FFPLP_Endometriosis3_ TCC with Endo: Audio automatically transcribed by Sonix

FFPLP_Endometriosis3_ TCC with Endo: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to From First Period to Last Period, a science-backed health and wellness podcast dedicated to shining a light on all of the women's health topics that have long been considered taboo. From UTIs to Endometriosis, we're amplifying women's needs and voices because we know there's so much more to the female experience than what happens at the doctor's office. With From First Period to Last Period, we're doing the legwork on your whole body so you can be the expert in you. Now, let's dive in.

Kristyn Hodgdon:
Hi everyone, and welcome back to From First Period to Last Period. I'm your host, Kristyn Hodgdon, and I'm so excited to be here today with my friend and co-host, Doctor Aimee. Hi, Doctor Aimee!

Aimee Eyvazzadeh :
Hi, Kristyn! Thanks for inviting me.

Kristyn Hodgdon:
Absolutely, thank you for making the time and your very busy schedule. For those of you who don't know Doctor Aimee, she is also lovingly referred to as the Egg Whisperer by her many patients. She is a fertility specialist in the San Francisco Bay area, and since founding her practice over 15 years ago, she has truly sparked a global fertility movement that continues to inspire millions. She's the star of The Egg Whisperer Show, the number-one-rated fertility podcast with over 3 million downloads to date. And on the podcast, she demystifies complex fertility topics like egg freezing and IVF. Love your continuous message of fertility, hope, and positivity, Doctor Aimee, and we're so happy to have you here today.

Aimee Eyvazzadeh :
Me too! I'm so excited to spread my love, and I'm just kidding. The sparkle.

Kristyn Hodgdon:
The sparkle effect, yeah. No, you're just incredible, and I'm sure so many people have seen your page, listened to your podcast, but today, we're talking all about Endo. So we're diving deep in into a condition that affects and gets 200 million people globally. And I was talking to a friend who's an Endometriosis advocate for a previous episode of the podcast, and she was just talking about the importance of really getting the definition of Endometriosis correct. So before we dive in, I'm just going to provide a little bit of a refresher. So Endometriosis is tissue similar but not identical to the lining of the uterus that is found elsewhere in the body, typically in the pelvic region, or also has been found in pretty much every organ, I think, typically characterized by pelvic pain, specifically around the menstrual cycle and fertility, inflammation, and the list goes on. Really excited to dive in specifically about, like, why it takes so long for us to diagnose Endometriosis. I know it can take up to ten years on average. So, can you speak to that a little bit?

Aimee Eyvazzadeh :
Yeah, I think because, as women, we're told it's normal to have pain, and so our pain is normalized, and it's called gaslighting. So when you go into the doctor and they and you say I'm having pain, they're like, oh, honey, you're a woman, that's normal. But it's actually not normal. You have cramps, sure, you take a Motrin, and they go away. But like during pain, throughout your pelvis, pain with sex getting worse over time, heavy periods, and can't get out of bed on a downward dog like with heating pads, like, not normal, and I think that's why. And people sometimes go to the ER for this pain, and they're told that they have cysts on their ovaries, but no one's actually saying they're cysts of Endometriosis, right? And so that's how it gets missed until you meet someone like me where I'm like, I just am so sorry that no one has pieced this whole thing together for you and told you that it's Endometriosis. That's the explanation.

Kristyn Hodgdon:
And when patients do come to you initially? Is it mostly for unexplained infertility?

Aimee Eyvazzadeh :
No, it's for a number of things I call and explain untested. But yeah, I have a lot of patients that are super frustrated. They've even done four or 5 or 6 IVF cycles, and no one has given them the why, even though the why is sitting right there. No one's actually sat down and reviewed it with them and used words to just have a conversation about what is wrong. So, a lot of what I deal with is Endometriosis, especially because so many people are doing multiple rounds these days. 10 or 15 years ago, patients would do 1 to 3 rounds and then maybe consider other options. Now patients are doing sometimes 9 or 16 IVF cycles. And you better believe that all that stimulation is going to cause Endometriosis, even if you didn't have it in the first place. Multiple rounds of stimulation is a risk factor for Endometriosis.

Kristyn Hodgdon:
Well, wow. I don't think I put that together, but it is driven by estrogen, right?

