The Anovulatory Cycle: When Menstruation Doesn't Mean Ovulation

Send us Fan MailIn Part 3 of our three-part Egg Freezing Series, Dr. Mark Amols answers one of the most overlooked questions in fertility preservation:Once you are finally ready to have a baby, should you actually use your frozen eggs?The answer is not always yes.If you froze eggs when you were younger and are still relatively young with good fertility when you are ready to conceive, it may make more sense to try with your current fertility first and keep those younger frozen eggs as a backup.In this episode, we discuss: Why frozen eggs do not automatically need to be used first  When it may make sense to leave younger eggs in storage  How current age, ovarian reserve, sperm, tubes, and family-size goals affect the decision  Why someone who froze eggs at 28 may make a very different decision at 32 than at 42  What actually happens when frozen eggs are warmed  Why previously frozen eggs are generally fertilized using ICSI  Why not every egg survives warming  Why not every surviving egg fertilizes  How eggs move through the funnel from warming → fertilization → embryo development → blastocyst → transfer Why 20 frozen eggs do not equal 20 embryos or 20 babies  When PGT-A may or may not be considered  Whether eggs lose quality simply from being stored for many years  Why the age of the egg and the age of the pregnancy are two different things  What happens if you never use your frozen eggs One of the most important takeaways from the entire series is this:Egg freezing can preserve the age of your eggs, but it cannot freeze the age of the pregnancy.And sometimes, the best outcome of freezing your eggs is that you never need to use them at all.This is Part 3 and the final episode of our Egg Freezing Series.If you missed Parts 1 and 2, start from the beginning to learn who should consider egg freezing, when it makes sense, how many eggs you may need, and what actually happens during the stimulation and retrieval process.Explore the full series, search fertility topics, and try our interactive tools at TacoBoutFertility.com.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailIn Part 2 of our three-part egg freezing series, we walk through the entire egg-freezing process from start to finish.What medications do you take? How long are the injections? How often do you need ultrasounds and bloodwork? What happens during the trigger shot? Does the egg retrieval hurt? And what actually happens to your eggs once they reach the embryology lab?Dr. Mark Amols explains the process step by step, including: What AMH and antral follicle count help predict before treatment  Why fertility medications do not “use up” your future eggs  How ovarian stimulation works  What patients can expect from the injections  How follicles are monitored during the cycle  Why trigger timing is so important  How modern protocols help reduce the risk of OHSS  What happens during the egg retrieval  Why the number of follicles, eggs retrieved, and mature eggs frozen are often different  What “MII” means  How vitrification works  What recovery is like after retrieval  Why some patients may need more than one egg-freezing cycle One of the most important concepts in egg freezing is understanding the difference between follicles, retrieved eggs, mature eggs, and the eggs that are actually frozen.Egg freezing is usually a much shorter process than many people expect—but every step matters.This is Part 2 of our Egg Freezing Series.In Part 3, we answer a question that almost nobody talks about:Once you are finally ready to have a baby, should you actually use your frozen eggs—or leave them in the freezer as your backup?Explore more fertility episodes and interactive tools at TacoBoutFertility.com.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailIn Part 1 of our three-part egg freezing series, Dr. Mark Amols breaks down who should consider egg freezing, when it actually makes sense, and why there is no single “perfect age” or magic number of frozen eggs that guarantees a future baby.We discuss the important difference between age, AMH, and ovarian reserve—including why a high AMH does not necessarily mean better egg quality and why a low AMH does not mean your eggs are bad.You'll also learn:• Who should consider planned fertility preservation• Why freezing younger eggs is biologically better—but doesn't always mean freezing earlier is the right decision• How your desired family size changes the conversation• What AMH and antral follicle count actually tell us• How many eggs you may need to freeze• Why 10 frozen eggs at age 28 are not equivalent to 10 frozen eggs at age 40• Why one frozen egg does not equal one future baby• When freezing embryos may make more sense than freezing eggs• Whether an egg-freezing cycle “uses up” your future eggs• What the research really says about regret after egg freezingEgg freezing isn't a guarantee and it isn't a biological time machine. Think of it as a reproductive backup plan—preserving some of the reproductive potential you have today in case you need it later.This is Part 1 of our three-part series on egg freezing. In Part 2, we'll walk through exactly what happens during an egg-freezing cycle—from the injections and monitoring to the retrieval and vitrification of your eggs.