WEBVTT - Ep 145 IVF, Part 3: Industry 0:00:00.880 --> 0:00:01.040 Hi. 0:00:01.120 --> 0:00:03.280 I'm Diana and I'm Paul, and we've been married for 0:00:03.400 --> 0:00:06.800 about thirteen years. Our journey began twelve years ago. After 0:00:06.880 --> 0:00:09.440 trying to conceive for a year without assistance. We were 0:00:09.480 --> 0:00:12.879 referred to a fertility clinic where we endured vigorous testing 0:00:13.320 --> 0:00:17.560 and were devastated with the diagnosis of PCOS and cryptozoospermia, but. 0:00:17.480 --> 0:00:19.480 That didn't stop us. We had high hopes that IVF 0:00:19.520 --> 0:00:21.599 treatments would help us grow our family. I entered my 0:00:21.640 --> 0:00:24.079 first fair CASELL removal surgery about ten years ago, which 0:00:24.120 --> 0:00:27.520 is unfortunately not successful. Our fertility doctor informed us that 0:00:27.600 --> 0:00:30.560 was such low Seman parameters IUI and even conventional IVF 0:00:30.600 --> 0:00:33.159 wouldn't work for us. Instead, we were advised to pursue 0:00:33.159 --> 0:00:36.839 a then novel way of fertilizing eggs introcytoplasmic sperm injection 0:00:37.000 --> 0:00:40.680 also known as IXI fertilization. However, due to antiquated BMI 0:00:40.720 --> 0:00:42.879 restrictions at our local clinic, Diana was not allowed to 0:00:42.880 --> 0:00:45.040 move forward with an egg retrieval. They explained that the 0:00:45.080 --> 0:00:47.960 anesthesia team did not perform these services on larger bodies 0:00:48.200 --> 0:00:49.800 that we believe this is one of the many ways 0:00:49.840 --> 0:00:52.640 that clinic artificially inflated their success rates. We wanted to 0:00:52.680 --> 0:00:54.720 move forward with an IVF at our local clinic, Diana 0:00:54.760 --> 0:00:55.680 had to lose weight first. 0:00:56.040 --> 0:00:58.640 Spoiler alert, it took me nearly ten years to finally 0:00:58.640 --> 0:01:01.120 lose enough weight to qualify for TIS treatment in our hometown, 0:01:01.360 --> 0:01:05.160 which resulted in wasting a decade of my fertility. Once 0:01:05.200 --> 0:01:07.280 we were finally able to access the care that would 0:01:07.319 --> 0:01:10.000 hopefully help with grow our family, we were warned that 0:01:10.080 --> 0:01:12.399 I likely had bad egg quality due to my age, 0:01:12.480 --> 0:01:15.160 which was thirty nine at the time. After entering ten 0:01:15.240 --> 0:01:17.800 rounds of IVF and countless tests over the past three years, 0:01:18.120 --> 0:01:20.760 we now better understand that our greatest obstacle all along 0:01:20.880 --> 0:01:23.199 was not my weight, my age, or my equality. 0:01:23.319 --> 0:01:25.800 Our biggest obstacle has always been my sperm, which had 0:01:25.800 --> 0:01:28.800 gone ignored by almost every fertility doctor we worked with. 0:01:29.160 --> 0:01:31.760 More specifically, our biggest impediment was the very high level 0:01:31.760 --> 0:01:34.600 of DNA fragmentation present in my sperm, something that we 0:01:34.640 --> 0:01:37.240 discovered after our own research and had to strongly advocate 0:01:37.280 --> 0:01:39.840 for and convince our ARII to even test for. This 0:01:40.000 --> 0:01:42.720 is why, after multiple failed rounds of IVF, I decided 0:01:42.720 --> 0:01:45.080 to move forward with another vericocell removal surgery to help 0:01:45.080 --> 0:01:48.520 overcome our DNA fragmentation issues, this time with the reproductive 0:01:48.560 --> 0:01:52.160 urologist who successfully improved all our semen parameters and as 0:01:52.200 --> 0:01:54.560 a result, improved our final IVF outcomes. 0:01:54.960 --> 0:01:57.160 Over the past three years, we have researched and tried 0:01:57.240 --> 0:02:01.640 everything related to improving our fertility, including losing one hundred pounds, 0:02:01.680 --> 0:02:05.720 trying experimental treatments such as different protocols, fresh embryo transfers, 0:02:05.760 --> 0:02:10.520 reproductive immunology, acupuncture, red light therapy, ovarian PRP, uterine PRP, 0:02:10.639 --> 0:02:13.720 and so much more. We have worked with multiple clinics, 0:02:13.760 --> 0:02:15.800 traveling out of state for the best care for our 0:02:15.880 --> 0:02:18.400 unique needs. In fact, we record this audio from a 0:02:18.440 --> 0:02:21.200 tiny studio apartment in Manhattan as we work with the 0:02:21.200 --> 0:02:22.280 clinic in New York City. 0:02:22.720 --> 0:02:25.239 We've retrieved one hundred eggs from Diana's ovaries through ten 0:02:25.360 --> 0:02:29.480 extremely brutal egg retrievals. We have forty seven embryos which 0:02:29.560 --> 0:02:32.520 resulted in ten blasticists that were genetically tested. Six of 0:02:32.520 --> 0:02:34.760 those are frozen in time, just like Han Solo, ready 0:02:34.760 --> 0:02:36.639 and waiting to be transferred into Diana's uterus. 0:02:36.960 --> 0:02:39.480 Throughout this expedition, we have learned so much about the 0:02:39.480 --> 0:02:42.240 fertility industry, the insurance industry, and each other. 0:02:42.560 --> 0:02:44.400 The biggest and toughest lesson that we have learned while 0:02:44.400 --> 0:02:46.560 immersing ourselves in the world of fertility treatments is that 0:02:46.600 --> 0:02:48.239 efforts do not equal outcomes. 0:02:48.320 --> 0:02:51.000 Still, we publicly share everything that we have learned so 0:02:51.040 --> 0:02:52.760 that others may learn from our mistakes. 0:02:52.840 --> 0:02:55.040 More importantly, we share our stories so that others suffering 0:02:55.040 --> 0:02:57.160 through infertility will know that they are not alone. 0:03:01.400 --> 0:03:05.040 When I turned thirty eight, I decided to have a 0:03:05.160 --> 0:03:08.960 child on my own. I'm a single lady. I had 0:03:08.960 --> 0:03:11.880 just gotten out of a pretty serious relationship and didn't 0:03:11.880 --> 0:03:14.320 really want there to be the pressure of a baby 0:03:14.360 --> 0:03:18.960 hanging over another. So I went in for a consultation 0:03:19.200 --> 0:03:21.280 to find out what was going on with my body. 0:03:21.680 --> 0:03:23.919 Turns out I had pretty good follicle count. I went 0:03:23.919 --> 0:03:27.000 pretty quickly and found a donor. In the meantime, I 0:03:27.040 --> 0:03:30.120 did my own genetic carrier screening and I found out 0:03:30.160 --> 0:03:33.680 I had was a carrier for two rare diseases, and 0:03:34.680 --> 0:03:36.880 the donor I selected had only been screened for one 0:03:36.960 --> 0:03:40.600 of them. One of them was not included on most screens, 0:03:41.360 --> 0:03:44.400 so he actually ended up going back to the sperm 0:03:44.440 --> 0:03:47.360 bank with those results, which was great. So this was 0:03:47.400 --> 0:03:51.240 an anonymous donor, although we did do open ID so 0:03:51.520 --> 0:03:54.960 my daughter spoiler Alert, can reach out when she turns eighteen, 0:03:55.440 --> 0:03:57.320 so that decision is up to her to reach out 0:03:57.360 --> 0:04:00.640 if she wants. So I had one round of IUI, 0:04:00.680 --> 0:04:04.520 which was unmedicated, and then that didn't work. I was 0:04:04.720 --> 0:04:07.960 pretty disappointed and just didn't want to wait any longer, 0:04:08.160 --> 0:04:10.640 just given the amount of time that went between each cycle. 0:04:10.680 --> 0:04:14.200 Of course every month kind of aligning with your menstrual cycle. 0:04:14.880 --> 0:04:17.400 I went to IVF right after that, and at the 0:04:17.400 --> 0:04:21.560 beginning of that second attempt, I got COVID and my 0:04:21.640 --> 0:04:24.360 follicle account was really terrible when we went titcheck at 0:04:24.360 --> 0:04:26.720 the middle of the month, and so we waited for 0:04:26.760 --> 0:04:29.760 another month, which was like that's eight weeks. Then from 0:04:29.800 --> 0:04:33.000 the start, I did about two weeks of shots and 0:04:33.040 --> 0:04:36.040 I had one not so fun episode where I had 0:04:36.040 --> 0:04:39.080 to go on a Sunday to sitting nearby. Didn't have 0:04:39.080 --> 0:04:40.839 a car at the time and had to take a 0:04:40.880 --> 0:04:45.120 bus and a train and had very sore ovaries and 0:04:45.279 --> 0:04:47.760 was super swollen and feeling awful. But I had to 0:04:47.760 --> 0:04:50.720 get one more Gona left pen for I think it 0:04:50.760 --> 0:04:53.440 was the quarter of the remaining dose that I needed 0:04:53.920 --> 0:04:55.839 for that night. And then I did my trigger the 0:04:55.880 --> 0:04:59.320 next week two days later, which was also neebrecking. So 0:04:59.720 --> 0:05:03.279 after that I got about twenty mature eggs. We used 0:05:03.520 --> 0:05:06.160 XY and I eventually ended up with a fair number 0:05:06.240 --> 0:05:09.800 of embryos that were PGT normal. I had two that 0:05:09.880 --> 0:05:12.520 were abnormal that were discarded, and a couple that just 0:05:12.560 --> 0:05:18.000 didn't make it. So I let the embryoagist decide which 0:05:18.080 --> 0:05:20.000 embryo to implant because I didn't want to get the 0:05:20.520 --> 0:05:22.920 sex of the embryos revealed. I did not want to 0:05:22.960 --> 0:05:26.160 make that choice and I wanted to keep as much 0:05:26.200 --> 0:05:29.839 of it kind of normal as possible. That this totally 0:05:29.880 --> 0:05:32.800 bizarre journey to have my daughter. I guess it's not bizarre, 0:05:32.880 --> 0:05:35.680 but it was just different than what I expected. So 0:05:37.080 --> 0:05:39.919 we did it for It was an embryo transfer in November, 0:05:40.160 --> 0:05:43.520 and I found out I was pregnant right after Thanksgiving, 0:05:44.080 --> 0:05:46.680 and I had her last August. So I have my 0:05:46.800 --> 0:05:50.119 beautiful baby and I have several embryos on ice. 0:06:36.360 --> 0:06:39.960 Thank you again, everyone's so so much for sharing your 0:06:39.960 --> 0:06:43.440 stories with us. It it really means so much and 0:06:43.640 --> 0:06:45.880 Aarin and I have been like talking about this sort 0:06:45.920 --> 0:06:49.359 of off the air and just about how appreciative we 0:06:49.440 --> 0:06:52.680 are and how amazing it is to get to to 0:06:52.800 --> 0:06:56.240 learn this, this wide range of experiences and feelings that 0:06:56.240 --> 0:07:00.840 people have about this, and how greatful we are that 0:07:00.920 --> 0:07:03.719 we get to share these with other people as well. 0:07:03.920 --> 0:07:04.680 So yeah, thank you. 0:07:04.800 --> 0:07:08.680 Think we maybe all have an idea of what we 0:07:08.720 --> 0:07:12.800 think IVF might be like, and so many of us 0:07:13.160 --> 0:07:16.360 have absolutely no idea, and it's so different for so 0:07:16.440 --> 0:07:18.920 many of you. So thank you all so much for 0:07:19.000 --> 0:07:21.720 taking the time to write in, to record your stories, 0:07:22.160 --> 0:07:24.720 and to be willing to share such a difficult and 0:07:24.800 --> 0:07:27.560 vulnerable time with so many people. 