IVF Protocol Optimization: What Your Doctor Isn’t Telling You (Episode 518)

Full Transcript: Episode 518

Lisa: In today’s episode, we are diving into a topic that we don’t cover as much on the podcast, which is optimizing your chances of conception with IVF. Naturally, the strategies that we talk about to support egg quality do lend themselves to improved IVF outcomes — because when you’re improving egg quality you are naturally doing that. But in today’s episode we jump into a bit of a different take on this topic.

Today I’m sharing my interview with Tasha Blasi. She is an IVF consultant and founder of IVF Uncovered. Using her background in the sciences and personally going through 10 rounds of IVF for her two children, she has created a life mission to help patients doing IVF know almost as much as their doctor about perfect protocols and strategies — so they can protect their investment, increase their chances for success, all while bringing an unfiltered, humorous tone to this often heartbreaking subject. Without further ado, let’s jump in to today’s episode.

I’m so excited to be here today with Tasha Blasi. Welcome to the show.

Tasha: Thank you. I’m so excited to be here with you as well. I love your work and I love what you do — it’s so important.

Lisa: Well thank you so much. This is a topic that I don’t cover as frequently as I probably should, but today we’re going to dive into IVF and talk about some of your strategies to optimize that. I would love to start by having you share a little bit about your background and what brought you into the work that you do. And I would love to also hear your personal story, because I know that’s part of your journey.

Tasha: My story is a little bit different. Most people say, “Oh, the hero’s journey — you go through a struggle, you figure out what the problem is, you come out successful, and then you want to share that with the world.” That wasn’t exactly what happened with me. I did nine egg retrievals and 10 embryo transfers, and it was a male factor, and I was in my early 30s. That just didn’t make sense.

When people are like, “What finally worked?” I’m like, “Don’t do anything that I did.” Hindsight, I was being qualified. Nobody is going to — well, it’s harder to listen to somebody who is like, “Oh, I got pregnant with my two kids after two rounds.” I think I was being qualified, hindsight. And I needed to go through just such an insane journey for the five years that I did to have my two kids, because I can now fully and totally empathize with my clients.

I’m an IVF consultant. It was after my journey — my second was born — and it was somebody else’s idea that I should be a fertility coach. I’m like, that’s not a thing. This is back in 2016. And they’re like, make it a thing. And then six days later, I get fired from my corporate job. I was a biology teacher, then I went into corporate America and I got fired six days later. I was like, okay, God, I hear you.

That’s when it started my journey — that was in 2016. And then my research really began of what is preventing people from easily getting and staying pregnant. I just have been researching ever since. And then in 2022, I actually put together a formula for perfect protocols and strategies for IVF, for every individual biology. And that’s, I think, the biggest miss here.

The protocol that they were doing on me — again, 33-year-old, great egg reserve, no fertility issues, we’re doing this because of male factor — that protocol didn’t work. That’s what I call the cookie-cutter approach. It’s the same one that I see on my patients with PCOS, my patients with low egg reserve, short cycles, long cycles. This is not the most optimized way to do IVF. My journey has been a lot of research and finally creating an actual formula to make IVF as successful as possible, as well as supporting the women that I’m working with along the way.

Lisa: That’s incredible — not in a good way — but just to think about what you had to go through over those five years. That’s a lot. I want to dig into that a little bit — you mentioned that you were young, your egg reserve was actually okay, your egg quality was probably fine. And in your case, it was related to male factor. Share with us from your perspective what they did and what they did wrong in your case.

Tasha: What they did wrong is now what I teach my clients. First, there’s the science — and this is the protocol. I was not doing the right protocol. I was doing the cookie-cutter approach: you take birth control, 300 Gonal-F, 150 Menopur, an antagonist, you do an average stim, nine days later was the trigger shot. It was the wrong protocol. It was not the right strategies. Hindsight, I should have been on a very different protocol.

I should say — because this leads me to the second part — I got pregnant on the second round of IVF. Two egg retrievals, two transfers. I never had excess embryos, it was always kind of like, we only got a couple out of the 15 eggs, let’s just put them in. That was my son — round two. So I wasn’t doing the right protocol to allow for optimized IVF. It worked the second round.

Baby number two, however, took me an additional eight transfers, seven egg retrievals, and three years. And I think that was a combination of, again, the wrong science. I was doing the same protocols over and over. Sometimes they’d increase the dose a bit, then they’d add on a Lupron flare. And it’s like, if that doesn’t work, eventually they’re like, you need egg donor. And that’s exactly what they told me — it’s not working, you must need egg donor, even though I was still in my mid-30s at that point.

