880
Speaker 3: been going on with her and then kind of the

278
00:15:15,920 --> 00:15:18,600
Speaker 3: burden of knowledge she's not just whistling through life going

279
00:15:18,640 --> 00:15:20,720
Speaker 3: over will be fine. Yeah, She's got all this knowledge

280
00:15:20,720 --> 00:15:23,360
Speaker 3: and that's and she's aware of the problems she might have.

281
00:15:24,160 --> 00:15:27,160
Speaker 3: What we don't have, as far as I can see,

282
00:15:27,280 --> 00:15:28,920
Speaker 3: is a plan. Yeah, so we need a plan.

283
00:15:29,120 --> 00:15:29,280
Speaker 6: Yeah.

284
00:15:29,360 --> 00:15:30,480
Speaker 5: Yeah, she's better.

285
00:15:30,320 --> 00:15:32,920
Speaker 1: Off now knowing all of this, someone who started at

286
00:15:32,960 --> 00:15:34,920
Speaker 1: thirty thinking, oh now I want to have my babies

287
00:15:34,960 --> 00:15:35,280
Speaker 1: for sure.

288
00:15:35,400 --> 00:15:36,320
Speaker 5: Yeah, yeah, for sure.

289
00:15:36,360 --> 00:15:39,160
Speaker 3: So she's definitely better off, but she may not feel

290
00:15:39,160 --> 00:15:41,720
Speaker 3: that on a daybat basis, and a plan is going.

291
00:15:41,640 --> 00:15:43,200
Speaker 5: To help a lot.

292
00:15:43,720 --> 00:15:48,160
Speaker 3: So there's a number of things going on. And the

293
00:15:48,200 --> 00:15:51,600
Speaker 3: first thing I would say is that this is a

294
00:15:51,640 --> 00:15:57,600
Speaker 3: specialist is a specialist level problem. The question of whether

295
00:15:57,640 --> 00:15:59,440
Speaker 3: you should be trying naturally or going straight to a

296
00:15:59,520 --> 00:16:04,280
Speaker 3: sister tread production is a complex one, and the things

297
00:16:04,280 --> 00:16:07,880
Speaker 3: that are going on with you are complex and really

298
00:16:07,920 --> 00:16:16,080
Speaker 3: at at a specialist level. So we need reproductive opinions,

299
00:16:16,200 --> 00:16:20,440
Speaker 3: and we need gynecological opinions and some obstetric planning and

300
00:16:20,480 --> 00:16:24,760
Speaker 3: so forth. And this is someone that needs a lot

301
00:16:24,760 --> 00:16:30,880
Speaker 3: of our expertise. So the big issues there's been significant

302
00:16:30,880 --> 00:16:35,000
Speaker 3: animetrios to stage three endo, she said, diagnosed laposcopically I

303
00:16:35,080 --> 00:16:38,280
Speaker 3: hope it was also treated. Yeah, so let's assume for

304
00:16:38,280 --> 00:16:43,440
Speaker 3: a moment it's been treated. It's pcos apparently or policystic

305
00:16:43,520 --> 00:16:50,640
Speaker 3: ovaries with multiple follicles on each ovary proofly located. That

306
00:16:51,080 --> 00:16:57,120
Speaker 3: brings into question whether we're ovulating. There's a marina that

307
00:16:57,160 --> 00:17:01,920
Speaker 3: needs to be removed. That's probably the easiest thing. There's

308
00:17:02,880 --> 00:17:06,360
Speaker 3: what looks like some ultrasound evidence of some residual endometriosis

309
00:17:06,440 --> 00:17:10,760
Speaker 3: that has not been excised. Adenomiosis of the uterus, where

310
00:17:10,760 --> 00:17:14,520
Speaker 3: that abnormal glandular tissue is present in the wall of

311
00:17:14,560 --> 00:17:18,879
Speaker 3: the uterus, not just outside the uterus, and fact to

312
00:17:18,960 --> 00:17:22,400
Speaker 3: five lighten, which is a pro coagulant condition, a genetic

313
00:17:22,840 --> 00:17:27,480
Speaker 3: inherited genetic situation where you're more likely to get early

314
00:17:27,520 --> 00:17:32,879
Speaker 3: pregnancy loss and deep venus from bosis. So plenty of

315
00:17:32,880 --> 00:17:36,119
Speaker 3: planning needs to be done here. The question at the

316
00:17:36,200 --> 00:17:37,639
Speaker 3: end of the day from the call was should I

317
00:17:37,640 --> 00:17:40,280
Speaker 3: be trying naturally or should I be having assisted reproduction?

