SPEAKER_00 0:01

Welcome back to the Fertility Suite Podcast, Day Victory, where we're bringing the fertility experts to you so you can make the most informed educated choices about your fertility. Good evening, everybody, and welcome back to another episode of the Fertility Suite podcast. And I'm super excited this evening because joining us we have Dr. Victorie. And Dr. Victorie is a reproductive endocrinologist and fertility specialist. And this evening we're going to be talking about endometriosis and unexplained infertility. So, Dr. Victorie, thank you for joining us. Would you like to just introduce yourself and tell everyone a little bit about yourself first?

SPEAKER_01 0:38

Sure. Thank you for having me. I appreciate that. I am a reproductive endocrinology and fertility specialist. I've been in practice for too long to share on social media. It's going to age me. I recently got licensed in the UK and I'm just waiting for my work permit. But we have several clinics in Canada and focus a lot on individualized care, holistic approaches, doing deeper dives into what's wrong and figuring it out and optimizing rather than just plowing people endlessly through infertility treatments like IVF, expecting it to just, you know, sort of work because we did it enough time. So we're quite cautious about what we do, but it does end up working pretty well.

SPEAKER_00 1:21

Yeah, amazing. And that's so in line with kind of how we work as well, which is why I was really excited to have you on the podcast. So let's have a chat then about endo. So do you want to start by just explaining to our listeners kind of what endometriosis actually is and how it does really affect your fertility? Because I think it's hugely misunderstood and it's a word we hear a lot, but it's really good to actually get to the nitty-gritty of actually what it is and how it affects fertility.

SPEAKER_01 1:47

Sure. Endometriosis is when the endometrium, which is the material women shed every month with their period, actually ends up outside of the uterus. So it can be on the surface of the uterus, it can be on the fallopian tubes, on the ovaries, it can be as high as the diaphragm. Some people have it in their lung or in their brain. So it can really kind of travel anywhere in the body, but typically it locates itself mainly in your pelvic region. And it causes a lot of inflammation because your immune system immediately recognizes this doesn't belong here and tries to attack it and get rid of it, but that causes a lot of scarring, inflammation, adhesions, and it can have wide-ranging impacts. So egg quality diminishes, tubal function can diminish depending on the severity of the endometriosis. The implantation decreases, miscarriage rates are higher. And there are some studies that suggest actually that the genetic component of the embryos, whether they're euploid or aneuploid, as we say, can also be impacted by endometriosis. So it really impacts the whole gamut and can really negatively have an effect on whether or not you're going to get pregnant when you're trying.

SPEAKER_00 3:05

So it's a lot more systemic than perhaps people might believe, I guess, when you're explaining it like that.

SPEAKER_01 3:10

So you'll have a local effect, which is sort of structural. You have adhesions, you have scarring, the the sperm and the egg can't get together, for example. You'll have sort of fairly local, but not quite that local. So things like egg quality impact, impact on the endometrium, whether or not the embryo is able to actually implant or be accepted by the endometrium. And then you have the more systemic effects where it's actually driving up inflammation, activating your immune system. And your immune system, for all the good that it does us, is also quite indiscriminate. It can't necessarily tell friend from foe sometimes. So when an embryo lands in the uterus, it might look at that and say, well, that's kind of half us, but not half us. And if it's already overactive because it's fighting off endo, sometimes the cells that go, well, that's not half us say maybe we should kill it. And then they actually try to kill the embryo. There's a famous British personality I had a lovely chat with recently and did a podcast with who does dancing on ice and one dancing on ice, Alex Murphy Klein. And she was recently diagnosed with being sort of allergic to her partner. And that's essentially what endo can do to you. It can make you sort of aggressive in your immune system so that it's almost behaving hostile towards an embryo trinum implant.

SPEAKER_00 4:40

Yeah, absolutely. I think that yeah, there's that's probably the more misunderstood side or lack of understanding. People don't really know that about endo, right? Like it does have this really big effect on the immune system. So, in terms of those lesions or the endometrial cells that you said move away from the endometrium itself, how does this happen? Like, do we really know? Is that the$64 million question?

