In this video, I’m joined by Dr. Janelle Luk of Generation Next Fertility as we discuss my interview with her in Chapter 11 of Yes You Can Get Pregnant. We focused on updated info since I wrote this book, how western and eastern medicine work together for better success, and you'll gain insight on how reproductive endocrinologists look at your case.

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imee Raupp:

Well, hello everyone, how are you? I am excited to be here with all of you. We are doing the last, well, I think it's the last chapter. The last chapter from the, yes, you can get pregnant. This is supposed to be my book club episode, but we had to adjust it because we have a special guest coming on and I'm super excited for it. So years ago, in 2014, when I wrote, yes, you can get pregnant I interviewed two doctors in the back section getting inside the head of your doctor. So it was chapter 11, getting inside the head of your doctor, top reproductive endocrinologists speak. And I had the luxury at the time to interview two doctors, Dr. Hugh Taylor. He was at the time, I think he's still there at Yale Reproductive Medicine and Dr. Janelle Luke, who has been a colleague and I have referred to so much over the years. And so Dr. Luke has decided to come live with me today to, I asked her a series of questions in 2014 and I'm going to ask those of her again today.

Aimee Raupp:

And then I actually have a couple extra bonus questions that I'm going to throw in for all of you. So I thought it would be really fun because I like to see too how perspectives shift over the years. I mean, this book now is eight years old and things are always changing and we're learning more. And Dr. Luke is now at a different clinic, her own clinic, and she's had so much success with women in their 40s, with women with low AMH, high FSH. And so I really want to see her perspective and maybe how it's shifted over time. So now we're just kind of waiting for her to come on and join. Right? I don't think I see her yet, Beth, correct me if I'm wrong, but I do not see her yet. So we will let Dr. Luke come on. And just so you guys can anticipate the questions I'm going to be asking things like from your clinical perspective.

Aimee Raupp:

Do you believe a woman at the age of 40 can, oh, I said, “Do you believe a woman can safely wait until she's 40 to get pregnant? From your clinical perspective do you feel women need to do IVF? What's your take on natural IVF?” So that was kind of like new and just starting, people weren't doing natural IVFs. Someone like her was, which is why I was sending. She was at New Hope Fertility at the time in the city as was Dr. Murky. It's so funny. Two of my still colleagues and buddies in the world of reproductive medicine, they both worked together at New Hope eight years ago. Now they're both on their own separate and still they collaborate. And obviously I collaborate with both of them and respect them both tremendously and send patients to both of them on a regular basis. There's new things that they're doing like PRP and Ozone. So I want her take on that. And then I want her take kind of on natural IVFs and the direction we've gone with that.

Aimee Raupp:

What we're seeing in older women, how they're responding, or is it age? Or is it more ovarian reserve related and less about age? I want to know her take on pre genetic diagnostic testing. I did ask her that back in the day, because it was pretty brand new. I said, “What is your take on pre-implantation genetic diagnosis, PGD? Are you at all concerned about how PGD can affect embryonic development?” So my team is checking in with her team because now we're four minutes in. I love her. She does run a little late in time so we'll be patient. She said, “Our center,” so she's at New Hope, “Is publishing our own PGD data.” Which is now New Hope has gotten in trouble for some of their data stuff from back in the day but we won't make get into that maybe. In this coming year, we have found that PGD has significantly improved implantation rate, pregnancy rate, live birth rate of embryos that have normal genetic makeup. I believe that PGD is the future of IVF.

Aimee Raupp:

This is what she said, “It has the highest success rate and is very precise and accurate for some patients.” So then I asked her about acupuncture. I asked her about diet and lifestyle. Maybe while we're waiting for her, I'm going to go over. So I asked the same questions, oh, I'm with Dr. Luke's team. She's finishing up with a patient. Hope to have her on in five minutes. Okay. Let's see if I can, for the next five minutes, what I'm going to do is read to you what Dr. Hugh Taylor had said. And what's funny is I was introduced to both Dr. Taylor and Dr. Luke through separate people. Right? And Dr. Taylor came through a friend, a family friend, who actually worked up at Yale. And so I interviewed him first. Lovely, lovely man. And then when I get introduced to Dr. Luke, I tell her, she said, “Oh, who else have you interviewed for the book?”