The second part, other than the wrong science — which is always my first pillar — is my body was in chronic survival mode. And this is where this is the genius of your work. Our bodies tell us, give us very clear signals that we are in survival mode. And we don’t listen to them, or honestly, it’s not about not listening — it’s not being aware that that’s what is happening.

I was working in New York City at the time. At this point I have a small child because I started baby number two when Hudson was one. And I was just running on empty, but I didn’t realize it. It’s just what you did — you worked all day and then you took care of your baby all day and night. I had once in a while migraines, once in a while these excruciating stomach pains, I did have constipation, I did have major anxiety. But I was in New York City in corporate America with a young kid.

Why I say all this is — round two, my body was like, I let you get pregnant the first time because you were only 33. You are not getting pregnant again. And I think that was a big miss. I just didn’t know. But the big miss is we need to listen to the signs — like you talk about the fifth vital sign. If your period isn’t easy and regular, there’s something wrong, there’s something off. There’s a hormonal imbalance that you could fix if you know what to do and why it’s happening.

Lisa: You mentioned the protocols and the cookie-cutter approach. Are you referring to just the drug cocktail, how they prepare the uterus with the synthetic estrogens, their process — when you talk about the protocol?

Tasha: When I’m talking about the protocol, it’s the medications used and also the strategies used — how long are we on medication and how is the growth. Little tweaks like that, even just in how many days you’re on stim drugs, can really affect the quality of the embryos. And then yes, preparing for the transfer — that is very cookie-cutter. It’s always just like, give them a ton of estrogen and then give them progesterone and then you’re done. And some women — most women, I would say — do terribly on estrogen. We need to be very careful with this synthetic estrogen.

And by the way, before we put in the embryo, do we know for sure nothing is blocking implantation? When I say the cookie-cutter approach, depending on if I’m talking about an egg retrieval or a transfer, yes, it’s about the protocols and strategies for both.

For the transfer specifically, I want to assume things will get in the way of implantation and cross that off — that we know for sure they won’t — versus most of the IVF doctors are going to assume nothing is going to get in the way of implantation, but not know for sure until there’s a problem. The problem is multiple failed transfers or multiple pregnancy losses.

Lisa: If you’re the patient, how would you change the course of events?

Tasha: This is where the finesse comes in and what I do. I’m kind of in the background. I teach my clients: first of all, I go over everything with them — this is what I see, this is how it can be modified, this is your perfect protocol and strategies. And then it’s questions for the doctor. And we always approach the questions with respect, kindness, and curiosity.

When you approach it with, hey, I noticed really uneven growth — what do you think we should do next time to help even up the growth? We always listen to what they have to say. And then it’s, “I have heard that XYZ could help even up the growth. What do you think?” We cannot tell a doctor what to do. If we approach it very factually of, you can agree this wasn’t ideal — okay, yeah — next, what do you think we should do to help it? And for the most part, the doctor is like, yeah, sure, we can try that.

I find it to be a very big red flag, however, when the doctor gets very offended by questions. I can think about this one — where the doctor was like, “I’ve been doing this for 30 years.” And that’s all his response was. What’s kind of funny about that is I have a doctor behind me supporting me, mentoring me. We talk about protocols, we do our research together. And I brought this up to her and she said, you’re not missing something — and by the way, he’s not even board certified. He was an OB-GYN with a certification, not board certified, ramming it down my client’s throat with “I’ve been doing this 30 years.” Yeah, but you probably haven’t had any training in the last 30 years to know how things have changed.

Lisa: I like the way that you approach it because things work better if they think it’s their idea. Not even just with doctors — even with husbands or children, it always goes better if they think that it’s their idea.

Tasha: And then something about — I know for a lot of your clients, they can’t get blood work done. For me, I need certain blood work done to know: why did you have a pregnancy loss? Well, what was your progesterone? Oh, it wasn’t measured. Okay, we got to get that measured. The doctor may say, “Your progesterone was fine” — basically we just assume it’s fine. I hate assuming.

Another way to approach something like blood work is to say, I understand this isn’t the way it’s done. However, data just really helps me understand things. Make it about you needing data. They don’t need the data, but could you just support me? Because I need the data, it helps me feel more secure. That’s another way to approach doctors. And if they ever say to you, “Well, it’s not needed” — what’s the reason? I always say, the reason is you haven’t been pregnant. That’s the reason.

I always say to my clients, don’t expect your IVF doctor to know how to get your body out of survival mode. You having a thyroid issue — the doctor is going to handle the what: what’s the problem? Take a medication to lower your thyroid. Functional medicine experts are going to handle the why: why do I have a thyroid issue? They go into the whole — your iodine is this and your testosterone is this and then that leads to a thyroid issue. I don’t fault the medical doctors for not knowing this stuff. This is a totally different area of study. I don’t love that they kind of poo-poo it like it doesn’t matter. Your cycle doesn’t matter? Of course it matters. It’s your fifth vital sign. It’s a sign of something is off.

