From IVF to Menopause: A New Approach to Hormone Monitoring

[00:00:00] Hi, welcome to Beyond The Paper Gown, where we explore the factors that impact on women's

[00:00:13] self and how we can use that knowledge to be our healthiest self.

[00:00:17] I'm Dr. Mitzi Krockover.

[00:00:20] You know if you've gone through IVF or in vitro fertilization, then you know how rigorous

[00:00:25] and time consuming it can be.

[00:00:28] You probably also know then that hormone monitoring plays a crucial role.

[00:00:33] Today, we're going to talk about the process of hormone monitoring.

[00:00:37] We'll learn how new technology may be able to make the IV process more convenient and

[00:00:42] efficient.

[00:00:43] We'll also talk about the other end of the spectrum menopause, and how such monitoring

[00:00:47] may help us personalize hormone treatment in the future.

[00:00:51] And stay tuned until the end when we discuss the current over-the-counter hormone measurement

[00:00:56] diagnostics and how accurate they are.

[00:00:59] Just a reminder, this podcast is for educational purposes only and should not be taken as

[00:01:04] medical advice.

[00:01:06] Please do speak with your healthcare provider for any specific questions related to

[00:01:10] your personal situation.

[00:01:15] I am very excited about this conversation that we're about to have because it talks

[00:01:29] about hormones and some really interesting new science and innovation.

[00:01:36] We have Dr. Effert Eliyahu, who's an assistant professor of genetics and genomic sciences

[00:01:42] at the Icon Institute in New York.

[00:01:44] She specializes in embryology and reproductive research, and she is an advisor to a Vita

[00:01:52] life, which is a women's health diagnostic company.

[00:01:55] And we're going to welcome later another member of the team of a Vita health, Dr. Natasha

[00:02:01] Streisand, who is a process architect at a Vita life.

[00:02:06] And we'll also find out what a process architect is.

[00:02:09] So if I can call you Effy, Effy, it is great to see you today.

[00:02:14] Thank you.

[00:02:15] Yes.

[00:02:16] Thank you.

[00:02:17] Great.

[00:02:18] First of all, let's talk a little bit about your work and what you focus on.

[00:02:25] So my work is actually focusing on how to improve in general women's health, focusing

[00:02:37] on trying to promote safe and effective hormonal therapy, and also to try to improve the IVF

[00:02:51] and vitro fertilization protocol that is heavily using hormonal therapy.

[00:02:59] Let's take a moment to talk about IVF, so we're all on the same page.

[00:03:03] In IVF, eggs are combined with sperm outside the body in a lab setting.

[00:03:09] This process includes several steps, starting with medications to control a menstrual cycle,

[00:03:15] followed by stimulating the ovaries to produce multiple eggs.

[00:03:19] These eggs are then retrieved, fertilized with sperm, and the resulting embryos are transferred

[00:03:25] back into the uterus, hoping for a successful implantation and pregnancy.

[00:03:31] Hormone monitoring is pivotal in this process.

[00:03:34] Hormones regulate everything from the growth and release of eggs to preparing the uterus

[00:03:38] for embryo implantation.

[00:03:41] In IVF, precise hormone control is critical.

[00:03:45] It helps in effectively stimulating the ovaries to produce viable eggs, ensuring they're retrieved

[00:03:50] at the right time and preparing the uterus to receive the embryo.

[00:03:55] Any imbalance can affect the chances of success which makes hormone monitoring so important

[00:04:01] in this process.

[00:04:03] Dr. Aileahu's work focuses on enhancing the way eggs and embryos are cultured during IVF.

[00:04:10] The goal is to improve the conditions in which these cells develop, aiming to extend their

[00:04:14] viability and increase fertilization success rates, and potentially reduce the need for more

[00:04:20] intense hormonal treatments that are often part and parcel of IVF today.

[00:04:26] Dr. Aileahu's approach is particularly relevant in today's diverse IVF landscape.

[00:04:31] It's no longer just couples struggling with fertility for years who seek IVF.

[00:04:36] The patient base now includes a wider spectrum, older individuals, same-sex couples, and

[00:04:41] single people eager to start families.

[00:04:44] Dr. Aileahu advocates for personalized treatment protocols that cater to the unique needs of

[00:04:49] each of these groups.