Aimee Raupp:

And I was also interviewing Dr. Braverman for the book. In Dr. Braverman typical fashion he could not get me all of the answers by the time I needed them for my deadline. So we kind of scratched Dr. Braverman in the book. But what's funny is Dr. Luke studied under Dr. Taylor at Yale. Isn't that the funniest thing? And it was just kind of like, of course, I think very synchronistic, but so I said to Dr. Taylor, “How do you?” Because he's a big epigenetic researcher. He's really into the researching of how environmental toxins, especially endocrine disrupting chemicals are impacting fertility in future generations. So I said, “How do you see epigenetics affecting fertility? Epigenetics is a huge issue.” He said, this is eight years ago guys, eight years ago. And I give myself kudos there because I've been talking about epigenetics for fucking 12 years. Okay. “Epigenetics is a huge issue. It is not well understood. Clearly epigenetics is having an impact on fertility. Science shows that fetal exposures, meaning exposures that your mother had to environmental agents slash chemicals when she was pregnant with you clearly impact women in their fertile years.

Aimee Raupp:

So what we're seeing is the impact of these harmful environmental toxins on future fertility, so future generations. And that's kind of the premise of what I always preach, right? Women who heal themselves heal their children's children. So we're not just talking about transgenerational traumas, like emotional traumas and what we pass down from that emotional space and nature versus nurture. But we're also talking about what we consumed in our pregnancy, what we consumed leading up to our pregnancy and how it's impacting our children's health for generations, two generations. So epigenetics is the science of how we live our life, determines whether genes turn on or turn off. So not that our genes are set in stone. And what we see is these environmental toxins like the ones in your bath and beauty products, like the pesticides in your non-organic foods. Oh my gosh, they do a number on your fertility, but then also your children's fertility and their children's fertility, if you don't control for it.

Aimee Raupp:

And so Dr. Hugh Taylor is a huge researcher in this field. So then I asked him, “Can exposure to environmental agents endocrine disrupting chemicals affect a women's fertility?” Laura Fletcher, miss you. “Can they affect a women's fertility later in life?” So can exposures to environmental toxins and chemicals affect a women's fertility? This is what a top reproductive endocrinologist says, “These influences impact fertility. The earlier in development the exposure, the greater the risk. Environmental agents are clearly leading to infertility. When it comes to PCOS and endometriosis, there is no clear genetic cause. You can inherit a propensity to develop up PCOS or endo. However, heredity alone is not enough. These diseases result from complex interplay between genetic risk, developmental programming and environmental cues.” So what he is saying is the exposures trigger the disease, which is epigenetics. That's what epigenetics is all about. So you're not born with PCOS, you have a propensity towards PCOS.

Aimee Raupp:

You're not born with endometriosis. You're not born with recurrent pregnancy loss. You have a propensity, you have certain triggers and then how you live your life determines whether they manifest, which also means how you live your life, determines whether they manage themselves. And you can if quote unquote, fix them so you can get pregnant. Hormones can be changed. Genetic predispositions can be shifted. You can amplify your predisposition in the way of health versus the way of disease. And this is again, not just Amy talk. This is a top reproductive endocrinologist talk. With nearly 30%, this is my question to him, “With nearly 30% of fertility issues being diagnosed as idiopathic,” So that means no known cause. Unexplained infertility, right? “Do you think the majority of these idiopathic cases are actually misdiagnosed or an undiagnosed autoimmune condition?” Now I have to tell you the backstory to this question.

Aimee Raupp:

When I was introduced to this guy, I went, you know me, I'm a research scientist, went down the rabbit hole of all his research. And I saw he was looking at the same things I was looking at. [Fausa 00:09:29] I owe you a fricking response. I remember that you texted me, email me, and then I will not forget to respond to you, but the answer is yes. See, I'm catching up on communications with people I've missed as I see them pop on the live. But so I had gone down this rabbit hole already. I'm writing yes, you can get pregnant and you guys have heard this story before, but all of a sudden I'm like, “Wait a second. All this PCOS stuff, all this endometriosis stuff, it all kind of looks like, acts like an autoimmune condition. Are all these unexplained infertility cases actually an undiagnosed or a misdiagnosed or a mismanaged immune issue? Inflammatory issue?” So I say that to him. We get on the phone and he's curious about me, my background. He knows I did research science at UCSD.

Aimee Raupp:

So he's curious about who I worked with, blah, blah, blah. We're like talk and shop. And I said to him, I was like, “I got to tell, I really think that endo and PCOS are going to start to be looked at more as an autoimmune condition. Do you think that most of these unexplained, this idiopathic 30% fertility unexplained in fertility, 30% of fertility challenges are unexplained. Do you think they're actually mismanaged or misdiagnosed autoimmune conditions?” And he says to me, because he was older than me. He said, “Young lady, you are onto something.” And he was so impressed with my level of research. And he said, “Every single woman that's coming to our clinic now, we're screening for Hashimotos, which is thyroid autoimmune condition, which I talk about in here and Celiac, which I also talk about in here, which is a common autoimmune. And he's like, “We are floored at how many women with unexplained infertility have one or both of these conditions. And then endometriosis. Layer that in which is technically an inflammatory disease that has autoimmune characteristics, same with PCOS but they all act very similar similarly in the body.”

