Recurrent Pregnancy Loss: What Your Doctor Should Evaluate After a Miscarriage | Dr. Gerard Barroso

Dr. Barroso: [00:00:00] I always explain recurring miscarriage in, you have a box and the box is divided in two. 35 percent of the pregnancy, no matter it's natural, insemination or fertilization, 35 percent is the chromosomal, the genetic health of the embryo and the rest is a house. So, what is going on in the house? 

Dr. Brighten: It's so much easier in a 20 something to start to course correct hormones than it is in the 30 something.

And especially as we get older and nearer to perimenopause, it can be more difficult to make those corrections. And so, do you feel like some of these really lend themselves to people not getting the extensive investigation they need about their own reproductive health? 

Narrator: Dr. Gerardo Barroso Villa. Is a world renowned fertility expert and reproductive biologist with an impressive pedigree.

Narrator 2: Trained at prestigious institutions like the Jones Institute for Reproductive Medicine and Cornell University. 

Narrator: With advanced expertise in microsurgical male factor treatment and IVF techniques along with a doctorate from Eastern Virginia Medical School. [00:01:00] 

Narrator 2: Dr. Barroso has over 2, 500 international citations for his research and serves as an ad hoc reviewer for leading medical journals.

Narrator: A member of esteemed medical academies and a national researcher for the SNI, he is a leading force in reproductive medicine. Known for his cutting edge approach and unwavering commitment to advancing fertility science. 

Dr. Brighten: When you look at sperm, KPIs, DNA fragmentation, what are you looking for? What should people know?

That if their doctor has run some of these tests that, you know, if you've got these parameters, we need to interview them.

Welcome back to the Dr. Brighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most up to date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment or share this with a friend because it helps this podcast get out to everyone who needs it. All right, let's dive in. Dr. Barroso, welcome to the show. Thank you. I'm so excited. You know, I was sharing with people that, uh, somebody was putting a baby in me and it was you and you're not my husband.[00:03:00] 

Sounds weird. It's so weird, right? When I said it, I was like, this is so weird. But then all of these women started sharing. They're like, Here is the woman who got me pregnant, here is, and they were sharing their doctor and they're like, yeah, I thought the same thing, but I never said it out loud because I didn't want anyone to think I was weird.

I was like, well, I'll say the weird things. Thank you. But you're him. You're the guy. And you're here. And I'm so excited. You are. Yeah. So I want to, we're going to be talking today about some of the newer technologies. In IVF, and I think we have really exciting things to cover, but I think where we should start is talking about the concept of unexplained infertility, the definition of fertility, and I'm curious from your perspective, When couples are told it's just unexplained, how often do you think they're getting as thorough of a workup that you do or going through some of these technologies?

Dr. Barroso: Thank you so much. I Lemme start with the definition of infertility because we have a [00:04:00] misconception. Lemme challenge you. Infertility become a definition, a disease. In 2010, according to the WHO, you have to try for a year and see what's going on before you start looking for a diagnosis, using any tool for, for treatments.

But besides that, is it really, we have to wait a year, six months, it's more dynamic. 

Dr. Brighten: Let 

Dr. Barroso: me, let me explain to you. If you have. A couple. 38, your soul. One ovary with some endometriosis and you have something in the sperm. Do you really are gonna wait for a year to start doing something? 

Dr. Brighten: Mm hmm. 

Dr. Barroso: The other side, the other side you have a, um, [00:05:00] a couple.

26, 25, the both of them, and she got, uh, antemurian hormone, the ovarian reserve is very low. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: Yeah. And PCO, we have a polycystic ovary, you have overweight, you have all these hormones running all through, and the quality of the egg, we know, is not the best to get pregnant. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: So, under my point of view is.

Doctor, because it's not a reproductive doctor, your first contact, mainly your primary or the gynecologist, but they just have a perception and the perception kills because you really don't have the real picture. Of what's going on on their day fertility condition. So for me is, by the time you're clear, [00:06:00] got to get pregnant, you're looking for a family, start doing your research.

You have to see if everything is working well, not because you're looking for something bad. Is really everything working well, the sperm is working well, you have your tubes working well, you have any infection, SGD, or endometriosis, or if you have some overweight, you're related with polycystic ovary, so we have to define that everything is working as natural as we're looking for.

If it does. Well, we can look for in a specific treatment and maybe will be some medication for gyrochiroid or some, uh, antimicrobial, uh, drug [00:07:00] for infections. But if you have. Your tubes are obstructed. You're not going to thrive for a year. 

Dr. Brighten: Yeah. 

Dr. Barroso: You have a very low count of sperm. Yeah, we have to do something.

Yeah, before that. So, as I said, we have to get as far as we can the real picture for the fertility field. 

Dr. Brighten: Yeah, and I appreciate, so a few things that you brought up, hypothyroidism, being worked up, being looked at, polycystic ovarian syndrome, as we call it in the States, and endometriosis. These are two leading causes of infertility, and we know that these conditions often go overlooked, underdiagnosed, and so often, women go to their doctor and they really get triaged in this way.

The doctor says to them, Do you want to have a baby right now? And if you say no, then your irregular periods, your [00:08:00] acne, your painful periods are often met with just birth control. And that woman is never told, well, you do need to think about your future fertility. And so I appreciate you bringing that up because if you are 20 something and you know that there are signs of PCOS, It's not best just to delay and to think, well, you know, like a lot of doctors tell women like, we'll just deal with it when you want to get pregnant because insulin resistance can keep going, uh, the, the testosterone issues, how it impacts regular ovulation.

And it's so much easier in a 20 something to start to course correct hormones than it is in the 30 something. And especially as we get older and nearer to perimenopause, it can be more difficult to make those corrections. But the other thing I'm hearing you say is that. It's not just the female factor we have to think about, we also have to think about the male factor.

So I definitely want to get into that more today, um, and I'm going to have some questions for you about sperm and testing. What I am curious about, so the [00:09:00] definition of infertility being if you're, you know, in your 20s, under 35, you try for six months and You don't get pregnant or over 35 you try for a year.

You don't get pregnant and The other thing I wanted to bring up is recurrent pregnancy loss So often it isn't until your third fourth miscarriage that a doctor will finally say well Maybe we should look into why that is and so do you feel like some of these? Really lend themselves to people not getting the extensive investigation.

They need about their own reproductive health. 

Dr. Barroso: Yes, they do for the When we talk about endometriosis or polycystic ovary, everything is related 

Dr. Brighten: and 

Dr. Barroso: infertility is a chronic disease. It's related with time, 40 years ago, there wasn't any infertility. Doctors doesn't know about it. Endometriosis, 

Dr. Brighten: polycystic 

Dr. Barroso: ovary is a [00:10:00] new entity.

