What Chipotle Can Teach Us About Disappointing IVF Cycles

What does a messed-up Chipotle order have to do with a disappointing IVF cycle? More than you might think. In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols uses the burrito analogy to explain an important concept in fertility treatment: one bad outcome does not automatically mean the entire plan was wrong. Sometimes the issue is not the whole recipe, but one part of the process — like trigger timing, fertilization method, sperm quality that day, lab variables, or another unexpected outlier.

Dr. Amols breaks down why patients often feel the urge to change everything after a poor cycle, and why that is not always the smartest move. Instead of overhauling a protocol just because the outcome was disappointing, it is often more important to carefully review each step of the cycle and identify what actually failed. Was it poor maturation? Poor fertilization? A sperm issue? A timing issue? Or just a bad batch and bad luck?

This episode walks through how IVF protocols are built, what stimulation medications actually do, what they do not do, and why small targeted changes can sometimes matter more than a complete overhaul. If you have ever had a disappointing IVF cycle and wondered whether you should change everything next time, this episode will help you think about it more clearly and have a better conversation with your doctor.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about what Chipotle burritos can teach us about disappointing IVF Cycles. I'm, Dr. Mark Amols, and this is Taco about fertility Tuesday. I love Chipotle. I don't mean just like, like it. I love it. I've actually made it in my house. I found the copycat recipe, made everything. It was unbelievable. I can truly say I am a barista. But what does that have to do with fertility? Well, surprising. My experience at Chipotle can be very similar to experiences in fertility. Let me set the stage. Now, if you know me, I am a creature of habit. I literally eat the same Chipotle every time. And it's not your basic recipe. When I put on those fajitas, I literally tell them, whatever you think is a ridiculous amount, put that on, and then keep putting some more. So it's a very specific recipe that's for me. But if anyone knows, if you've ever ordered online, sometimes you don't get your burrito the same way. Or sometimes you get someone there who doesn't. It doesn't make it right. I'm not paying attention because maybe I'm helping my son and all of a sudden the wrong salsa's on it. Or maybe something's missing out of it because I wasn't paying attention. Or potentially the worst thing that could happen to anybody. A wrapping disaster. Now, joking aside, obviously it's not the end of the world. I mean, technically not, because my burrito, was ruined. But the thing is, I noticed that the burrito was made wrong. And so next time I go back to Chipotle, I'm not going to change my entire order and go, well, that didn't work last time. No, because I recognized that it was not the burrito that was bad, but the way the burrito was made. And today we're going to talk about that. When it comes to IVF Cycles or IUIs or other treatments, we tend to look at the outcome, meaning how, did the burrito taste? But we have to also look at how did we get there. And if some of those things were bad, we can't look at the whole experience as bad, but we have to realize that parts of it were bad. And that's what we need to fix. And in that way, we have a better chance of improving it again. Let me give you an example. I had a patient the other day who went through ivf, and in her IVF cycle, we went and did standard insemination. It was the right choice. The sperm was good. Everything Looked fine. Now, standard insemination is when we put the sperm on top of the eggs, we don't inject them in. And unfortunately, almost none of our eggs fertilized. We were down to maybe one or two embryos out of something like 16 eggs. And that led us to just one embryo. And more to the story, that embryo ended up being a day seven embryo that was frozen as a blast assist and then layer transferred and unfortunately did not work. Now, it would be easy to look at that and think, we need to change everything because that didn't work. It's not unreasonable to think, let's add everything, let's throw the kitchen sink at it. Because again, we're looking at the outcome. We're saying it didn't work. So something in that made it didn't work. So let's get rid of the whole thing. But I love my chipotle burrito. I am not going to give that up when something outside affected it and it wasn't the actual burrito that I usually get. And the same principle here is we have to look at that cycle and go, what was different? Where was the step that things went wrong? Now, sometimes we don't know the future steps, right? Let's say we do icsi, we fertilize them, and then we find another problem that can happen. And that's difficult because if you fix something and it still goes bad, then you're going to feel like, why didn't we do everything? But the problem with doing everything is that then you don't know what worked. The point is, the reaction is completely understandable, but it's not always the best reaction. What's more important is to look at the cycle and go, what went wrong? And we look at each part, each looking at the priming, looking at the stimulation, looking at the culturing, the fertilization, all of these steps matter. So let's break down that cycle and talk about it for a little bit more. So what is the point of the priming? Well, the priming is to get the ovaries ready for stimulation. We want to synchronize them and upregulate receptors. So we look and go, well, did that work? Well, if there was a nice cohort together and it didn't look like there was any major effect, I'd say yes, even if the cycle didn't go well. So then we look at the stimulation. Did we make the number of eggs that we anticipated? So, for example, if there were 16 follicles at the beginning and 16 follicles grew, then I would say that's a success. Now, obviously, if there are eight or nine other follicles that were behind it and didn't grow, I would say that's not a success. And then I would want to change that protocol, with one effect, specifically, the stimulation. But if someone only had eight eggs, and eight eggs grow, but let's say a cycle before they had 16 follicles, and they say, well, I only made half the number. Well, that's true, but you didn't make half the number because of the protocol. You made half the number because that's all that was there that month. The part you can control is how many were there, just like I can't control who is making my burrito. Unfortunately. Now, by all means, if you have 16 follicles and only eight grow, yes, that may not be the right protocol, and there may not be a protocol for you. There are some women who are near menopause. It doesn't matter what we do. Not all the eggs are going to grow. And just because something happened a year before doesn't mean it's going to happen now. Disappointment is completely understandable and reasonable, but it's important to look at the details before just changing things up. The way you want to think of a protocol is you want to think