[00:04:52] As a scientist, the way that we have in order to try to improve the clinical protocol is

[00:05:03] by first I was trying to improve the culture conditions, for example, in the IVF, in

[00:05:13] order to prolong the life of eggs and embryos in culture, to bring into higher successful

[00:05:23] rate, fertilization rate.

[00:05:25] So there will be no needs of aggressive super-ovalation and aggressive hormonal therapy in order

[00:05:36] to achieve a successful cycle, IVF cycle.

[00:05:43] For those who have not experienced IVF, tell us a little bit about that process and why

[00:05:51] what you're focusing on is so important.

[00:05:55] So I would like to start with explaining why I believe the protocol in the IVF is as

[00:06:06] it is today and why I believe it's need to be addressed.

[00:06:13] So decades ago when the IVF clinic was helping couples that were challenged to get pregnant,

[00:06:26] in most of the cases, couples were trying for several years to get pregnant and when

[00:06:33] they reached the point that they were desperate, they went to the IVF clinic in order to get

[00:06:41] a solution.

[00:06:43] And back then the protocol was just based on the population that was coming to the clinic.

[00:06:53] This protocol was based on hormonal therapy in order to increase the number of outside

[00:07:01] that can actually survive in the in vitro environment to receive embryos.

[00:07:11] These days most of the patients that are coming to the IVF clinic have different challenges

[00:07:18] than what it was years ago.

[00:07:22] There are a lot of patients that they have advanced age, not that it wasn't in the past

[00:07:30] but mainly today's much more one of the most examples of the needs to IVF clinic help.

[00:07:40] And also different couples or same sex couples or just patients that do not have the other partner

[00:07:52] to concede.

[00:07:54] And all of those new patients so-called are going through the same exact protocol.

[00:08:01] It's like one size fits all.

[00:08:04] Yes, and one protocol fits all mainly.

[00:08:08] And of course we know that there are different clinics and different I don't want to say that

[00:08:13] everyone is like that but this is the mainstream phenotype that we are seeing.

[00:08:21] So aside of trying to improve the IVF media and culture and conditions, I thought that

[00:08:30] in order to enable physician to do hormonal monitoring and not just one dose fits all

[00:08:39] in order to reduce the side effect that patients, especially patients that are going through

[00:08:44] IVF is to enable the physicians and the providers to do hormonal monitoring.

[00:08:55] So my second push was to try to see if there is any way to give those patients, not only

[00:09:06] the IVF patient and we can touch later on which population actually can benefit from that

[00:09:13] to be able to monitor the fluctuations and changes in hormones in order to bring better

[00:09:22] efficiency of the treatment that they are going through.

[00:09:26] And also safety.

[00:09:29] And I would also assume convenience because right now they are having to come in every

[00:09:35] few days, get their blood drawn and also an ultrasound.

[00:09:40] And so if I'm understanding you correctly what you're saying is that if you could do this

[00:09:45] at home then that would cut down on the number of visits as well.

[00:09:53] But how would you deal with the need for ultrasound?

[00:09:56] So there's no question about the convenience home test, allowing the individuals to monitor

[00:10:03] their hormone wherever they want if it's in the office or at home and they don't have

[00:10:08] to necessarily rush into the clinic.

[00:10:11] So in most of the clinic, the protocol today you need to come to the clinic for a period

[00:10:19] of time between 7-12 days, almost every day for blood drawing and not always also a vaginal

[00:10:29] ultrasound to validate the size and the amount of follicles in the ovaries.

[00:10:36] In order to better predict when to do the outside retrieval and the other procedure that

[00:10:42] need to be done, the ultrasound is not necessarily done every visit.

[00:10:49] Sometimes they ask because the patient is already there.

[00:10:53] But if we could just reduce the amount of visits in the clinic during every cycle and

[00:11:04] the quality of life of those patients will dramatically improve.

[00:11:10] Let's back up a little bit and just kind of start from the beginning so that everybody,

[00:11:16] our listeners are all on the same page.

[00:11:20] Let's talk about what are the sex hormones that are important in women's health if you

[00:11:26] will.

[00:11:28] Okay, so sex hormones actually have effect on almost every aspect of our body.