0:07:27.680 --> 0:07:33.000 We really appreciate it. Yes, well said Hi. I'm erin 0:07:33.080 --> 0:07:35.680 Welsh and I'm erin allman Updike. 0:07:35.720 --> 0:07:37.840 And this is this podcast will kill you. 0:07:38.360 --> 0:07:42.720 We're coming to you with our third of three episodes. Yeah, 0:07:42.760 --> 0:07:43.640 i've yf. 0:07:44.600 --> 0:07:48.520 Yes, if you have not listened to the first two episodes, 0:07:48.960 --> 0:07:50.840 you should go listen to them. You should go try 0:07:50.840 --> 0:07:54.600 showus out, but just for a little bit of context 0:07:54.640 --> 0:07:59.680 in case you're like, I'll do that later after this. Yeah, afterwards, 0:07:59.800 --> 0:08:02.080 this is what you could expect to find in episodes 0:08:02.080 --> 0:08:06.560 one and two. Episode one, we were primarily focused on infertility, 0:08:06.880 --> 0:08:09.400 sort of the concept of infertility and how it has 0:08:09.520 --> 0:08:14.800 changed over space and time and how we evaluate infertility 0:08:14.840 --> 0:08:16.880 today in a biomedical setting. 0:08:17.360 --> 0:08:21.720 Yeah, and then our second episode was focused really on IVF. 0:08:22.520 --> 0:08:24.080 How did we do it? 0:08:24.400 --> 0:08:27.040 Like, how did people come up with IVF, what kind 0:08:27.080 --> 0:08:29.440 of science was required for us to be able to 0:08:29.480 --> 0:08:34.240 make that happen, and what are the steps of IVF. 0:08:34.040 --> 0:08:38.520 Today and then get in today's episode. 0:08:39.400 --> 0:08:43.120 Today's episode is sort of a very i would say, 0:08:43.160 --> 0:08:49.239 like a very surface level overview of the current landscape 0:08:49.280 --> 0:08:51.199 of IVF technology. 0:08:51.280 --> 0:08:53.480 You're going to say a surface level deep dive just 0:08:53.520 --> 0:08:55.119 to like be contrary. 0:08:57.120 --> 0:09:00.599 I do feel like that is like our stick is. 0:09:04.280 --> 0:09:04.600 Yeah. 0:09:04.720 --> 0:09:09.320 Yeah, this is mostly about like from innovation to industry essentially, 0:09:09.360 --> 0:09:15.040 how IVF has become the thing that it is today 0:09:15.240 --> 0:09:17.520 and then also where it might go in the future. 0:09:17.920 --> 0:09:18.479 Yeah. 0:09:18.679 --> 0:09:23.400 Yeah, But before we get into all of that, it's 0:09:23.440 --> 0:09:24.640 still quarantiny time. 0:09:25.120 --> 0:09:28.319 It is, and it's still the same Quarantini as our 0:09:28.360 --> 0:09:29.679 first two episodes. 0:09:30.240 --> 0:09:33.480 It's a work of art, it is. 0:09:34.640 --> 0:09:38.559 And if you would like to get the full recipe 0:09:38.600 --> 0:09:42.800 for the quarantiny and non Alcoholic Placy Brita a work 0:09:42.840 --> 0:09:46.440 of art. You should check out our social media channels. 0:09:46.520 --> 0:09:50.120 We've got posted there. Check out our website. We've got 0:09:50.200 --> 0:09:53.920 them posted there. Also on our website. Lots of cool, 0:09:54.000 --> 0:09:57.080 great stuff, you know, transcripts, We've got links to merch 0:09:57.160 --> 0:09:59.640 links to bookshop where you can find all of the 0:09:59.640 --> 0:10:02.760 book books as well as the books that we reference 0:10:02.880 --> 0:10:05.800 for all of our episodes. You can find good Reads lists, 0:10:06.280 --> 0:10:11.199 you can find Patreon, lots of things. I know I'm 0:10:11.200 --> 0:10:13.480 forgetting stuff, but you know what, you did. 0:10:13.400 --> 0:10:17.400 A great job. Check it out this podcastle Tillia dot com. 0:10:18.720 --> 0:10:19.640 Let's get started. 0:10:20.000 --> 0:10:21.120 Let's please eron. 0:10:21.160 --> 0:10:25.240 Tell me about this global landscape because oof, I have 0:10:25.320 --> 0:10:27.680 some ideas about it, but I don't really know. 0:10:28.280 --> 0:10:31.160 Yeah, that's sort of how I ended up. So we'll 0:10:31.160 --> 0:10:33.880 see what the journey that I took to get there 0:10:34.320 --> 0:10:35.600 right after this break. 0:10:52.160 --> 0:10:55.080 Hi, my name is Melissa. I'm forty one years old, 0:10:55.120 --> 0:10:58.720 and my fertility journey started ten years ago. My husband 0:10:58.760 --> 0:11:01.240 and I tried to conceive for two years without success 0:11:01.320 --> 0:11:04.640 before being referred to a fertility clinic. We spent the 0:11:04.640 --> 0:11:07.960 next year undergoing various tests to determine possible causes for 0:11:07.960 --> 0:11:10.960 our inability to get pregnant. We found out that we 0:11:11.000 --> 0:11:14.960 both have fertility issues. Our physician recommended that we try 0:11:14.960 --> 0:11:19.520 intrauterine insemination to improve our chances. We tried several rounds 0:11:19.559 --> 0:11:22.120 of UI and were finally successful with the birth of 0:11:22.160 --> 0:11:25.760 our daughter in twenty eighteen. In twenty twenty two, we 0:11:25.920 --> 0:11:28.000 decided to try again, so we went back to our 0:11:28.040 --> 0:11:32.000 fertility clinic. We tried two unsuccessful rounds of IUI and 0:11:32.040 --> 0:11:34.480 then moved on to IVF, as by this time I 0:11:34.600 --> 0:11:38.520 was nearing forty. We underwent our first day retrieval process 0:11:38.600 --> 0:11:41.320 last summer. To say that I was unprepared for the 0:11:41.320 --> 0:11:45.840 difficulties of undergoing IVF was a huge understatement. To prepare 0:11:45.840 --> 0:11:48.679 for the retrieval, I had to inject myself with fertility 0:11:48.720 --> 0:11:51.439 meds multiple times a day. I had to do several 0:11:51.480 --> 0:11:54.040 internal ultrasounds so the clinic could monitor the growth of 0:11:54.080 --> 0:11:56.960 my eggs. On the day of the retrieval, I was 0:11:57.040 --> 0:12:00.200 so hopeful, but again totally unprepared for the experience of 0:12:00.240 --> 0:12:04.040 the procedure. I was given pain medication, but the process 0:12:04.040 --> 0:12:06.439 of piercing through my vaginal wall to aspirate the eggs 0:12:06.480 --> 0:12:10.680 from my ovaries was excruciating. The retrieval resulted in four 0:12:10.720 --> 0:12:14.520 embryos which were frozen and sent for PGTA testing, but 0:12:14.640 --> 0:12:17.360 only a single embryo came back as viable for transfer, 0:12:18.559 --> 0:12:21.520 so I began the process for embryo transfer, which involved 0:12:21.600 --> 0:12:25.800 daily intramuscular injections of progesterone in oil. I had a 0:12:25.840 --> 0:12:28.840 reaction to the oil and ended up with painful, red 0:12:28.880 --> 0:12:32.640 hot lumps on both of my thighs. We transferred the embryo, 0:12:32.840 --> 0:12:38.200 but unfortunately it didn't survive. I was devastated. Our doctor 0:12:38.240 --> 0:12:40.760 had us try again, this time with a huge increase 0:12:40.760 --> 0:12:45.840 in medication dosage. I went through the awful process of injections, ultrasounds, 0:12:45.880 --> 0:12:48.600 and agg retrieval yet again, and this time we got 0:12:48.640 --> 0:12:51.720 six embryos. We were so hopeful that it would work 0:12:51.760 --> 0:12:55.600 this time. Unfortunately, none of the embryos were viable, so 0:12:55.679 --> 0:12:58.720 we couldn't transfer any of them. We were told that 0:12:58.760 --> 0:13:01.440 my eggs are too damaged and we shouldn't try to 0:13:01.679 --> 0:13:05.320 do any further retrievals. Our best hope now is to 0:13:05.360 --> 0:13:07.720 buy eggs from a donor egg bank, with the hope 0:13:07.720 --> 0:13:09.920 that we might get a healthy embryo that has at 0:13:10.000 --> 0:13:14.360 least my husband's DNA. This journey of IVF has been 0:13:14.400 --> 0:13:18.000 an emotional roller coaster. I've been heartbroken again and again, 0:13:18.559 --> 0:13:20.720 and now we are left unsure if we will ever 0:13:20.800 --> 0:13:24.880 have another child. 0:13:25.800 --> 0:13:26.000 Hi. 0:13:26.200 --> 0:13:28.360 I'm Sarah and our journey to having children was a 0:13:28.400 --> 0:13:31.240 complicated one. My husband and I began trying to fall 0:13:31.280 --> 0:13:34.480 pregnant shortly after marriage. After nearly eighteen months with no conception, 0:13:34.600 --> 0:13:37.760 we went to the GP for preconception testing and discovered 0:13:37.760 --> 0:13:41.440 that my husband had azuspermia feud in conjunction with deranged 0:13:41.480 --> 0:13:44.360 hormone levels. The GP recommended follow up genetic screening, so 0:13:44.400 --> 0:13:47.120 two months later we received the results that he had 0:13:47.200 --> 0:13:50.600 forty seven xx ye Climbfelter syndrome, a condition that often 0:13:50.640 --> 0:13:53.920 results in infertility. We were then referred to a fertility 0:13:53.920 --> 0:13:56.560 clinic where we decided to try a testicular sperm aspiration 0:13:56.679 --> 0:13:59.120 to see if they could find any viable immature sperm. 0:13:59.360 --> 0:14:02.160 None were found. We now knew a sperm donor would 0:14:02.160 --> 0:14:04.800 be required as the only treatment option for non obstructive 0:14:04.800 --> 0:14:09.000 asiospermic male factor infertility in Australia. Or gammic donation has 0:14:09.040 --> 0:14:11.800 to be altruistic, so finding local sperm is very difficult. 0:14:12.120 --> 0:14:14.720 Our specialist suggested we look at known donors, specifically a 0:14:14.760 --> 0:14:18.400 family donor. We decided to approach my husband's brother as 0:14:18.400 --> 0:14:20.640 a potential donor, and we're very grateful that he agreed. 0:14:21.160 --> 0:14:23.600 A known donor pathway is significantly different to a purchase 0:14:23.680 --> 0:14:27.280 sperm pathway and required further genetic screening of myself, the 0:14:27.320 --> 0:14:30.720 donation and freezing of the donor sample, mandatory counseling to 0:14:30.800 --> 0:14:33.360 ensure all parties were aware of the legalities and potential 0:14:33.360 --> 0:14:36.200 emotional mine fields of the situation, and the six month 0:14:36.240 --> 0:14:38.880 cooling off period post donation, which served for testing of 0:14:38.920 --> 0:14:41.680 the donated sample and allowed for change of mind of 0:14:41.680 --> 0:14:44.560 the donor. After those six on months, we were ready 0:14:44.560 --> 0:14:47.440 to finally begin treatment, as is the case with all 0:14:47.480 --> 0:14:50.520 male factor in fertility. After that sperm aspiration procedure, all 0:14:50.520 --> 0:14:53.480 further surgeries, medication and treatment was for the carrying parent. 