Why? Because our parents, grandparents, they got pregnant before the 20s and around the 30s, they ended with the conception to get a family. Today, we delay the time. So with this, everything comes in a chronic condition, endometriosis. Growing continuously, polycystic ovary related with, uh, insulin resistance is every, uh, even worse.

And, um, today we don't have this. Under diagnosis, uh, entities. Yeah. We, we, we are losing the, the, the chances for a better quality lifestyle 

Dr. Brighten: mm-hmm . 

Dr. Barroso: To impact over your protein, uh, issues. Like okay, you have istic [00:11:00] o ovary. I have a doctor 20 years ago used to say, oh, I have a patient. That is going to, is going to be a egg donor and he's a publicist and they have 20, 25 eggs and say, I'm so happy.

I say, I'm not because the quality of the egg is very bad for every 10 eggs. we retrieve for those ovaries, only one or two are healthy. So it's really a, uh, a condition that we kind of, we have to stick today. It's not just doing in vitro fertilization. If you don't have the control for, for the weight, Insulin resistance, supplementation, even before you start a ovarian stimulation, you have 40 percent chances [00:12:00] for not the best outcome during the treatment.

So you have to do something before the treatment. When we talk, you ask about a miscarriage, recurrent miscarriage, I always explain recurrent miscarriage in. You have a box and the box is divided in two, 85 percent of the pregnancy, no matter is natural insemination or in vitro fertilization, the 5 percent is the chromosomal, the genetic healthy of the 

Dr. Brighten: embryo 

Dr. Barroso: and the rest is a house.

So what is going on in the house? Most of the time, the doctors say, by definition, you have to, to last at least two pregnancies before they start looking for the problem. And I say, why, why we have to do that? [00:13:00] Even if you have the first miscarriage. Take the tissue, make the chromosomal analysis, and see if everything was as expected.

Some genetic abnormality means Down syndrome. If it, if it's not, where is the problem? We have to look at the house. Materials we have to see if you have any scars into the uterus. Most of the time in the United States, they have a previous, uh, miscarriage or you have to use some cur mm-hmm . 

Dr. Brighten: So 

Dr. Barroso: create some, um, scars into the, the endometrium and you can't see that.

It's nothing you can see that, yeah, or you have some, uh, blood disease like 

Dr. Brighten: germophilias. 

Dr. Barroso: Okay. So we have to be in the correct site to, to, to [00:14:00] look into the house or into the embryos. When in, in our population, germophilia is a real issue. 

Dr. Brighten: We 

Dr. Barroso: look for, uh, HMTRP, we look on the, uh, To the tree, a factor related with the thrombophilia, even though if you got pregnant and you have thrombophilia, you have the risk for prematurity or preeclampsia or.

Other placental disorders. So we can, when we use the correct therapeutic tool, we have the chances to correct them to get forward in the pregnancy, yeah, to get a healthy baby. 

Dr. Brighten: So I think this is a great time to talk about endometritis. Because this [00:15:00] can be a big contributing factor to recurrent pregnancy loss.

This is something I know that you test for, I was tested for. So as we talk about endometritis though, I think we should do it, we should sparse it out with endometriosis because people get those often confused. So when we talk about endometriosis versus endometritis, what are the difference between those and what should people know about endometritis?

Dr. Barroso: Well, it's a big difference. Endometriosis became for your regular men's during that time you expose all this blood and tissue, but some of them have a reflux. into the tubes. So all this blood goes through the tubes and reaches the ovaries, the, the, later, all the pelvic organs. Blood [00:16:00] is very irritative.

Monthly, every month, you have this reflux and create scars. At the beginning, no matter if you have, because we have stages from one to four to mild, moderate or severe, no matter which, which stage you are, you have a chronic inflammatory condition. So impaired with the motility of the sperm, the tube, the diameter of the tube is, is One of my hair.

Dr. Brighten: Which is looking lovely after surgery today, I must say. 

Dr. Barroso: Right. So increase the chances for blocking the interaction between the sperm and the egg. So we have to do something. The other side, endometritis. We know in the United States and many other countries, STD is [00:17:00] a very pandemic condition. No one can escape from that.

If you say, well, I check my vaginal cultures and everything is fine. Yeah, but it's not. For the last 20 years, we believe that the endometrial cavity was sterile. It was not. No. No. No. So we have to find a specific, we perform a specific, um, test to look. For those chronic infections, we call the ALICE, so the ALICE has the chance, this very advanced technique, genetic technique, where we can look into the cavity and find if you have the, this condition.

Also, okay. You have the, the infection, and many times you, we, we, [00:18:00] we are people who, who likes to, to take some, uh, antibiotics. 

Dr. Brighten: Mm-hmm . 

Dr. Barroso: For everything. For the flu, for the gastroenteritis. Yeah. Everything affects. 

Dr. Brighten: Mm-hmm . Affects 

Dr. Barroso: your microbio. 

Dr. Brighten: Yes, 

Dr. Barroso: your natural barmy. So we have, we require this balance into the microbio, into the uterus.

The CEUs is have to be according for the healthy, eh, relationship with the embryo. 

Dr. Brighten: Mm-hmm . 

Dr. Barroso: So now we know that we, we have found that. Some of the patients, they have a great, beautiful, genetic test embryos, they don't get pregnant. And they found that they don't have any 

Dr. Brighten: lactobacillus, 

Dr. Barroso: or they have an infection also, yeah?

[00:19:00] That is, when you repeat all this paginal examination, we never found something to help us to recover. treat and make to, uh, make apart infections and start looking to create the best environment for, for, for the embryo. 

Dr. Brighten: Mm hmm. Well, I love that you bring up that what affects your gut health is going to affect the reproductive microbiome as well.

And so people understand the gut microbiome, we want to be very diverse. Diversity is a sign of health. The endometrial microbiome, we want almost no diversity. It needs to be 90 percent predominantly lactobacillus species. And so you mentioned the Alice test. So there's Alice and Emma. Those are done by endometrial biopsy.

Is there any sign outside of that that someone would know that possibly they could have endometritis without doing that testing? No, really. There's not. So, Why is it that we don't see more [00:20:00] clinicians doing this testing, making sure that the health of the uterus is optimized, not just the health of the egg.

I feel like, uh, when it comes to fertility, there's still so many doctors that reduce everything to just the egg. And I like to say that women are both the seed and the soil. We are going to provide the egg, but sperm matters as well, and we're going to talk about that. But there's also the soil, and the soil has to be healthy.

The microbiome, as you mentioned before about supplements, your nutrients, the amount of inflammation, all of that can really determine whether that healthy embryo implants or not. 

