BackTable Women's Health

What does it take to design a career in medicine that truly fits your values, your life, and your goals? On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Chitra Akileswaran, board-certified OBGYN and founder of Avaiyar Private Care, for a candid discussion on building a career that breaks the mold. Dr. Akileswaran traces her path from global public health and a joint MD-MBA to leadership in county health systems, digital health startups, and now direct pay practice, sharing how each chapter reflected her changing priorities.

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Timestamps

00:00 - Introduction
06:19 - Public Health and Global Work
10:33 - Residency and Early Career Choices
15:04 - Founding a Digital Health Company
19:48 - Ambulatory Operations Leadership
24:36 - Leading a County Medical Group
29:32 - Physician Needs and Retention
34:25 - Physician Compensation Overhaul
41:47 - Physician Unionization and Employment
46:25 - Pregnancy Loss and Perspective
49:09 - Launching a Direct Pay Practice
57:10 - Mentorship in Private Practice
01:03:28 - Closing Remarks

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More about this episode

The conversation explores lessons learned leading hundreds of physicians, overhauling compensation and benefits, and navigating unionization and administrative change. Dr. Akileswaran speaks openly about personal milestones, including pregnancy loss, and how it drove her to redesign her life and practice. Topics include mentorship, apprenticeship, work-life integration, and the practical steps and mindset shifts needed to carve out a fulfilling, sustainable career in medicine.

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Resources

Avaiyar Private Care, Dr. Akileswaran's direct pay OBGYN practice
https://avaiyarprivatecare.com/
Cleo, the digital health company she co-founded
https://hicleo.com/

ACOG Well-Being and Physician Support Resources
https://www.acog.org/career-support/well-being

AMA Physician Practice Benchmark Survey: Smaller Share of Doctors in Private Practice Than Ever Before
https://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever

MGMA Provider Compensation Data Reports, the benchmarking source referenced on air
https://www.mgma.com/mgma-data-reports

Dr. Chitra Akileswaran, UCSF OBGYN Residency Alumni Profile
https://obgyn.ucsf.edu/residency-program/chitra-akileswaran-md-mba

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies.

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This podcast is supported by

Medtronic Pelvic Health
https://urgencyisreal.com/

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Timestamps

00:00 - Introduction
04:00 - Shared Decision-Making
06:51 - Clinic Efficiency
10:38 - Expanding OAB Therapy Options
12:27 - Long-Term OAB Care
17:41 - Building an OAB Program
18:18 - Staff Training and Follow-Up
25:32 - OAB Navigator Implementation
27:14 - Navigation Outcomes
28:39 - Scaling with Staff and Epic
30:35 - Algorithm Resources
34:08 - Neuromodulation Advances
38:37 - New Tibial and Battery-Free Devices
40:56 - Quality of Life in OAB Care
46:11 - Access and Adoption
51:22 - Streamlining Therapy Discussions
52:47 - Closing Remarks

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More about this episode

The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey.

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Resources

Patient navigation for overactive bladder improves access to care
https://link.springer.com/article/10.1007/s00192-019-04085-7

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Advances in endometriosis research are reshaping how clinicians diagnose, understand, and treat this complex multisystem condition. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Hugh Taylor for an in-depth discussion of the systemic nature of endometriosis, including its metabolic, psychological, and cardiovascular effects, as well as central pain sensitization and bowel and bladder symptoms. They also explore how animal models and biomarkers like microRNAs are deepening our understanding of these connections.

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Timestamps

00:00 - Introduction
03:26 - Endometriosis Beyond the Pelvis
05:17 - Understanding Systemic Symptoms
10:35 - Why Diagnosis Takes Years
12:54 - Key Clues to Endometriosis
14:35 - Emerging Noninvasive Diagnostics
18:13 - Pain Versus Disease Stage
19:33 - Precision Medicine Approaches
24:04 - Treatment Strategies and Follow-Up
27:17 - GnRH Antagonists and Add-Back Therapy
29:45 - Danazol and Surgical Options
34:26 - Future of Immune-Based Therapies
37:49 - Fertility Counseling and Egg Freezing
40:17 - Wrap-Up and Key Takeaways

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More about this episode

Given that many patients wait years for a diagnosis, Dr. Taylor emphasizes the importance of presumptive clinical diagnosis and selective imaging to expedite treatment. He highlights emerging biomarkers that may offer more noninvasive diagnostic options and help clarify pain mechanisms. The conversation reviews current management strategies, including continuous oral contraceptives, the challenge of progestin resistance, and the promise of blood-based tests to predict treatment response. They also discuss GnRH antagonists, Danazol, surgery for refractory cases, and future directions such as immune-based therapies targeting the inflammation and immune dysfunction at the root of endometriosis.

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Resources
Clinical evaluation of the oral gonadotropin-releasing hormone-antagonist elagolix for the management of endometriosis-associated pain: https://pubmed.ncbi.nlm.nih.gov/31434540/

Circulating microRNAs as potential biomarkers for endometriosis: https://pubmed.ncbi.nlm.nih.gov/25772772/

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost.