Aimee Raupp:

So anyway, I say to him, “With nearly 30% of fertility issues being diagnosed as idiopathic, do you think the majority of these cases are actually undiagnosed or misdiagnosed autoimmune conditions?” He says, “Some idiopathic cases are 100% autoimmune, but not all of them. When it comes to infertility, there is so much more that we don't understand. Impacts from autoimmune diseases, environmental triggers, damage from other diseases, all play a role in ovarian aging and infertility.” So again, coming back to what I always preach, your fertility is an extension of your health. It is not separate. We can't just take fucking NAD and improve our egg quality and think that's it. You can't do that. It doesn't work. You have to get to the root of the challenge, right? And so, this is stuff I've been talking about, why I get so fired up. This is eight years old guys, eight years old, I've been talking about this, right? You can't out supplement a crappy lifestyle or crappy diet.

Aimee Raupp:

You have to look at all the layers. And I said, “Do you think age is our biggest issue?” And he says, “Age is certainly not the biggest issue.” It's what he says. “Age is certainly not the biggest issue. It is a large issue and women need to be made aware of how their fertility changes with age.” “What are your thoughts on egg freezing?” He said, “I would recommend it if there was a woman who was 35 and hasn't yet had children.” And then this is the question I asked both of them, “But is it true that frozen embryos are much more stable than frozen eggs when thawing?” “Yes, but egg freezing techniques are getting better and better when freezing eggs for future use you need more eggs than if you were using embryos. However, to create an embryo we need sperm.” Yeah, I know SWG nutrition pregnant at 43. Some may not be at the point in their life where they're ready to commit. So say that the same woman in a few years winds up needing to do IVF, would you use her frozen eggs or fresh eggs?

Aimee Raupp:

And I have a great story of hope I'm going to do soon on a woman that froze her eggs, 38 and 40, and didn't work with me and had decent. Oh, Dr. Luke is here. Anyway, I'll say that story but anyway, 44 and we got four PGS normals, four PGS normals after six sent off, four normals. The doctor was floored. She's six years older, better at quality. Dr. Luke? All right, I'm going to make you come in. Let's see, so I think you have to ask to join me, Dr. Luke. Let's see if I can, or can I? Okay, I can invite you to join. I've invited you to join and let's see if it worked. She's requested as well. Let's see. Well, I invited you. I'm going to accept. There we go. Hi, you did it. You made it. All right, guys. Here she comes. Hi, Mr. Nice eyes. How are you? All right, come on. Except I'm accepting your request to join Dr. Luke, do you see it? Let's do this. I like this. I love when I see all these familiar faces.

Aimee Raupp:

Thank you guys so much for your support and love. Okay, come on. When someone joins, anyone? Dr. Luke, are you on your phone or on your computer? I love how you knew it was you, because on your computer you can't join. You have to be on a phone. I think you know that. Let's see, now she's unable to join. So anyway, I'll go back to that case. So follow the egg quality diet is now 43 slash 44 going through a egg retrieval cycle using donor sperm and floor. We got six to, I think she got nine, 6% off. Four were normal, four. Her doctor who was at CCRM was like, “Ah, these results are ridiculous. This is amazing.” Okay. Sorry. I'm going to use a different phone. Okay. I'm going to wait. I'm going to wait because why not? Have until about 12:20 and then I got to hang up on you, Dr. Luke, so let's do this. So I'm going to tell you a little bit about her. Now this is her bio from eight years ago.

Aimee Raupp:

So it's changed, but she's a board certified specialist in OB-GYN and reproductive endocrinology. As well at the time she was co-director of the diminished ovarian reserve program at New Hope. She is an innovator in her field employing a combination of conventional stimulation methods and using natural stimulation protocol methods, meaning no medication to synthesize the most optimal stimulation method for each individual patient. Dr. Luke and I discussed topics from can a woman safely wait to her 40s to get pregnant, to what type of dietary recommendations she thinks her best for fertility. Here's what she had to say. So let's try you one more time, my love, hopefully this works. Fingers crossed. Sorry guys. I appreciate your patience- [crosstalk 00:16:24].

Dr. Luk:

Hi. I think I need my new phone.

Aimee Raupp:

Hi. It's okay.

Dr. Luk:

How are you? [crosstalk 00:16:33] Oh my God, what a pleasure to see you.

Aimee Raupp:

I know, I've missed you.

Dr. Luk:

Hopefully you've overstayed and apologize to our audience, Dr. Luke does- [crosstalk 00:16:40].

Aimee Raupp:

It's okay. I kept them busy. I read them, because remember this is the interview. So what we're going to discuss the interview I did with you eight years ago-

Dr. Luk:

How ago was that?

Aimee Raupp:

Eight years.