Aimee Eyvazzadeh :
Yeah, it ... me, and that's exactly what the Endometriosis is looking at this estrogen and be like, ha, and then it's growing. So when I have a patient who's done multiple rounds, and we're preparing for an embryo transfer, I talk about, let's assume and treat you before we do a transfer as if you have Endometriosis, so that's one of the considerations before transfer.

Kristyn Hodgdon:
Interesting, I definitely want to dive into that more about what the protocol would be prior to a transfer. But first, how does Endometriosis impact fertility in the first place?

Aimee Eyvazzadeh :
Yeah, so it can rob a woman's fertility in so many ways. So, if you're a young person who's been told you have Endometriosis. What I would recommend that you do is talk to a fertility doctor about fertility preservation because it is a fertility-threatening condition. If you're someone who is undergoing surgery for Endometriosis by someone who is not an excision surgeon, someone who is a well-intentioned OB-gyn, stop and get a second opinion; meet with an Endometriosis specialist. If you had a heart attack, you wouldn't go to your primary care doctor. You would go right to the cardiologist. So go right to the specialist in that field. So those are some of the things that I share with people. When you're thinking about Endo and fertility, it can rob you of your youth and your young eggs. It can cause your eggs to act a lot older than your age. It can increase the risk of genetic abnormalities in your eggs. It can also decrease egg maturity. And then, the hardest part is that they may not implant because of the inflammation it can cause inside the uterus. So I know I sound like doom and gloom, but the thing is, you can get pregnant with Endometriosis. You can, like so many women can, even with severe stage four Endometriosis, it can happen even unassisted. But I want people to reach their family-size goals. And if you don't think about these things up front and you wait, which so many women do, to have a baby later on in life, it might be too late for you. It might be, so that's why I just want people to prevent having fertility regret and preserve their fertility. When you're given a fertility-threatening condition as a diagnosis, I think it's safer to consider freezing eggs, making embryos, and having your babies as soon as possible, especially because of how Endometriosis behaves. It comes back with a vengeance. I call it the craziest spring break. You never wanted to go to the Spring Breakers. They keep coming back, but you're like, go away, I'm gonna ban you from Miami Beach. But they just won't stay away. They just keep coming back. So, the recurrence risk is really high as well.

Kristyn Hodgdon:
Yeah, wow. No, that's great advice. I'm a big advocate for egg freezing, but it's so true. If you've been diagnosed with Endo and you know that it can affect your egg quality, why not? Especially if you have coverage and there's no barrier to care in that regard. What about the people who don't know that they have Endometriosis, like they come to you with just unexplained infertility? And then how do you go about diagnosing them at that point?

Aimee Eyvazzadeh :
Yeah, careful history taking. I have them do a test, they download this app, it's a Doctor Najat app, I have them take the test and see how they scored, and then, depending on how they score, I'll have them see an excision specialist. For some patients who have already done IVF and it doesn't make sense necessarily to do these things, we'll do a test called the receptivity test. So this is an Endometrial biopsy that allows me to see another way of seeing how they score. And based on those results, then we'll decide whether they need to be treated for Endometriosis or not. So, I have something called the Egg Whisperer D.I.E.T. I don't know if you've heard about it. It's like my recipe for IVF success. Of course, success to me means feeling like you did everything possible because I can never get to success for anybody.

Kristyn Hodgdon:
Of course, please give us the cheat sheet.

Aimee Eyvazzadeh :
Yeah, it's like diagnosis, doing your IVF cycle, embryo transfer prep, and then transfer. And so that part is where I insert this extra Endometrial testing. So that's when I do the receptivity test before I prepare for the transfer, because I work so hard for these embryos, I'm like I'm getting up every morning crack of dawn, like rolling out of bed. And I don't want to give you those visuals, but I work really hard for each and every one of these embryos. So, I just want to make sure that I'm being as thoughtful and careful when it comes to transfer planning as well. I don't like Vegas. I don't like rolling the dice for patients. I don't want patients to feel like we're just rolling the dice for them. That's how it feels, of course, because we just don't know everything. But if there's something that I can do that could potentially improve someone's chances, diagnose them with Endometriosis, and then treat them, I want to do that.

Kristyn Hodgdon:
Yes. So, do you do the receptivity test in everyone that has had implantation issues or implantation failure or people who have suspected Endometriosis? Or do you do it with everyone?