Dr. Barroso: Yeah, I believe it's, it's related with the, how the doctors. are, they think in, in, in our organization, let me explain, sometimes it's not a medical issue.

You start doing [00:21:00] more than 10 years ago, PGTA for everyone. 

Dr. Brighten: Okay, but define what PGTA is so people know. Sorry. 

Dr. Barroso: PGTA. No, it's okay. It's the test that help us to recognize some chromosomal abnormality, some genetic disease. Um, we have a 20, 25 percent in our best condition to get pregnant. And the question is why?

Is because not of. All the eggs or sperm is healthy, so when we have the health of the DNA for each one and grows all these chromosomes, um, you get a healthy embryo, for some, for some conditions, you get not. Like down syndrome, Blaney Further, Turner, uh, syndrome. Um, when I were talking with my team, I say, we want to perform [00:22:00] PGTA.

Dr. Brighten: All right. 

Dr. Barroso: This pre implantation genetic test. But some of the papers say should be over 30 or some of them say no more than 35. Yeah. 

Dr. Brighten: Yeah. Yeah. 

Dr. Barroso: Yeah. This. Yeah. Yeah. Yeah. That science is not. And the society is. Yeah. 

Dr. Brighten: Every year saying something different. It's different 

Dr. Barroso: because science is not static and it's not perfect.

But the decision is not related with science, it's related with, uh, information. As much information you get, you can decide because infertility is so many variables. You got appendicitis, okay, make your, your ultrasound or, uh, whatever, uh, image tool to do this site. And you have a diagnosis and a treatment for [00:23:00] infertility, you just have variables.

You have factors. Yeah. And no one knows if you have to do surgery, laparoscopic, open or insemination, or you have to try to the six months, uh, regular intercourse or insemination or in vitro fertilization. Why? You have to decide what is going to be the platform related with the information. So the decision is if you have as much information, you have the power for decision.

If I know how is a microbiome, if I know you have, have that endometritis, a healthy embryo with PGTA or, uh, uh, thrombophilias. Our chances to get pregnant increase dramatically because it's, you say, it's the percentage of [00:24:00] the, the, of one population. Yeah. The, the, the patient don't want to be in statistics.

You're looking for objective. So that's why we have to do. 

Dr. Brighten: Yes, and that's why I love your approach because it's very data driven. I'm a big fan of trying to gather as much data as possible and it's very bio individual. And I feel like so often I run into clinicians who are like, well, this is what the research says and we just stick to that.

And it's like, well, you have to interpret it in the context of the individual who's sitting in front of you. We can't just say, well, statistically speaking, this is what's true for somebody who's 35. Well, Like if we just look at who actually will go into studies, they're very different than the average human being usually.

Um, you know, you look at even the studies that are done in like 20 somethings, they're usually college kids. They're living a very different life. So we have to understand that the individual data should be [00:25:00] driving these decisions and that's. Something I really appreciate about you and, you know, to your point about the endometritis, so I want to circle back to that, you know, because I was reading statistics about it, you know, miscarriages we related 20 percent of the time to the uterus and 30 to 60 percent of the time we've got endometritis going on when there's been this recurrent pregnancy loss.

So. Who would be at risk for endometritis aside from maybe you had a really good time in college, you may have contracted an STI, but what puts you at risk for endometritis and how do we treat that? How do we restore the microbiome? 

Dr. Barroso: As I said, if by the time you, you test and you don't have to be infertile.

Mm 

Dr. Brighten: hmm. 

Dr. Barroso: I have a patient who, she, she got pregnant, uh, she delivered a baby, it was kind of complicated, and she got an infection after the, the delivery. She can't get pregnant two [00:26:00] years after that. And No one can find what was the problem. And we were talking, I say, yeah, how was your, your, your delivery? Was, uh, was a c section, yeah, was a c section, but I have an infection.

I say, did you, right? I perform analysis. She got a pretty bad infection. Into the uterus. Just a chronic. Not symptoms, no high temperature or something and no lactobacillus. So, we treat the, we treat the, the, the infection and start doing our supplementation. 

Dr. Brighten: And we treat the infection with the antibiotics, so everybody's clear that there is a time and a place for antibiotics.

Dr. Barroso: Always, always, when you treat an infection, you have to start with, with [00:27:00] lactobacillus. You have to, to recover this microbiome because you're going to kill it. So two months later, she got pregnant spontaneously. Yeah. But you have to think there is, I like, I love to work with processes. My head is working in process and in process we define these KPIs.

key performance indicators for me. So easy. My first, 

Dr. Brighten: this, this is where the MBA steps into the treatment room. Absolutely. 

Dr. Barroso: Something that changed my mind because I always. I have a question for, for, for my team. I say, you are living in Mexico in a place we call Istapalapa. 

Dr. Brighten: What does that mean? 

Dr. Barroso: Istapalapa is a low, [00:28:00] low, um, resource population in Mexico.

So you have 5, 000 diabetic, uh, patients and you only have. Three endocrinologists, how do you attend 5, 000 diabetic, uh, people with three endocrinologists? And I say, we don't know. Well, what about if you have regular physicians, you have a nutritionist, you have the therapist and you have a protocols for each one.

And you apply the one that required insulin or not insulin is a medication. What kind of medication, everything is in a process and behind for some really drastic condition patients, you have the endocrinologist, yeah, but you have, you, you, you, the problem with the doctor [00:29:00] is you can do everything by yourself.

We are very expensive, uh, subjects. Prepare a doctor, gynecologist, and reproduction is very expensive. And also, if you have some period of time to work, if you do it by yourself, you're going to miss something. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: In our team, we have all these processes and we have this KPI. 

Dr. Brighten: I want to hear what these KPIs are.

I'm very interested. The 

Dr. Barroso: first one is, how is your ovarian reserve? 

Dr. Brighten: Okay. 

Dr. Barroso: You are 28, you're 38. 

Dr. Brighten: And that was the AMH you mentioned earlier, antimalarian 

Dr. Barroso: hormone. Antimalarian. Yeah. Please, do something. Um, did you find that your antimalarian hormone decrease is the time for looking for a pregnancy? Or free fix.

Dr. Brighten: Mm-hmm . 

Dr. Barroso: If you are. really certain that you, [00:30:00] you, you're going to be mom or, or that second always is a sperm. One of the first conditions for infertility is the male factor. We have a study from Fulvedium that they look from sperm in males from 1920 to 1994 and they saw a decrease in under 50 percent 

Dr. Brighten: of 

Dr. Barroso: Concentration and motility.

So we have to be sure that we're working with a good, healthy sperm or start doing something. 

Dr. Brighten: What do you think is impacting sperm? 

Dr. Barroso: A lot. 

Dr. Brighten: Yeah. 