0:14:54.240 --> 0:14:57.360 Our first collection cycle and fresh embryo transfer was unsuccessful, 0:14:57.400 --> 0:15:01.200 with no additional embryos to freeze. Our second collection cycle 0:15:01.200 --> 0:15:04.280 and fresh embryo transfer was also unsuccessful, however, had also 0:15:04.360 --> 0:15:07.680 produced true embryos to freeze. Here, we took a break 0:15:07.720 --> 0:15:10.440 for a few months before returning for a frozen embryo transfer, 0:15:10.480 --> 0:15:13.480 which was thankfully successful and resulted in our gorgeous baby girl. 0:15:14.520 --> 0:15:16.760 Twelve months after her birth, we returned to the fertility 0:15:16.800 --> 0:15:19.920 clinic to transfer the remaining frozen embryo. Whilst it felt 0:15:19.960 --> 0:15:21.800 strange trying to get pregnant again when it felt like 0:15:21.840 --> 0:15:24.200 we still had a little baby, the knowledge of how 0:15:24.200 --> 0:15:26.320 hard the fertility treatment was men I wanted to rip 0:15:26.320 --> 0:15:28.600 off the band aid, complete the last treatment cycle and 0:15:28.640 --> 0:15:31.840 know with certainty what our family would look like. We 0:15:31.880 --> 0:15:35.840 repeated the same successful frozen transfer protocol, which was again successful, 0:15:35.840 --> 0:15:38.480 and this time we had a beautiful baby boy. With 0:15:38.600 --> 0:15:40.480 twenty months between the kids. We were deep in the 0:15:40.480 --> 0:15:42.960 two under two club and extremely grateful for the treatment 0:15:43.000 --> 0:15:44.800 options that we had been able to utilize to have 0:15:44.880 --> 0:15:48.240 our family. Seven months after having our son, we heard 0:15:48.240 --> 0:15:50.280 from the clinic asking us about the remainder of our 0:15:50.320 --> 0:15:53.520 frozen donated sperm. This is when we decided our family 0:15:53.640 --> 0:15:55.920 was complete and we would discard the remaining samples and 0:15:55.960 --> 0:15:59.640 close the door on our fertility journey. Fertility treatment is 0:15:59.640 --> 0:16:02.600 emotion only, physically and financially taxing, and we're very thankful 0:16:02.640 --> 0:16:04.120 to have come out the other side. With our two 0:16:04.160 --> 0:16:07.320 gorgeous little kids. We are acutely aware that not everyone 0:16:07.360 --> 0:16:09.960 walks away from fertility treatment having had a child. 0:16:36.560 --> 0:16:39.840 Last week. I left off sometime in the nineteen eighties, 0:16:40.160 --> 0:16:43.600 after the number of IVF clinics began to grow rapidly, 0:16:44.120 --> 0:16:49.920 leading to technological improvements, wider applications, and questions about regulation, 0:16:50.560 --> 0:16:56.240 about access, and about the ethics surrounding this technology. Any 0:16:56.360 --> 0:17:00.880 new technological advancement is going to carry with it ethical considerations, 0:17:01.240 --> 0:17:04.399 especially those that are widely used and that have a 0:17:04.440 --> 0:17:09.320 great deal of impact or potential. And what often happens 0:17:09.400 --> 0:17:13.520 is that these technologies and their applications develop faster than 0:17:13.560 --> 0:17:17.239 our regulation of them or even our ability to know 0:17:17.560 --> 0:17:20.720 how we feel about them, Like what do we think 0:17:20.720 --> 0:17:26.600 about them? IVF is no exception. IVF is an incredibly 0:17:26.720 --> 0:17:31.320 powerful technology that has enabled millions of people around the 0:17:31.320 --> 0:17:35.400 world to fulfill their dreams of having children. I mean, 0:17:35.440 --> 0:17:39.000 think about that, like that is it is truly amazing? 0:17:39.280 --> 0:17:44.399 It is incredible, Like it is so cool and incredible. 0:17:44.680 --> 0:17:50.800 Yes, it absolutely this is not hyperbole. Revolutionized reproductive technology 0:17:50.880 --> 0:17:55.800 around the globe like before IVF, after IVF very clear 0:17:56.160 --> 0:18:00.840 line and so of course a technology as powerful as 0:18:00.880 --> 0:18:06.000 IVF will carry with it substantial ethical implications and questions 0:18:06.040 --> 0:18:10.119 of regulation. Just as we're still working out the kinks 0:18:10.119 --> 0:18:13.720 of IVF technology, we're still figuring out how to best 0:18:13.840 --> 0:18:18.240 regulate this industry and how to protect everyone involved and 0:18:18.320 --> 0:18:21.760 where the future might take us. And today, I want 0:18:21.800 --> 0:18:26.119 to go through some of the ethical considerations or questions 0:18:26.119 --> 0:18:30.680 of regulation of IVF that have emerged over the history 0:18:30.680 --> 0:18:34.520 of this technology. I'm not going to present pros and cons. 0:18:34.960 --> 0:18:37.360 I'm not going to make value judgments. I just want 0:18:37.359 --> 0:18:40.280 to touch on a few areas, not all of the areas, 0:18:40.320 --> 0:18:45.720 not comprehensively, because I think that this story in general, 0:18:46.160 --> 0:18:51.159 the regulatory landscape of IVF, is an important It's a 0:18:51.240 --> 0:18:55.840 necessary part of the story or history of IVF and 0:18:56.119 --> 0:19:00.199 its future. This is a really complex topic with so 0:19:00.320 --> 0:19:05.320 much nuance, and we're not ethicists or policy experts or 0:19:05.480 --> 0:19:08.240 anything in IVF. We're just going to try our best 0:19:08.320 --> 0:19:11.760 like we always do, and I'm going to focus primarily 0:19:11.840 --> 0:19:17.360 on the regulation, access, and innovation side of things. If 0:19:17.359 --> 0:19:20.320 you live in the US, I'm sure you've come across 0:19:20.400 --> 0:19:24.840 recent headlines about the Alabama Supreme Court ruling in February 0:19:24.880 --> 0:19:29.360 of this year that frozen embryos can be considered children 0:19:29.560 --> 0:19:34.520 in that state. The short term and long term implications 0:19:34.560 --> 0:19:37.880 of this ruling are not yet clear, and I'm sure 0:19:37.960 --> 0:19:40.479 that in the next few months leading up to the election, 0:19:40.880 --> 0:19:44.400 we'll see more discussion about this and about the other 0:19:44.480 --> 0:19:49.400 ways that political groups and religious organizations are trying and 0:19:49.640 --> 0:19:54.840 sometimes succeeding, to push an agenda ultimately aimed at controlling 0:19:54.920 --> 0:19:59.960 people's bodies and choices. Banning IVF is just one part 0:20:00.119 --> 0:20:04.200 of this wider movement to reaffirm gender roles, restrict access 0:20:04.200 --> 0:20:08.880 to healthcare, reinforce cycles of poverty, and control people's bodies. 0:20:09.560 --> 0:20:13.639 And it feels truly dystopian to be watching this unfold 0:20:13.840 --> 0:20:17.879 and gain traction, like I both can't believe but also 0:20:18.200 --> 0:20:21.680 sadly can believe that it's happening right in front of us. 0:20:22.359 --> 0:20:25.920 But today, we're not going to debate when life begins, 0:20:26.119 --> 0:20:28.959 or what should or shouldn't be considered a child and 0:20:29.040 --> 0:20:32.879 be granted personhood, or even what an embryo is, because 0:20:32.920 --> 0:20:36.680 there are actually many definitions of embryo that very globally 0:20:37.840 --> 0:20:40.640 and we're not going to debate these things because first, 0:20:41.000 --> 0:20:46.040 you can't really debate what comes down to essentially fundamental 0:20:46.040 --> 0:20:50.520 disagreements over closely held beliefs, like I believe to my 0:20:50.720 --> 0:20:54.960 core that abortion is healthcare and that IVF should not 0:20:55.000 --> 0:20:59.639 be banned. I cannot imagine entertaining any argument trying to 0:20:59.640 --> 0:21:04.000 convince me otherwise. And secondly, in the rest of the world, 0:21:04.240 --> 0:21:08.439 discussions of the ethics of IVF have moved beyond the 0:21:08.520 --> 0:21:12.080 question of whether or not IVF should be done and 0:21:12.320 --> 0:21:15.919 onto how it should be done. And so that's what 0:21:16.000 --> 0:21:19.199 I'm going to touch on today. But first, let's go 0:21:19.320 --> 0:21:22.200 back to the early years of IVF to see how 0:21:22.240 --> 0:21:25.800 it grew, with a special emphasis on the US, because 0:21:25.800 --> 0:21:28.720 that will get us to the current landscape of IVF. 0:21:30.080 --> 0:21:34.480 The early nineteen eighties established that IVF seemed here to stay, 0:21:34.880 --> 0:21:37.560 and by the end of the decade, nearly two hundred 0:21:37.600 --> 0:21:41.720 clinics offered IVF in the US, and an estimated thirty 0:21:41.800 --> 0:21:45.879 thousand women in the US had sought pregnancy using IVF. 0:21:46.760 --> 0:21:48.560 By the end of the nineteen eighties. 0:21:48.359 --> 0:21:51.359 Thank you, Yeah, I was like, wait, wait, wait, wait, year. 0:21:51.280 --> 0:21:57.600 Again, but attempts to develop clear federal regulation for IVF 0:21:57.840 --> 0:22:02.040 fell short. Other countries had come up with licensing bodies 0:22:02.080 --> 0:22:06.479 to regulate research and treatment with committees consisting of people 0:22:06.560 --> 0:22:11.160 with varying backgrounds and expertise, and the US tried this 0:22:11.640 --> 0:22:15.639 but didn't get as far as formalizing the committee's recommendations 0:22:15.880 --> 0:22:19.520 even when there was consensus, and in the meantime, the 0:22:19.560 --> 0:22:23.840 IVF industry in the US continued to grow. There were 0:22:23.880 --> 0:22:27.639 those guidelines from the Society for Assisted Reproductive Technology that 0:22:27.680 --> 0:22:31.120 I mentioned last week, but no requirement to follow them. 0:22:31.800 --> 0:22:35.120 As of the late nineteen eighties, any licensed physician could 0:22:35.119 --> 0:22:37.639 open an IVF clinic. You didn't have to be a 0:22:37.680 --> 0:22:42.840 board certified reproductive endocrinologist or even an obgyn, and this 0:22:42.920 --> 0:22:45.920 showed in the range of live birth rates in clinics. 0:22:46.480 --> 0:22:51.960 More established clinics with highly experienced reproductive endocinologist reported rates 0:22:51.960 --> 0:22:55.760 of twenty percent, more than double the national average of 0:22:55.880 --> 0:22:59.600 nine percent, and twenty one percent of all clinics in 0:22:59.640 --> 0:23:02.400 the US in nineteen eighty eight did not have a 0:23:02.440 --> 0:23:03.840 single live birth. 0:23:04.440 --> 0:23:05.160 Wow. 0:23:05.600 --> 0:23:09.359 Yeah, And that isn't to say that twenty one percent 0:23:09.400 --> 0:23:12.600 of all clinics were terrible and just like exploiting people 0:23:12.600 --> 0:23:16.360 and taking their money, but that perhaps the entire field 0:23:16.480 --> 0:23:19.760 might benefit from best practice guidelines that would protect the 0:23:19.800 --> 0:23:24.240 interests and health of everyone involved, from practitioners to patients. 