SPEAKER_01 5:04

Yeah, that's the that's the trillion dollar question. Um listen, if you figure it out, let me know. We could be billionaires by tomorrow morning, but there are theories. So there's one that's very popular called retrograde menstruation, which is essentially as your uterus is cramping to push out the menstruation, some of it actually goes through the fallopian tubes and lands in the pelvis, adheres to the tissue, and then kind of regrows or starts to redevelop its blood supply and then can flourish. Some people believe that you're just born with the cells there. There, so that's congenital. It can actually be unfortunately placed there by us, cesarean section being probably the number one culprit. So that's very possible as well. You can get cesarean scar endometriosis, you can get endometriosis just because the endometrium was brought out during the repair of the C-section. So there's various issues there. It can jump into the bloodstream or the lymphatic system. And then there's this wild theory that it can actually change from one type of tissue to another.

SPEAKER_00 6:12

Oh wow. It's that advanced in its thinking. That's crazy. I once had a patient that had it in her appendix. She went in for laparoscopy and they found her appendix were like riddled with endometriosis. They ended up taking them out. So yeah, it can it can just really get everywhere essentially.

SPEAKER_01 6:28

It can't. There are patients that have something called cataminial seizures, which means you have a seizure every month with your period. And it's because the endo is in their brain. I actually have one right now. So you have to give them birth control just to prevent them from having seizures. So it can really go anywhere in the body at all.

SPEAKER_00 6:47

That's crazy. And we'll come and talk about diagnosis shortly. But yeah, that's part of the worrying thing, I guess, about endo. So for anyone kind of listening, how would you know if it's possible to know whether you may have it? What would the signs and symptoms be? How does it present typically and like atypically, I guess?

SPEAKER_01 7:06

Sure. Uh the typical symptoms we call the three Ds. So dysmanorhea, which means painful menstruation, dysperunia, which means painful intercourse, and then deep pelvic pain. So you're just kind of sore or achy in your deep pelvis on a regular basis or inopportune times. So those are the typical symptoms. There are other symptoms, however. So things like pain with urination, pain with defecation, significant kind of radiating pain that goes down your legs or up into your back. Some people will have positional pain with intercourse where certain positions are worse than others. So that can be uncomfortable as well. So all of these are significant factors which can contribute. Having said that, we know that from very well done research, in fact, pretty recently, 44% of people that have unexplained infertility, where there are no symptoms whatsoever, actually have underlying endometriosis as their diagnosis. So it sometimes is silent endo, as we like to call it, and there are no symptoms whatsoever. There are some other signs that we can find. So, for example, we find a lot of women whose uteri are sort of flipped over upside down, so it's kind of curled over like that. That's called a retroverted retroflexed uterus. It's very common in endo patients. And then we have other women that have, for example, a very diminished ovarian reserve or a rapidly declining ovarian reserve. And those women also have a higher risk of having endometriosis. So there are some signs that we look for that aren't just symptoms, but symptom-wise, traditionally it's those 3Ds and a couple of peripheral things we look for as well.

SPEAKER_00 8:56

Yeah, and I guess some of those things that you were just mentioning in the latter are things that unless you're undergoing fertility investigations, you wouldn't necessarily know, you know, what the positioning for uterus was and things like that. So you kind of have to be already in the system as we call it over here. So why is the why is the time to diagnose this so long? Like I read somewhere that the average diagnosis time in the UK, I believe, is around eight years. It feels like something that takes longer to diagnose than it should.