Dr. Luk:

First of all, congratulations on your new book.

Aimee Raupp:

Oh, thanks. Thanks. Thank you. But- [crosstalk 00:16:56].

Dr. Luk:

Am I able to audible? Is it OK? Can you hear me?

Aimee Raupp:

Yeah, I can hear you. You're great.

Dr. Luk:

Okay.

Aimee Raupp:

So I kept them busy reading through Dr. Taylor's responses and told them to the backstory on how you studied with Dr. Taylor. Isn't that so funny? Now you're frozen young lady.

Dr. Luk:

Okay. So sorry, Dr. Luke not touch anything. I was trying to change the volume, but anyway.

Aimee Raupp:

Hi.

Dr. Luk:

Hi.

Aimee Raupp:

So how are you? Tell me what's- [crosstalk 00:17:35].

Dr. Luk:

How are you? [crosstalk 00:17:39] I know we had pleasantries and lots of audience watching us. So.

Aimee Raupp:

Yeah. I know. I know. You're doing good though? You guys are keeping busy?

Dr. Luk:

I'm doing okay. It's been a tough year. Families and I have kids, it's just really tough. I've become a kindergarten teacher and elementary teacher.

Aimee Raupp:

So are they full homeschooled right now or no?

Dr. Luk:

Well, they were, they were. But it's very interesting. I mean, I actually want to start another Instagram just to talk about education because my education has been America and Hong Kong. So it is really interesting. I learned so much about their curriculum now.

Aimee Raupp:

I know I have a kindergartner too and it's snap words. Our life is snap words.

Dr. Luk:

Yes, yes. Amy, oh my God. Yes. You and I met so for the audience and I thought, and I heard you introduced me already for quite some. Thank you so much, Amy for introducing me.

Aimee Raupp:

[crosstalk 00:18:36] From eight years ago. So now you're at your own facility. Generation Next, next generation. Why do I always screw it up. Generation Next. So I wanted to go through and ask you the same questions. Is that and see where you stand?

Dr. Luk:

Please. Please. I don't think I would ever change my answers too much.

Aimee Raupp:

I don't think-

Dr. Luk:

Go ahead.

Aimee Raupp:

You're like me. It's just like we're set in our ways and that's that. Firm, but I think we evolve and see things.

Dr. Luk:

That's right.

Aimee Raupp:

So from your clinical perspective, do you believe a woman can safely wait until she's 40 to get pregnant?

Dr. Luk:

Thank you. 40? Did you say 40?

Aimee Raupp:

[crosstalk 00:19:21] Question though, right?

Dr. Luk:

Yeah. I'm trying to clear up.

Aimee Raupp:

Four, zero.

Dr. Luk:

Four, zero. Is it safe to get pregnant after 40? Is that? Okay, I just want to make sure.

Aimee Raupp:

Well, do you think she can wait until 40 to get pregnant?

Dr. Luk:

She can wait to get, okay. So it is a very interesting way of thinking about it. First of all, just because of my fertility and my study in fertility, as well as watching many women who find so hard after age struggle, I never usually intently or actively say, “Hey, you should wait until 40 to get pregnant.” I don't think that has ever come out my mouth like saying, “Hey, you should wait.”

Aimee Raupp:

But do you think there's hope after 40? I mean- [crosstalk 00:20:16].

Dr. Luk:

So I think there's still hope of definitely getting pregnant after age of 40. I do think in terms of now, so let's be clear, hopefully you will not cut a excerpt of me talking.

Aimee Raupp:

Exactly.

Dr. Luk:

It's true. Women are very, very healthy. I mean, majority of the patients I'm seeing on general obesity, many things in the CDC, looking is great. So we are all, a lot of patients are more, I think the new generation as well as the timing of women empowerment, they're conscious about diet with our, and I do think that does affect the biological clock. However, because biological clock is intrinsically in the gene. So the biological, even though again, I mean, you're doing great work after your acupuncture, diet, nutrition, but you cannot really reverse it too much. As a result I do not encourage patients to wait until 40.

Aimee Raupp:

Yeah. We wouldn't encourage, but say a woman was in the predicament like I was in, right? I didn't meet my husband until I was 39. Right? So it was like that was the option for me. But I agree, it's not always an encouraged thing. However, I know you have great success with women even into their late 40s, to be honest. You've helped make some, and this is a question that came to me now that's not in the book and you might not be able to answer it, but do you think age weighs as heavy as FSH or AMH? I mean, I think FSH is not as static, but do you take that all into account? Say she's got a great AMH and she's 43, or does that just mean you have more eggs to work with or you can get more?