[00:11:39] So there are physical traits, there are physiological traits, there are mental health and emotional

[00:11:46] well-being influence.

[00:11:50] And of course, our sexuality function and also about our reproductive health.

[00:12:01] So and also I would like to mention that some hormones have also influence and are involved

[00:12:09] in some of the oncology field like in breast cancer, some tumor are depend on a story,

[00:12:19] hormone and so on.

[00:12:21] So really sex hormone has a very wide effect on our body.

[00:12:32] Unlike an IVF where hormone levels are monitored frequently, in menopause Dr. Eliah who notes

[00:12:37] that hormone replacement therapy or HRT is often a one protocol fits all approach where

[00:12:43] adjustments are made based on symptom relief.

[00:12:46] However, she emphasizes the potential risks and benefits of HRT highlighting that without

[00:12:52] monitoring hormone levels it's challenging to determine the therapies impact on conditions

[00:12:57] like cancer or cardiovascular disease.

[00:13:01] Dr. Eliah who also points out the variability in how individuals process hormones especially

[00:13:06] as they age and how this affects hormone therapy.

[00:13:10] We got into the conclusion that if you are not monitoring the level of hormones during

[00:13:21] time, if you are not monitoring you cannot say for sure if the hormonal therapy is actually

[00:13:29] causing damage or increase the risk for ABC or D if you cannot even correlate it to the

[00:13:37] level of the hormones in the blood.

[00:13:41] And it doesn't matter for me if you are saying okay for taking one year, two years and

[00:13:45] four years because what we see in actually animal model that we perform is study that we

[00:13:50] performed.

[00:13:51] What we can see is that there for example there is a very important enzyme in the liver that

[00:13:57] responsible for the processing and breaking down clearance of the estrogen in the blood.

[00:14:03] But during aging and I want to remind you that when you are starting the menopause or

[00:14:10] where you are deep in menopause, eposmenopause condition, those conditions, those enzyme levels

[00:14:18] is going down.

[00:14:20] So if you are taking today 1 milligram of estrogen or you are taking it in three years deep

[00:14:27] in menopause, the level in your blood will be totally different.

[00:14:35] And then it can switch between helping to damaging and everything can be controlled easier

[00:14:43] if you can just monitoring.

[00:14:45] So answering your question I think even at the beginning, physician are not monitoring

[00:14:53] the hormones because it's not important and that what we are trying to fight.

[00:14:59] You don't know that it's important because you are not measuring each the egg or the chicken.

[00:15:05] Sure.

[00:15:06] But just to be clear, at this point in time even if a clinician was monitoring it, there's

[00:15:14] no guidelines about what to do with respect to those different levels.

[00:15:21] Absolutely and this is how we can get into resolution.

[00:15:25] If we will have the hormonal monitoring at home device to do hormonal drug monitoring,

[00:15:35] the clearance of the drop from the body, the absorption of the blood which is totally

[00:15:41] different from one person to another if we want to personalize hormonal therapy, we

[00:15:48] will, if we will do it, we'll be able to do a wide clinical trials to validate and finally

[00:15:59] to solve those questions where and who should take the hormonal therapy.

[00:16:06] How much should be a have if there is any disposition for a lung disease in that patient, do

[00:16:14] not advise to take hormones or and so on.

[00:16:18] But in order to raise the flag, yes no, we have to have those devices in order to prove

[00:16:29] that monitoring can dramatically change the quality of life of patients.

[00:16:36] You know what you're really highlighting is that we don't have information and it's

[00:16:43] really amazing given that every woman will go through menopause, should they live that

[00:16:49] long and yet we have such little information about it because really research has lagged

[00:16:56] behind.

[00:16:58] So what you're really talking about in a lot of ways is needing to progress that research

[00:17:06] very quickly.

[00:17:08] Yes, and you know one of the efforts that I would say for a vital life was okay.

[00:17:16] You are saying that we need a device in order to actually answer those questions in order

[00:17:21] to create a real time, a clinical studies.

[00:17:25] And for example, you know, I'm sure you know with your background, for progesterone for

[00:17:31] example, used to be tested during pregnancy and it stopped.