0:23:25.440 --> 0:23:29.560 The calls for more regulation both then and now didn't 0:23:29.600 --> 0:23:32.960 just come from the outside, like people working on the 0:23:33.000 --> 0:23:36.080 outside of IVF, but also those who were most intimately 0:23:36.160 --> 0:23:40.480 involved in this work. In the nineteen eighties, IVF practitioners 0:23:40.560 --> 0:23:44.520 knew that this booming field could be severely harmed by 0:23:44.640 --> 0:23:47.879 just a handful of physicians who saw IVF as an 0:23:47.880 --> 0:23:53.479 opportunity to exploit rather than help. Without guidelines, the field 0:23:53.560 --> 0:23:58.240 could grow increasingly market driven, with private clinics competing for 0:23:58.320 --> 0:24:03.000 clients by doctoring their or not being fully transparent about 0:24:03.040 --> 0:24:08.200 their rates of live birth. Ultimately, it was fear of exploitation, 0:24:08.600 --> 0:24:11.560 along with a scandal, that helped to inspire the first 0:24:11.720 --> 0:24:16.320 major piece of regulation for IVF in the US. Even 0:24:16.400 --> 0:24:20.080 though Cecil Jacobsen, the physician at the heart of the scandal, 0:24:20.119 --> 0:24:24.120 did not offer IVF, he did defraud many people at 0:24:24.119 --> 0:24:27.600 his reproductive health practice and also used his own sperm 0:24:27.680 --> 0:24:31.280 to impregnate patients, saying it was anonymous donation. He was 0:24:31.320 --> 0:24:32.360 one of those Yeah. 0:24:32.640 --> 0:24:34.800 Is he is this the one that that podcast is 0:24:34.840 --> 0:24:36.680 about the retrievals? 0:24:36.920 --> 0:24:39.600 Yeah, no, that retrievals is something else. 0:24:39.760 --> 0:24:43.000 I'm sorry. Wow, okay, yeah. 0:24:42.760 --> 0:24:47.040 Yeah, there are there's more than one, more than one. 0:24:47.160 --> 0:24:50.080 Okay, great, yeah, very very great. 0:24:50.480 --> 0:24:53.400 It's wonderful. Yeah, and Cecil Jacobson was sentenced to five 0:24:53.480 --> 0:24:54.360 years in prison. 0:24:54.640 --> 0:24:57.600 Five years okay, yep, yeah. 0:24:57.359 --> 0:24:59.920 There's some. He also did some other really horrible thing 0:25:00.000 --> 0:25:02.760 thanks to some of his patients. I won't even get 0:25:02.800 --> 0:25:05.600 into it, but you know, just give them a Google. 0:25:07.000 --> 0:25:11.480 But finally, in nineteen ninety two, the Fertility Clinics Success 0:25:11.600 --> 0:25:15.240 Rate and Certification Act was passed, largely in the name 0:25:15.359 --> 0:25:20.200 of consumer protection, to require that clinics be transparent about 0:25:20.200 --> 0:25:23.919 their procedure success rates. So this is straight from the 0:25:23.960 --> 0:25:29.800 CDC website. This act quote mandates that clinics performing art 0:25:30.119 --> 0:25:34.560 annually provide data for all procedures performed to the Centers 0:25:34.560 --> 0:25:38.560 for Disease Control and Prevention and sets forth definitions and 0:25:38.600 --> 0:25:42.679 reporting requirements. CDC is required to use these data to 0:25:42.760 --> 0:25:46.520 report and publish clinic specific success rates and certification of 0:25:46.560 --> 0:25:47.680 embryo laboratories. 0:25:47.800 --> 0:25:48.400 End quote. 0:25:49.400 --> 0:25:52.840 So what I'm not sure about is how those rates 0:25:53.119 --> 0:25:56.880 or which of those rates are communicated to IVF clients. 0:25:57.280 --> 0:26:00.560 Is it a clinic wide average, does it inclclude people 0:26:00.600 --> 0:26:04.720 experiencing infertility or people who seek IVF for other reasons. 0:26:04.960 --> 0:26:07.600 Is it across all ages? How much of it is 0:26:07.640 --> 0:26:11.280 influenced by the decision tree to use IVF, Like depending 0:26:11.320 --> 0:26:13.960 on the person seeking treatment, some clinics may jump straight 0:26:14.000 --> 0:26:19.800 to IVF, while others may explore less expensive, less involved options. 0:26:19.840 --> 0:26:24.080 First, I don't have answers to that, but the CDC 0:26:24.200 --> 0:26:27.360 does have a really awesome interactive way that you can 0:26:27.400 --> 0:26:29.919 look up all of the clinics in your area, like 0:26:29.960 --> 0:26:32.000 by zip code, and so you can at least see 0:26:32.000 --> 0:26:33.240 some of the rates, and they have a lot of 0:26:33.320 --> 0:26:36.600 disclaimers on there about what it counts for and what 0:26:36.640 --> 0:26:38.639 it doesn't account for and all of that kind of stuff. 0:26:38.680 --> 0:26:42.760 So yeah, it's definitely like, yeah, I think that is 0:26:42.800 --> 0:26:46.360 a really important tool to have, Yeah, at I get 0:26:46.440 --> 0:26:48.600 starting it at least, yeah, to get And I think 0:26:48.600 --> 0:26:53.439 it sometimes can put that the onus of research on 0:26:53.640 --> 0:26:56.679 the person who is doing this, and that's that's challenging. 0:26:56.760 --> 0:26:58.920 And also I don't know, as someone who has never 0:26:59.000 --> 0:27:02.080 sought IVF, I don't know how easy or difficult or 0:27:02.119 --> 0:27:05.400 like how different clinics interact with you. 0:27:05.720 --> 0:27:07.800 Right, Well, and I'm sure yeah, it's all going to 0:27:07.880 --> 0:27:11.160 also vary, like which one, if any take your insurance, 0:27:11.200 --> 0:27:12.960 how much does your insurance cover, how much does this 0:27:12.960 --> 0:27:16.040 one cost versus that one costs. Like it's all just 0:27:16.080 --> 0:27:20.360 a huge web, you know, and you just are stuck in. 0:27:20.320 --> 0:27:23.119 It, and you're just suck in it. And then there's 0:27:23.359 --> 0:27:28.199 egg freezing, which is a totally separate procedure that I 0:27:28.240 --> 0:27:32.840 think more recently at least, we have gotten better numbers on. 0:27:32.960 --> 0:27:35.200 But in the beginning, it was sort of like, here's 0:27:35.280 --> 0:27:38.960 this hypothetical scenario that we're going to do. And a 0:27:39.000 --> 0:27:41.880 lot of these egg freezing programs were started by people 0:27:41.920 --> 0:27:46.880 who didn't have necessarily backgrounds in medicine or reproductive medicine. 0:27:47.600 --> 0:27:49.399 And I know that, like you know, I'm sure that, 0:27:49.440 --> 0:27:51.439 as you'll talk about, we have a better grasp on 0:27:52.040 --> 0:27:55.480 what egg freezing looks like. But it can also be 0:27:55.560 --> 0:28:00.560 measured in many, many, many different ways, so it's complicated. 0:28:01.600 --> 0:28:04.640 And the other thing about this act is that there 0:28:04.680 --> 0:28:09.239 aren't clear consequences for the clinics that don't participate in 0:28:09.320 --> 0:28:13.679 reporting to the CDC. Ninety percent do in the US, 0:28:14.800 --> 0:28:18.120 and the bottom line is that this is still a 0:28:18.400 --> 0:28:22.560 market driven enterprise. Estimated at five point three four billion 0:28:22.640 --> 0:28:25.120 dollars in the US in twenty twenty four. 0:28:25.680 --> 0:28:27.159 Just in the US. 0:28:27.280 --> 0:28:31.000 Just in the US, yeah, oh boy. Yeah. And so 0:28:31.640 --> 0:28:33.280 I think what it comes down to for a lot 0:28:33.320 --> 0:28:37.520 of people is that opportunities exist for clinics to massage 0:28:37.560 --> 0:28:42.200 their results to stand out from the competition because of 0:28:42.240 --> 0:28:44.880 the way that a lot of this is market driven. 0:28:45.920 --> 0:28:49.120 But it is untrue that IVF in the US is 0:28:49.320 --> 0:28:53.760 completely unregulated wild West. In some ways, there are stricter 0:28:53.880 --> 0:28:57.320 reporting requirements for IVF than there are for other medical 0:28:57.360 --> 0:29:02.360 procedures in the US who don't have to report cess rates. Granted, 0:29:02.520 --> 0:29:06.120 it is less regulated than in other countries, especially those 0:29:06.120 --> 0:29:11.520 that have national healthcare systems, but legislation does exist, and 0:29:11.600 --> 0:29:14.320 it's not just the nineteen ninety two Act that helps 0:29:14.320 --> 0:29:19.320 to protect consumers. Some US states have accreditation and inspection laws. 0:29:19.840 --> 0:29:22.920 And then there's also the US legal system, which allows 0:29:22.960 --> 0:29:27.520 patients to sue clinics and doctors for medical malpractice. But 0:29:27.680 --> 0:29:31.360 litigation is reactive, and so it still allows for the 0:29:31.400 --> 0:29:36.800 potential for exploitation or abuse within fertility clinics. Instances of 0:29:36.920 --> 0:29:40.800 doctors using their own sperm to impregnate clients without their 0:29:40.840 --> 0:29:46.200 knowledge or consent, not providing adequate care during procedures, or 0:29:46.320 --> 0:29:51.680 ignoring pain so that that podcast, The Retrievals by Cereal 0:29:52.280 --> 0:29:55.360 tells the story of how women underwent these painful surgical 0:29:55.400 --> 0:29:58.320 procedures at an IVF clinic, where a nurse had swapped 0:29:58.360 --> 0:30:03.239 out fentanyl for saline solution, but no one believed that 0:30:03.280 --> 0:30:06.080 the women were actually experiencing pain. They were like, no, 0:30:06.160 --> 0:30:08.719 this is normal amount of pain, but really they were 0:30:08.800 --> 0:30:10.120 undergoing procedures that with. 0:30:10.240 --> 0:30:11.680 Emily they would be pain. 0:30:11.800 --> 0:30:15.480 Yeah. Control, Yeah, I haven't listened to it, but it 0:30:15.600 --> 0:30:25.560 sounds rage inducing and well done. Yeah, or some clinics 0:30:25.600 --> 0:30:30.000 will not properly inform of risks involved or things like 0:30:30.120 --> 0:30:33.880 extreme And it also leaves open things like extreme deviation 0:30:34.080 --> 0:30:37.120 from the standard of medical care, such as when a 0:30:37.200 --> 0:30:41.720 doctor transferred twelve embryos into a woman named Natalie Suliman, 0:30:41.960 --> 0:30:46.440 resulting in the world's first surviving octopletz octomom as. We 0:30:47.040 --> 0:30:52.240 probably remember that doctor's license was later revoked, But again, like, 0:30:52.280 --> 0:30:56.800 how do we better protect against misuse or abuse from 0:30:56.840 --> 0:31:02.680 the outset? I don't know. The added regulation and threat 0:31:02.680 --> 0:31:06.480 of litigation did not dampen enthusiasm for IVF in the 0:31:06.600 --> 0:31:09.360 US during the rest of the nineteen nineties and into 0:31:09.400 --> 0:31:14.200 the two thousands from the book Pursuit of Parenthood Quote. 