Dr. Barroso: It's not just for looking for the positive pregnancy test because 20 years ago, we, we do everything just to get a pregnant. 

Dr. Brighten: Mhm. 

Dr. Barroso: Now. We're looking not just for the pregnancy, for a healthy baby, because the [00:31:00] placenta came from the sperm.

Dr. Brighten: Mm hmm. 

Dr. Barroso: So now in vitro fertilization babies, we know they born early, they have prematurity, they have diseases related with vascular disease, 

Dr. Brighten: aspergillamsia, 

Dr. Barroso: and? Everything is related with the, with the sperm. Yeah. So now we, we have to look and we are doing not just the regular semen analysis, like the concentration or motility or morphology.

We also can evaluate the fragmentation of the DNA and see how healthy or how it's going to impact during the embryo, uh, formation, you know, so, and we have another tools to select. The right sperm. We use some, uh, we call pixie. 

Dr. Brighten: Mm-hmm . 

Dr. Barroso: Is, uh, we use, uh, [00:32:00] hyaluronic acid to attach the more functional 

Dr. Brighten: mm-hmm

Dr. Barroso: Sperm before make the injection through Ixi into the X 

Dr. Brighten: and in ixi. You choose the sperm under a microscope. You don't allow the sperm to choose to, well, let me back that up. The egg gets to choose the sperm in a normal environment. Well, I shouldn't say normal, but in the natural environment and in the lab, ICSI is taking the sperm and actually choosing the sperm that will inseminate the egg.

Dr. Barroso: Yes, it's correct. And we do ICSI for everything. Because We know already with something is not working well, yeah, um, could be a molecular diagnosis because in vitro, okay, you're looking for a treatment, but also it's a diagnostic tool. You can see in every step what is going on and if you, you, you have to change something during the process.

So, um, uh, at the end [00:33:00] we perform the AXA because our last outcome is has to be to get this healthy PGTA. embryo before the embryo 

Dr. Brighten: transfer. When you look at sperm, KPIs, DNA fragmentation, what are you looking for? What, what, what should people know that if their doctor has run some of these tests that, you know, if you've got these parameters, we need to intervene?

Dr. Barroso: Usually the parameters have changed for the, for the last year or so. If you have below 15 million. of sperm more time. I mean, because you, you, you can have 15 million, you just move 

Dr. Brighten: 10%. 

Dr. Barroso: No, it's not work. Before that, we have to start thinking about insemination. Or even mitral fertilization. But also the question is, which one is better?

Because in the [00:34:00] school, everyone thought that they, you have to escalate, like stirs. You try naturally and then we're going to give you a pill, the clomid, or, and then we're going to start apply some injections, and after that, we're going to do insemination during the 80s. The, the, the, the, for the pregnancy outcome using IVF or dissemination was pretty much the same.

Dr. Brighten: Mm hmm. 

Dr. Barroso: 20%. Today, you still have it in unexplained infertility. For me, it is not unexplained, but 

Dr. Brighten: it 

Dr. Barroso: is because you're not looking right, but suppose you have unexplained. Do your KPIs, people. You have unexplained infertility, you have your 20%, but today with in vitro fertilization, we can reach over 70 percent chances to [00:35:00] get pregnant.

So, in vitro fertilization is also, um, very jealous, because When you start with this third process to reach after five years IVF, you lose any chances for your ovarian reserve. The best chance for in vitro fertilization is when you have a really good number of eggs, good quality, you're young. Yeah. And you have the best for, the best of view for in vitro fertilization.

That's why always you have to decide what, uh, which one is the best way for you. It has, it's not have to be just for the medical. People sometimes came and say, I don't have the guts to look for a pregnancy and see if it came with [00:36:00] some condition. 

Dr. Brighten: Yeah. 

Dr. Barroso: I have to be certain that it's healthy. I have a patient, well a couple, let me, let me tell you, they have this dwarf condition, you know, these little guys with big hands, so this genetic condition that you can transmit in the 50 percent of the cases.

So they came to me and say, we're going to do in vitro fertilization, uh, PGTA to look for this gene condition in the embryo. At the end, I got two embryos, one, one with dwarf condition, and the other one, uh, with No dwarf 

Dr. Brighten: condition. 

Dr. Barroso: Regular, normal, chromosomal condition. Some, we, we, we talk, um, we transfer the, um, [00:37:00] uh, the embryo, you say.

Dr. Brighten: You played normal genetics? 

Dr. Barroso: No. 

Dr. Brighten: No? 

Dr. Barroso: They came for the dwarf baby because they came from one population in Ohio that everyone was dwarf. 

Dr. Brighten: Yeah. 

Dr. Barroso: So they want the little dwarf baby because it's normal for 

Dr. Brighten: them. I love that. Yeah. It's a good story. So it's impressive 

Dr. Barroso: because if you realize, really, what's normal?

Dr. Brighten: Yeah. Yeah. 

Dr. Barroso: What's normal in life, yeah? So I learned a lot from, from, from this case. 

Dr. Brighten: I love that. Uh, so can we talk about supplements and about lifestyle? Because you mentioned for PCOS and then we've talked about sperm health. So I'd love to know like the top science backed supplements for egg quality and then sperm quality and especially in the context of if we're having [00:38:00] DNA fragmentation issues.

Dr. Barroso: I always say that the supplementation is important, but some people, some want, sometimes confused that put everything in the same line. So, you know, you have to live in Mexico and you have the Mercados, yeah, and these Mercados has people who sell you some species on the, like in G for fertility. Yeah. Yeah.

And this is miracle. Yeah. And I said, yes, everything is important. Just put in the right way. So you have circles, that is important, your healthy embryo, your endometrial implantation, but your diet, your supplementation, according to for what you have. So lifestyle is important. Obesity is important. You have to control your weight.

Sometimes the doctor avoid to talk about the, these because the, the, the, the, the, the The, the patients can [00:39:00] feel frustrated and do nothing around, but you have to do something. 

Dr. Brighten: Yeah. Well, and I think also when you go through the IVF process, like I did so much to try not to gain weight. I gained weight after the third egg retrieval, my endometriosis inflammation came on and then I went on Lupron, which was a glimpse into like how hard it is to be metabolically healthy in menopause.

And I think that also makes it difficult because as a patient. And I'm glad that I had, it brought humility into my life even more. I'm always grateful for it where I'm like, I was doing everything right, but until I really got the hormones, the endometriosis under control and worked on all of that, did things start to shift.

So I think you're right, doctors don't want to talk about it. And sometimes patients, they don't want to hear it because they're like, I'm trying. And it's like, well, let's, let's work together on that. 

Dr. Barroso: Yeah. Yeah. Because obesity, endometriosis, PCO, everything is. An [00:40:00] inflammatory condition, a chronic condition, and it's, it's, they have this disability and impair the quality of your gamete.