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Timestamps

00:00 - Introduction
03:05 - Evolving Guidelines and Consensus
10:02 - Lead-Time Bias and Cost Considerations
12:05 - Maintenance Therapy and Surveillance Nuances
14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam
20:24 - Key Takeaways from the TOTEM Trial
24:04 - Future Tools, Lifestyle Counseling, and Shared Care
27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance
31:13 - Hormone Therapy Considerations
34:37 - ctDNA and MRD Testing
37:39 - Emerging Technologies and Limitations
43:22 - Rapid Fire Takeaways
45:33 - Closing Thoughts

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More about this episode

The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy.

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Resources

TOTEM Trial
https://ascopubs.org/doi/abs/10.1200/jco.22.00471

2010 Ovarian Cancer CA-125 Trial
https://pubmed.ncbi.nlm.nih.gov/20888993/

Society of Gynecologic Oncology Clinical Practice Statement on Surveillance
https://pubmed.ncbi.nlm.nih.gov/41308226/

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Are we addressing sexual health in clinical practice? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner is joined by Dr. Christine Vaccaro, a double board-certified urogynecologist and sexual medicine specialist, to discuss the evaluation and care of women’s sexual health concerns. They highlight the importance of open conversations, patient empowerment, and a multidisciplinary approach to support well-being and improve quality of life.

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Timestamps

00:00 - Introduction
04:01 - What Is Sexual Medicine
07:58 - Understanding Libido, Arousal, and GSM
15:54 - Clinic Visit Structure and Patient Counseling
19:17 - Clitoral Exam, Adhesions, and Anatomy Education
28:17 - Addressing Stigma, Patient Education, and Myths
32:03 - Tools for Patient Empowerment: Apps and Self-Examination
39:55 - In-Office Procedures, Pain Mapping, and Hormonal Considerations
46:37 - Managing Complex Cases and Multidisciplinary Collaboration
53:47 - Closing Remarks

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More about this episode

The conversation explores practical strategies for evaluating and managing issues such as libido, arousal, orgasm, and sexual pain, with a focus on genitourinary syndrome of menopause (GSM) and clitoral anatomy. Dr. Vaccaro shares her approach to assessing clitoral adhesions, pelvic pain, and hormonal changes, as well as effective ways to educate patients about anatomy and self-examination. They discuss the importance of reducing stigma, addressing misconceptions, and using a multidisciplinary approach to improve patient outcomes. The episode also highlights the role of clinician training, patient-centered counseling, and collaborative care in supporting women’s sexual health across the lifespan.

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Resources

International Society for the Study of Women’s Sexual Health: https://www.isswsh.org/

Female Orgasmic Disorder: Current Understanding and Clinical Management: https://pubmed.ncbi.nlm.nih.gov/42314165/

OMGyes: https://www.omgyes.com/join

You Are Not Broken by Dr. Kelly Casperson: https://kellycaspersonmd.com/you-are-not-broken-book/

Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris - https://academic.oup.com/smoa/article/6/2/115/6956478?login=false

Clitoral Adhesiolysis: Technique and Patient Selection - https://www.vjsm.info/videos/all/clitoral-adhesiolysis-technique-and-patient-selection

Female Orgasmic Disorder: Current Understanding and Clinical Management - https://pubmed.ncbi.nlm.nih.gov/42314165/

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients.

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Timestamps

00:00 - Introduction
04:05 - Case One: Recurrent UTIs
05:19 - Workup Basics
08:50 - Non-Antibiotic Prevention
11:42 - Antibiotic Prophylaxis Options
15:16 - Case Two: Asymptomatic Bacteriuria
19:14 - Case Three: Complex Patients
19:58 - Male vs. Female UTIs
21:22 - Neurogenic Bladder Workup
22:52 - Elderly Patients and ID Consults
25:01 - Case Four: Transplant ESBL
25:23 - Machine Learning for Antibiotics
29:49 - Catheter Biofilms
31:55 - Embedded Bladder Reservoirs
35:23 - Recurrent UTI Vaccine
36:23 - Future of Recurrent UTIs
39:04 - Wrap Up

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More about this episode

The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic.

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Resources

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Have you ever wondered what role the mind could play in treating women’s health conditions? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Sonia Gupte, a family medicine physician and board-certified clinical hypnotherapist, about how clinical hypnotherapy can help patients access the subconscious, resolve emotional barriers, and rewire patterns that affect both body and mind. Dr. Gupte discusses the use of hypnotherapy for a range of women’s health concerns including PMS, postpartum depression, hot flashes, infertility, and chronic pelvic pain, highlighting the potential for more holistic care.