318
00:17:41,880 --> 00:17:46,040
Speaker 3: The answer to that will actually become pretty clear. But

319
00:17:48,640 --> 00:17:52,919
Speaker 3: let's say for arguments sake, the fact of five laden

320
00:17:53,040 --> 00:17:55,720
Speaker 3: is just something that's been discovered but hasn't actually caused

321
00:17:55,760 --> 00:17:58,960
Speaker 3: any problems yet. That will then in most cases, the

322
00:17:59,040 --> 00:18:02,359
Speaker 3: question about whether that needs anticoagulation or not would not

323
00:18:02,400 --> 00:18:04,679
Speaker 3: be one we will worry about until you're actually pregnant.

324
00:18:06,600 --> 00:18:11,920
Speaker 3: The effect of the residual endometriosis, we won't know about

325
00:18:11,960 --> 00:18:16,439
Speaker 3: that until you're trying. Okay, So probably the most pressing

326
00:18:16,480 --> 00:18:19,720
Speaker 3: issue is with those ovaries that have a polycistic appearance

327
00:18:19,720 --> 00:18:20,480
Speaker 3: on ultrasound?

328
00:18:21,600 --> 00:18:24,359
Speaker 5: Are you ovulating? That would be the big one.

329
00:18:24,960 --> 00:18:27,320
Speaker 3: I'd also not like in this situation to find a

330
00:18:27,320 --> 00:18:30,280
Speaker 3: male factor problem twelve months after we've been trying with

331
00:18:30,320 --> 00:18:33,440
Speaker 3: everything else. So a few things I would recommend will

332
00:18:33,480 --> 00:18:37,040
Speaker 3: be number one. Escalate this problem up to specialist level.

333
00:18:37,280 --> 00:18:39,560
Speaker 1: Can I just say, what do you mean specialist level?

334
00:18:39,880 --> 00:18:43,439
Speaker 3: Well, I don't think that this is going to be

335
00:18:43,600 --> 00:18:46,720
Speaker 3: within the skill set of your family doctor. There's a

336
00:18:46,760 --> 00:18:50,080
Speaker 3: lot going on here, and I think that this woman

337
00:18:50,119 --> 00:18:55,920
Speaker 3: should be having a pre pregnancy assessment from a gynecologist

338
00:18:56,160 --> 00:19:01,639
Speaker 3: obstrician gynecologist. Now, yeah, there's too many things that you

339
00:19:01,680 --> 00:19:03,359
Speaker 3: don't want to find out twelve months later you should

340
00:19:03,359 --> 00:19:04,280
Speaker 3: have fixed twelve months ago.

341
00:19:04,520 --> 00:19:04,720
Speaker 6: Yep.

342
00:19:04,840 --> 00:19:07,879
Speaker 3: Yeah, And I would often say that that should be

343
00:19:07,920 --> 00:19:10,359
Speaker 3: done by an O and G or by a dedicated

344
00:19:10,359 --> 00:19:12,639
Speaker 3: family doctor. But I think in this case there's so

345
00:19:12,720 --> 00:19:15,000
Speaker 3: much going on that this would be at specialist level

346
00:19:16,280 --> 00:19:20,639
Speaker 3: and then work out with those with those ovaries that

347
00:19:20,680 --> 00:19:22,240
Speaker 3: have an unusual appearance on ultrasound.

348
00:19:22,280 --> 00:19:23,040
Speaker 5: Are we ovulating?