0:31:14.240 --> 0:31:17.800 Between nineteen ninety nine and twenty fifteen, the volume of 0:31:17.840 --> 0:31:21.360 treatment in America's fertility centers, measured by the number of 0:31:21.400 --> 0:31:24.080 egg retrieval cycles, went up more than two and a 0:31:24.120 --> 0:31:27.840 half times to nearly two hundred and thirty two thousand 0:31:27.880 --> 0:31:31.040 retrieval cycles, about eighty percent of them with the intent 0:31:31.120 --> 0:31:33.800 to achieve a pregnancy and the rest for the purpose 0:31:33.880 --> 0:31:37.320 of freezing and banking the resulting embryos for future use. 0:31:38.160 --> 0:31:41.280 Just under sixty one thousand women gave birth after being 0:31:41.320 --> 0:31:44.920 treated that year in twenty fifteen, for an overall take 0:31:44.920 --> 0:31:47.760 home baby rate of about thirty three percent, up from 0:31:47.760 --> 0:31:51.200 about twenty five percent in nineteen ninety nine end quote. 0:31:53.080 --> 0:31:56.760 And patient makeup at these clinics was also changing, with 0:31:56.920 --> 0:32:00.880 more single women and same sex couples using ibas, as 0:32:00.880 --> 0:32:05.560 well as an increase in traditional and gestational surrogacy, egg donation, 0:32:05.960 --> 0:32:09.920 and so on. These trends were not happening just in 0:32:09.960 --> 0:32:13.320 the US, but also globally, and they have led to 0:32:13.560 --> 0:32:18.080 continued discussion and heated debate over how to best regulate 0:32:18.200 --> 0:32:22.120 some IVF practices, and so here's where I want to 0:32:22.160 --> 0:32:25.520 move more generally into the global landscape of IVF to 0:32:25.600 --> 0:32:27.560 touch on some of the questions that have been raised 0:32:27.560 --> 0:32:33.520 about practices within IVF beyond consumer protection and clinic transparency 0:32:35.000 --> 0:32:40.160 laws about things like surrogacy, egg and sperm donation IVF 0:32:40.200 --> 0:32:44.560 for single parents or same sex couples age cutoffs. These 0:32:44.680 --> 0:32:48.400 laws vary globally, which has led to people traveling to 0:32:48.440 --> 0:32:52.760 other countries to seek fertility treatment, called cross border reproductive 0:32:52.800 --> 0:32:56.800 care or fertility tourism. The US, for instance, is one 0:32:56.840 --> 0:33:01.120 of a handful of countries where paid or commercial is legal. 0:33:01.560 --> 0:33:04.520 India used to be a very popular destination for surrogacy 0:33:04.600 --> 0:33:07.240 due to its lower cost, but they have since banned 0:33:07.240 --> 0:33:13.400 foreign couples seeking surrogacy. Other countries permit only altruistic surrogacy, 0:33:13.560 --> 0:33:16.520 where the cost of medical care and other pregnancy related 0:33:16.560 --> 0:33:20.280 expenses are covered but no additional fees, and in some 0:33:20.360 --> 0:33:26.640 countries surrogacy of any kind is illegal. This variation in 0:33:26.680 --> 0:33:32.120 surrogacy laws reflects discussions around whether paid surrogacy always carries 0:33:32.160 --> 0:33:36.920 with it the risk of exploitation, whether the transactional nature 0:33:37.000 --> 0:33:41.800 of paid surrogacy better protects both commissioning parents and surrogate 0:33:42.120 --> 0:33:46.280 by more clearly outlying expectations. How to deal with the 0:33:46.280 --> 0:33:50.240 fact that pregnancy is inherently risk laden and can be 0:33:50.440 --> 0:33:55.760 especially so with IVF if multiple embryos implant, or what 0:33:55.920 --> 0:34:00.360 to do when the unexpected happens. Commissioning couples divorcing during 0:34:00.400 --> 0:34:06.040 the surrogacy, pregnancy, pregnancy loss, health issues developing during pregnancy, 0:34:06.200 --> 0:34:10.280 or as a result of pregnancy, people changing their mind midway. 0:34:10.960 --> 0:34:13.920 There was one case where a genetic scan revealed that 0:34:14.000 --> 0:34:17.279 one of the fetuses that a surrogate was carrying had 0:34:17.320 --> 0:34:21.160 TRISO only twenty one down syndrome, and the commissioning couple 0:34:21.280 --> 0:34:25.759 only adopted the twin without the condition. Then that led 0:34:25.800 --> 0:34:28.239 to a lot of other issues. It was it was 0:34:28.280 --> 0:34:33.520 like a long, really long drawn out process. Wow that 0:34:33.560 --> 0:34:38.960 this in general is a very complicated topic, as is 0:34:39.000 --> 0:34:44.279 the commodification of sperm, eggs, and embryos, similar to gestational 0:34:44.320 --> 0:34:49.200 surrogacy or traditional surrogacy. Countries have varying laws regarding sperm 0:34:49.239 --> 0:34:52.680 and egg donation or sale, and this is another reason 0:34:53.000 --> 0:34:57.719 that people travel across borders for reproductive care. Then there's 0:34:57.840 --> 0:35:01.719 anonymous donation as in is there still such a thing 0:35:02.080 --> 0:35:08.360 as anonymity with the advent of ancestry testing, Yeah yeah. 0:35:08.920 --> 0:35:13.200 Discussion has also arisen over the use of frozen eggs, sperm, 0:35:13.360 --> 0:35:17.520 or fertilized eggs after a couple splits, or if someone 0:35:17.640 --> 0:35:22.920 dies in situations where there is no written documentation indicating 0:35:22.960 --> 0:35:27.319 the wishes of the deceased, how should posthumous reproduction be 0:35:27.440 --> 0:35:31.640 allowed to proceed or should it? I came across one 0:35:31.719 --> 0:35:34.239 high profile case where a couple died in a car 0:35:34.320 --> 0:35:38.560 accident and their two sets of parents engaged the services 0:35:38.600 --> 0:35:42.360 of a gestational carrier to carry their grandchild from frozen 0:35:42.360 --> 0:35:46.799 embryos from the deceased couple, So four years after the 0:35:46.840 --> 0:35:49.080 couple had died, their baby was born. 0:35:50.480 --> 0:35:51.000 Wow. 0:35:51.640 --> 0:35:55.280 Yeah. There are a lot of a lot of stories 0:35:55.600 --> 0:35:59.880 similar to that. Okay, you know, frozen sperm, frozen eggs, 0:36:00.040 --> 0:36:07.520 commissioning a gestational carrier. Yeah yeah. And then finally, recent 0:36:07.560 --> 0:36:11.759 technological advancements like gene editing where people can select for 0:36:12.080 --> 0:36:16.959 sex or other advertised quote unquote like designer babies. These 0:36:17.000 --> 0:36:20.960 have also raised questions along the lines of just because 0:36:21.000 --> 0:36:25.200 we can, does that mean we should? It's still very 0:36:25.200 --> 0:36:27.880 early days when it comes to the practical application of 0:36:27.920 --> 0:36:32.160 gene editing technologies such as Crisper to human embryos, but 0:36:32.239 --> 0:36:36.719 it is in our future, quite possibly are very near future, right, 0:36:37.239 --> 0:36:41.120 and many people have called for discussion and regulations now 0:36:41.280 --> 0:36:44.719 to start drawing lines between what is considered acceptable use 0:36:44.760 --> 0:36:50.160 of this technology and what could be considered misuse. Beyond 0:36:50.280 --> 0:36:53.920 how IVF is done or how the practice is regulated, 0:36:54.080 --> 0:36:57.200 is the question of access. I've already talked about how 0:36:57.200 --> 0:37:00.600 most stories featuring IVF tend to have a quote unquote 0:37:00.600 --> 0:37:04.800 happy ending resulting in a baby, and stories where IVF 0:37:04.840 --> 0:37:08.520 didn't work out aren't highlighted as much. But even more 0:37:08.560 --> 0:37:12.120 silenced are the stories where people can't seek out IVF 0:37:12.239 --> 0:37:17.640 due to economic, insurance or geographic reasons, or reasons pertaining 0:37:17.680 --> 0:37:23.439 to their identity, whether that's marital status, sexual orientation, age, etc. 0:37:24.000 --> 0:37:28.960 Sometimes referred to as socially infertile. The WHO and the CDC, 0:37:29.360 --> 0:37:34.239 among other organizations around the world, classify infertility as a disability, 0:37:34.920 --> 0:37:38.600 but in the US, insurance companies are not required in 0:37:38.680 --> 0:37:43.640 all states to cover or offer coverage for IVF. Some 0:37:43.840 --> 0:37:47.239 clinics offer IVF lotteries where people can enter to win 0:37:47.280 --> 0:37:51.279 a free cycle and of course, lack of access to 0:37:51.360 --> 0:37:56.200 IVF disproportionately impacts people of color and poor people. To 0:37:56.360 --> 0:38:02.240 quote American sociologists, law professor, and social justice advocate Dorothy Roberts, quote, 0:38:02.400 --> 0:38:05.040 the people in the United States most likely to be 0:38:05.160 --> 0:38:09.799 infertile are poor, black, and poorly educated. Most couples who 0:38:09.880 --> 0:38:14.080 use IVF and other high tech procedures are white, highly educated, 0:38:14.160 --> 0:38:14.840 and affluent. 0:38:15.400 --> 0:38:16.680 End quote. 0:38:17.160 --> 0:38:21.440 This problem of access extends globally, with resource poor countries 0:38:21.480 --> 0:38:26.160 tending to have lowest access to assisted reproductive technologies like IVF. 0:38:27.080 --> 0:38:31.280 Laws and regulations that limit or remove reproductive rights, whether 0:38:31.360 --> 0:38:37.600 that's access to contraceptives, abortion, fertility treatments without exception, have 0:38:37.680 --> 0:38:42.399 a disproportionate impact on the poor and disadvantaged. We may 0:38:42.440 --> 0:38:45.200 not know what's going to happen in the future, but 0:38:45.280 --> 0:38:47.040 that much we do know, right. 0:38:47.040 --> 0:38:50.399 That has been clear for a very long time. 0:38:50.440 --> 0:38:51.880 That is established. 0:38:52.040 --> 0:38:53.839 We haven't fixed that problem yet. 0:38:54.239 --> 0:39:02.160 It's still in existence in perpetuity. Yes, the history, the regulation, 0:39:02.320 --> 0:39:08.160 the technology. It's such a hugely, vastly complex topic and 0:39:08.280 --> 0:39:10.799 may become even more so in the coming decades with 0:39:10.840 --> 0:39:15.160 the incorporation of new technologies. Figuring out how to regulate 0:39:15.200 --> 0:39:21.320 a constantly evolving technology is challenging but essential. IVF holds 0:39:21.360 --> 0:39:24.279 so much potential. It has given so many people the 0:39:24.360 --> 0:39:27.719 children they have always wanted, and it has helped to 0:39:27.800 --> 0:39:32.040 expand our definition of what constitutes a family in a 0:39:32.080 --> 0:39:36.920 really beautiful way. And it also forces us to examine 0:39:36.920 --> 0:39:39.879 our feelings about what the limits of this technology are 0:39:40.239 --> 0:39:43.040 or what they should be in the future. And it's 0:39:43.080 --> 0:39:45.920 okay to not know how you feel about all these 0:39:45.920 --> 0:39:50.520 different aspects of IVF, like posthumous reproduction or gene editing. 0:39:51.040 --> 0:39:53.839 It's complex stuff. And if it were easy to come 0:39:53.880 --> 0:39:57.839 to a consensus or know that this is you know, 0:39:58.200 --> 0:40:01.040 this is the dividing line, then we would have already 0:40:01.120 --> 0:40:06.400 done that at this point, like at least country to country. Instead, 0:40:06.440 --> 0:40:08.800 what we can do, I think is some self reflection. 