Aimee Eyvazzadeh :
I offer it to everybody. So, I like patients to know what testing options they have, and then they get to choose what they would like to do. And then I share with them what I would do in their situation, knowing what their goals are and what they've been through, what their symptoms are, and then we discuss, and then we come up with a plan. But yeah, I would say many of my patients do the ReceptivityDx test to help get to the right protocol before we do our first transfer. And so many patients have already done transfers before seeing me, and this test can shed light maybe on why things haven't worked up until now.

Kristyn Hodgdon:
Yeah. No, it makes total sense. I've been thinking about it a lot for myself because I've had five failed transfers, and no one suspects Endometriosis. But at the same time, we know that it can only officially be diagnosed through surgery. And unless you do test for the positive bcl6, but that's not like an official diagnosis. It's, do you, I don't know, I'm still I'm a big believer of the ReceptivityDx test, but like when you, it's hard to like, all these doctors are telling me that they don't think I have Endometriosis, so why? So it's just it's a tough decision to make.

Aimee Eyvazzadeh :
I had my special protocol for patients who've had that number of transfers, and that includes treating you for people who don't want to do the test, treating you as if you have it, months of suppression or lesser Depot Lupron, making sure your fallopian tubes are open, taking supplements like L-arginine, I add HGH for uterine receptivity. Neupogen starting the day of the transfer, uterine PRP three days before, and potentially intralipid 7 to 10 days before transfer. So I also add aspirin, steroids, antibiotics if you haven't taken them before, and then a probiotic. So that's like my special sauce.

Kristyn Hodgdon:
Okay.

Aimee Eyvazzadeh :
There's a lot of ingredients in that sauce. But that's how I take care of patients who've had a number of transfer fails. Even if a patient of mine has had one transfer, that doesn't work because I've done so much testing ahead of time. Often all of these things, or at least talk to them about it for the second transfer.

Kristyn Hodgdon:
I love that; I love just offering it and giving them the education and then letting them make the decision themselves because cost can be a factor, but just having the option is so important because I think sometimes there's the standard protocol that a lot of doctors and clinics use, and it's, oh, let's just see if it works and see if it's six and try another embryo, and then you're down to, I've been there. Then you dwindle down your embryos, and like you said, you work so hard for those embryos that you don't want to just take a chance and see if it sticks. What can patients expect from Lupron? The two months of Lupron, if they do have to do that?

Aimee Eyvazzadeh :
As far as side effects, is that what you mean?

Kristyn Hodgdon:
Yeah, I think Lupron can be scary for some people who've never taken it before.

Aimee Eyvazzadeh :
So there's a reason why I call it double Lupron because while you're on it, you're gonna feel like the devil is coming for your soul. And I'm not kidding. I actually have a survival guide on my website. You can go to my website and put it, and it's basically tips to help you keep your sanity when you're on a drug that's trying to help you lose your sanity. But there's another option, too, for patients. That's for Liza. So that's a pill, basically a pill form of Depo Lupron. So Depo Lupron, one shot, it lasts about 30 days in your system. Once it's in, you can't go back, or Liza is a pill. So once you take it, if you hate how you feel, you stop the pill. It's out of your system pretty quickly. For patients who have baseline depression, anxiety, and insomnia, I will not prescribe, no matter how much they beg either of these medications. You have to have stable depression. If you have depression, you can take it, but you have to be treated, and currently not depressed, not anxious because it can cause someone to spiral, and that's just an ugly situation. We do not want that. If you don't think you can tolerate those two medications, then you can do a combination of birth control pills with letrozole daily, and then you can also consider excision. So patients who have an active mood disorder, who might have very good reason to just consider going right to excision surgery, that would be a good reason as well, not just having symptoms of Endo but also having a mood disorder. So, you might want to consider surgery first. The side effects are basically headaches, anxiety, sleeplessness, hot flashes, and mood disturbances. The other thing is like your vagina will feel like sandpaper. Yes, vaginal dryness is another symptom, and the way you can handle it is being extremely active. So I tell patients, 60 minutes of rigorous exercise every single day, going outside, and making sure their relationships are good before they start the medication, and when I'm talking about the relationships with the people inside your home and with yourself. And then the other thing would be to make sure that you keep your room cool at night and have it sleep at aids by the bedside. So melatonin, Tylenol, PM, Unisom, and Zicol, like those kinds of things. And then, if you need pharmaceutical aid, like an anti-anxiety medication or an antidepressant, ask for it. Do not tough these symptoms out. If you get a headache, take pain medication. It is not cool to be, like, I've had a headache for two weeks and, like, did you take Tylenol? No, I haven't taken anything. I just wanted to see when it would go away. I'm like, that's lame. Take that, ... Like why are you doing that to yourself? The other things I had patients do while they're on these medications is they take calcium, acetylcysteine, letrozole, and norethindrone. So this also might help reduce or shrink Endometriosis and also help with the side effects, and prevent bone loss from the medication. I know, sounds like no fun at all. It isn't fun, but it can really help. Like I've seen cases where patients have had so many failed transfers they try this protocol next transfer works beautifully, and you're like, oh no. But I've also had patients that say they feel great on the drugs, like they feel the best that they've ever felt, and I think those are the patients who had really bad Endometriosis. So, not everyone's going to feel like garbage. Not everyone's going to feel like they're being sucked down to hell. Some people actually feel pretty good about it.