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailEver remember something from Taco Bout Fertility Tuesday and think, “Wait… which episode was that?”Now there’s an easier way to find it.Visit TacoBoutFertility.com, where you can search the entire podcast library based on the questions you’re trying to answer, browse episodes by topics like IVF, embryo transfer, PGT, IUI, egg quality, and more, or ask the podcast to help you find episodes related to a specific fertility question.We’re also adding interactive fertility tools covering topics like hCG rises, AMH, IVF success by age, PCOS criteria, and more.Don’t just listen to Taco Bout Fertility Tuesday.Explore it.Visit TacoBoutFertility.com.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailThinking about freezing your eggs—or already have eggs frozen and wondering what happens next?Over the next three episodes of Taco Bout Fertility Tuesday, we’re taking a deep dive into egg freezing.We’ll cover who should consider freezing their eggs, when timing matters most, how many eggs you may actually need, what to expect from the medications and retrieval, and what happens years later when you’re finally ready to have a baby.Because egg freezing isn’t a guarantee, and it isn’t a time machine.It’s a backup plan.The three-part Egg Freezing Series starts Tuesday on Taco Bout Fertility Tuesday.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailHave you ever asked three people at your fertility clinic the same question—and somehow gotten three different answers?It can feel like nobody is communicating. But sometimes the explanation is more complicated.In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols takes you behind the scenes of a fertility clinic to explain how the care team actually works. Front desk staff, medical assistants, nurses, nurse practitioners, physicians, embryologists, billing teams, and office managers all have different training, experience, responsibilities, and access to information—and that can affect the answers you receive.You'll learn the important difference between knowledge gained through repetition and experience versus knowledge built on a deeper medical foundation, why the most confident answer isn't always the most individualized answer, and why a physician saying “it depends” may actually reflect more—not less—understanding of your situation.You'll also learn a simple way to figure out who should answer your question:• Administrative questions• Billing and insurance questions• Medication and treatment instructions• Clinical interpretation• Individualized medical decisions• Embryology and laboratory questionsDr. Amols also explains why yesterday's answer may legitimately be different today, how new ultrasound findings, hormone levels, embryo development, or other information can change your treatment plan, and why not every member of your fertility team may have the newest information at the same moment.Plus, we tackle the difference between communication and customization. A clinic where every patient follows the same pathway may appear incredibly consistent, while individualized fertility treatment creates more moving parts—and a greater responsibility to explain why the plan changes.Most importantly, you'll learn two questions that can prevent a tremendous amount of frustration during IVF or fertility treatment:“Did something change?”and“Who is the best person to answer this question?”Sometimes different answers really do mean there is a communication problem. Other times, the answer changed because your care changed.If you've ever felt confused about who to call, who to trust, or why you're hearing different information during IVF, IUI, fertility testing, or embryo transfer treatment, this episode will help you navigate your fertility clinic with much more confidence.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailDoes the ERA test actually improve your chance of pregnancy with IVF—or has endometrial receptivity testing been oversold?Patients often receive completely different advice. Some fertility specialists say the Endometrial Receptivity Analysis, or ERA, can identify a personalized window of implantation. Others say research has proven the test does not work. The truth is more complicated.In this episode, Dr. Mark Amols revisits ERA in light of newer randomized trials, meta-analyses, and research on recurrent implantation failure. He also examines statements from his earlier episodes—including why he would no longer confidently tell patients that an ERA “cannot hurt.”Topics include:How ERA attempts to identify the window of implantationWhether ERA improves live-birth rates during routine IVF treatmentWhat the major randomized trial actually foundWhether that trial was adequately poweredWhy the data do not support ERA before a routine or first embryo transferThe unresolved role of ERA after recurrent implantation failureWhy results differ between untested and euploid embryo transfersWhether changing transfer timing could potentially lower successConcerns about test accuracy and cycle-to-cycle endometrial variabilityWhen ERA might still be discussed as an optional, unproven interventionThe current evidence is reasonably clear for the average IVF patient: routine ERA testing does not improve live birth. For patients with repeated implantation failure—particularly after failed euploid embryo transfers—the answer remains uncertain because the adequately powered randomized trial needed to settle the question has not yet been completed.This episode separates what ERA has been proven to do, what it has been proven not to do, and what fertility medicine still does not know.