[00:17:37] And you're asking physician and I can ask you why do you think it stopped?

[00:17:43] Is it meaningful?

[00:17:45] But we know that progesterone is so important for the support of the embryos in the uterus.

[00:17:52] The embryo can be perfectly fine and still you will go into miscarriages.

[00:18:00] And because of the wall of the uterus that was not supportive enough with progesterone to

[00:18:04] hold the embryo.

[00:18:07] So I'm asking myself why it stopped?

[00:18:10] Because it's not convenient.

[00:18:12] It's impossible to monitor the progesterone during pregnancy, but we strongly believe,

[00:18:18] I strongly believe that bringing back the hormonal monitoring or hormonal testing will

[00:18:29] help us to light the knowledge of what going on.

[00:18:35] And also, the fact that hormones are changing during the day.

[00:18:40] So some physician said it's not important because I will test it in the morning and

[00:18:44] will test it in the evening.

[00:18:45] It will be different.

[00:18:46] What does that mean to me?

[00:18:48] But if you're doing monitoring during time or more frequently only at home, you can

[00:18:56] do it.

[00:18:57] And then you can get the whole picture of what's going on in this particular body.

[00:19:05] Well you alluded to or you actually mentioned Avitra.

[00:19:08] So let's bring on Dr. Natasha Streisand, who is the, as I said, process architect of

[00:19:16] Avitra life to talk about the company a little bit and what you're trying to achieve.

[00:19:22] Natasha is so great to see you.

[00:19:25] So tell us what a process architect is.

[00:19:28] Thank you for having me.

[00:19:31] Process architect is a person who synchronizes efforts of multiple teams.

[00:19:37] So if we were talking about, if he was talking about analyzing patient data and Avitra trying

[00:19:45] to build the device for monitoring, hormonal monitoring, and have a clinical piece where

[00:19:51] the doctors can explain how we can better integrate something that Avitra is developing

[00:19:59] into the healthcare.

[00:20:01] And then of course as a business, business faster where we want to make it affordable and

[00:20:10] profitable at the same time for the company.

[00:20:13] So I'm trying to synchronize all the efforts that all is going to lead to the same result

[00:20:19] where we can produce something that can improve women's health.

[00:20:24] Thank you.

[00:20:27] And so talk a little bit, either one of you about what you are creating and what's the

[00:20:36] hope for the next few years.

[00:20:39] Natasha?

[00:20:40] I can take it.

[00:20:41] Great.

[00:20:42] So I think we talked about lack of misinformation, about lack of knowledge.

[00:20:51] And I want to echo that and say that healthcare providers and technologies or reproductive

[00:20:57] medicine specialists, it is impossible for them to deduce how to optimize treatment

[00:21:05] because they are lacking the tools that are needed.

[00:21:09] And also they don't have the capacity to do this kind of evaluation in real time.

[00:21:16] So we want to, our first goal is to gain knowledge and share knowledge about what are

[00:21:24] the specific variables for each woman that either in the hormonal baseline levels or the

[00:21:35] outcomes of the treatments or the side effects that are long-term side effects in a large

[00:21:42] scale.

[00:21:43] So once we have the knowledge and we have the tool that we're developing, we want to help

[00:21:49] bring this into healthcare practice, help the doctors optimize the timing and the dose

[00:21:56] of treatment, prevent long-term health risks and of course improve, achieve better clinical

[00:22:03] outcomes, better health and better, a whole more balanced women.

[00:22:10] Either they need hormonal treatment or they don't but you want to help them achieve

[00:22:14] both.

[00:22:17] And Fee are you planning to do any large clinical trials with respect to getting some of

[00:22:24] that data that you need in order to help physicians know what to do with this information?

[00:22:31] Absolutely.

[00:22:32] I'm dreaming for that day.

[00:22:36] Literally, I dedicated my career in order to get to the point that we can do the change with

[00:22:45] my scientific break from my education, I could just go and be the head of IVF clinic and make

[00:22:53] a lot of money.

[00:22:54] Other than staying in the academic and doing this change.

[00:22:57] I do want to get into this point of having a and the number of clinical trials that can

[00:23:03] be done are huge.

[00:23:07] Most of them won't be done by us, right?