of the different parts of the protocol. The protocol has a lot of parts, like I said, priming stimulation, whether you do ICSI or whether you do standard insemination, whether you use a Zymod chip, all these things play a part. So if your stimulation wasn't good, then you add more medication. You may change the protocol to maybe a coflar protocol. If you had early recruitment, you might even add a pre antagonist or start in the luteal phase. There are many different ways to do it, but you have to look at what was your situation, and you have to recognize it wasn't just the entire protocol, but parts of it. One of the things I'll see sometimes is I will have patients who will hear about people who, who have a great response with certain protocol and say to me, oh, can we do that? I tell them, yeah, I'll let you do it. But I'm not going to recommend it because just because someone else had that experience doesn't mean you're going to. Just like, if someone tells me, man, I really like the al pastor chicken. I know I'm not going to like it because I like what I like. I'm not going to just do it because it worked for them. And I Know that my burrito didn't taste well because it was the wrong person making it. Well, if you have someone who has a high FSH level, for example, and, you need to get more eggs, you're going to need to do something, such as adding letrozole, clomid, and you want to reduce suppression. But I'll, have patients come to me and say, well, I want to now start in the luteal phase, which is great. The problem is, in the luteal phase, your pituitary is going to be suppressed. And now you can't use letrozole, the one thing that you need because you have a very high FSH of in the 20s. Or I'll be told, can we use a low dose protocol, which I'm, fine with, but you're going to make less eggs. That is established even by studies. So it's important when you're looking at the protocol. No one is saying you should never change things. But what I'm saying is that you want to look at what was the problem and what things should you change. The amount of medication you use cannot make your egg quality poorer. Now, there is a small exception with certain people with pcos with severe insulin resistance. But for most people, that will not be true. Maturity and fertilization do not depend on so much the stimulation. It does depend on when you trigger. It may even depend on what type of trigger shot you use. The point is, small targeted changes can matter more than the complete overhaul. If I notice when Gary makes my burrito, it's a little bit dry. I know. I'm going to tell Gary to put on some more of that tomatillo sauce, because Gary is a little cheap with the sauce. What I don't do is overhaul my perfect burrito. The important thing to take away from this is one of the things we do with all our patients. If we ever have a failed cycle, we go through it. And the reason we go through it is because then we can talk to and identify where were the problems. Was it a problem with maturation, fertilization? Was there a sperm issue that day? Do we think the trigger timing can be off? Maybe the type of fertilization is poor? Could there have been something in the process in the lab? For example, maybe last time you did IVF and this time you did ivc, and you're not a good candidate for ivc. And sometimes it's just a true outlier case. The point is, before changing everything, figure out what actually failed. Yes, changing everything feels great, but that doesn't mean that's always what's best for you. So let's go over a couple situations that might be helpful for you to talk to your doctor with. Let's say you had pore maturation. Well, then maybe the trigger timing or the trigger type needs to be adjusted on the whole protocol. Adding Menopur might be beneficial, but in reality, maybe you just need a trigger a little later. Maybe you may benefit from a dual trigger, such as Lupron, N HCG or even a higher dose of hcg, as long as it's safe. Maybe the fertilization was poor. Maybe you should use ICSI or maybe a Zymon ship because that can help the sperm reduce DNA fragmentation. Or maybe you had a poor cycle and after transfer, it didn't go so well. And when you didn't get corrected, it feels like every time it hasn't worked, you need to change something. But then you realize that that time you had a day seven embryo. And we know that day seven embryos have a lower chance. And so the question isn't so much what made the day seven embryo, because there are many things that can do that. But the point is, the expectation that should have worked is going to be down. And so it's important to look at that and go, okay, I need better quality embryos. That's what I need. And that's what we need to fix. That would be like the equivalent of getting your burrito from Taco Bell and then upgrading the Chipotle. That's a better burrito. And so you have to look at your situation and say, is it the clinic? They can be a good clinic. And maybe you're just not a good candidate for that clinic. Maybe for some reason your eggs don't do as well there. Maybe there's some exposure that you have that you're not realizing. And sometimes it's just a bad batch of eggs. It happens. We know this. We know when people have a good batch of eggs that they will actually get pregnant again with those eggs. And other people who have a bad batch of eggs, they might get one pregnancy out of that. I've seen people with different batches where they'll get multiple pregnancies from one batch and maybe just one from the other batch in the end. What Chipotle can teach us about fertility cycles is that the wrong salsa is put on your burrito. You don't switch to a salad. You fix the salsa problem. The point is, don't let one abnormal cycle trick you into thinking the whole plan is bad. Yes, sometimes you need a new recipe, but sometimes you just need a better burrito maker, a timing adjustment, or a small tweak. Hopefully this episode was helpful for you, or maybe it might be helpful for one of your friends. If you like this Always tell your friends about us and pass the word about this podcast. The overall story we should learn from Chipotle is when the IVF cycle goes poorly, the question is not what can we change? The question is what actually needs to be changed? That will do so much more for you than just changing everything. But as I always say, talk to your doctor. If you had a cycle that wasn't good, you should always follow up with your doctor so you can figure out what those things that need to be changed are changed. And it's never wrong to tell him if there's something you want to try. Even when I'm completely against something, I, will let a patient know. As long as it doesn't harm them, I'm willing to try it. But I do tell them I don't recommend it. I'll explain why you are allowed to be an advocate for yourself, but it's important to also hear what your doctor is saying and then take the time to evaluate that. Well, if you love this episode or even just Taco about fertility in general, please give us a five star review on your favorite medium. Tell your friends about us to help build our listener base, but most of all keep coming back that I look forward to talking again next week on Taco Belt Fertility Tuesday.