Episode 12.3 Conception timing, tips for obese laparoscopy, and more!

We challenge a few stubborn pieces of OB-GYN “common sense” and ask what the data actually supports, from trying to conceive after miscarriage to how we start and adjust ovulation induction. Then we shift into practical laparoscopy tips for obese patients and end with a sober look at how evidence quality shapes care, from magnesium sulfate debates to the rise in pregnancy-associated overdose deaths. 

• why waiting a full cycle after first-trimester miscarriage lacks evidence for better outcomes 
• why routine progestin withdrawal bleeds before letrozole or clomiphene can be unnecessary and even harmful 
• how stair-stepping ovulation induction dosing can shorten time to ovulation 
• four operating room tips for minimally invasive surgery in morbid obesity, including port geometry and Trendelenburg dry runs 
• what a recent D&E fetal demise paper suggests about DIC and hemorrhage risk beyond 28 days 
• why retrospective birth registry studies can mislead when randomized trial data exist 
• how Medicaid timing findings highlight confounding rather than causation 
• a clever low-port approach to perforated IUD removal using a transabdominal hysteroscope 
• why overdose deaths are rising faster in pregnant and postpartum people and what fentanyl changes 

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0:00 Welcome And What We’re Reading

0:29 The Myth Of Waiting After Miscarriage

1:08 Skip The Provera Withdrawal Bleed

7:49 Data On Conceiving Sooner

13:52 Laparoscopy Setup For Obese Patients

25:07 D&E After Second Trimester Demise

28:39 Magnesium Sulfate And Study Quality

39:06 Medicaid Timing And Confounding

44:57 Single Port Perforated IUD Removal

49:33 Overdose As Leading Pregnancy Associated Death

57:57 Book Shout Out And Closing

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