Today we talk about a concept I think is quite misunderstood. Batching in IVF cycles. What does it mean? And what does it mean for you? I'm Doctor Mark Amos, and this is taco, about fertility Tuesday. So, as I started the, podcast, I mentioned that I think this is a very misunderstood topic. A lot of patients will come to me and say, do you guys batch? And I'm always surprised when they ask me that, because I think, why would they care if we batch
our cycles? And then I started understanding from a patient perspective, one of the concerns is they feel like we're taking a square peg and trying to put it through a round hole, meaning that their body is being put on birth control to fulfill our need and not their need, which makes a lot of sense. I could clearly see how that's true, because with batching, there are start dates, and so it would feel like they're being pushed into a situation that may be bad
for them. But as we've talked about in other podcasts, being on birth control is not a bad thing. That is priming. And so you can prime in many different ways. But the reason for batching is slightly different. And so I want to take a moment first to talk about what batching is, and then talk about why clinics use it and the benefits of batching. And then we'll start talking about patients concerns and what you can do about it. So the first question is, what's the definition of
batching? There are many different ways to batch. So I think the classic way people think of batching is everyone starts on the same day, so they're all lined up, and all the IVF cycles fall within a bell shaped curve over the next month or weeks. But that's actually not what batching means. All that means to batch is that one point, your clinic is stopping doing IVIP procedures. That means both retrievals and transfers. So if you don't batch, it means your clinic never takes
a break. It doesn't matter what day of the month it is. The clinic is either doing IVF retrievals, transfers, or culturing embryos, and it never stops. A clinic that batches is going to at one point, stop for a period of time and then restart up. Now, when I say batching as a wide definition, what I'm talking about is there are some clients that just do one cycle a month and they have everyone start on the same day. There are other places that batch most of the month and then take a week
off. There are some that are on for two weeks and two weeks off. The point is, the word batching is just defining as taking that break. How significant that batching is and how it affects patients is going to change. So some clinics will start some patients, let's say, on Monday, and then they will start some more patients on Tuesday, and then Wednesday, and then Thursday and so on until all the patients have gone through. And so then they get done by the end of the
month, and they go down for a week. Other places may start everyone on that Monday, and then the following Monday, start another batch of people. Now, the question is, what is the benefit of batching? So, from the clinic side, the benefit is it allows a lab to concentrate a lot of patients together. And so that allows for better use of supplies, because you can share the supplies over multiple patients versus having to individually use
it for one group. It allows for the doctors and staff not to have to work every single weekend and eventually have one weekend off so they can be with family and go on trips. It also allows for some scheduling, because it allows them, the doctors, to have days that they can focus on patients for consultations and things like follow ups and even procedures that they wouldn't be able to do if they were waiting for IVF
all the time. And to understand that more, what you have to understand is that we never know when someone's going to undergo a retrieval. So we have to basically block our entire morning for that retrieval, whether it's going to happen or not. And that means patients can't be seen during that time. I can't make a consult in a day I don't know about. And so it, limits how many patients can be seen at the clinic.
Whereas if you batch, you know, okay, there's going to be no retrievals or transfers during this time. So I can now see patients and do follow ups. And if your doctor is someone who's at a satellite clinic, meaning that they don't even reside at the clinic, that does the retrievals, then they have to block that time also even to get there in the case that they have retrievals.
And so it becomes very inefficient for the clinic and even for the patients in some ways, because now you have more time to be with your doctor versus the doctor's schedule being filled with times that he may or she may never use. Now, on the patient side of things, there's also some benefits that may not be direct, but there are some
benefits to the quality of the lab. So, for example, if a lab is up all the time, that means the lab is not getting cleaned all the time you cannot bring cleaning products into a lab when there are embryos there, it will hurt the embryos. So the only time you can clean is when you take a break. Most labs shut down for at least once a year, if not twice a year, to
be able to do this. Deep cleaning. Clinics that batch are, able to do the cleaning much more often, which means there's a cleaner lab, and that means possibly less free radicals floating around. That also means potentially more QC, meaning quality control, because now when you're down, there could be some testing that needs to be done.
You wouldn't be able to do this with the lab being up all the time because most, clinics are using most of their equipment, so they can't do a lot of testing on them when the equipment's being used, especially when the patient's going through. Now, it's important to understand not batching is also not bad. But there is no question that they can't clean the lab as much. Now, maybe if it's a place that has a very big lab, maybe they can shut down one section,
clean one. But if they're all using the same air system, they can't do that. There are many clinics who would just let someone start their period and then start a stimulation. And a lot of people think, well, the reason my clinics not letting me do that is because they batch. That's actually not true. Whether we batched or not, I would almost always still prime patients. And because priming has some
benefit. One of the things I talked about in one of our prior episodes is that getting FSH levels down a little bit lower to upregulate the receptors helps with the stimulation. So that concept that batching is purely to benefit the clinic is not completely true. Sometimes the reason why you're on birth control isn't because of the batching, but it's because it actually allows you to upregulate receptors.