0:40:09.280 --> 0:40:12.840 We can listen, we can learn, and we can ask questions. 0:40:13.680 --> 0:40:17.279 And so I'll end with a question, Aaron, what can 0:40:17.320 --> 0:40:20.520 you tell us about the potential future of IVF. 0:40:20.920 --> 0:40:23.760 Oh, I can tell you a little bit and maybe 0:40:23.800 --> 0:40:26.240 a lot right after this break. 0:40:40.360 --> 0:40:43.560 Hi, my name is Madeline Kronfeld. My story is about 0:40:43.560 --> 0:40:46.360 egg retrieval and freezing, because that's what I'm in the 0:40:46.360 --> 0:40:50.040 middle of doing. When I turned thirty eight in August 0:40:50.280 --> 0:40:53.600 twenty twenty three, I found myself in a situation that 0:40:53.680 --> 0:40:57.160 I didn't expect. I was single, with no prospects of 0:40:57.200 --> 0:41:01.480 a partner, and desperately wanting to be a mother one day. 0:41:01.560 --> 0:41:04.279 I've always wanted children, and I've always been in long 0:41:04.360 --> 0:41:08.279 term relationships, so I just assumed it would happen. I 0:41:08.360 --> 0:41:11.480 was married and divorced before I turned thirty, and then 0:41:11.600 --> 0:41:15.040 in a year's long relationship after that that I thought 0:41:15.120 --> 0:41:18.120 was going to lead to marriage and kids when it didn't. 0:41:18.239 --> 0:41:20.840 And after the death of my mom in May twenty 0:41:20.880 --> 0:41:23.840 twenty three, I decided that I had to take matters 0:41:23.880 --> 0:41:27.080 into my own hands and start the egg freezing process. 0:41:27.719 --> 0:41:31.560 Given my age and test results, it's expected that I 0:41:31.680 --> 0:41:34.239 need to do three to four cycles to freeze the 0:41:34.360 --> 0:41:38.240 twenty five to thirty eggs that the fertility clinic recommends. 0:41:38.760 --> 0:41:40.520 At more than fifteen. 0:41:40.120 --> 0:41:43.840 Thousand dollars per cycle, this would have been entirely cost 0:41:43.840 --> 0:41:46.880 prohibitive when I was younger. Of course, I would have 0:41:46.960 --> 0:41:49.200 had more eggs at that point, so maybe only one 0:41:49.280 --> 0:41:52.399 or two cycles. But even at a time when I'm 0:41:52.400 --> 0:41:54.920 more equipped to afford a large portion of this on 0:41:55.000 --> 0:41:58.719 my own. It's incredibly draining on my bank account and 0:41:58.880 --> 0:42:03.680 my emotions. So far, I've done two egg retrievals, one 0:42:03.840 --> 0:42:07.320 in February twenty twenty four and the second very recently 0:42:07.719 --> 0:42:12.720 in April twenty twenty four. Between those, I have seven 0:42:12.760 --> 0:42:16.160 frozen eggs. I'm happy to have any, but I'm also 0:42:16.600 --> 0:42:19.799 really disappointed that I don't have more. So I've been 0:42:19.920 --> 0:42:23.279 on this insane roller coaster of emotions, which is not 0:42:23.480 --> 0:42:27.239 helped by the extra hormones coursing through me. I plan 0:42:27.280 --> 0:42:30.640 on doing one more round and then I'll reassess things 0:42:30.680 --> 0:42:34.120 with my doctor. What's getting me through it is knowing 0:42:34.200 --> 0:42:37.239 that I'm actually doing something, even if I never need 0:42:37.280 --> 0:42:40.480 to use these frozen eggs or I do and it 0:42:40.520 --> 0:42:45.000 doesn't actually result in a viable pregnancy. I know that 0:42:45.080 --> 0:42:47.920 I'm privileged in the sense that I have an incredible 0:42:47.960 --> 0:42:51.120 support system of family and friends around me. I have 0:42:51.200 --> 0:42:54.200 the savings to afford it because my insurance doesn't cover 0:42:54.320 --> 0:42:58.160 any of this, I have the flexibility with my schedule. 0:42:57.760 --> 0:42:58.200 To do it. 0:42:58.600 --> 0:43:03.080 And I live in in Northern Virginia, which is a 0:43:03.120 --> 0:43:08.040 big metro area where there are excellent fertility resources. I 0:43:08.120 --> 0:43:13.120 feel really strongly that IVF, IUI, egg freezing, and any 0:43:13.120 --> 0:43:17.200 other fertility treatments are really empowering, whether you do it 0:43:17.280 --> 0:43:20.120 with a partner or on your own. Right now, I'm 0:43:20.160 --> 0:43:23.560 doing it on my own, and I really hope that 0:43:23.680 --> 0:43:27.680 one day I have a child again, whether it's from 0:43:27.960 --> 0:43:31.200 one of these frozen eggs or naturally. But I can't 0:43:31.239 --> 0:43:34.040 wait to tell them how much I wanted them in 0:43:34.080 --> 0:43:38.040 my life. 0:43:38.760 --> 0:43:41.000 Hi, my name is Mallorie, and I'm going to share 0:43:41.040 --> 0:43:44.400 my experience with IVF. My husband and I started trying 0:43:44.400 --> 0:43:47.279 to get pregnant after a year of marriage. We thought 0:43:47.280 --> 0:43:50.800 it would be easy, we were both young, healthy. Fast 0:43:50.840 --> 0:43:53.920 forward two years and we had tried natural conception, we 0:43:53.960 --> 0:43:57.840 had tried clomid, and finally IUI all without a pregnancy, 0:43:58.640 --> 0:44:02.239 so we started our first round. I injected myself with 0:44:02.320 --> 0:44:05.560 a cocktail of hormones to stimulate my ovaries and got 0:44:05.600 --> 0:44:10.800 to experience all the fun side effects waking, bruising, bloating, headaches, 0:44:11.000 --> 0:44:16.160 massive mood swings. I had blood work and vaginal ultrasounds routinely, 0:44:16.640 --> 0:44:19.560 and was finally told to give myself the last injection 0:44:19.680 --> 0:44:25.240 of hCG to stimulate my ovaries to ovulate the next morning, 0:44:25.360 --> 0:44:28.400 I went under anesthesia for the egg retrieval. However, I 0:44:28.440 --> 0:44:30.640 woke up to my husband telling me it didn't work. 0:44:30.760 --> 0:44:33.560 We had to repeat the injection and the procedure again 0:44:33.600 --> 0:44:36.640 in two days. The second time, they were able to 0:44:36.640 --> 0:44:39.040 retrieve about twenty eggs from my ovaries. 0:44:39.719 --> 0:44:40.399 But after this. 0:44:40.440 --> 0:44:43.520 Second procedure, I kept feeling worse and worse. I had 0:44:43.560 --> 0:44:48.640 severe nausea, vomiting, lack of appetite, abdominal tenderness, and bloating 0:44:48.640 --> 0:44:51.319 to the point I looked six months pregnant. When I 0:44:51.360 --> 0:44:53.960 finally couldn't take a deep breath, I went to the er. 0:44:54.560 --> 0:44:59.640 I was diagnosed with ovarian hyperstimulation syndrome, an exaggerated response 0:44:59.680 --> 0:45:04.160 in thevaries that caused swelling and leakage of the blood 0:45:04.239 --> 0:45:08.640 vessels into the abdominal cavity. They drained about three liters 0:45:08.719 --> 0:45:12.120 off my abdominal cavity at the bedside. Spent the night 0:45:12.160 --> 0:45:15.160 in the hospital because that promptly tanked my blood pressure, 0:45:15.760 --> 0:45:17.759 and then went home with a drain the next day 0:45:18.160 --> 0:45:22.120 to keep removing fluid over the next week. Two months later, 0:45:22.239 --> 0:45:25.760 we did have frozen embryos and planted. I gave myself 0:45:25.960 --> 0:45:30.080 progesterone injections into my buttock every day for twelve weeks, 0:45:30.840 --> 0:45:35.600 and thankfully, our daughter was born healthy without complications. Two 0:45:35.680 --> 0:45:39.960 years later, after using our last chromosomally normal embryo, my 0:45:40.040 --> 0:45:45.760 son was born. I found IVF to be incredibly difficult physically, mentally, 0:45:45.800 --> 0:45:50.160 and emotionally. I wish fertility and the possibilities of infertility 0:45:50.200 --> 0:45:52.480 had been discussed more when I was younger, and I 0:45:52.560 --> 0:45:56.560 had been better prepared. I'm a healthcare provider in women's health, 0:45:56.600 --> 0:45:59.319 and I feel there's been a massive shift in awareness 0:45:59.320 --> 0:46:03.879 and perception of infertility. The rise of women finding platforms 0:46:03.920 --> 0:46:07.719 to vocalize their experiences with IVF and infertility has had 0:46:07.800 --> 0:46:11.200 major effects. I applaud the spread of information and the 0:46:11.239 --> 0:46:15.080 empowering and cathartic nature of women sharing their stories and 0:46:15.160 --> 0:46:18.960 forming communities. But I see women almost daily who are 0:46:19.040 --> 0:46:22.000 terrified that they're infertile and won't have children because of 0:46:22.040 --> 0:46:25.319 what they've seen or heard. I think it's so important 0:46:25.440 --> 0:46:29.239 to provide accurate, honest information. None of us have a 0:46:29.280 --> 0:46:32.800 crystal ball to see what the future of our fertility holds, 0:46:33.000 --> 0:46:35.640 and while there are some tests that can give insight 0:46:35.719 --> 0:46:39.279 into general reproductive health, The fact of the matter is, 0:46:39.320 --> 0:46:41.759 for most people, we never know how easy or heart 0:46:41.760 --> 0:46:59.000 it will be to get pregnant until we start trying. 0:47:12.000 --> 0:47:17.799 So let's start with how many babies are born via IVF, 0:47:17.960 --> 0:47:18.319 shall we? 0:47:18.440 --> 0:47:18.840 Yeah? 0:47:19.080 --> 0:47:19.440 Yeah. 0:47:20.200 --> 0:47:24.000 In twenty twenty four, most papers that I read, most 0:47:24.040 --> 0:47:27.279 figures say that the total number of humans that have 0:47:27.320 --> 0:47:31.000 been born as a result of IVF, like total globally 0:47:31.840 --> 0:47:34.280 is ten million people. 0:47:35.840 --> 0:47:40.280 That's amazing, I know, isn't that incredible? Yeah? Wow? 0:47:40.520 --> 0:47:43.439 We had people wrote who wrote in who were quote 0:47:43.480 --> 0:47:47.520 unquote test two babies. Yeah, help themselves, and like that's 0:47:47.680 --> 0:47:52.880 that's incredible, like that it it still absolutely blows my 0:47:53.040 --> 0:47:58.839 mind that this is possible, like it is. It is 0:47:58.880 --> 0:48:01.080 so fascinating and everything that we went through in the 0:48:01.160 --> 0:48:03.319 last episode about all of the steps that had to 0:48:03.360 --> 0:48:06.280 happen for us to be able to have IVFB a reality, 0:48:06.320 --> 0:48:09.960 and now that it is becoming something that for a 0:48:10.000 --> 0:48:12.480 lot of people, though, as we'll talk about, not for everyone, 0:48:12.560 --> 0:48:17.560 but for a lot of people, is an attainable possibility. 0:48:17.960 --> 0:48:20.160 Like, it's incredible, We've come so far. 0:48:21.160 --> 0:48:26.080 In twenty twenty two, globally it was estimated that well, globally, 0:48:26.160 --> 0:48:29.560 it was reported that over seven hundred and fifty thousand 0:48:29.600 --> 0:48:33.000 babies were born just in twenty twenty two. And that 0:48:33.200 --> 0:48:36.680 is to the kind of global registry of all places 0:48:36.680 --> 0:48:39.719 that report out their their figures and their numbers. But 0:48:39.880 --> 0:48:42.000 just like in the US, it's not required, and so 0:48:42.360 --> 0:48:46.120 it's thought that this is an underestimate. So it's possible 0:48:46.160 --> 0:48:49.480 that the real number was possibly closer to a million. 