Dr. Luk:

Yeah, that's right. Age is always trump the blood work. And I think the world of REI really focus on this stuff down here, the FSH, the AMH, because that's the only blood work. Of course as a doctor, you focus on the diagnostic. We don't say no to someone or yes to someone just because on the age. However age is, so I always believe in a woman who is 32 as you know the nature of mental reserve is my love, my passion. I always love to be outside the box.

Aimee Raupp:

She's a magician.

Dr. Luk:

Oh, I remember a patient. I remember I was at, okay not to mention any institution, but very traditional, great institution in the past where they really didn't understand the AMH and how to, the two types of women I felt like the REI is as the new generation going to modify like Amy and using alternative medicine and how to really redefine medicine in a different way in this coming 10 years. But one of the thing is two types of patient where I felt like the traditional way of thinking have felt that, one is patient with dementia brain reserve. Or doesn't make is a younger age so you're judging her ability by saying, “Oh, you can't be an image is one.” Which we don't do that. Or don't go for retrieval because, oh, your AMH is point one or we don't get the three follicles. I don't know why three, it's a very small, don't always say thing here that, and in my medical school is that-

Aimee Raupp:

But it's not how you work. It's not how Marty works. You're not- [crosstalk 00:23:36].

Dr. Luk:

I know. It's a baseball. Three, you're out, right?

Aimee Raupp:

Yeah.

Dr. Luk:

Okay. I'm a big basketball fan and football. Anyway, so then the second thing is women who are older, is that fascinating? And I discover why, this has lots of thing with the women empowerment, the forces of where we are. Because not many women, maybe my mom's generation, Amy and I are the same age, but like older, they are getting pregnant in them 20s. Right? I think my mom, I mean, so that trend, and also women's empowerment, lots more CEO. I mean, I'm just giving it more medical student are female. I heard Yale with the first female medical school student is 1960. But they're coming, the wave is coming more. So I think that also was very different as a result, the rise of REI and how it was started, which is great. Clinical medicine was for the younger group to stimulate clinical research. [crosstalk 00:24:50] Research now [crosstalk 00:24:51] sorry, go ahead.

Aimee Raupp:

It's a natural approach or lower stem. And so I think this is a question, I ask it similarly in here where what's your take on natural IVF? What population do you think this approach is best for? But I would also say though, or what I want to hear you talk about is do you believe less meds can render better quality in a certain population?

Dr. Luk:

Yes, I do. I truly believe it. I am trying to do my studies yet it's very hard because you have a bio, definitely someone came from New York City, lots of big names do come here after two or three cycles or elsewhere.

Aimee Raupp:

[crosstalk 00:25:33] of course. I'm saying but we all can be the most challenging cases.

Dr. Luk:

They come here and then I also do not want to do the, and you know the way I talk, I'm just one is one, two is two. But I try to be as clear as myself not to give false hope or, but I will say, “Well, let's try this.” And basically I'm trying something that they didn't do, which is very obvious and then Einstein would say what? Repeat the same thing and expecting a different result is the meaning of insanity. So they try something different and then they issue is how does that will help? Is it because of my stimulation or is it because the fifth cycle? And so I do believe it's not the quantity get that to the baby. Sometimes it's the, which egg is coming which one to get to the baby. So there are some days you would try and that means if I- [crosstalk 00:26:25].

Aimee Raupp:

You'll have more for no months.

Dr. Luk:

That's right.

Aimee Raupp:

Because nature shows that too.

Dr. Luk:

We don't know because the issue is, how come I got that pregnant? And this is our start day is coming out from Generation Next. Which mostly, I mean, I need numbers. Like COVID vaccine has numbers. I don't know how you feel about COVID vaccine but so I was going to lead to is why that not every doctor does it? Well, us doctors practice of stand of treatment. I know you guys are going to be like let's say cardiology, life and death. There's no like, “Oh, getting two versus one egg is different.” Right? So they do like this multibillion, same as a vaccine. I know it was a multibillion dollar research-

Aimee Raupp:

You don't have that population or the funds.

Dr. Luk:

So we're going to do research is now a case basis and then if I'm generation, and we are trying to get some data out there, even though there're going to be lots of critique. And when you guys reading papers and it's going to say, oh-

Aimee Raupp:

It's the same with [crosstalk 00:27:20] data. It's hard. It's the same with nutrition data. It's very hard because there's so many other variables to control for because it could have been her fifth IVF and now she's completely changed her diet. She's trying a new doctor. She's on the supplements for a year now. There's so many layers. I totally agree. But I feel like what I see and I've been in this a long time too now and I see it from you and other, I call them the boutique fertility clinics. That's what I put you guys as boutiques, less stems tend to render better quality and even in women, maybe in their late 30s, but it's not always, right? It's not always the case.

Aimee Raupp:

I've had girls in their 40s at certain clinics where they're doing 300 fall stem for however many days and they're getting good embryos. But it's a case by case basis and I do think that's where you're a bit of a magician when it comes to that where you can work on.