Kristyn Hodgdon:
Wow. I did not know that part. Can you speak a little bit to silent Endometriosis? I know we talked a little bit about receptive. So why are women who don't have outward symptoms of Endometriosis really have bad period pain, heavy periods, and painful sex? Like why are they testing positive on the Receptiva for markers of Endometriosis? And is it just because they haven't been cut open?

Aimee Eyvazzadeh :
Yeah, I think that is something that can cause inflammation. It can cause infertility. So most of the patients, everyone who's seeing me, you've seen me because they're having fertility issues. So Endometriosis can be a cause because of the inflammation it creates inside the pelvis. That's why someone could potentially not have symptoms, but their symptom is a fertility issue and not have the pain symptoms, but still have silent Endometriosis. If patients have no pain and they come in and they have huge cysts of Endometriosis, that's silent Endometriosis; I don't have to do the biopsy to diagnose them because you can see it on ultrasound.

Kristyn Hodgdon:
Okay, right, the Endometriomas are what you can see on the ultrasound, but the actual tissue is what you can't see on the ultrasound, correct?

Aimee Eyvazzadeh :
No, you can't. You can see the actual tissue.

Kristyn Hodgdon:
Oh, but. I thought the only way to officially diagnose it is through laparoscopic surgery.

Aimee Eyvazzadeh :
No, you can. For someone who's good at ultrasound, you can tell someone 100% certainty if they have Endometriosis based on ultrasound. So it's not the diagnosis just made at the time of surgery for patients who, let's say, have no signs, meaning there's no ultrasound evidence of it, then you would say surgery is what we would need to do to see if you really have it. But these excision surgeons are really good at ultrasound. They can see sometimes deep nodules or lesions of Endometriosis on ultrasound, and they can also feel it with a pelvic exam, so a really good pelvic exam. It's another way of feeling these nodules.

Kristyn Hodgdon:
Okay, that makes sense. Do you ever recommend surgery to anyone that you're just not sure if they have it or not? But maybe they don't want to take the Lupron or Liza rule out and maybe excise it if it is there.

Aimee Eyvazzadeh :
Yeah, so in the old days, laparoscopy was part of the fertility workup. It was like the L-TUSHY method. It was like laparoscopy, and then get your tubes checked, ultrasound, scan, sperm check, hormones, your genetics. But because IVF is so successful, our IVF rates are so much higher than they were 15 or 20 years ago. We don't do that anymore. So, just telling someone, oh, go do a laparoscopy just to see that's not a thing of today. However, if someone, let's say has done a few cycles of IVF, the embryo quality is really poor. I always wonder if they have Endometriosis, even if they don't have symptoms. So if their eggs are behaving like they're being exposed to Endometriosis, low maturity rate, low blast formation rate, high aneuploidy rate despite having a young age, I'm going to be very suspicious about Endometriosis, and we're going to talk about it. I'm going to send them to an excision surgeon and then see what they think. Whether they think doing an excision surgery would be helpful or not.

Kristyn Hodgdon:
That's really helpful. Yeah, I definitely met more people who have had IVF failure or whether it be egg retrieval or embryo transfer. Yeah, what are some of your diet tips for Endometriosis? I know you mentioned it earlier.