SPEAKER_01 9:24

Yeah. So there's the cynical answer, and there's the politically correct answer. So I mean, the politically correct answer is we're going in blind, and it's not something you can diagnose unless you do laparoscopic surgery. And so, you know, sometimes it's just challenging to be able to figure out what to do. So in many instances, we don't know. Like you're looking at the patient, you're thinking, is it possible? Is it not possible? And there is a huge amount of pressure to get people into treatment in fertility centers rather than focus on necessarily what's the diagnosis, which I do find deeply problematic. Having said that, the cynical part of me is that women are ignored, they're often gaslit, their pain is downplayed, they're told it's normal or natural when in reality it isn't. And so a lot of it is just physicians failing to address the concerns of the patients in an appropriate fashion. Some of that happens at the primary care level. I think a lot of it happens at that level. Some of it happens at the gynecologist level, and then a lot of it happens at the fertility specialist level because many fertility programs are owned by venture capital or private equity. They're not making money off of patients that go for surgery to fix their endometriosis and get pregnant naturally. They're making money from patients that are doing IVF. So they want to ignore your infertility or I should say your endometriosis and just tell you it doesn't matter, which is a very common refrain. And then they say, just do IVF, it's going to fix it. Well, you know, I I've been shouting this for ages, but IVF does not fix endometriosis at all. In fact, it makes it worse.

SPEAKER_00 11:14

Worse, yeah, yeah.

SPEAKER_01 11:15

So that's not a solution for the patients that have endo.

SPEAKER_00 11:19

Yeah. It's really sort of what's the word I'm looking for? It's like a breath of fresh air, I guess, to hear you say that, because that's something we see in our, you know, we we practice holistically, and these are conversations we're having on a day-in, day out basis with patients. And it's about helping patients to advocate for themselves. But it's really hard when they're being gaslit. And I think if these things were picked up on at a younger age, you know, typically in the UK, if you go to the doctor with painful periods, you know, when you're in your early teens or late teens, you will be put on the oral contraceptive pill, and that will be the solution. And that's not fixing endometriosis either, right? And the investigations need to be done earlier to support people's fertility. It is, I, you know, I echo your frustrations. But yeah, I mean, it does kind of make sense, right? How then, if you like do have endo, or you were for someone listening who perhaps is thinking I need to go down the diagnostic route, but then what does that mean? You know, there's no point kind of chasing a diagnosis if it doesn't change what you you're gonna do. Like, what is the what are the treatment options for patients with endo?

SPEAKER_01 12:22

Uh treatment options or diagnostic options? Treatment. So so treatment options really fall into ignore it and just try, which is not a good option. Pursue insemination, which will bump up your chances a little bit, pursue medical therapy, which almost universally will prevent you from getting pregnant because it's some type of hormonal manipulation which prevents ovulation and pregnancy, or go for doing IVF, which is beneficial for patients with endo, but the endometriosis has to be dealt with as part of that protocol. You can't just ignore it and go through the IDF. Or go for surgery. And during surgery, it can be surgically excised, removed, burned, treated, whatever the case is, in which case your your chances significantly improve. We at our clinic advocate for a very holistic approach. So we use lots of natural supplements in our endocatients. We make sure we're keeping their estrogen levels low, both through diet and through medication use. We use high dose progesterone because the patients are all progesterone resistant. So the normal dose doesn't work for them. And then we know their immune system is inflamed. So we actually engage in an immune protocol where we're addressing the components of the immune system that are disrupted.

SPEAKER_00 13:51

That's a really good explanation, actually. And it shows people listening that how complex it can be and how you need to have this multifaceted approach and looking at all these things at the same time. You touched on the fact that endo can make, um, sorry, IVF can make endometriosis worse. Can you just explain a little bit about the sort of theory behind that and why?