Dr. Luk:

I am. You just started in new paper. We are starting a research branch on our second floor. One of the thing, we may be start doing this coming year. I don't want to release too much of research secrets here, but is to really see oversaturation on what would happen to the cell.

Aimee Raupp:

Too much FSH, right. I agree. I think there has to. I mean, anyway, I agree. So you guys- [crosstalk 00:28:44].

Dr. Luk:

But let's talk about study. So what is randomized [inaudible 00:28:51] for your audience is that I'm blinded, which is really hard. How can you blind doctor not look at medical records to treat a patient? You have to, but if real research is blinded, and not subsidized. So it's all free then you put the number of month, so vaccine was like that. It was blinded, supposedly you don't know, and everyone just get the shot. You need to repeat the same shot, whatever shot someone's placebo shot, maybe just water injecting. And that is how we do it. So no matter what, they will also not be blinded because there is [inaudible 00:29:25] right? So then however, there are limited case studies already done in the last 10 years. So we just want your audience to know mild stimulation and conventional high steam has not really had a significant results difference between the two as in life birth [crosstalk 00:29:46] because that one has been done.

Dr. Luk:

But the cause and analysis for this two groups is tremendously different because now the mild stimulation, so then my argument to this patient who has been doing it elsewhere, is that why would you do the same thing and you are going to lose another $5,000? Because that five may get you another cycle to get today, because-

Aimee Raupp:

And it's less intense on your body. I think you would agree with that too. It's a less because I mean that's right. A lot of times we're moving to FETs or frozen transfers because maybe they were so hyper stimulated their bodies aren't ready for the transfer too. I mean, I think there's research to show the FETs are greater success rate, but is it because of how stimulated they were and then they had time to kind of come back to zero? I don't know. I don't know. Just another thought in my mind.

Dr. Luk:

Absolutely. And then also the response I do believe, I always see the ovary like a plan or let's say a horse. They're tired, they need to run the race because you need more eggs. But if the horse is tired, you can't keep on hitting the horse, which I feel like the FSH is that. It's like stimulating.

Aimee Raupp:

Exactly. It's over-stimulating and then it can cause it to crash too. Right? And then-

Dr. Luk:

That's right. So what do you do to a horse? The way I explain to my patient gives some water, you try to help her. So as you do that, sometimes DGA, sometimes acupuncture.

Aimee Raupp:

That's what I was saying, encouraging follicular genesis not blasting it. Right?

Dr. Luk:

Right. Right.

Aimee Raupp:

Okay. So do you still feel the same way about PGD testing? What's your stance on PGD these days?

Dr. Luk:

Oh, that's such a great question, Amy. Wow. You really know the trend of our patients feeling. So last 10 years has been crazy. PGTA kind of, I feel like even centers are adjusting. I'm seeing patient when they transfer to me, I'm like, “Oh, you're not tested? Weird.” So the centers are also changing. So I'm talking about-

Aimee Raupp:

And then also saying if you have a PGS normal and you get pregnant and you're over the age of 40, you should still do a CVS. Do you know that? Now? They used to say-

Dr. Luk:

Oh, now even CVS? Oh my gosh. Okay.

Aimee Raupp:

Now you should do CVS or an Amio. So it's like, wait, what? So what are you telling me? So there could be an abnormality, even though you tested the embryo and everything's normal? Yeah. And that's what we're-

Dr. Luk:

I think this is also from some of the bigger biopsy places where we send it out. I know some centers they do their own biopsies when they have enough volume, we send it out, which is great. You send out, you do cover, right? Double check. And they do over the nation. Sometimes they do other institutions too. They have about 300,000 biopsies in this place that they do all the biopsies and there's only three and it was like monopoly now, but there are only three and they will say, and they were very clear and say, “Yes, there are percentages. There is an error. Either it's caused by human or have no human. It's just scientific error.” Placental mosaicism versus any division or something. different lines that are getting expressed. But the issue here is that I do believe that not everyone is meant for biopsy.

Dr. Luk:

So the stand away, when I told you about the two types of patient where I felt like our protocol when I was in my education was not who would attend to, with the [inaudible 00:33:07] reserve and the older patients. Because the rise of REI was not for them. The rise of REI was for the younger patient who cannot get pregnant or who has a surgery, whatever. So that was the rise of REI in the past or unexplained infertility down patients. So now PGTA, is it for everyone? No, I do not think so. There are two types of people that I do recommend PGTA. One if have loss of quantity. So they embryo, I don't know what to do. Which is what REI is built for. It's really built for that. They are the patient that is like, oh, every REI says, oh, come, come, come. They should get pregnant anywhere They go. And they have 10, you explain more to your audience.