0:48:49.680 --> 0:48:54.239 Is what the paper that I read said. Okay, that's 0:48:54.600 --> 0:48:57.240 a huge number of people every year. 0:48:57.320 --> 0:48:58.520 That's wow. 0:48:58.920 --> 0:48:59.480 Yeah. 0:49:00.239 --> 0:49:01.400 What I will also. 0:49:01.160 --> 0:49:06.040 Say is that this is from a reported three million 0:49:06.719 --> 0:49:12.960 art cycles each year, three million cycles of IVF or 0:49:13.000 --> 0:49:17.640 IVF with ICSI to get seven hundred and fifty thousand babies. 0:49:18.880 --> 0:49:23.880 So when you think about what so many people have 0:49:24.000 --> 0:49:27.279 had to go through, when you have heard so many 0:49:27.400 --> 0:49:29.879 of these first hand accounts, and so many of more 0:49:29.920 --> 0:49:33.839 of you who wrote in a lot of these art 0:49:34.000 --> 0:49:39.799 cycles are often required before there is a baby. So 0:49:39.920 --> 0:49:43.600 this is a massively huge industry. Like you kind of 0:49:43.680 --> 0:49:48.440 highlighted aarin and these numbers, this seven hundred and fifty 0:49:48.480 --> 0:49:53.080 thousand babies, these three million art cycles, they're not split 0:49:53.120 --> 0:49:55.520 in an equal fashion. We see that in the US, 0:49:55.560 --> 0:49:58.440 and we see that globally. On a small scale. Here 0:49:58.480 --> 0:50:03.319 in the US, in twenty eight art accounted for I'm 0:50:03.320 --> 0:50:06.239 not calling it art today, it's calling an art last time, 0:50:07.080 --> 0:50:11.719 feeling a little spicy. Art accounted for zero point four 0:50:11.800 --> 0:50:14.680 percent of babies that were born in Puerto Rico and 0:50:14.800 --> 0:50:18.239 five percent of babies born in Massachusetts in the UOW 0:50:18.600 --> 0:50:21.160 that's like the biggest scale that we see. 0:50:21.360 --> 0:50:23.120 That is quite a range. 0:50:23.200 --> 0:50:24.359 Yeah, it's illustrative. 0:50:26.120 --> 0:50:31.680 Globally, half of all people who have infertility or who 0:50:31.760 --> 0:50:35.879 are dealing with difficulty conceiving or infertility don't even gain 0:50:36.120 --> 0:50:40.400 access to medical treatment, and in many cases people are 0:50:40.440 --> 0:50:44.360 seeking care for years before they can actually get access. 0:50:45.080 --> 0:50:47.920 That's true in the US, that's true in Europe, but 0:50:48.000 --> 0:50:51.320 this is especially true in low and middle income countries. 0:50:52.360 --> 0:50:56.160 And like you mentioned, Aaron, race and ethnicity are hugely 0:50:56.200 --> 0:51:00.640 impactful in terms of who has access to infertility services, 0:51:01.320 --> 0:51:05.200 both because of systemic disparities in like economics and access 0:51:05.200 --> 0:51:08.879 to healthcare, but also because of the biases of our 0:51:08.920 --> 0:51:14.759 healthcare system and the burdens of the infertility treatment process itself, 0:51:15.840 --> 0:51:19.040 and on top of that social stigmatization or distrust of 0:51:19.080 --> 0:51:20.239 the medical establishment. 0:51:20.280 --> 0:51:20.839 Like there's a. 0:51:20.840 --> 0:51:27.440 Lot of layers of barriers to good infertility treatment, especially 0:51:27.440 --> 0:51:32.880 for marginalized communities in the US and globally. But we 0:51:33.040 --> 0:51:36.279 have come an incredibly long way in terms of the 0:51:36.320 --> 0:51:40.160 technology itself, and so I want to kind of focus 0:51:40.280 --> 0:51:43.520 on what some of those advancements have been, both for 0:51:43.600 --> 0:51:48.439 the good and for the how do we do this 0:51:48.880 --> 0:51:54.359 going forward? Yeah, And what's interesting I think in going 0:51:54.400 --> 0:51:57.279 through and reading all of this about like, how has 0:51:57.320 --> 0:52:01.560 IVF changed since the early days. Some of the hugest 0:52:01.600 --> 0:52:07.120 advances in IVF in recent decades are now so commonplace 0:52:07.640 --> 0:52:09.960 that they're actually just part of the IVF process that 0:52:10.000 --> 0:52:13.959 I described last episode, So they wouldn't even be considered like, Ooh, 0:52:13.960 --> 0:52:16.680 this brand new, super exciting on the edge thing. It's like, no, 0:52:16.760 --> 0:52:19.360 that's just how we do IVF now. Yeah, But I 0:52:19.400 --> 0:52:23.040 want to highlight them because there were incredible advancements in 0:52:23.080 --> 0:52:26.840 the last few decades. ICSI is one of them, and 0:52:26.880 --> 0:52:29.880 that again is interra cite, a plasmic sperm injection allowing 0:52:29.920 --> 0:52:33.799 for one single sperm to fertilize one single egg like 0:52:33.920 --> 0:52:38.360 via a tiny needle. This has allowed for successful IVF 0:52:38.640 --> 0:52:42.439 in the face of very severe male factor infertility, which 0:52:42.520 --> 0:52:44.440 was not possible before this. 0:52:45.719 --> 0:52:46.480 That's major. 0:52:47.280 --> 0:52:51.359 We talked last episode about blasticist stage implantation, that is, 0:52:51.600 --> 0:52:55.160 growing the embryo or whatever you want to call it 0:52:55.800 --> 0:52:58.400 until it gets to day five, where it becomes that 0:52:58.520 --> 0:53:03.680 blasticist that wasn't the norm before. And this not only 0:53:03.760 --> 0:53:08.160 allows for more successful implantation, but it also allows for 0:53:08.239 --> 0:53:11.840 the testing of embryos because there's enough cells there to 0:53:11.880 --> 0:53:13.880 be able to take some to be able to test. 0:53:14.760 --> 0:53:18.120 This has allowed for a variety of genetic testing methods, 0:53:18.160 --> 0:53:19.879 which I want to spend a little bit of time 0:53:19.920 --> 0:53:22.719 on because some of them are still a lot more 0:53:22.760 --> 0:53:25.719 controversial than I realized, and some of them are just 0:53:26.160 --> 0:53:30.360 amazing for people living with certain genetic conditions. But I 0:53:30.400 --> 0:53:32.960 also just want to mention single embryo transfer as kind 0:53:33.000 --> 0:53:38.080 of like a novel occurrence. And this is possible today 0:53:38.160 --> 0:53:41.920 in part because of the things that I just mentioned ICSI, 0:53:42.120 --> 0:53:46.279 blasticist transfer, being able to do genetic testing, which has 0:53:46.520 --> 0:53:51.040 increased the success rates of each cycle of IVF, but 0:53:51.120 --> 0:53:55.399 single embryo transfer also substantially decreases the risks to both 0:53:55.440 --> 0:53:59.040 the person carrying the pregnancy and the fetus, so that 0:53:59.120 --> 0:54:03.960 has also been like a pretty huge technological advancement, and 0:54:04.000 --> 0:54:08.160 then there are a whole bunch more And you mentioned Aaron, 0:54:08.320 --> 0:54:13.040 how as a marketplace driven phenomenon, part of what IVF 0:54:13.080 --> 0:54:17.640 clinics have to do is get clients, and so a 0:54:17.680 --> 0:54:20.960 lot of them will offer a range of add ons 0:54:21.400 --> 0:54:27.080 that they recommend or offer to patients that could potentially 0:54:27.160 --> 0:54:31.239 help their chances of having a live birth. And this 0:54:31.360 --> 0:54:34.000 is not just true in the US, this is across 0:54:34.040 --> 0:54:37.680 the globe. But the big thing that I learned about 0:54:37.719 --> 0:54:40.879 a lot of these add on procedures is that many 0:54:40.920 --> 0:54:43.760 of them have little to know evidence that they're actually 0:54:43.760 --> 0:54:47.040 going to improve the chances of having a live birth, 0:54:47.560 --> 0:54:51.080 and in some cases they could even be harmful. So 0:54:51.120 --> 0:54:52.960 I want to go into what some of those are 0:54:53.480 --> 0:54:55.720 and kind of like break down some of the data 0:54:55.880 --> 0:54:59.560 on what things are really potentially helpful and what things 0:54:59.600 --> 0:55:02.920 are maybe just still in the stage of research and 0:55:03.000 --> 0:55:07.120 yet they're already being used in practice. So this includes 0:55:07.200 --> 0:55:09.839 things like assisted hatching. I don't know if you came 0:55:09.880 --> 0:55:12.840 across that, Aaron, No, I did not. I When I 0:55:12.840 --> 0:55:14.760 came across this, I was like, Wow, I've never felt 0:55:14.800 --> 0:55:20.680 more like a chicken hatching. Okay, assisted hatching, This has 0:55:20.840 --> 0:55:23.800 not great evidence. From what I can tell, it's a 0:55:23.800 --> 0:55:27.560 little bit unclear. Maybe it works, the data seems poor 0:55:27.640 --> 0:55:30.160 on kind of all sides, whether it supports it or 0:55:30.160 --> 0:55:34.480 whether it's not beneficial. But basically what it is is 0:55:34.520 --> 0:55:38.880 it's using a laser or something to drill a little 0:55:38.880 --> 0:55:43.759 bit into this blasticism prior to implantation to because the 0:55:43.760 --> 0:55:49.160 blastistis because in order for implantation to happen, the blasticist 0:55:49.280 --> 0:55:51.600 has to kind of break out of what's called the 0:55:51.680 --> 0:55:55.120 zona pellucida in order to implant in the uterus. So 0:55:55.120 --> 0:55:58.160 it's basically like making a little crack in that to 0:55:58.520 --> 0:56:01.400 hopefully improve the chances of implantation. 0:56:02.040 --> 0:56:03.000 Assisted hatching. 0:56:03.120 --> 0:56:07.319 Assisted hatching is what it sounds like. There's not great 0:56:07.360 --> 0:56:11.800 evidence for it though, So it's one of those where 0:56:12.200 --> 0:56:14.480 perhaps in certain situations, if you've had a lot of 0:56:14.480 --> 0:56:17.719 failed implantations or something like that, could it be beneficial. 0:56:18.000 --> 0:56:20.560 Maybe. But I think, and this is. 0:56:20.520 --> 0:56:22.880 True for a lot of these potential add ons, is 0:56:22.920 --> 0:56:27.440 that if they're offered as just a suite of items, 0:56:29.000 --> 0:56:32.560 I can imagine if you are someone who has tried 0:56:32.880 --> 0:56:36.439 so many different things, of course you're going to try 0:56:36.640 --> 0:56:41.200 anything that someone says could be beneficial, and so I 0:56:41.200 --> 0:56:44.200 think that's where these things can become really problematic if 0:56:44.200 --> 0:56:45.520 they're not well regulated. 0:56:45.960 --> 0:56:48.560 Okay, So I have a question about assisted hatching. Okay, 0:56:48.960 --> 0:56:52.280 you said that there's not good evidence. Is there evidence 0:56:52.320 --> 0:56:54.640 in one direction or another? Or is it just so 0:56:54.760 --> 0:56:58.520 context dependent, like is there a trend toward assisted hatching 0:56:58.680 --> 0:57:03.400 being potent potentially like decrease rates of success. 