SPEAKER_01 14:10

Oh, well, it's more than theory, it's proven. So uh when we're doing IVF stimulation, we are basically increasing your estrogen levels. And we're doing that because we're trying to drive up the number of eggs that you produce. When you increase the number of eggs, you increase the amount of estrogen. Endometriosis is a 100% estrogen-dependent disease. So as you increase estrogen levels, you're increasing the stimulation to the endometriosis. So, for example, in women that have endometriomas, which are cysts of endometriosis, they get bigger when you do IVF. So we know that doing IVF has an adverse impact on the patients with endo because you're essentially fueling the fire very much. Whether it's from an inflammatory standpoint or a direct mechanistic standpoint where it's impacting the lesions of endo or the cysts of endo, you're impacting it in every way possible. And because of that, we often tell people if you're going to do IVF as part of your endometriosis journey, make sure that you do all your IVF first, then go get your endometriosis surgery and then do your embryo transfers. Because if I do surgery on you as an endo patient and then I do your IVF, I made you better and then I made you worse, which makes absolutely no rational sense. So we try and stage it in an in an appropriate sequence. On the other hand, if people don't want to do IVF, they want to try natural or they want to try IUI, you should be doing the endosurgery first because it's going to optimize those chances.

SPEAKER_00 15:46

Yeah, it has to be tailored to the patient's plans and choices, right? Yeah. Exactly. And you touched on progesterone receptors. Can you explain a little bit more about that? Because I think this is again something that that's really important to talk about. It's not just a case of just like progesterone pesteres and they work, sort of thing. Like touch on this a little bit more.

SPEAKER_01 16:07

Sure. So I think the thing people need to realize is that progesterone is both a pericrine and an endocrine hormone. So endocrine means it goes into your bloodstream and it works on all sorts of different parts of your body. And peracrine means it works adjacent to where it's released from. So when you release progesterone, there is some being absorbed into your bloodstream and going around and doing all the things that it does. Some of which goes back to your uterus, some of which goes into your pelvis, some of which is going to everywhere else in your body, including your brain. When you're working on it from a pericrine standpoint, that's really the direct impact on the uterus. So when you take vaginal progesterone, you're really only getting that pericrine aspect of it. You're not getting the systemic impact. Add to that the fact that patients with endometriosis or adenomiosis are progesterone resistant. So those patients actually need more progesterone just to actually get the same level as someone that doesn't have endo or adeno. So merely doing the vaginal pessaries or you know, suppositories does not work. It's insufficient for those patients. We advocate for using what we call double progesterone, which is the vaginal to mimic the peracrine, and then an injectable, either the oil or you guys have Lubion in the UK where they can do a subcutaneous injection. And that way you're getting both the systemic endocrine effect and you're getting that peracrine effect at the same time.

SPEAKER_00 17:44

Yeah, that's a really good explanation. Thank you. So when we're talking about endo, for people who are listening, it probably sounds a little bit depressing. Like if you're worried you've got endo or you know you've got endo, like everything we've talked about sounds quite scary for fertility. Sure. Can you talk to us a little bit about the pregnancy outcomes in patients with endo and and just give people some examples of patients you've helped or how how you guys can help, like some a little bit of hope and positivity?

SPEAKER_01 18:15

So, I mean, pregnancy outcomes are good actually if you have an appropriate approach. Our protocol has actually garnered quite a lot of attention. And I was at the British Fertility Society meeting in Edinburgh last week, and well, about two weeks ago now. And at that meeting, they came from a clinic in that is present in the UK, but actually originated in Spain and is now kind of global. It's a very large clinic. And one of the gentlemen there presented one of the main talks, and he said for adenomyiosis, which is essentially the sister of endometriosis, that they had tried using lupron for down regulation and they knew it didn't work. But then they thought maybe we should try lupron and letrazole, and that combination would be more potent. And I people in the audience that knew me were kind of pointing at me and chuckling because I've already been saying this for four years. And we mean we've been using that protocol for a long time. And he said they had just used it on four patients and they all got pregnant. So, I mean, if you use the right protocol, there's actually quite a bit of hope, and you can almost normalize those patients' chances and really get good results. But if you're doing the cookie cutter medicine approach, which unfortunately is all too common, or you're telling the patient things like endo doesn't matter, just do IVF, you're gonna get sub-avage results, not just compared to, you know, what would be reasonable in a general UK population, but you're gonna get lower than that. You're not even gonna meet the norm, you're gonna get less than the norm. So we really advocate for these customized, individualized protocols where we can kind of help people and guide them appropriately to a successful conclusion.