Aimee Eyvazzadeh :
For diet, I would recommend an anti-inflammatory diet, and I want my Endometriosis patients to be lean and mean. I want them to work on their six-packs, literally. I don't want you to lose weight. I want you to gain muscle. Fat gets converted to estrogen. As we spoke about earlier, Endometriosis loves estrogen, so the leaner you are, the less fat you have on your body, and the better your Endometriosis symptoms will be. This is well-known. So being active, 60 minutes of exercise, hydrating well, and eating healthy is really important. And there are Endometriosis nutritionists and this is what they focus on, so I'll refer my patients to one of them so they can get the best advice. Knowing what you already eat, they can help you with suggestions as far as what you can do to make things better for your Endometriosis pain and potentially egg equality.

Kristyn Hodgdon:
I love that you do that because I'm a big believer in like marrying conventional medicine and holistic approaches where you can; it never hurts to eat. Mediterranean diet and anti-inflammatory diet, and I've seen it over the past year. Like my egg quality greatly improved over a year just going back to the basics, which I feel like sometimes people forget. You think you need to take all these supplements, which supplements are great, but at the end of the day, like eating your fruits and vegetables and getting enough sleep and all of that can really help. And speaking of supplements, though, are there any that you do recommend to your patients with Endo who are trying to conceive?

Aimee Eyvazzadeh :
Absolutely. Melatonin at night and acetylcysteine. So those are the two, but I also focus on egg quality with my patients and supporting their egg quality, because we know about what Endo can do to egg quality. So they'll take a really good prenatal, also have them take a precursor of NAD, which is called Nicotinamide Riboside, and then they'll also take Resveratrol as well as CoQ10. So those are like the five things that I would have someone take. I think that was five; I didn't count. Maybe it was not, but those are the supplements I have patients take. I also had them consider using red light therapy. And then, depending on where you are in your journey and when we're going to start IVF, we'll use HGH potentially as well.

Kristyn Hodgdon:
I've been seeing red light therapy everywhere. I've been very tempted. Are all equal? That's been my question. Should I just buy one on Amazon, or should I invest now?

Aimee Eyvazzadeh :
Yeah, I would say if you invest, then when you're done with it, you can just sell it to someone else who'll buy it off of you very easily.

Kristyn Hodgdon:
Oh, that's true.

Aimee Eyvazzadeh :
Not like a drug. It's not illegal to sell your red light to somebody else. It's not like the leftover fertility meds that you're selling.

Kristyn Hodgdon:
Yeah. What else? What did we miss? Let's see. We talked about protocols.

Aimee Eyvazzadeh :
Yeah, you can ask me, is there anything that someone with Endometriosis should think about when they're done having kids?

Kristyn Hodgdon:
Oh, I love it when it comes to secondary infertility or just trying to prevent infertility a second time around. What are some things to keep in mind after a pregnancy for women with Endometriosis?

Aimee Eyvazzadeh :
Yeah, so the first thing I tell them is to breastfeed as long as possible or pump. If that's not possible for you, then consider taking a birth control pill, for example, a progesterone-only pill. These things will prevent you from ovulating, preventing periods, and this will also prevent the recurrence of Endometriosis. They won't affect your egg quality negatively at all. And then, once you're ready to have a baby, I would also encourage women who have the diagnosis to try and get pregnant as soon as possible. And if you haven't done a fertility preservation procedure and you have the diagnosis, take a look at what's going on with your fertility levels and consider freezing eggs, embryos, or both after your first birth because a lot of patients are told things that aren't true. Oh, you got pregnant; you have Endometriosis. The next one's going to be easy. Yeah, it could be. It could be, but it might not be especially if you had a struggle for your first.

Kristyn Hodgdon:
Yeah. No, absolutely. That's great advice. So do you typically recommend IVF right away for women that come to you with Endometriosis first, like IUI or anything like that, just because of the wanting to just bank embryos?

Aimee Eyvazzadeh :
Right away, absolutely. If it's doable for them if it's not, then I would potentially have them say; if not, then I would have them meet with an Endometriosis specialist for surgery first before we did IUI. There are patients of mine who've gotten pregnant unassisted after Endo surgery, so I would recommend fertility preservation to anyone with a diagnosis, no matter what your age is.

Kristyn Hodgdon:
Love it. And then the other question was, what advice would you?

Aimee Eyvazzadeh :
What advice do you have for someone who has Endometriosis? Who has done having kids?

Kristyn Hodgdon:
Okay, so what about if you're done having kids? What advice would you give to someone with Endometriosis in that case?