Dr. Luk:

They cannot transfer all ten in. And then they will take that 30% risk or 2%, whatever risk. I also want them to choose or they may want the luxury of choosing the gender. The second type of patient is miscarriages. So they keep on having miscarriage. And regardless of how many embryos they have, they may have a, Amy are you good? Sorry. I know.

Aimee Raupp:

Can you hear me or no?

Dr. Luk:

I can hear you. I can hear you. Yes.

Aimee Raupp:

Okay.

Dr. Luk:

Okay. Clear, very clear. And actually, this is really amazing.

Aimee Raupp:

A phone call came through and I had to, and then that, sorry.

Dr. Luk:

Oh, okay. So then another problem is a patient with miscarriages. I do talk to them about testing. I said, not testing you guys seem like having sex and then some patient well, it was too hard for me for miscarriage. So as a result, I have to come here so we'll have them test. So, those two-

Aimee Raupp:

So it becomes more of an emotional decision too. And then I think a luxury decision almost, like if I have plenty to test, then I should test them versus I have to test them all. Yeah, I know.

Dr. Luk:

Yeah, no, but then when patient have done all this, this is fascinating. I just had a patient from a very big institution. They did the testing. She's 40, 41. And she had 10 abnormal embryos. So every time she get baths, like first five glasses from the first center, five glasses for the second IVF for the first center.

Aimee Raupp:

Wait, I know the patient. And now she's pregnant naturally. You did a first-

Dr. Luk:

Oh, no. See, I know. No, we did IVF, [crosstalk 00:35:32] but we had one. Yes. I bet you and I have lots of, oh, come on, Amy. This is not even quantity.

Aimee Raupp:

But that one, anyway, go on with your story. Go on.

Dr. Luk:

And we did another retrieval and she looks at me, she's all distraught. Right? She only have one more IVF cycle. And she had been testing testing 10, I said, “Why don't we just transfer?” So she was pregnant twins. So this is the caviar. And she understand what the risk. I said while it can be both abnormal and just let your audience know, majority abnormal embryos do not get implant. That's why you have 12 months of sex, you do not have 12 months of miscarriage. You may have one or two most, and you don't have 12 times of miscarriages before you get pregnant. So she got pregnant, but one was miscarriage right now. The other one, they did the MI, all the prenatal, amino, DVS, and all of them. So she was so happy that she didn't test. But then-

Aimee Raupp:

And that is not fascinating. So there, in that case, like in my head, and we have a similar case and the same thing happened. In my head it's a couple of things. She's been on the diet and the supplements longer maybe that impacted equality. You used a lot less meds and you went after quality, not quantity and you did a fresh transfer. So there's all these questions of, is the testing, was it after?

Dr. Luk:

Oh, right. She did a frozen embryo transfer.

Aimee Raupp:

Oh, she did an FET? Okay.

Dr. Luk:

So she freeze without testing. And this is also very interesting that I'm trying to do for some of my patients. So everyone asked me this frozen and fresh. I do feel just from a nature, frozen embryo and also from logic and has also been proven by data, frozen embryo transfer will always have a high success rate than fresh. Why Dr. Luke? Well, you're freezing and thawing and the embryo survive. So if you look at collective data on the whole, well obviously frozen has to be better than fresh. And fresh auto logically is they are always stimulated. They feel not comfortable [crosstalk 00:37:26] and stress. But then is it worth it to do like, so this patient did the test and do what for her, she needs the mental rest.

Dr. Luk:

And she also wants to not test because of what happened. So it was very clean, but it's really hard to give that suggestion to patients sometimes just FYI, because they will say, “Well, if you are going to three, why not testing?”

Aimee Raupp:

[crosstalk 00:37:55] and then I'm going to ask the last we'll start to wrap up.

Dr. Luk:

Yes.

Aimee Raupp:

PRP, I don't have this in the book because we weren't talking about PRP back then, but tell me where you're at with PRP as far as ovarian rejuvenation and quality impact.

Dr. Luk:

Yes. Yes. Amy, actually, we have amazing data on PRP and it is led by Dr. [Chate 00:38:14].

Aimee Raupp:

I know. Tell me.

Dr. Luk:

Yes. I will tell you a little bit. And I actually think when I was talking to you, I think we need to have this separate just on PRP session because it's fully on the mental reserve. So, because there's so much data coming out, we are gathering. PRP is basically the idea of using a patient's plasma, so it's their own blood. It's not like some extra chemical. Inside the blood there's something for growth factors and plasma. So you spin down that. Okay. Inside blood was inside blood. It's like inside the ocean water, what's there? There's some salt. Inside the blood, there's some red blood cells. There's some white blood cells. There's some plasma, there's some platelets. So if you go back to Google, I'm sorry to ask you to Google, but there's some good information on what's inside blood, on Wikipedia. So blood there's different groups of cells and molecules, but one of them is growth factors that is circulating in our body right now and going-

Aimee Raupp:

And it's your own growth factors like you said.