SPEAKER_00 20:05

Yeah, fertility is not one size fits all, right? Tell us a little bit more about this protocol then. So what would the sort of, not the perfect, but you get my gist, what would the sort of what's the protocol, the success protocol, let's call it, that you just talked about?

SPEAKER_01 20:18

It's on our YouTube channel. I think it's under endo protocol, but we essentially suppress patients first. So three months of lupron and letrazole. And then we don't give them estrogen unless we absolutely need to. Usually just coming off the letrozole will be sufficient to allow the endometrium to grow. If we do need estrogen, we give them very, very little. So a lot of times, especially in Europe, the kind of de rigueur approach to things is a medicated frozen embryo transfer, and you're getting these very elevated levels of estrogen given to you. We avoid that completely. So, where many programs will use eight to 12 milligrams of estrogen per day, we're using one or two, and you still get the same result in terms of endometrial thickness. So we start with that. We keep the patients on multiple different supplements: NAC, curcum, resveratrol, ALA, coenzyme Q10, melatonin, fish oils, prenatal vitamins, vitamin D, all the good stuff, reduce the inflammation, reduce the high levels of oxidative stress. And then we put them on an immune protocol, which traditionally includes intralipids, a drug called tachrolimus and steroids. And then when their lining is ready, we start them on this high dose progesterone and we monitor their levels carefully to make sure we're hitting the right target. And then we'll do a very careful embryo transfer. And the embryo transfer can be unique as well. In cases of endo where you have that retroverted uterus, you can't see anything when you're trying to do a trans abdominal transfer. So we've actually mastered using the transvaginal ultrasound to guide the embryo transfer, empty blood. Ladder, no pressure, no sort of, you know, severe discomfort for the patient where they're really pushing very, very hard on the abdomen with the ultrasound probe because we're doing it all intravaginally. It's comfortable, it's easy, and you get a crystal clear view of where you're placing that embryo. So there are some things we can tweak to really maximize the success.

SPEAKER_00 22:24

I'm sure there's lots of people that are jumping at with joy at the thought of a uh empty bladder embryo transfer and everyone's a bit. Yes. Yeah. It's really tailored then. That's a really good example of like exactly how tailored it is. And I'm sure you make tweaks, you know, according to patients. But yeah, it's really interesting to hear. Thank you. Going off on a bit rogue to what we originally talked about. I'm just intrigued to know what your thoughts are around the microbiome and patients with endometriosis, because something that I have noticed is a lot of patients with endo have like classic IBS type symptoms. And when we run microbiome testing, it looks like there is a more, shall we say, dysbiotic picture than perhaps in the average patient. And I'm not gauging that from any research studies I've read just from my own clinical observations. But what you obviously see a large amount of patients with endo. So what would your thoughts be on that?

SPEAKER_01 23:23

So there's no question that the data actually, the research actually does support a association between the presence of endometriosis and dysbiosis. And in fact, I think it was about 18 months ago or so, there was a study that came out that said that a very specific type of bacteria called fusobacterium may actually be one of the causative agents of endo because they were finding it in much higher quantities in endometriosis patients. I read the study, it wasn't convincing, but nevertheless, that that belief is there that there is definitely some association between endo and dysbiosis. We don't know which one comes first, so it's a chicken or the egg question, but for sure there is an association between the two. We definitely are big believers in the microbiome here. I was probably globally one of the earliest adopters of it, working closely with a company out of Greece called Fertilysis. And we're actually developing our own test in-house now, and it'll should be ready any day now. And so we very much are believers in the microbiome. I have done all sorts of things for people to adjust their microbiome, including antibiotic washes directly into the uterus to try and help them. And we have seen remarkable, remarkable results with that, uh, massive improvements in outcomes and safety as well, because a lot of these patients that have a diotic endometrium will actually have higher rates of miscarriage, but also higher rates of things like preterm, premature rupture of membranes, preterm delivery, chorioamnianitis, and so on. We can actually spare these patients those horrors by treating them ahead of time and avoiding it completely. And I've had patients that have had multiple 16-week losses, 18-week losses, 23-week losses, just horrific tragedies that are very difficult to even recover from. And then you eradicate these bad bacteria, you establish a normal microbiome, and they sail through the pregnancy. So we're really big believers in that. It's it's a critical component of what we do, and and it's very much ignored in the scientific community, in the medical community, but it should be standard.