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailCould chronic endometritis—silent inflammation in the uterine lining—affect IVF implantation, miscarriage, or embryo-transfer success?In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols explains what chronic endometritis is, what it is not, and when it may actually be worth investigating.We break down CD138 biopsies, hysteroscopy, cultures, EMMA, ALICE, and vaginal microbiome testing—and why these tests are not interchangeable. We also discuss antibiotics before embryo transfer, what ASRM says about routine antibiotic use, and why finding bacterial DNA does not automatically mean treatment will improve live-birth rates.The takeaway: chronic endometritis can be real and treatable in the right patient, but not every borderline result explains infertility, miscarriage, or a failed IVF transfer.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailWhat does it mean when your hCG is above the “discriminatory zone,” but a transvaginal ultrasound still shows an empty uterus? It raises concern—but it does not automatically diagnose an ectopic pregnancy or miscarriage.In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols explains what the discriminatory level can—and cannot—tell us about an early pregnancy. He explores how this decades-old threshold became part of medical practice, why it represents a probability rather than a biological boundary, and how viable pregnancies can occasionally remain invisible even when hCG has crossed the expected level.You’ll learn:• The usual ultrasound sequence from gestational sac to cardiac activity• What “pregnancy of unknown location” actually means• Why PUL is not the same as an ectopic pregnancy• Why one hCG result should not automatically trigger methotrexate• The difference between a probable gestational sac and intracavitary fluid• How IVF dating, multiple gestations, symptoms, and follow-up change the interpretationThe key lesson: hCG provides a biochemical signal, while ultrasound provides anatomy. Neither one, by itself, tells the entire story.Severe abdominal or pelvic pain, shoulder pain, dizziness, fainting, weakness, or heavy bleeding requires urgent medical evaluation. This episode is educational and is not a substitute for individualized medical care.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.

Send us Fan MailYour first beta hCG is 100. Two days later, it rises to 150—but it didn’t double. Does that mean miscarriage? Could it be ectopic? Or could the pregnancy still be progressing normally?Before Google diagnoses you with three different pregnancy complications, take a breath.In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols explains why the familiar rule that hCG must double every 48 hours is outdated—and how that rule grew from a 1981 study involving only 20 patients.You’ll learn:• What hCG does during early pregnancy and which cells produce it• Why we call the test “beta hCG”• Where the 48-hour and 66% rise rules originated• How the expected rise changes based on the starting hCG level• Why IVF pregnancies may occasionally progress with much slower rises• Why a slow rise does not diagnose miscarriage or ectopic pregnancy• Why even a perfect rise cannot confirm that the pregnancy is inside the uterus• Which symptoms require urgent medical evaluation regardless of the latest betaThe bottom line: hCG is useful, but it is not a pregnancy report card, a crystal ball, or a GPS. It provides one piece of the story—followed by another beta, careful symptom monitoring, and eventually an ultrasound.If you have severe or worsening abdominal or pelvic pain, shoulder pain, dizziness, fainting, weakness, or heavy bleeding, seek urgent medical evaluation. Do not wait for your next scheduled blood test.Next week, we’ll continue the conversation by discussing pregnancy of unknown location, the hCG discriminatory level, and how clinicians evaluate the possibility of an ectopic pregnancy.Thanks for listening to another episode of Taco Bout Fertility Tuesday with Dr. Mark Amols.If you found this episode helpful, please share it with someone who might benefit—and don't forget to follow the show and leave us a review on Apple Podcasts, Spotify, or wherever you listen.Want to explore more fertility topics? Visit TacoBoutFertility.com, where you can search our entire episode library, find episodes about the questions that matter to you, try our interactive fertility tools, and submit questions or topic requests for future episodes.Join us next Tuesday for another episode of Taco Bout Fertility Tuesday, where we make fertility medicine easier to understand—one topic at a time.