So even if it's an egg or a sperm, egg and sperm are so fragile 

Dr. Brighten: in 

Dr. Barroso: the men, if you don't Sleep well. You have ity. You work so hard. You have some, some eh prob troubles with your, your weight. We have seen that is changing constantly. 

Dr. Brighten: Mm-hmm . 

Dr. Barroso: It's not, it's not like the woman, like we can track. with the antimmunary and ovarian receptor and see how it's going on.

I can perform a semen analysis today and in three months can be different. So. 

Dr. Brighten: So this is like positive though because that means that you can shift your sperm roughly 72 [00:41:00] days to generate that. So if you're listening to this. This is what Dr. Barrosa recommends 

Dr. Barroso: for sperm. I mean, yeah, we have to live, we're going to live longer.

No matter what we do, we're going to, at least you have some real condition, cardiovascular or metabolic cancer. But if, if we don't, we're going to live longer, but, uh, at the end is under what conditions? Yeah. We have to take care of where, I mean, like. Doing some muscle. Today? 

Dr. Brighten: Mm hmm. Build 

Dr. Barroso: muscle. 

Dr. Brighten: Yeah. 

Dr. Barroso: Helps with the insulin sensitivity.

Mm hmm. Reduce your obesity, and I mean, realize that we have to do something better, not just for our fertility. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: For our life. And, uh, in men is so important. So, because always we look at the [00:42:00] woman and say, you have to do A, B, C, D, and just the men just never say anything. 

Dr. Brighten: Yeah. 

Dr. Barroso: We never look at the, for, for the, for the male factor and we have to, and we have to do some supplementation.

For example, for PCO, there are, there is very specific supplementation to, to this anaphylactic acid that increase. The chances to get a better, um, quality of the egg, I mean. It's not magic. It's not, you're going to start taking for a couple of weeks and wow, voila, you have a great eggs, not that we can start today.

We can work on, we can work on it and it's the same for, for the sperm. Sometimes, um, I recommend that no, not using the sauna [00:43:00] or these guys. They start in the bicycle, 30, 40 kilometers a day because it's going to damage the quality of the sperm, even decrease the number. So I believe it's important. 

Dr. Brighten: And the sauna piece, so we know that, um, as you bring this up and you were talking about cardiovascular health, you know, frequent sauna use is associated with a reduction in cardiovascular related risks.

So saunas do have lots of benefits, but. in the scheme of fertility, when you're, when you're under that high heat, that can be problematic for sperm production. 

Dr. Barroso: Yes, it is. Yes, it is. 

Dr. Brighten: People are gonna be mad if we take their sauna away. I know. Come on, you can do anything for a couple of months. Of course. Or reduce the time.

Um, and so riding, riding bike, uh, you know, anything that can, you know, be causing heat in that area. But also, you know, I've seen, um, I remember in, uh, [00:44:00] rotations seeing chronic proctititis, uh, just for people riding bikes. So people should be aware that there are certain things that are, they're healthy for all intents and purposes, but during fertility, it might not be the best.

Dr. Barroso: Today I'm using also hyperbaric chamber. 

Dr. Brighten: I almost did that before my egg retrieval, but I was having such a difficult time finding a place here. But do you do that before egg retrieval? 

Dr. Barroso: Yes, I do. It's behind the clinic. Stop. 

Dr. Brighten: See, I didn't even find your clinic. You have to get a better website. This is why we're doing this.

People need to know about you. I didn't even know there was one right there. But hyperbaric oxygen, I want to hear about that. And I want to tell you a couple other things that I did that helped my egg quality. Um, and we went from. zero embryos on the first retrieval to having three healthy retrievals by the third or three healthy embryos by the third.

But tell us about hyperbaric oxygen. 

Dr. Barroso: Hyperbaric case, when you [00:45:00] increase the atmosphere, when you breathe, the oxygen goes with the Carrier. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: The hemoglobin. 

Dr. Brighten: Yes. The red blood cells. So this one 

Dr. Barroso: is this carrier, this little truck going into the cell and gives the oxygen. When you are over 1. 7 atmosphere of pressure, you don't need this carrier.

By diffusion, the oxygen to go to the tissue and the cells. So what we're looking is to increase the oxygen into the follicular blood flow 

Dr. Brighten: and 

Dr. Barroso: in the endometrial receptivity, yeah, to have a more healthy cells. before egg retrieval or before embryo transfer. 

Dr. Brighten: I'm like, why did we not do this? I went from sea level to Mexico City, [00:46:00] which is like 7, 000 elevation.

I'm like, I should have done this. 

Dr. Barroso: Of course, naturally. 

Dr. Brighten: So hyperbaric oxygen, um, do you recommend so many sessions before the egg retrieval? I 

Dr. Barroso: have my protocol. Um, 

Dr. Brighten: do you have it in front of you? 

Dr. Barroso: Yeah, well, not, not, not my, uh, uh, when you go to the, to the chamber, 

Dr. Brighten: yeah, 

Dr. Barroso: those guys have, uh, has my, yeah, my protocol.

So there's 10 sessions. Yeah. You got insight. You can sit with, with your partner and start looking for some Netflix, a movie or some because it's around an hour. Yeah. And it's working well. 

Dr. Brighten: Awesome. 

Dr. Barroso: Yes. 

Dr. Brighten: So the, uh, the things that I did is I did NAD infusions. And so my first egg retrieval, I was shocked when we had no healthy embryos, no euploid.

We had, we made lots of embryos, . Right, right. We had 15 embryos and none of [00:47:00] 'em turned out it was so sad. Um, I remember and I was like, I remember I was in Paris and I was like, it's gonna be the best. And then I got the results and I was like, how could anything ruin a time in Paris like this Absolutely did

Dr. Barroso: So Right. Well it, 

Dr. Brighten: oh, but I went, um, I saw, um. A friend, I actually went to London and saw a friend there. He has a clinic and I did NAD infusions and I also started near infrared light therapy over my pelvis and that, the next retrieval we got one, which is to be expected, so people know it's like 90 days, whatever you do, you got three months later, so by the time we got to that three months later, that's when we got the 3 euploid and so that NAD, Really helps supercharge the mitochondria and that's where I focused my entire protocol around is that if we can get the mitochondria healthy, it should, in theory, because we don't have tons of research on this, make for healthier embryo [00:48:00] quality.

Dr. Barroso: Right. Right. So everything that can help us, uh, we use, you remember the, the PRP. 

Dr. Brighten: Yeah. I was going to talk about that next. I'm glad you brought that up. So we did PRP. Well let me have you explain, you guys don't say PRP here. You say the letters differently, but as soon as you were like, there's this treatment.