Lisa: Because they’re overriding your natural cycle — they’re replacing your natural cycle. I think this is an interesting topic especially for my audience and my practitioners, because if I have practitioners whose clients are thinking of doing IVF at some point, there is a bit of a clash of worlds. When you choose IVF, that’s not the same as when you chart your cycles, because they’re actually preparing the uterus with the hormones — they’re administering the hormones before ovulation to optimize the uterine lining. They’re triggering ovulation based on their schedule. They often put women on birth control to sync up the cycle or get it on their schedule.

You’re submitting to a highly medicalized approach to conception that doesn’t exactly match the concept of classic cycle charting. I feel like there could still be some value in journaling to identify the different phases, but someone needs to say it’s not going to be the same if you’re charting through an IVF cycle.

Tasha: Yeah, but I disagree a little bit in terms of — you do need to know your cycle, period. Because again, that is your fifth vital sign. And when I’m preparing somebody for a transfer and if we know for sure you build up your lining beautifully naturally and your progesterone is beautiful naturally, we don’t recommend that they get on a lot of those medications. The cookie-cutter way to do IVF is downregulate and estrogen. That’s actually not the protocol that I ever recommend at first for most cases pending the issues.

But if you can get as fertile as possible naturally, that is absolutely going to help your IVF — the medications that you do or don’t have to take. And also, you can’t force a pregnancy. You can’t even force an embryo. We need that really good, healthy egg quality. You can try to force fertilization even with ICSI — putting the sperm in there doesn’t mean it’s going to fertilize unless it’s healthy enough. You can’t force the embryos to grow.

Your work of getting you as fertile as possible — IVF can’t override that. And you need to be as healthy and fertile and synced up naturally as possible for the best results. Your AMH can increase, your FSH could go down when you are as fertile naturally as possible. I just think it makes IVF — and that getting pregnant part, which you absolutely can’t force — so much easier.

Lisa: Yeah, and I think we may be saying more similar than different. Of course, I’m all for charting throughout the process. I think for a lot of couples, everyone has a period of time which they’re comfortable trying naturally. And if they happen to pass that time frame, obviously it makes sense to start looking at other options. But up until that point, I think that charting is essential. Even in what you were talking about before with male factor — that’s one of the reasons why I talk about it so much. Because when you see that a woman’s menstrual cycle is healthy and functioning, but the pregnancy isn’t happening cycle after cycle, you have to start to wonder what’s going on.

Is it possible for someone to do IVF without all of that estrogen and progesterone, based on their own natural cycle?

Tasha: That would be a natural transfer cycle. There are natural transfer cycles — which is nothing, you just track your own ovulation and the doctor tracks it too. And then there are modified natural transfer cycles — maybe you take letrozole, which is an estrogen suppressor, which can be nice for certain clients, and then a trigger shot to know for sure when the surge is happening. That’s called a modified natural transfer cycle or a letrozole transfer cycle. Yes, you absolutely could skip a lot of the medications based on what you do naturally.

Lisa: Is there interesting research on those approaches?

Tasha: Yes, I mean the research on using letrozole in a transfer cycle — I have three articles off the top of my head. There is definitely research on how letrozole could help a frozen embryo transfer cycle.

Lisa: The reason I ask is, if you were trying to advocate for an IVF cycle that utilized either less hormones or even a natural cycle, I would imagine that would be an opportunity for pushback given that it’s not the cookie-cutter approach.

Tasha: I always find when you optimize IVF for the patient — and it’s really based on a bunch of factors — all of these protocols that are customized, I absolutely feel they optimize the outcomes. And I can’t stand it when there’s a medicated cycle for a frozen embryo transfer for no reason. Because women’s bodies hate synthetic estrogen, so many of them. We assume that women’s bodies love synthetic estrogen. It’s just not true.

Lisa: I would love to truly interview some doctors and be like, why don’t you know this, or why would you assume this? I feel like I kind of know the answer, because the medical profession turns out cookie-cutter doctors — it’s an assembly line. And I would imagine the reason that most women have that specific experience related to the protocols is because that’s what they teach in med school. The doctors that actually learned it could be done differently are the curious ones — the ones who took it upon themselves to do some specific research, attend specific conferences, continue to learn new techniques, study under someone who knows more than them. There’s a huge difference between your average doctor and the doctor who became curious and learned more than what they were assigned at the time.

Tasha: I think there is a culture with IVF that good enough is good enough. Because if you only do good enough, you have to do more IVF. And it’s only 2% to 27% of Americans who have IVF covered by insurance, and people do it on average 2.3 to 2.7 times at roughly $23,000 a pop.