[00:23:09] Because it will be in any field that hormones take in place but I would like to add one more

[00:23:16] point about and it's actually touching a little life but I think there is a big issue that

[00:23:26] I mean let's do the point that we do not have good diagnostic tests for hormones.

[00:23:31] It's because steroids hormones are a tiny molecule that are in such low concentration

[00:23:42] in the blood in a picogram levels.

[00:23:46] You don't need much of estrogen in order to cause a chaos.

[00:23:53] And we know that tiny level of picogram level of estrogen will do the change.

[00:23:58] And that's also why the reason that there have a lot of severe side effect when you're

[00:24:02] overdosing because they are tiny molecules that do a lot of chaos.

[00:24:11] And so the reason that they are very small and in very low concentration making the diagnostic

[00:24:19] test super challenging.

[00:24:23] Even in the blood role, in the regular labs, the clinical labs it's challenging.

[00:24:30] So to have it in the home device, from fingerprint for example is really challenging or from saliva

[00:24:38] or urine and so on.

[00:24:41] So what I liked at the Vita was to help them and you know, to develop a unique tool,

[00:24:53] new tool for the diagnostic that will enable us to test not only steroids and hormones.

[00:24:59] You know it's also can be applicable for any pharmaceutical drug.

[00:25:03] How nice it will be that the patient can take them and you know their lattice to home

[00:25:10] and see if they are in the toxicity level or not.

[00:25:15] And so what the Vita life is doing and actually my lab is collaborating just to validate their

[00:25:22] you know test, they put together a very healthy brains I want to say that from the field

[00:25:29] of a molecular biology biochemistry chemistry diagnostic and so on in order to put together

[00:25:38] a new molecule that will enable this precise accurate diagnostic test.

[00:25:47] That I strongly believe and hope that they will succeed, that we will succeed all together

[00:25:54] to have this key and to have this option of the diagnostic.

[00:26:03] And because most of the tests also limited with the range, estrogen can go from one

[00:26:09] picogram up to thousands. So having a test that can be very accurate and by the way a lot

[00:26:17] of physicians unfortunately don't even trust the test results that they are setting into

[00:26:21] the lab. And so if indeed a Vita will be able to deliver such a test I will be very happy.

[00:26:33] Any company that will do that, I will be very happy.

[00:26:37] Yes. You know right now there's a number of tests on the market both primarily focused

[00:26:44] on menopause or are you going into menopause or are you fertile and there's saliva test

[00:26:54] there's blood test and there's urine test. So briefly tell me about the state of our diagnostic

[00:27:04] testing or at home diagnostic testing at this point in time.

[00:27:10] Yes, so as I mentioned we have to keep in our mind that home tests in general are not

[00:27:16] so accurate. As the let's say the laboratory test that are offered and also provider usually

[00:27:25] won't trust any home test at an end of the laboratory. So it's true there are a lot

[00:27:31] of different kits and tests that are offered at home. And there is the ovulation predictor

[00:27:40] kit that different companies are selling over the counter for a large levels and so on.

[00:27:51] There is as we mentioned before pregnancy test over the counter pregnancy test that measuring

[00:27:58] mainly the beta HCG hormones and most of them are urine tests. There is also saliva hormonal

[00:28:09] testing, some of them are offering even estrogen and progesterone I know that some company

[00:28:17] are working in order to bring it to the market. Everybody is telling me why do you want

[00:28:23] to do the blood test? Why not go to non-invasive glucose test and I'm so precise, I'm

[00:28:31] saying no with that you cannot go to the saliva test. Simply because for example there's

[00:28:38] a lot of type of food that have stories in them that can really change the sensitivity

[00:28:46] the accuracy of the hormonal level. There are home blood fingerprint blood tests, but

[00:28:58] there are most of it are blood spot test that you are putting one drop of the blood on a paper.

[00:29:04] But for that you need to send it in the mail and waiting for the results and so on.

[00:29:12] The urine hormone tests are more reliable, but from my experience which I try to help a

[00:29:19] lot of friends and different couples to find the right timing for a ovulation and so on.