Takes your plasma. I was like PRP. I'm in let's do it. It's something that dr. Amy the egg whisperer She talks about like everybody who I think is leading in the field of fertility is talking about PRP uterine PRP. So what is it? Why use it? 

Dr. Barroso: Yeah. What's the magic? It's a platelet rich plasma. So it's an emerging, um, therapeutic option in IVF.

So what we do is during the preparation for embryo implantation, we took some, um, [00:49:00] blood from the patient, made the centrifugation to get some growth factors and some proteins. To enhance the chances for implantation, to change the environment, so now it's, uh, I believe it's, okay, we're working on it, and we have pretty good, pretty good outcome, and it's so easy.

Dr. Brighten: You 

Dr. Barroso: remember that we performed a sonogram to the blood sample and about 23 minutes later, we made the transfer for the, for the platelets. So, I mean, it's, I think it's a pretty good options, not really invasive. So, yeah. They're still doing some research. We're looking to measure some interleukin reaction to see if any, [00:50:00] uh, modifications still working in privates.

Dr. Brighten: So helping with inflammation. Improving quality of the endometrium and so people know the worst part about the entire thing Is that you have to do it with full bladder and that's really I think the worst part Because people are like when I shared that I was doing this people are like They're going to like put a needle into your uterus.

I'm like, no, no, no, it's not that bad It's just a catheter and a little bit of fluid and then you lay there for like 15 minutes It's just thinking about how you have to go to the bathroom, but, uh, yeah, so you've introduced this. Have you yet to do PRP ovarian injections? 

Dr. Barroso: Yes. And still our research is nothing to date than proofs.

That is really working. 

Dr. Brighten: And 

Dr. Barroso: I say that because unfortunately some people doing these treatments with no chances [00:51:00] for they took the platelets and after the, the, when you make the puncture on the ovary after the egg retrieval, it injected into the empty follicle. The thing is how much of this platelet is going really through the ovary because it's already broke, you know, so, and the, the thing is you are creating an illusion that some patient with really, really low, low, low ovarian reserve is going to have 10 really good eggs.

So, we have to be so careful with this kind of, uh, therapy. I stopped doing because we don't find a really, uh, significant, uh, outcome. [00:52:00] 

Dr. Brighten: Okay. 

Dr. Barroso: Yeah. 

Dr. Brighten: Yeah. I know it's something that people are still researching and looking into, so maybe there'll be a different technique or a different way in the future, or?

Maybe we're just not there yet. I do believe, and I hope it's in my lifetime, we will find a way to extend the life of ovarian function. It only makes sense with how long we're living. There was new, uh, research. There's a study actually going on a trial for rapamycin, uh, and I'm excited for that. I'm like, please get us answers before menopause is knocking on my door if this will work.

So I think there are exciting things out there. We just, I just don't think that we have prioritized some of this research in the way that we needed to, as you were talking about with PCOS, endometriosis, like, that not really being considered as much until recent years about fertility because of the delay in which women were getting pregnant and, uh, you know, there's nothing wrong with that delay.

Like, I'm someone, I had a, my first child at 31 [00:53:00] and my second at 40 and I'm like, I'm a better mom at 40. I wish that nature worked out to where I could just be a mom in my 40s because, you know, Well, I love the one I had in my early thirties. I'm like, I'm definitely I'm a better mom in my forties. We have 

Dr. Barroso: to be very respectful because it's not just like 50 years ago that you, you're a woman just to, to, to have babies.

Dr. Brighten: Yeah. 

Dr. Barroso: And be at home. You know, it's so many things you have to do and delay is an option. Now we can, we can free sex, that is something good. I'm certainly sure that the, in the next five, 10 years, we're going to start using some therapeutic options to preserve in a physiological condition, um, our ovarian reserve and the quality of those, of those eggs.

Today's is, we are the, [00:54:00] the, the mirror of that, my. My father at my age, he was a senior, looks really senior. I 

Dr. Brighten: mean, if you look at TV shows when we were kids, people our age, we're elderly. 

Dr. Barroso: Very. 

Dr. Brighten: It's crazy, right? Yes. 

Dr. Barroso: And we're not. No. No, we're doing something different. Because we're 

Dr. Brighten: building our muscle. Of course.

Of course. 

Dr. Barroso: Muscle is the organ for longevity. 

Dr. Brighten: Well said. 

Dr. Barroso: Yes. Yes, it is. Yes. So we, we want to live healthy and longer. Start building muscle. 

Dr. Brighten: Absolutely. I agree with that. I want to go back. So we talked about Alice and Emma, um, but I didn't ask about endometrial receptivity. So that testing can be done at the same time.

And this is all done via endometrial biopsy, which at your clinic, you don't subject people to being awake or not having pain management, uh, in the United States, most of these are [00:55:00] performed while women are completely conscious, not being given pain medication. And, uh, so I just want to say to people there are options for clinicians who provide pain management if the mention of an endometrial biopsy makes you shy away.

But ERA, what is it? Why should we do it? I imagine this is in your KPIs. 

Dr. Barroso: Yes, because we, we, we're looking for the, if we're looking for the house, we have to know that is a window during the implantation stage that we have to assess if you are in the right time for the right, uh, transfer. If you have a five years, uh, five days embryo, it's around plus, minus 120 hours.

Sometimes we find, we, we, we found that we displace the window and you're not 120, you may be [00:56:00] are 144, it's 20 hours. hours that you have to wait before embryo transfer. 

Dr. Brighten: And it's not just waiting, this is how long you have to be taking progesterone and being exposed to progesterone to optimize. Everything 

Dr. Barroso: is related with the progesterone, yes, with the starting of progesterone.

So we perform, we, we found like 3 percent of our patients change this implantation window. So we, we follow that now. So we have the, the embryo, healthy embryo. So now we are required to know where is the best time to put the, the embryo into the, the cavity. 

Dr. Brighten: And so with that, so I just want to talk about that.

These tests can be done all at once. You can understand, is there endometritis that has to be treated? With that you were saying antibiotics and then you are you using vaginal and oral probiotics? Yes. Okay, so vaginal oral [00:57:00] probiotics, emphasis on lactobacillus and then that data of the ERA is going to tell you how long you need to be, and you do vaginal progesterone in your clinic, how long do you need to be exposed to that progesterone to optimize the endometrium?

And for people to understand that lining, it's not just about building it up and having the three layers, but it actually has to be receptive. It has to be, I like to call it like the nice down comforter, you know, where you just like, you can't help but snuggle in, like you want the embryo to be like, Oh, it's so good.