349
00:19:23,480 --> 00:19:27,800
Speaker 3: That's and if not, address that, workout why not and

350
00:19:28,280 --> 00:19:29,840
Speaker 3: give some treatment to start ovulating.

351
00:19:30,040 --> 00:19:32,560
Speaker 1: And that's Can we just deep dive on that? So

352
00:19:32,600 --> 00:19:35,320
Speaker 1: that is her having some blood tests? Yeah, twenty one

353
00:19:35,359 --> 00:19:36,800
Speaker 1: day blood tests, is that right?

354
00:19:36,880 --> 00:19:38,560
Speaker 3: Yeah, we don't know much about the cycle, but we

355
00:19:38,600 --> 00:19:40,800
Speaker 3: could use some ovulation predicted kids as the first thing

356
00:19:40,840 --> 00:19:43,240
Speaker 3: to see whether they're turning positive or some day twenty

357
00:19:43,280 --> 00:19:47,639
Speaker 3: one progesterones to see whether we're ovulating. Check mail factor

358
00:19:48,680 --> 00:19:53,000
Speaker 3: and then set some Let's assume that. Let's assume that

359
00:19:54,119 --> 00:19:57,359
Speaker 3: you know, I've talked about my simplified model for getting pregnant.

360
00:19:58,280 --> 00:20:02,320
Speaker 3: We need eggs, So let's say she's been proven to ovulate.

361
00:20:02,840 --> 00:20:04,440
Speaker 3: We need a save place for them to get together.

362
00:20:04,480 --> 00:20:07,040
Speaker 3: On your insightble, let's say the laparoscopy, despite finding a

363
00:20:07,040 --> 00:20:10,480
Speaker 3: lot of endometriosis, also showed normal juices in a normal.

364
00:20:10,280 --> 00:20:11,520
Speaker 5: Cavity in the uterus.

365
00:20:11,560 --> 00:20:16,280
Speaker 3: Well, that gets a tick and then third, so check

366
00:20:16,359 --> 00:20:19,040
Speaker 3: the Seaman analysis and let's say they all get a tick.

367
00:20:20,040 --> 00:20:24,520
Speaker 3: Then then if the advice is to try naturally for

368
00:20:25,920 --> 00:20:30,879
Speaker 3: six months, just needs a clear cutoff. Yeah, we're going

369
00:20:30,960 --> 00:20:33,280
Speaker 3: to try for those six months because we've got tons

370
00:20:33,320 --> 00:20:35,520
Speaker 3: of time. We're only we're only twenty four years old.

371
00:20:36,680 --> 00:20:40,199
Speaker 3: But we're not going to try for ever unless it

372
00:20:40,240 --> 00:20:45,120
Speaker 3: unless it just works, so clear cut off. And then

373
00:20:45,400 --> 00:20:49,600
Speaker 3: after that clear cutoff is up, reassess not pregnant yet

374
00:20:50,040 --> 00:20:55,480
Speaker 3: off for a reproductive opinion. Now, yeah, so has the ovulate.

375
00:20:55,560 --> 00:20:58,320
Speaker 3: Let's say we're using a drug like letrosol to make

376
00:20:58,440 --> 00:21:01,600
Speaker 3: us ovulate. Has that worked every time? And yet after

377
00:21:01,600 --> 00:21:04,840
Speaker 3: six months were still not pregnant? Then the opinion we

378
00:21:04,840 --> 00:21:07,240
Speaker 3: need now is from a reproductive specialist as sort of

379
00:21:07,240 --> 00:21:10,320
Speaker 3: a branch of O and G, where that person might say, right,

380
00:21:11,760 --> 00:21:17,280
Speaker 3: your best option is more endometriosis surgery, or your best

381
00:21:17,320 --> 00:21:22,080
Speaker 3: option is continued ovulation induction or not your best options IVF,

382
00:21:23,560 --> 00:21:29,679
Speaker 3: And that advice these days is surprisingly scientific and surprisingly protocolized.