Aimee Eyvazzadeh :
Yeah, so this is a well-known fact, but unfortunately, a lot of women with Endometriosis do not know this, but Endometriosis is a risk factor for ovarian cancer.

Kristyn Hodgdon:
Oh, wow.

Aimee Eyvazzadeh :
So I tell my patients with Endo, move forward, but I hope you're going to be in my life forever, and I want you to be healthy for the entire time. So what I tell my patients is to request a salpingectomy, which means removal of the fallopian tubes once you're done having kids. Well, this is the single best thing that you can do to prevent ovarian cancer. And I just said tubes, and you're like, Aimee this isn't the ovary is where ovarian cancer happens. Actually, ovarian cancer originates in the fallopian tube. Isn't that wild? So we're moving the tubes will actually prevent ovarian cancer. And so, I highly recommend to women who have Endometriosis to do this. This isn't something that your ob-gyn is not going to have heard of. They're going to say hopefully, oh, I'm so glad you brought it up. I would have recommended the same thing. We'll talk about it when you're, let's say, 40, or you guys can come up with a plan based on your family size, goals, and when you're done with your babies.

Kristyn Hodgdon:
This is so frustrating to me because this is the first time hearing about this and our Director of Partnerships. I know she won't mind me sharing, she suffered from really bad Endo her whole life, debilitating pain during sex, etc., one of the previous episodes in this season, actually, we chat with her all about it, but doctors just recommend hysterectomy for her left and right. She's not sure if she's done having kids yet, but she feels like it's like a hysterectomy or no pain relief at this point, and I just don't even know that she knows this is an option. So, right after this, I'm going to tell her that.

Aimee Eyvazzadeh :
Yeah. So, if she's still having pain, the removal of the tubes won't remove her pain. Yeah. So for her, she might want to consider a Marina IUD. So, one of these progestin-secreting IUDs, anything that will prevent her periods from coming, should hopefully help with her period pain. So that would be a good idea for her. And if she has embryos already frozen and she's not sure, then she could still remove her tubes, because the thing is that she doesn't need the tubes if she's going to use embryos.

Kristyn Hodgdon:
I see. Okay, that makes total sense. And ovarian cancer is so scary to me because it's silent.

Aimee Eyvazzadeh :
Silent killer.

Kristyn Hodgdon:
Not a ton of outward, yeah, it's not a ton of outward symptoms that can help identify it. one of those scary things. What would you rescript about the way people think about Endo trying to conceive with Endo? If they're feeling really hopeless, will I ever be a mom?

Aimee Eyvazzadeh :
Yeah. I think the key to Endometriosis is early diagnosis, management of your symptoms and then treatment and not waiting. I think there's so much out there about the dangers of birth control pills right now that seems to be trending. And then I have patients with Endo who really would benefit from them, and they're not taking them. So birth control pills, one of the non-contraceptive benefits, is actually treating Endometriosis does not cause it. So that's something that I want more people to know.

Kristyn Hodgdon:
I'm going to pull out that clip and post it all over social media because there was a Washington Post article, I think, a week or two ago about how so much health misinformation on the internet is leading to women stopping the birth control pill. And it's so true in cases like women with Endometriosis and women like myself with PCOS. Is it ideal? I don't love having to be on it, but at the same time, it's for the past six weeks has let me dictate when I wanted to do my transfer. Otherwise, my cycles are so unpredictable, and it can be four months before I get a period. So it gives you that, or in my case, it gives me that autonomy over my body that my body usually doesn't allow me to have. So it can be so helpful in so many situations. Awesome. Thank you so much, Doctor Aimee. This was wonderful, as always. And where can everyone find you?

Aimee Eyvazzadeh :
Easy to find. Just put an egg whisperer everywhere, and you'll find me. You might see some pictures of omelets of other people hashtagging it, but for the most part, I'm on YouTube. I have a class, eggwhispererschool.com. I love for people to join. No matter where you are on your journey, it's a great way to get more fertility information.

Kristyn Hodgdon:
Love it. I don't know how you have the time in the day, but because I know how much close attention you pay to all of your patients. But I appreciate you taking the time to be here and to talk to me about Endo. So have a great night. Thank you so much, Doctor Aimee.

Aimee Eyvazzadeh :
Thank you, Kristyn. We'll see you soon.

Kristyn Hodgdon:
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