SPEAKER_00 25:41

Yeah, well, hopefully with companies like Fatilysis and yourself, this narrative will start to change. Are you going to be offering the uterine washes when you come to the UK then? Slightly excited by this prospect. Amazing. We will be. Yeah, this is brilliant because um we've in our clinic our patients that have gone to fatilysis in Greece, they've had really good results with the uterine washes. And yeah, that's why I was really intrigued to hear your thoughts and opinion on it. And I think it's really important for listeners to understand you know, another area that relates to endometriosis as well. So it's all about making informed choices, right? If you have the information, then you can make informed choices.

SPEAKER_01 26:16

So absolutely. It's always about informed choice.

SPEAKER_00 26:19

Yeah, absolutely. So that has been like super interesting and helpful for myself, but more importantly, hopeful for the for the listeners. Do you want to tell people a little bit about where they can find you? And yeah, exciting news, you're coming to the UK. Like, tell us a little bit about this.

SPEAKER_01 26:34

So I got my license just at the end of 2025, and I'm just working on getting my work permit. And I'll probably be there somewhere around four to seven days a month. See patients do consults, offer treatments, teach some of my colleagues how to do the things we do our way so that we can improve the outcomes. And then my colleagues have agreed to do the egg retrievals and transfers because that's quite easy as long as I teach them the sort of protocols that we want to use. So yeah, I'm very excited about that. I will very likely be working with the Avenues Clinic in London. And I love the city of London. I love the UK people. My wife's a UK citizen, so we have some ties there. And yeah, so I'm very excited about that. In the interim, for those who want to contact us, pretty much everything we do is on one of the various social media platforms. So we're on Facebook, Instagram, TikTok, YouTube, and X. And we are developing a LinkedIn page as well. We do a live show every Tuesday. Unfortunately, it's quite late for the UK. So it's eight o'clock Eastern Standard Time, so about 1 a.m. But we do actually have some very faithful people that watch the show and they'll stay up to watch it. And we answer questions live from all across the world. So we we've got people from Korea and Australia and all over the place to watch and ask their questions. And yeah, you can always contact the clinic via our website, which is just drvictory.com, drvictory.com, or infoinf o dr victory.com.

SPEAKER_00 28:08

Great, brilliant. And what I'll do is I'll put all of that contact information in the episode notes. For so for anyone listening, just go to the episode notes and you'll find all the contact details for Dr. Victory. And you can get yourselves booked in for his big arrival in the UK, which is very exciting. Excited about that. I'll ask you again in winter how excited you are to be here.

SPEAKER_01 28:28

Well, apparently, where I am in Canada, Ontario, our province, it's supposed to be the coldest place in the world this weekend. So it's going to get down to minus 50 Celsius.

SPEAKER_00 28:40

Wow, you've got a big storm coming, haven't you? I saw that. Yeah. Wow.

SPEAKER_01 28:43

I believe so. So I think we're all hunkering down for a bit of battle of optimism. A breeze. Yeah.

SPEAKER_00 28:50

Anyway, it was awesome to see you. Thank you so much for coming to join us. And I know that everyone listening, like I said, will have found that super helpful. And yeah, wishing you all the best in your UK ventures.

SPEAKER_01 29:00

Thank you. I'm looking forward to uh meeting you in person when I'm over there.

SPEAKER_00 29:04

Yeah, for sure. Thank you.

SPEAKER_01 29:06

All right, sounds good. Take care.