Now, you may be on the birth control for an extra day or two because of batching, because you may line up a little bit better. But, most clinics have multiple days that they start. So rarely are you being forced into a cycle thats not good for you. Its just youre being manipulated a little bit around to fit in the best cycle for you. That works with the clinic as well. And then the batching is benefiting you because youre able to clean the lab. So, for example, at my clinic, we batch
every month. Every month we do a deep clean. Were down for about one week. And during that one week, there are no IVF procedures going on, no transfers, no retrieval. And then before we start the next month, we have a brand new lab, basically a clean lab that's been deep cleaned and ready to go. And I personally believe that helps with pregnancy rates versus having a lab constantly up. There's no chance for cleaning.
I've been in those clinics before, and at those clinics we shut down once or twice a year to do a deep clean. Now am I going to pretend that that makes our clinic the best in the world? No, I think it makes small differences. Matter of fact, I think it makes more of a difference depending on who the patient is.
Ive always made the comment that if youre young and youre 24, with really very little fertility problems and maybe a sperm problem, you can probably go to Bob's backyard IVF and do just as well and become a way successful. But if youre someone whos failed multiple, multiple cycles and now youre trying to get pregnant on maybe your 6th or 7th ivF, it may help being at a clinic that batches a little bit more to be able to have a cleaner lab because those free radicals
may be the difference of it working or not for you. I think the most important point here is don't look at batching as bad. There are going to be, though, outliers. Obviously. If your clinic is saying that, hey, we only do ivf cycles in June and then again in September, then yes, putting you on birth control for several months to try to get you to line up with that is not a good situation. You are then taking a square peg, trying to put through a circle.
But just because they batch within the month does not make things bad. And like I mentioned, even if your clinic wasn't batching, there is a very high chance that they would be putting you on, birth control regardless. It's not there to make you line up, but it's also there to help up regulate those receptors to help improve your IVF cycle. And there's plenty of evidence to back this up. We know that labs that have better air systems do have better pregnancy rates. When you're comparing
the complicated cases. Again, if you take all the best cases, they probably can do well anywhere. If we're just using pregnancy as the outcome. But if you're looking at things like number of blastocyst being made and let's say cumulative pregnancies, then air condition
makes a big difference. And that condition of the air isn't just the system they use to clean the place the air, but also how the place is cleaned is it the same dust that's been around for six months, or is it just dust that came from the cells of the embryologist skin over just the last few weeks? We all release dead cells. Not to gross you out, but the average human sheds around 30,000 to 40,000 dead skin cells every minute. That's millions a day per month.
That's 1,000,000,005, hundred 12 million skin cells. And within a month, that means there's approximately 543.6 grams of dead skin cells shed by the average person. That is half of a kilogram. I don't think you'd be shocked to know that could make a difference in the cleanliness of the lab. So, overall, the point of this podcast was to help reassure you, don't be concerned that your clinic does
batching. I think it's important to ask what their batching is, because again, if you're a clinic that only operates three times a year, then that batching could be a little bit detrimental, because being on birth control for three months would be a concern. But if the batching is there to be able to help improve the lab, and you're not on birth control for three months, then there are actually major benefits to you and to your embryos and having the highest quality
lab. And so it doesn't make labs that don't batch every month worse, and it doesn't make labs that are continuously up bad. But I want you to at least understand what the reason behind the batching is and why it still benefits you. And so with one system, you're giving up the cleansingness of the lab, but in the other system, you might have to be on birth control for a few days longer than you originally been
on. But the most important part to understand is, even if the lab didnt batch, most programs that are using batching or not batching, are still using birth control. And there are very few clinics that just allow you to start stimulation with your menses, which we call cold start. We do it as well. Matter of fact, every cancer patient that comes through is usually a cold start, because we have to start them right away. But if we had the choice, most doctors are going to do some type of
priming. I would even make the argument that some of the clients that are not using priming are even doing it for ulterior motives. Meaning they want to get the patient in right away. They don't want them to second guess. They want them start as m soon as possible, because you can't change your mind once you started. Now, I can't prove that, but that's my personal opinion, because I don't see the benefit of never putting people on
priming. There is absolute evidence that there is benefits of being on, priming. So if you never do it, there has to be another reason for it, because it's definitely not for the patient every time. There may be situations where it is, but it is not true all the time. As always, hopefully this episode was helpful to you and that maybe have a better idea of understanding, batching, and maybe something you were concerned about, you were able to feel more comfortable about,
or maybe help you make a decision. But in the end, as I always say, thank you so much for coming and listening to this podcast. And as always, please spread this podcast as much as you can, because I don't advertise it, and so it's you who does the advertising to let people know about it. And the more people that listen to it just makes me more excited to do it. And so I really love seeing the comments that come in and also seeing the numbers of people listening to
this show. If you love it, tell someone about it. Maybe tell a family member and give us a good five star review if you really like it. As always, the most important part is to keep coming back. I look forward to talking next week, on talk about fertility Tuesday.