Fertility Q&A with Dr. Rahi Victory: IVF, Endometriosis, DOR, and Recurrent Miscarriage
In this recorded fertility Q&A, Dr. Rahi Victory, Reproductive Endocrinologist and Medical Director of Victory Reproductive Care, answers audience questions about IVF decision-making, endometriosis and adenomyosis, diminished ovarian reserve (DOR), recurrent miscarriage workups, uterine lining thresholds, and embryo grading.
If you are navigating fertility treatment and want to hear how a reproductive endocrinologist approaches these topics directly, you can watch the full session below.
Watch the Full Fertility Q&A Here
IVF at 44 and Beyond: Understanding the Math
One of the most direct discussions in this Q&A centered on trying to conceive in the mid-40s using your own eggs.
Dr. Victory emphasized the importance of understanding the numbers behind embryo genetics and age. Whether conception happens naturally or through IVF, the percentage of genetically abnormal embryos increases significantly with age. That reality affects timelines, expectations, and how aggressively someone may want to pursue treatment.
Endometriosis, Adenomyosis, and Fertility Treatment
Dr. Victory discussed:
Why endometriosis is being diagnosed more frequently
How fibroid size and location influence transfer planning
Why suppression protocols matter in moderate to severe endometriosis
The role of hormonal management before embryo transfer
Diminished Ovarian Reserve (DOR): What It Means and How It’s Evaluated
Diminished ovarian reserve generally refers to producing fewer eggs than expected for age. It is commonly evaluated through:
Anti-Müllerian Hormone (AMH)
Antral follicle count (AFC)
Prior stimulation response
Recurrent Miscarriage: Why Diagnosis Matters
The key message: IVF alone does not address recurrent miscarriage unless the underlying issue is identified.
Potential contributing factors discussed included:
Uterine anatomy
Hormonal regulation
Immune activity
Thrombophilia
Genetic factors affecting egg or sperm
Embryo Grading and PGT-A
Dr. Victory discussed:
Differences between embryo grades
The relationship between grading and implantation rates
When PGT-A may be appropriate
Why grading systems vary between labs
Uterine Lining Thickness and Transfer Timing
Common clinical thresholds
What is considered suboptimal
Whether thicker is always better
The role of progesterone timing in transfer preparation
The concept of a “window of implantation” was addressed, including why certain endometrial receptivity tests are controversial.
Antibiotics and the Uterine Microbiome
Dr. Victory discussed concerns about broad antibiotic use when not targeted to a known infection and how altering the uterine microbiome may have unintended consequences.
Adjunct Treatments and Add-Ons
Questions were raised about add-on procedures such as PRP, Neupogen, intralipids, and endometrial scratch.
IVF, Mental Health, and Suppression Protocols
A brief but important part of the discussion acknowledged the emotional impact of suppression protocols and intensive IVF cycles. While medical strategies were the focus of the session, the emotional toll of treatment was recognized as real and significant.
Looking for More Fertility Q&As or Personal Support?
Explore more fertility Q&A videos with reproductive endocrinologists covering IVF, endometriosis, diminished ovarian reserve, and recurrent miscarriage — or reach out if you’d like support navigating the emotional side of fertility treatment.