My first round of IVF — again, 33, everything is great with me, 15 eggs — and I had like two poor-looking embryos the first time. Nothing happened with those. And when I said what happened, the answer was basically: I don’t know. Pay me again and we’ll try again. That’s your option. There’s a huge lack of accountability, a lack of transparency, and no insurance covering it. It’s such a big business.

That’s where I’m really hoping the education I put out on my podcast — IVF Uncovered — as well as some of the things coming out later in the year, can really change an industry. When every IVF patient knows this information, it has to change for the better. Because they start advocating for what they want, and if the doctors are not willing to play ball, they find a new doctor.

Lisa: And this is why we need a team. There’s a large percentage of women who get a crash course in all of this fertility-related information when they’re already two steps before IVF, because they’ve been trying for quite a while. I take it even before that — even when we’re teenagers, we should be learning about our cycles, about our fertility, how it changes over time, about contraceptives, the impact they have on our overall wellbeing. We should learn about that delay in the return of normal fertility so that when we’re coming off contraceptives we can incorporate that into our plan. And we should obviously learn about nutrition and the role of preconception nutrition and fertility, male factor, the key nutrients and foods that really support optimal fertility. Because I believe we could be the dream team. We could reduce the number of couples who need IVF, and then those who do need it, we could further optimize.

Tasha: If I had it my way, every client would have done your program — that further optimizes it. And maybe some of them get pregnant on the way, but the ones who don’t — if they can work with you for six to 12 months before, and then come in — it would be worlds colliding in the best way. It would mean less IVF, I think, for most.

So many of my clients have suddenly gotten pregnant naturally while preparing for IVF because I believe so strongly in the work of getting your body from survival mode to reproductive mode. It just is the formula. This is what I’ve studied and researched.

And I always say there is no such thing as unexplained infertility. That just doesn’t make sense, unless you were born with reproductive organs that were compromised in some way — you’d know about it.

Lisa: For the listener who tuned in for that reason, maybe share your top two or three takeaways for someone who is doing IVF.

Tasha: I would say it has to be equal science, survival mode, shift, and spirit. When you are in a cycle of fear and sadness, a lot of body shaming, a lot of judgment mostly on yourself, that just makes it harder. And I don’t believe in “think positively and positive things happen.” I think if you have clarity, you’re going to have confidence. If I give you clarity of what can optimize your IVF, that brings natural confidence. We always know there are things we can’t control, but what we can — we are doing that before you invest your time, money, egg reserve, energy. Number one: give it equal parts science, survival mode, shift in spirit.

And number two is, if it doesn’t feel right, it’s not. And this is absolutely for your clients as well. Any physical or mental ailment — like your period. If it is not easy, there is something off. Even picking a doctor — I don’t care what his or her name is and what clinic they’re at. First thing I tell my clients when they have met a doctor, I don’t ask what they talked about — I ask, how did you feel? Trust your instinct. Listen, be quiet, listen, and feel.

And it’s not free. It gets to be such a big investment. It’s like a car — a good one. If your doctor isn’t giving you the good vibes, leave and find another one, because that’s a lot of money to be spending to feel like crap when you’re speaking to somebody about something that is so integral, like building a family. Your brain wants you to be comfortable, and some people will forego what is right for comfort. I’ve had that many times — “Oh, it’s such a pain to change doctors.” No, call them. They’ll take you in a second. You would never go back to a hairdresser that chopped off your hair, or a sleazy car salesman. But for a doctor, they could be rude, ignorant, put you down, make you cry, and you’ll still go back. Stop that. Because those really famous ones on the morning breakfast shows — you can walk out of their offices too, honey. We give you permission.

What’s a pain is doing IVF over and over and over and never getting anywhere, and then all of a sudden it’s now you need to pay $50,000 for an egg donor. That’s what should be considered the pain.

Lisa: Tasha, where can everybody go to find you?

Tasha: IVF Uncovered is my podcast. I think the best thing to do is go to my website, TashaBlasi.com, and there is a quiz that you can take where you just have to answer a couple of questions, and I give you customized resources. Are you doing an egg retrieval or a transfer? Egg retrieval, low egg reserve, high egg reserve — that gives you just so many free resources. First step: go to the website and take that quiz and you will get customized free resources immediately.

Lisa: Awesome. Well, thank you so much for being here. This has been such a great conversation.

Tasha: Thank you for having me. And congratulations on your amazing book. I used to give my clients the Real Food for Pregnancy book all the time. Now I will be gifting Real Food for Fertility. I’m so happy that Lily and you collaborated on that.

Lisa: Well, thank you so much. Everybody buy the book — it’s such good stuff.