Dr. Barroso: Embryo mat helps to, to evaluate some really hard conditions. I mean, you have sometimes the, the line in the middle line 

Dr. Brighten: is 

Dr. Barroso: so thin. It's not growing. It's under seven millimeters. 

Dr. Brighten: Yeah. 

Dr. Barroso: And you don't know if it's, because it's not going to grow any more, is what 

Dr. Brighten: it is. 

Dr. Barroso: Yeah. So 

Dr. Brighten: we 

Dr. Barroso: perform the error, and if it shows that [00:58:00] we have receptivity, it's going to grow.

We put the 

Dr. Brighten: embryo, it 

Dr. Barroso: works, other size, myoma, myoma, when we talk about myoma, this benign tumor in the, in the uterus, we always say if it's in contact with the cavity, we have to remove. Okay. But what about if you have, not in the cavity, just in the body, in the, in the muscular glider. 

Dr. Brighten: Mm hmm. 

Dr. Barroso: You have to. 20, 25 is a lot of 

Dr. Brighten: myoma 

Dr. Barroso: that they take away the blood it can use to, for the perfusion of the embryo.

Yeah. And you don't know if it's affecting or not. It's not, you cannot make surgery because at the end, if you took all of them, it's going to be like a Gruyere cheese, you know, this cheese with holes. [00:59:00] It's 

Dr. Brighten: like adenomyosis as well. 

Dr. Barroso: Like the adenomyosis. Yeah, you can't just go 

Dr. Brighten: and take it out and it can cut off blood flow.

So when you're saying perfusion, so people understand the blood flow to the uterus and Yeah. So doing an ERA can help you understand about the perfusion as well. 

Dr. Barroso: It's correct. So, 

Dr. Brighten: yeah. 

Dr. Barroso: Yeah. Something that we're doing before all that now with artificial intelligence, we can now start make a score for the X or for the embryo because some Are 

Dr. Brighten: we going to talk about magenta?

Dr. Barroso: How 

Dr. Brighten: about these names? I love the fertility names. There's Emma and Alice, Violet and Magenta. Yeah, 

Dr. Barroso: it's, yeah, everything is so touching and romantic. Yeah. Right? Yeah. Some people came and say, well, I'm going to freeze my eggs. All right. Well, this is discovery. [01:00:00] Okay. Are they good? 

Dr. Brighten: Yeah. 

Dr. Barroso: Are they going to work?

Because I want to wait for the next five years. When you, they say it's working, we don't know because we don't know the quality. We don't know until we have the other part, if it's compatible with sperm, what is going to be the, the, the outcome of the embryo. And today with this, uh, artificially intelligent, we can evaluate the oocyte quality to predict it.

The likelihood of the success, I mean, we have all the eggs and you have a score and you have one to chain and say, okay, this one is 24, 68, or this is nine to chain, but you have an idea that how looks the, this, those eggs sometimes. In the regular [01:01:00] work in the lab, they look like, Oh man, we got those eggs, but they, uh, is granular and it's dark and doesn't look too good.

Yeah. And sometimes you, it's hard to explain to, to, to, to the patients, 

Dr. Brighten: but 

Dr. Barroso: with this platform, you have a score and you can say, okay, you have 10 from those 10, maybe three to four, you're going to get. embryo onto the blastocyst stage. So helps. This is with violet and with magenta do the same with the embryo in the embryo.

We start looking for these KPAs in the, in, in, in the embryo and see if there is the cell division, the symmetry, the fragmentation or something else that can predict if you're going to reach that stage. 

Dr. Brighten: So, [01:02:00] this, what I love about the Violet technology too is that it can also guide you. So, I think it's really important if people are new to the world of IVF to understand, um, and there's a lot of misinformation that happens in the United States where people think that every healthy egg Becomes an embryo and every embryo is healthy and that becomes a life and the reality nature is cruel I will say that in nature as you were saying you're only going to get a quarter of those embryos will make it so to have that guidance of Listen, this many eggs may become an embryo.

And then we have to do PGTA on that. And then what, so what's the percentage from healthy egg to euploid healthy embryo? 

Dr. Barroso: It depends. Mm 

Dr. Brighten: hmm. 

Dr. Barroso: Of the quality of the, mainly the age of the patient. 

Dr. Brighten: Yeah. 

Dr. Barroso: We hate that. But yeah. Definitely. Because how do we know that? When you are around 30. [01:03:00] Maybe 45, 50 percent of your eggs have some abnormal, uh, genetic condition, but that when you reach the 40s, 85 percent of your eggs are in really bad, bad condition.

So we know that for a woman over 40, we require at least 15 eggs to get one. The question is, okay, how do we do that? Because at fouries, you already have a diminished number of eggs, or the other side, I have patients for two years old, polycystic ovary, that they still have eggs and say, wow. I'm so healthy and I say maybe yes, maybe not, because we're gonna, we're gonna, um, get those [01:04:00] eggs and we really have to see how healthy and if we can reach a healthy embryo.

So, it depends by age, some condition like PCOS, or some of them to reduce the number because they have endometriosis into the ovary. We call endometrioma, and 

Dr. Brighten: the 

Dr. Barroso: endometrioma is still growing, it's your healthy, your healthy eggs, so. 

Dr. Brighten: And in those situations, I think it's important for people to know that, you A gynecologist may recommend excision surgery of the endometrioma, but I always say that should only be done with an endometriosis expert because often they take too much of the ovary and there's been complications of that.

And then. you're essentially left with one ovary. Uh, I did want to ask, so, so if somebody wants to prepare for an egg retrieval, maybe they're going to feed their eggs, maybe they're gonna, uh, [01:05:00] they're going to go the full, you know, nine yards and make an embryo. How do they get the best score? How do you gamify Violet and make the healthiest egg?

Dr. Barroso: Let me delete this. As you say, the question is, what if I have this 

Dr. Brighten: endometrioma? 

Dr. Barroso: You score from 0 to 40 when you have endometriosis, when you have endometrioma, you already have 20 points. So you are in between moderate to severe disease, and the question is, okay, what is next? I want to keep my eggs before the surgery.

Maybe I want to take my eggs and they try to restore the function of the embryos. Most of the time, they lose an ovary, your capacity to have enough eggs for whatever [01:06:00] therapy seems to be insemination or in vitro fertilization, so we have to be certain that we're looking for. Yeah. But you said your question specifically was.

Dr. Brighten: So how can we, how can we gamify? Like biohack as some people would say, or what are things we can do to improve the odds that those eggs are going to have the best score, that we are going to be stellar KPIs? 

Dr. Barroso: Absolutely. Lifestyle. Lifestyle is patient. I have patients. They don't even know that they're looking, they don't have a boyfriend, 

Dr. Brighten: yeah, 

Dr. Barroso: but they have endometriosis.