[00:29:27] There are not reliable too. It's really the first urine no no no actually let's go

[00:29:34] to the second one and how much did you drink? It's weird how come the dialysis now lower during

[00:29:40] the day comparing to the morning and so on. It's really frustrating in order to change

[00:29:46] the clinical protocol we have to measure the hormones in the blood that is the most reliable

[00:29:54] and stable fluid in order to really validate and change the concept in order to do an accurate

[00:30:02] clinical trial that when we will publish the paper it will be reliable. Thank you.

[00:30:09] So before we wrap up what did I not ask you Natasha that you wanted to make sure that our listeners knew?

[00:30:21] Yeah, thank you. I can just quickly maybe describe our

[00:30:27] roadmap to improving women's health and

[00:30:31] say you know what women can expect to hear from us about

[00:30:35] and so in the next year we hope to launch and

[00:30:41] accurate at home after general progesterone test which can be used to collect additional missing data

[00:30:48] point. So we'll probably involve women and

[00:30:53] collect these data points and help us better understand the result of different hormone

[00:30:58] treatment and then with that with this information in the following year we will improve

[00:31:07] AI guided prediction model that will help

[00:31:12] first understand how to optimize treatments. This will be it will have to be done in clinical

[00:31:18] trials so first we understand how and then we tested in clinical trial whether our

[00:31:25] AI guided algorithm will indeed result in improved clinical outcomes. And then final piece

[00:31:32] within three years or so we hope to integrate our technology in healthcare practice

[00:31:38] so that the doctors can recommend using our technology so they can give a better healthcare.

[00:31:47] My guess is that when you do that clinical trial you're going to be

[00:31:52] wanting and recruiting women to participate so hopefully you'll let me know so that we can

[00:32:00] let our audience know as well that this is something that they can do to contribute to the science

[00:32:07] that will help with. That's amazing, we'll be happy to keep you updated and you know touch base.

[00:32:13] So every what is it that you would like to leave our listeners with?

[00:32:18] So my call is we it's hormones are good in a level at a sense as long as there are

[00:32:32] monitored and the right levels and I want everyone to know they have two rights to go

[00:32:38] and to support in the future the personalized therapy for each patient with his own history

[00:32:48] his own genetics. And we are trying even to predict today by your DNA what are the risk for

[00:32:57] how you are going to react to this and that's therapy this and that dose so how come in such a world

[00:33:07] that I'm actually coming from such a simple blood monitoring for drugs and for stories is not there

[00:33:15] so yeah that may wish. That's really profound. Well thank you both for spending time with us

[00:33:23] I learned a lot and also thank you for your work. Thank you for having us. Thank you, thank you for

[00:33:29] having us. My pleasure.

[00:33:37] As we come to the close of today's episode of Beyond the Paper Gown I'd like to take a moment

[00:33:43] to reflect on the rich and insightful conversation we've had with both Dr. Effret Eliahu

[00:33:48] and Dr. Nishasha Streisand. It's clear that the fields of hormone monitoring especially in areas

[00:33:55] like IVF and menopause is on the brink of significant change. And one of the most compelling takeaways

[00:34:01] from today's discussion is the need to move away from the one size fits all approach that has long

[00:34:07] dominated hormone therapy you know it's evident that personalization and treatment is really not just

[00:34:13] a luxury but a necessity. The uniqueness of each individual's hormonal makeup demands a more nuanced

[00:34:20] and tailored approach to treatment. This is particularly critical when we consider the future

[00:34:26] of IVF and menopause management. The potential for at home precise hormone monitoring tools to

[00:34:33] revolutionize these treatments is enormous. Imagine a world where the IV process is less burdensome

[00:34:40] and success rates soar and menopause is managed more effectively all because we have a deeper

[00:34:47] data-driven understanding of each person's hormonal needs. Companies like Avita are working on

[00:34:53] exactly this area and it will be exciting to watch their progress so as we sign off from today's

[00:34:59] episode let's look forward to a future where hormone treatments are as unique as the individuals who

[00:35:04] need them. I thank you for joining me on Beyond the Paper Gown and I invite you to subscribe to

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[00:35:23] and I have just one request today. Please comment and rate us it helps us get noticed.

[00:35:29] Until next time take good care.

[00:35:38] Our podcast is produced by Patrick Shambhiyati and me and our associate producer is Kyla McMillion.