383
00:21:30,920 --> 00:21:33,800
Speaker 3: You know, it's almost like you can sort of feed

384
00:21:33,840 --> 00:21:36,439
Speaker 3: in the patient. Is this old has this problem, and

385
00:21:36,520 --> 00:21:39,080
Speaker 3: it'll say they should have IVF, Well, nope, they should

386
00:21:39,119 --> 00:21:44,160
Speaker 3: keep going as they are. So reproductive interventions are mature

387
00:21:44,240 --> 00:21:48,440
Speaker 3: enough at old enough now that they know the best,

388
00:21:48,760 --> 00:21:52,159
Speaker 3: most sort of evidence based advice to give individual people.

389
00:21:52,960 --> 00:21:57,320
Speaker 1: She said that she was able to cope with the endometriosis,

390
00:21:57,800 --> 00:22:04,240
Speaker 1: but the additional diagnosis of adnomiosis and endometrial cysts has

391
00:22:04,280 --> 00:22:07,840
Speaker 1: that impacted on her fertility to the degree that she

392
00:22:07,920 --> 00:22:08,919
Speaker 1: thinks it has well.

393
00:22:09,480 --> 00:22:14,160
Speaker 3: Adenomiosis is where that ad normal glandular tissue is within

394
00:22:14,200 --> 00:22:16,320
Speaker 3: the wall. And the kind of the worst or one

395
00:22:16,359 --> 00:22:19,000
Speaker 3: of the worst forms of atonomiosis is if they can

396
00:22:19,000 --> 00:22:22,560
Speaker 3: see something called a myometrial cyst, which is within the myometrium,

397
00:22:22,600 --> 00:22:25,719
Speaker 3: the muscle layer of the uterus, the wall. There are

398
00:22:25,760 --> 00:22:29,000
Speaker 3: these cystic structures which are big blobs of glandular tissue

399
00:22:29,000 --> 00:22:36,199
Speaker 3: that shouldn't be there, and that is not necessarily an

400
00:22:36,320 --> 00:22:39,600
Speaker 3: upfront course of infertility. Someone might have all of that

401
00:22:39,680 --> 00:22:42,640
Speaker 3: and still conceive. So in a twenty four year old,

402
00:22:42,680 --> 00:22:45,240
Speaker 3: we might say, well, let's find out, we've got time.

403
00:22:45,560 --> 00:22:47,359
Speaker 3: Let's see what six months are trying.

404
00:22:48,160 --> 00:22:48,840
Speaker 5: How that goes.

405
00:22:50,960 --> 00:22:54,400
Speaker 3: Whereas in a thirty eight year old we might say, well,

406
00:22:54,400 --> 00:22:55,000
Speaker 3: they might be our.

407
00:22:54,960 --> 00:22:56,440
Speaker 5: Best six months, let's not waste them.

408
00:22:56,680 --> 00:22:58,639
Speaker 3: Let's go to IV. If now to make sure we

409
00:22:58,680 --> 00:23:01,919
Speaker 3: get some good embryos and then we'll do that. So

410
00:23:02,080 --> 00:23:05,320
Speaker 3: age is super important in the twenty four year old.

411
00:23:05,359 --> 00:23:08,440
Speaker 3: You might say, well, look that apparent at an omiosis.

412
00:23:08,480 --> 00:23:10,280
Speaker 3: We don't know that for sure, that's an ultrasound opinion,

413
00:23:10,440 --> 00:23:12,800
Speaker 3: but let's say that that a parent at anomiosis.

414
00:23:12,880 --> 00:23:13,520
Speaker 5: Yes, it's there.

415
00:23:14,119 --> 00:23:17,480
Speaker 3: In a twenty four year old, it's unlikely to progress

416
00:23:17,640 --> 00:23:20,320
Speaker 3: to a horrible situation very quickly. And let's say I

417
00:23:20,320 --> 00:23:23,680
Speaker 3: we can get pregnant without overdoing the intervention.