Dr. Luk:

And it's your own growth factor- [crosstalk 00:39:15].

Aimee Raupp:

Yeah, exactly.

Dr. Luk:

Then you trace some growth factors out and then you inject back to the ovary. Now there is some criteria for PRP. Dr. Hay, who is my colleague who really started this whole process of PRP and has been doing a really amazing work and techniques that he had developed. But basically is the idea of injecting the growth factor specifically to the epithelium of the ovary, but there are patients who try not because it's also experimental. So we don't want to tell patients like, I always tell patients, I'm not a snake oil doctor like, oh, you stage and I'll rub your back. So I do be very serious. This is a last resort. And usually we recommend it to patients when it is really the last resort. They're not menstruating. So we also do not offer to patients who are on, blood thinner sometimes when we need to get done. We also not judge to patients who history of cancer.

Dr. Luk:

So I have patient with leukemia, we don't do that. We just don't know. I mean, it's all being common sense because there's no data, but we just want safety number one. And that is where right now that's the idea.

Aimee Raupp:

Have you seen more recruitment in the coming cycles? Like increasing follicle count?

Dr. Luk:

Yeah, we still in recruitment we have right now one natural birth. He is not yet born because we started back in June.

Aimee Raupp:

How old was the woman? How old?

Dr. Luk:

What about how high FSH? She was 40, 39, 40, actually 40. She was already skipping cycle when I got her, well, not skipping. She was still cycling regular [crosstalk 00:40:51] it was the first child. FSH was 107.

Aimee Raupp:

Wow. Wow.

Dr. Luk:

She was that, house skipping and suddenly we have an egg and she did her own, so I didn't do it. So she really didn't want to come back. She was breastfeeding. And at the third year she stopped and she said, “Well, I'm menstruating now doctor.” I said, “Great.” She has sex, but keep on having miscarriages. Then she came to me, it was too late. It was not too late by my FSH was 107, she's giving. I'm like, “Look, I'm sorry, but that's not much.” And then I think Dr. Hay, sometimes I'm monitoring, I know we are boutique side but sure Dr. Hay sometimes help me to see my patients because of the volume. And so Dr. Jesse is like, “Wait.” And talk to her. Somehow I didn't even ask them to do PR. I didn't bring that up.

Dr. Luk:

I think he was like, “Wait, I think you're a good candidate.” They did PRP. She ovulated the following side. And they're right now 26 natural, this is tax. And this should make sense because her tubes work. It works. The sperm works. So her first baby was actually IUI, it was also not IVF.

Aimee Raupp:

Do you think its improving egg quality? Is that what you're saying? I mean, can we say- [crosstalk 00:41:59].

Dr. Luk:

I don't know. I mean, right now, this patient are like, well, she had got pregnant, so one can argue, so this is hard because one can argue maybe if you didn't do the PRP, she ovulate, she would still have a life work. So I don't know.

Aimee Raupp:

Sure.

Dr. Luk:

But for FSH 107, it's a little bit hard, but it can happen. Nature has happened. So, that's why I'm still not saying, oh my God. But since you act like she's one more pregnancy other patients are calling to Dr. Hay, we have seen increased. Well, he doesn't have a two again, randomized control trial. There's so many people he see, but he's like, oh, we got newborn before. So she's comparing the patient from the before self. So there's only her- [crosstalk 00:42:40].

Aimee Raupp:

To do it, right? Isn't that the only way we can do it right now, it's hard.

Dr. Luk:

Right. But supposed idea of research is you do one group, both and then compare it. PRP and no PRP, but right now only comparing her. Oh, you did PRP so this happened.

Aimee Raupp:

Yeah. It's amazing.

Dr. Luk:

Which is a mess.

Aimee Raupp:

Okay. I'm going to let you go and I'm going to go, but this was so love to catch up with you and let me-

Dr. Luk:

It was amazing. Thank you so much. But Amy, I think we need to meet a little bit more.

Aimee Raupp:

I agree.

Dr. Luk:

Okay. So we should talk. My team, your team, because PRP is something. There's so much have happened since last time.

Aimee Raupp:

Yeah. I know.

Dr. Luk:

I haven't talked you about laboratory management at all.

Aimee Raupp:

Yeah. Let's talk. Okay. Okay.

Dr. Luk:

Okay, later.

Aimee Raupp:

We're going to talk.

Dr. Luk:

Bye.

Aimee Raupp:

Bye everybody. Thank you.

Dr. Luk:

Bye.

END TRANSCRIPT

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