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Timestamps

00:00 - Introduction
04:40 - Discovering Hypnotherapy
08:59 - What a Session Looks Like
13:02 - Remote Sessions and Results
17:27 - Follow-Up and Maintenance
20:13 - Women's Health Examples
28:05 - Talking to Patients
30:47 - Hypnosis vs. Therapy
33:07 - Pap Smear Trauma Case
37:28 - Breathwork Reset Tool
42:42 - Uncovering Repressed Trauma
46:17 - Burnout and Stress
49:12 - Barriers to Success
53:21 - Call To Action
54:58 - Live Demo Plans
55:50 - Closing Remarks

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More about this episode

Dr. Gupte shares how her mother’s experience with cancer, depression, and a suicide attempt inspired her to explore hypnotherapy and ultimately bring it into her medical practice. She describes what a typical hypnotherapy session involves, including relaxation, guided visualization, identifying emotional roots, and using protocols to help patients “reboot” their mental patterns. The discussion also covers practical aspects of integrating hypnotherapy into women’s health care, such as determining treatment frequency, offering remote sessions, setting patient expectations, and addressing common barriers to success.

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Resources

Within: Finding Yourself, Fixing What's Broken, & Finally Reclaiming True Health https://enso-nia.com/about-sonia/

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Every OBGYN, whether in the hospital or community, may face a high-acuity obstetric emergency. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner interviews OB hospitalist Dr. Katie Fung-Yip to explore the evolving role of OB hospitalists and the obstetric emergency department (OB ED) in managing critical situations. They discuss how in-hospital coverage, multidisciplinary teamwork, and dedicated triage protocols can improve emergency response and patient outcomes.

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Timestamps
00:00 - Introduction
02:42 - Breaking Down OB Roles
06:01 - MFM and Hospitalist Collaboration
07:35 - Inside the OB ED
12:31 - High Stakes Emergencies Overview
18:02 - Amniotic Fluid Embolism
21:33 - Cardiac Arrest Pearls and Drills
24:44 - Team Leadership Under Pressure
29:19 - Emotions Debrief and Bonding
37:48 - Simulation Practice and Mentorship
40:18 - Early Career Fit and Support
43:10 - Wrap Up

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More about this episode
Dr. Fung-Yip explains how the hospitalist role differs from community OBGYNs, emphasizing the value of continuous in-hospital coverage for urgent and high-risk cases. She describes the spectrum of care, from routine pregnancies to complex emergencies requiring collaboration among hospitalists, maternal-fetal medicine specialists, and multidisciplinary teams. The discussion covers OB ED operations, the Maternal Fetal Triage Index, hospital design for rapid response, and review of critical emergencies such as postpartum hemorrhage and amniotic fluid embolism. Dr. Fung-Yip highlights how these events can escalate to maternal cardiac arrest, requiring immediate ACLS, team coordination, and sometimes resuscitative hysterotomy. She stresses that preparedness depends on ongoing education, simulation, mentorship, debriefing, and strong teamwork.

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Resources
Maternal Fetal Triage Index (MFTI)
https://www.awhonn.org/education/hospital-products/maternal-fetal-triage-index-mfti/

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

Hormones aren't the problem. Misunderstanding them is. On this episode of BackTable Women’s Health, Dr. Karen Toubi sits down with Dr. James Simon to discuss menopause, sexual medicine, and his career journey from early IVF research to treating aging women. They also unpack his Green Journal paper with Dr. Barbara Levy, challenging common misconceptions about hormone therapy and explaining why treatment should be individualized because not all estrogens and progestogens are the same.

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Timestamps

00:00 - Introduction
03:11 - Why Menopause Medicine
07:51 - Hormone Therapy Paper
11:48 - Counseling Perimenopause
16:14 - Unopposed Estrogen Strategy
23:01 - IUDs And Progesterone
26:54 - Estrogen Types Explained
34:59 - Thrombosis Risk Approach
43:11 - Oral Estrogen Use Cases
44:48 - Breast Cancer Risk Counseling
46:49 - Estrogen Risk Myth
48:11 - Pregnancy and Breast Cancer
50:09 - Counseling BRCA Patients
53:26 - Duavee: Who Benefits?
55:32 - Bazedoxifene Access Limits
57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM)
01:00:37 - Dryness Explained
01:02:41 - Thrombosis Risk Screening
01:05:01 - UTIs and Vaginal Estrogen
01:07:18 - Starting HRT After 60
01:12:47 - Window of Opportunity
01:14:46 - Staying on HRT
01:16:43 - Blood Levels and Absorption
01:20:13 - Clinician Takeaways

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More about this episode

The conversation explores strategies for managing perimenopause, including when hormonal contraception is the best option and when symptom-focused hormone therapy may be more appropriate. They cover practical guidance on using transdermal estradiol, Mirena and Liletta for contraception and endometrial protection, and how thrombosis risk differs depending on the type and route of hormone therapy. The episode wraps up with a discussion on newer treatments for genitourinary syndrome of menopause, when to consider hormone therapy, and why clinical experience is so important in menopause care.

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Resources

A Contemporary View of Menopausal Hormone Therapy https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000005553~a-contemporary-view-of-menopausal-hormone-therapy?redirectionsource=fulltextview

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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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

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.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app