418
00:23:25,000 --> 00:23:27,200
Speaker 1: She doesn't mention it, but like you know, some people

419
00:23:27,280 --> 00:23:30,840
Speaker 1: with this long list of issues also has problems with

420
00:23:31,000 --> 00:23:34,040
Speaker 1: actually having sex, like you know, it's painful and it's yes. Yeah,

421
00:23:34,160 --> 00:23:36,080
Speaker 1: So that's another thing that if she hasn't mentioned it

422
00:23:36,119 --> 00:23:38,440
Speaker 1: in this that's something that she could be talking to

423
00:23:38,480 --> 00:23:39,560
Speaker 1: a bonecologist about.

424
00:23:39,440 --> 00:23:41,879
Speaker 3: One hundredercent because there's no sense if you've tick all

425
00:23:41,880 --> 00:23:43,760
Speaker 3: those other boxes so that you're going to experiment and

426
00:23:43,800 --> 00:23:45,879
Speaker 3: say places them to get together. You also need to

427
00:23:45,920 --> 00:23:48,040
Speaker 3: have the ability to have intercourse at the right time

428
00:23:48,040 --> 00:23:48,480
Speaker 3: of the marth.

429
00:23:48,960 --> 00:23:50,480
Speaker 5: Yeah, so some.

430
00:23:50,359 --> 00:23:56,199
Speaker 3: People would go to would go to IVF if they

431
00:23:56,200 --> 00:24:01,320
Speaker 3: couldn't have intercourse, which you know, and you might say,

432
00:24:01,359 --> 00:24:05,200
Speaker 3: I'll have an operation tracture fix your endometriosis. Well, sometimes

433
00:24:05,200 --> 00:24:07,880
Speaker 3: we'll operate on the endometriosis, take out all the end they.

434
00:24:07,880 --> 00:24:08,440
Speaker 5: Still got pain.

435
00:24:09,520 --> 00:24:16,760
Speaker 3: So there is a role in some couples for reproductive interventions,

436
00:24:16,800 --> 00:24:20,040
Speaker 3: just based on the inability to effectively have intercourse in

437
00:24:20,040 --> 00:24:20,840
Speaker 3: the fertile time.

438
00:24:22,119 --> 00:24:24,159
Speaker 1: So much for her to think about. And you know,

439
00:24:24,240 --> 00:24:27,359
Speaker 1: the looming idea that her mum had a hysterectomy at thirty,

440
00:24:27,840 --> 00:24:31,720
Speaker 1: I suppose is always ever present. Yes, and you know,

441
00:24:31,880 --> 00:24:33,400
Speaker 1: good on you for starting at twenty four.

442
00:24:33,520 --> 00:24:35,200
Speaker 3: That's that's one of the reasons why it's good news

443
00:24:35,200 --> 00:24:37,320
Speaker 3: that she's in a position to try for pregnancy now,

444
00:24:38,560 --> 00:24:41,440
Speaker 3: because often say, you know, as you go on ecologists,

445
00:24:41,440 --> 00:24:42,920
Speaker 3: it's none of my business when you have your babies.

446
00:24:42,960 --> 00:24:45,160
Speaker 3: But if I get a vote, I'd go for now

447
00:24:45,280 --> 00:24:45,840
Speaker 3: rather than later.

448
00:24:46,000 --> 00:24:46,520
Speaker 5: Yeah, you know.

449
00:24:48,160 --> 00:24:51,320
Speaker 3: So let's say, for argument's sake, her mother's hysterectomy was

450
00:24:51,400 --> 00:24:55,080
Speaker 3: done at the age of thirty for severe endometriosis and

451
00:24:55,080 --> 00:24:56,960
Speaker 3: severe adenomiosis of the uterus.

452
00:24:57,200 --> 00:24:58,520
Speaker 5: Well, we got to the babies before that.

453
00:24:59,080 --> 00:25:01,480
Speaker 1: Yeah, And the schooler might be thinking about how many

454
00:25:01,480 --> 00:25:03,760
Speaker 1: babies she wants to have too, So this is this

455
00:25:03,800 --> 00:25:04,120
Speaker 1: is good?

456
00:25:04,400 --> 00:25:07,840
Speaker 3: Yeah, so reaching out to us is terrific. But but

457
00:25:08,440 --> 00:25:11,960
Speaker 3: the answer is the lot going on here? It needs

458
00:25:12,000 --> 00:25:16,320
Speaker 3: specialist level assessment and planning.

