The standard infertility timeline does not apply to every patient. When should infertility counseling begin, and when is it risky to wait? OBGYN Dr. Nicole Faulkner and REI specialist Dr. Jennifer Kulp Makarov discuss how age, irregular cycles, endometriosis, recurrent pregnancy loss, and male factor infertility should shape counseling and referral decisions on this week’s episode of the BackTable Women’s Health.

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Timestamps

00:00 - Introduction
02:37 - Launching a New Practice
04:23 - When to Refer Patients
06:23 - Basic Infertility Workup
08:39 - Counseling Patients Over 40
14:05 - Personalized IVF Protocols
17:59 - Embryology and PGT-A
23:54 - Egg Preservation Timing
28:20 - Using Frozen Embryos Later
31:36 - Components of Personalized IVF
33:30 - Patient Experience and Education
37:25 - Alternative Fertility Options
40:46 - Approaching Recurrent Miscarriage
42:28 - Key Takeaways

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More about this episode

Dr. Kulp Makarov reviews when patients should be referred to an REI based on age, while emphasizing that earlier referral is appropriate for patients with irregular cycles, endometriosis, recurrent pregnancy loss, or known male factor infertility. Although anti-Müllerian hormone (AMH) testing can be a useful initial assessment, it should not delay specialist evaluation. The discussion also explores how advances in reproductive medicine have expanded fertility treatment options. Dr. Kulp Makarov highlights personalized IVF protocols, embryo banking, and preimplantation genetic testing, while emphasizing both the benefits and limitations of these approaches. She also shares practical guidance on egg freezing, pregnancy in the mid-40s, and when donor eggs, gestational carriers, or other fertility treatment options may be appropriate. Finally, she explains how REIs approach the evaluation and management of recurrent pregnancy loss.

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BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

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