So restore the endometriosis, look for the quality, get the medication, keep this inflammatory condition very low. So by the time they reach 25, 28. They're going to be good enough for, if they're looking for any treatment, yeah, will be [01:07:00] fine. Also with polycystic ovary, they're young, 16, 17 years old, where you're looking to look pretty because you have this androgen condition with acne and you have more hair in the face than me and they're overweight.

So you look. You restore this phenotypic condition to look. 

Dr. Brighten: Mm-hmm . Good. 

Dr. Barroso: And also with, with your ex, if now you're looking for 10 years later you're looking to have a baby, you start working before where you are in insulin resistance. Mm-hmm . You start taking your supplementation, keep your, understand that it's nothing but with your behavior.

It's a condition that you born like that. Mm-hmm . And you, if you are. Conscious. That is not what you're [01:08:00] doing because your friends, they are skinny and they eat ten tacos and, and they still skinny and you eat some tomatoes and lettuce and you increase, uh, two pounds. It's not you. Yeah. It's your condition.

Yeah. So don't 

Dr. Brighten: fight. 

Dr. Barroso: Take your medication, keep control. Make the best that you can do for your weight, and everything is gonna be so smooth. 

Dr. Brighten: Mm-hmm . How do you feel about coq 10 N Acetylcysteine, aop, poke acid, I can name a ton, but everything 

Dr. Barroso: helps. As I say, everything helps. . Yeah. Cookie chain is a very good.

antioxidant agent. What I mean, I have a patient during COVID and he was like two, uh, 200 pounds weight and he [01:09:00] said, if I take. Vitamin G is going to help you with COVID. And I say, yeah, but you have to stop eating Cheetos because he was eating Cheetos. In the treatment 

Dr. Brighten: room with you. I say, 

Dr. Barroso: man, everything helps.

Dr. Brighten: Yeah. 

Dr. Barroso: Vitamin D helps, but you have to do something before your supplementation. Absolutely. 

Dr. Brighten: Yeah. Yeah. So I love that approach of like, it needs to be the nutrition and lifestyle aspect before you add on the supplementation. Um, so what I just want to back up because I know this question will come up from people.

What specifically about PCOS is affecting poor egg quality? 

Dr. Barroso: Insulin resistance, insulin resistance, because PCO by definition, you increase the outlayer of the, of the ovary and you have these tiny follicles [01:10:00] that you don't have any ovulation. So it's still there. Years ago, we used to do some ovarian drilling, 

Dr. Brighten: yeah.

Dr. Barroso: When I do surgery, I, I do so much surgery, uh, with endometriosis and I use laser. So sometimes I do some drills into the, the ovary to help with some growth factors to help a natural and spontaneous ovulation. So insulin resistance is some, one of them and the androgens, androgens. It's killing the, because it's the two cells theory that you have produced more estrogens, but you have more, I mean, uh, for, for your audiences, you have more male or [01:11:00] hormones and you require the, uh, female hormones, but there is the ratio is, uh, is, is, is inverse.

Oh, it's not working in the same level. 

Dr. Brighten: Right. And, you know, with PCOS, I'm curious, do you ever use myo inositol? Yes. Yeah. I love myo 

Dr. Barroso: inositol. Myo inositol is really good. Yeah. It's very easy to get. Yeah. 

Dr. Brighten: Yeah. The other thing I really like, uh, for endometriosis and for egg health is melatonin. That's something that, I, people are like, why do you take melatonin at night?

And I'm like, I take it for the endometriosis, not for my sleep as much. Right. My kids run me so tired, I hit the pillow and I have no problem going to sleep. Um, so I appreciate you talking about the aspect of PCOS endometriosis. I do wanna bring on, um, something that I feel like you really are cutting edge on is using MRI to diagnose endometriosis.

Can you talk a little bit more about that? 

Dr. Barroso: Absolutely. [01:12:00] I really. endometriosis is underdiagnosed. So many people is living with endometriosis, not just for fertility, on pain. Yeah. And, um, and most of them, they have this low inflammation in the gut. And they have one of my questions when I, with the patient that I, I'm thinking they have endometriosis during your period.

Do you have diarrhea? 

Dr. Brighten: Yes. 

Dr. Barroso: And the woman say, I, I didn't know. I have a diarrhea. Okay. So it's not the doctor, I have to do some laparoscopic surgery or I have to open it to see if you have no MRI is the gold standard today to diagnose [01:13:00] endometriosis. And also. To make the stage of the endometriosis because sometimes is you go into the cabinet and say, whoa, it's very bad and you, you were not prepared for the surgery.

Dr. Brighten: Yeah. 

Dr. Barroso: So by the time you say you have endometrioma, um, you have the, Ovary is sticking to the tube and the tube is sticking to the bowel and going on and on. You have to go prepare for the surgery if the surgery is required. Yeah, because if you have symptoms. Okay, you require it. Maybe if you don't, and it's a fertility test, you see, you just remove the inflammatory condition into the pelvic cavity, and that's it, you're working on your treatment.

Dr. Brighten: Yeah. Well, I love this entire conversation. Where can people find you? Where can they follow you, learn more [01:14:00] about you? 

Dr. Barroso: But we are in Mexico City, as you know, we are in, we are 

Dr. Brighten: in Mexico City, in Mexico, 

Dr. Barroso: so it's big, but the, we're a nice, nice place, it's called, uh, Arcos Bosques, pretty secure, and something is lovely, we receive you.

patient from everywhere in the world. 

Dr. Brighten: I know I was in the waiting room and ran into people who follow me on social media who were coming to see you and some of them from various countries throughout the world. And I was just, I mean, every time I'm like, This is so amazing to see so many women coming here.

Dr. Barroso: Yes. It's amazing. And we have the first concept in Latin America because, uh, NACERE is in a building that shared in a mall with a hotel. A nice place is the Aqua and you [01:15:00] just go, most of our patients just arrive to the, to the Aqua, walk around. In Mexico, we have doctors everywhere, so in Guadalajara, in Monterrey, so we, in the United States, we start with a sonogram that's so easy, so you don't have to be here for two weeks.

And at the end, if you, a retrieval is Saturday, you arrive by Friday night, perform your equiretrieval, and by Sunday, you can leave. Everywhere. 

Dr. Brighten: Mm 

Dr. Barroso: hmm. So it's, it's very, it's very easy. 

Dr. Brighten: Yeah. It is. And you have a wonderful clinic. I love your staff and I love your KPI so much. But thank you for taking the time.

I know you're very busy, but I adore you and I appreciate this conversation so much. 

 

Dr. Barroso: A pleasure. And for me, it's just if what, if I can give you something that help you to make a different decision. Have He's so good for me. Thank you so [01:16:00] much.