459
00:25:17,119 --> 00:25:18,320
Speaker 1: You would think that she has a guy one in

460
00:25:18,359 --> 00:25:20,840
Speaker 1: collogist if she's had a laproscopic surgery.

461
00:25:20,520 --> 00:25:24,440
Speaker 3: For yes, and if from that person she can't get

462
00:25:24,440 --> 00:25:28,600
Speaker 3: a clear plan, then a referral to a reproductive service

463
00:25:29,600 --> 00:25:31,760
Speaker 3: is the is the answer. Those guys are all about

464
00:25:31,760 --> 00:25:32,440
Speaker 3: clear plans.

465
00:25:33,240 --> 00:25:35,800
Speaker 1: Good, all right, Well, we are thinking of you and

466
00:25:35,840 --> 00:25:39,119
Speaker 1: I listened to your speak pipe twice and both times

467
00:25:39,160 --> 00:25:40,879
Speaker 1: a right, yes.

468
00:25:41,000 --> 00:25:45,560
Speaker 3: We we we we hear you, and we're trying to

469
00:25:46,400 --> 00:25:49,240
Speaker 3: through this podcast. Thank you for the kind things you

470
00:25:49,280 --> 00:25:53,199
Speaker 3: said about the podcast. We're trying to help people not

471
00:25:53,320 --> 00:25:59,960
Speaker 3: just with their knowledge pace, but also with improve their

472
00:26:00,119 --> 00:26:03,320
Speaker 3: confidence to reach out to the system which can be

473
00:26:03,359 --> 00:26:07,040
Speaker 3: difficult to navigate. And say, I'm the exact person that that.

474
00:26:07,040 --> 00:26:09,200
Speaker 5: Podcast said I was supposed to get myself sorted out.

475
00:26:09,240 --> 00:26:10,680
Speaker 5: Now could you help me please?

476
00:26:10,760 --> 00:26:11,119
Speaker 3: Yeah?

477
00:26:11,200 --> 00:26:11,440
Speaker 4: Yep?

478
00:26:12,160 --> 00:26:15,919
Speaker 1: Good, all right, everybody, that's it for this week. We

479
00:26:15,960 --> 00:26:19,200
Speaker 1: hope you got some little gems from those callers. Thank

480
00:26:19,200 --> 00:26:23,040
Speaker 1: you for calling in. And currently we need some more

481
00:26:23,119 --> 00:26:25,000
Speaker 1: speak pipes, so there's a bit of space there if

482
00:26:25,000 --> 00:26:27,560
Speaker 1: you want to ring through and give us whatever your

483
00:26:27,680 --> 00:26:31,680
Speaker 1: issue is, We're here to help all right until next week,

484
00:26:32,080 --> 00:26:35,160
Speaker 1: Keep well, keep growing those babies, and we'll see you then.

485
00:26:35,359 --> 00:26:36,520
Speaker 5: Thanks for listening everybody.

486
00:26:36,640 --> 00:26:37,360
Speaker 1: Bye now.

487
00:26:40,240 --> 00:26:40,440
Speaker 4: Hey.

488
00:26:40,960 --> 00:26:43,560
Speaker 1: Even though doctor Pat is well a doctor and we

489
00:26:43,600 --> 00:26:46,560
Speaker 1: get lots of other doctors and other experts on our podcast,

490
00:26:46,840 --> 00:26:49,719
Speaker 1: I just need to remind you that this podcast is

491
00:26:49,760 --> 00:26:54,160
Speaker 1: for informational purposes only. We share lots of medical insights

492
00:26:54,200 --> 00:26:57,639
Speaker 1: and experience, but everything we talk about is general in

493
00:26:57,760 --> 00:27:02,440
Speaker 1: nature and may not apply to your specific Please always

494
00:27:02,480 --> 00:27:06,280
Speaker 1: consult with your own healthcare provider for your individual medical

495
00:27:06,320 --> 00:27:07,959
Speaker 1: advice when you grow your baby