0:57:03.640 --> 0:57:04.520 It's a good question. 0:57:04.800 --> 0:57:08.000 I read a Cochran review about it, which basically said 0:57:08.040 --> 0:57:09.880 that the quality of data that we have is so 0:57:10.160 --> 0:57:13.759 poor that you can't come to any conclusion one way 0:57:13.840 --> 0:57:14.239 or the other. 0:57:14.560 --> 0:57:18.040 Okay, I see, but given the fact that it's sold 0:57:18.080 --> 0:57:20.680 as an add on where it's like maybe. 0:57:20.920 --> 0:57:24.600 Maybe it's going to help you, But yeah, how much 0:57:24.720 --> 0:57:25.040 is it? 0:57:25.080 --> 0:57:27.760 And in the US do insurance companies cover this? 0:57:28.320 --> 0:57:30.960 Such a good question, Aaron, I didn't even look into 0:57:31.000 --> 0:57:34.120 the like numbers of prices on this because it varies 0:57:34.320 --> 0:57:38.440 so much like state to state, country to country insurance insurance. 0:57:39.520 --> 0:57:43.040 I would guess that anything beyond like a quote unquote 0:57:43.120 --> 0:57:47.920 standard cycle of IVF is probably not covered by most insurances, 0:57:48.760 --> 0:57:49.600 but I don't know. 0:57:49.640 --> 0:57:51.000 For sure because I didn't look it up. 0:57:51.320 --> 0:57:56.680 Okay, Yeah, And there's more things too. There's certain special 0:57:56.800 --> 0:58:00.880 culture media that some facilities might use that they call 0:58:00.920 --> 0:58:05.040 it sometimes embryo glue that supposedly makes the embryo more 0:58:05.160 --> 0:58:07.720 likely to implant. Not a lot of data for anything 0:58:07.800 --> 0:58:12.520 like that. There's something called endometrio scratching, which is exactly 0:58:12.560 --> 0:58:15.880 what it sounds like, scratching the endometrium to try and 0:58:16.000 --> 0:58:20.439 help implantation. There's not any substantial amount of evidence that 0:58:20.440 --> 0:58:21.960 that is going to increase. 0:58:21.600 --> 0:58:23.960 Live birth rates. 0:58:24.120 --> 0:58:27.160 Then there are things that the evidence is a little 0:58:27.200 --> 0:58:32.320 bit more specific and nuanced, So that's things like elective 0:58:32.400 --> 0:58:36.080 freeze only cycles that would be rather than trying to 0:58:36.160 --> 0:58:39.200 do a cycle of IVF where you implant the embryo 0:58:39.720 --> 0:58:43.760 right after that five days, you freeze all of the embryos, 0:58:44.080 --> 0:58:49.360 and then you plan for a cycle later. This doesn't 0:58:49.400 --> 0:58:52.200 seem to increase the chance of a live birth, that 0:58:52.320 --> 0:58:55.400 is not what the data shows, but it can decrease 0:58:55.440 --> 0:58:58.800 the risk of ovarian hyperstimulation syndrome, so it's kind of 0:58:58.840 --> 0:59:04.240 a trade off. And then we get into pre implantation 0:59:04.520 --> 0:59:07.960 genetic testing as a part of IVF, and I want 0:59:07.960 --> 0:59:09.600 to spend a little bit of time here because it's 0:59:09.640 --> 0:59:13.320 become a huge part of the IVF process. 0:59:13.240 --> 0:59:15.560 Before we do this real quick? Can I just ask 0:59:15.600 --> 0:59:17.240 a question about these add ons? 0:59:17.480 --> 0:59:17.680 Yeah? 0:59:17.800 --> 0:59:18.840 Please, I'm very so. 0:59:18.920 --> 0:59:21.240 There's also more, like there was so many more that 0:59:21.280 --> 0:59:22.160 I found. 0:59:22.920 --> 0:59:23.960 Yeah, there's more. 0:59:24.360 --> 0:59:29.080 I guess is there a certain point or threshold of 0:59:29.200 --> 0:59:34.000 evidence or something when an add on becomes part of 0:59:34.040 --> 0:59:39.200 the procedure, you know, like and then how are how 0:59:39.280 --> 0:59:44.680 are take home baby rates quote unquote reported? Oh you 0:59:44.680 --> 0:59:46.720 know based on add ons? Like can you do that 0:59:46.880 --> 0:59:50.000 for a clinic where you say, okay, well what is 0:59:50.040 --> 0:59:53.920 this add on? How does that change the rate? Versus that? Like, 0:59:54.440 --> 0:59:56.320 are those things communicated clearly? 0:59:57.440 --> 0:59:59.000 And these questions? 0:59:59.160 --> 1:00:02.760 Yeah, I guess I yeah, Nah, I don't have. 1:00:02.760 --> 1:00:05.200 An answer to those questions. They're very good questions. 1:00:06.160 --> 1:00:08.720 I really when I'm looking these things up to see 1:00:08.920 --> 1:00:11.680 what's the data on X, Y and z, I like 1:00:11.720 --> 1:00:13.680 full disclosure. I used a lot of up to date 1:00:13.840 --> 1:00:16.480 to get sources. But then I also was looking at 1:00:16.600 --> 1:00:19.000 Cochrane reviews to see because they do a lot of 1:00:19.040 --> 1:00:22.520 looking at all of the data that exists and what's 1:00:22.560 --> 1:00:26.560 the quality of the data. So there is IVF that's 1:00:26.600 --> 1:00:29.680 being done on the regular through these clinics and then 1:00:29.720 --> 1:00:33.400 there's IVF that is still being done at teaching institutions 1:00:33.400 --> 1:00:37.280 and academic institutions where they're collecting data for research on 1:00:37.360 --> 1:00:40.480 these things, so that is where the data is going 1:00:40.520 --> 1:00:44.200 to come from to then determine is this new or 1:00:44.240 --> 1:00:48.240 novel technology going to become a part of standard practice. 1:00:48.600 --> 1:00:50.680 Right now, all of those things that I mentioned, with 1:00:50.760 --> 1:00:53.760 the exception of pre implantation testing, which we'll get into 1:00:53.760 --> 1:00:55.960 more detail on, but all of those other ones that 1:00:56.000 --> 1:00:59.320 I mentioned are not part of a standard IVF procedure, 1:01:00.040 --> 1:01:02.400 so that is why they're considered as add ons. And 1:01:02.440 --> 1:01:05.600 again there are more One source that I found that 1:01:05.680 --> 1:01:09.080 was very helpful, especially as like a patient facing resource 1:01:09.360 --> 1:01:11.600 was actually out of the UK and it's a website. 1:01:11.640 --> 1:01:14.680 I'll link to it on our website, but it had 1:01:14.800 --> 1:01:20.440 really great pictorial graphics of all of the different types 1:01:20.560 --> 1:01:24.240 of add ons and what the evidence was, whether it 1:01:24.320 --> 1:01:26.440 was evidence that it could be helpful, whether it was 1:01:26.480 --> 1:01:28.800 evidence that could be harmful, or whether there just wasn't 1:01:28.840 --> 1:01:30.880 really good evidence for it one way or the other. 1:01:31.440 --> 1:01:34.000 And it had like a green or a red or 1:01:34.040 --> 1:01:36.040 a question mark or whatever. 1:01:37.280 --> 1:01:39.040 So that was a really helpful resource. 1:01:39.080 --> 1:01:41.240 And some of them, you know, you click on it 1:01:41.280 --> 1:01:44.400 and it'll say, well, in this particular scenario, it could 1:01:44.480 --> 1:01:47.440 be beneficial, where in all of these other situations we 1:01:47.520 --> 1:01:48.760 just don't have any evidence for. 1:01:48.680 --> 1:01:51.600 It, right, I mean, and it's a really interesting thing. 1:01:51.680 --> 1:01:56.040 But because, like you said, if you've tried this before, 1:01:56.240 --> 1:01:59.040 or you just want this to do, you desperately want 1:01:59.080 --> 1:02:02.320 this to work, then it seems like, okay, yeah, you 1:02:02.320 --> 1:02:05.520 would try anything that you possibly could if you can 1:02:05.760 --> 1:02:08.560 afford to do so. And then it's it is really 1:02:08.600 --> 1:02:11.560 interesting because even if we don't have good data now, 1:02:12.160 --> 1:02:16.040 in the future, we hopefully will have better data to 1:02:16.080 --> 1:02:19.160 be like, oh, this shouldn't be an add on, this 1:02:19.240 --> 1:02:22.320 should be part of standard practice, or this doesn't do 1:02:22.400 --> 1:02:26.320 anything exactly its exacts. Time to get to those things. Yeah, 1:02:26.360 --> 1:02:29.600 which is still it's just still so complicated. 1:02:29.840 --> 1:02:33.680 It is because you're you're living through you're living through 1:02:33.680 --> 1:02:36.520 a time where things are changing so rapidly that we 1:02:36.560 --> 1:02:39.120 don't have all of the answers. 1:02:40.200 --> 1:02:42.720 And that is true for pre implantation testing. 1:02:44.000 --> 1:02:47.600 So pre implantation genetic testing it goes by a few 1:02:47.640 --> 1:02:52.160 different names. There used to be kind of two different suites. 1:02:52.240 --> 1:02:56.240 One that was called pre implantation genetic testing, or PGT 1:02:56.560 --> 1:03:04.000 pg T, and one that was pre implaytion diagnosis or PGD. Okay, 1:03:04.120 --> 1:03:07.320 now they have split those and they're all called PGT, 1:03:08.440 --> 1:03:11.600 but then they have different letters after them. So I 1:03:11.640 --> 1:03:14.400 want to go through what each of them are, because 1:03:14.440 --> 1:03:17.840 what's important is that the three different main kinds of 1:03:18.000 --> 1:03:22.600 pre implantation genetic testing are used for very different things, 1:03:22.960 --> 1:03:25.920 and so the research is actually very different on the 1:03:26.040 --> 1:03:31.800 utility of these different things. Pre implantation genetic testing PGT 1:03:32.120 --> 1:03:35.560 A this is the first one, and that's pre implantation 1:03:35.680 --> 1:03:39.320 genetic testing for annuploid anti employde is when you have 1:03:40.240 --> 1:03:44.000 a different number of chromosomes than most people extra or 1:03:44.320 --> 1:03:48.120 one missing. So this type of genetic testing is the 1:03:48.240 --> 1:03:51.440 type that tests the embryo to make sure that there 1:03:51.480 --> 1:03:54.640 are the correct number of chromosomes, so it's looking for 1:03:54.720 --> 1:03:58.520 trisomes or other annuploides. This is things like Edward syndrome 1:03:58.680 --> 1:04:03.440 or Down syndrome, et cetera. In most of the literature 1:04:03.440 --> 1:04:06.840 that I read, this is still kind of on the 1:04:06.960 --> 1:04:12.680 line of a more experimental and research procedure, but it 1:04:12.720 --> 1:04:18.120 is very very commonly used in clinical practice. There isn't 1:04:18.280 --> 1:04:21.880 data that it improves live birth outcomes. And there's a 1:04:22.000 --> 1:04:26.080 lot of reasons that go into this. Part of the 1:04:26.160 --> 1:04:30.040 thought is that something that can happen as this embryo 1:04:30.200 --> 1:04:32.640 is dividing. And I'm sorry if this is getting too nerdy, 1:04:32.640 --> 1:04:36.360 but I find this really fascinating, but. 1:04:36.480 --> 1:04:38.040 Never apologized for being. 1:04:40.200 --> 1:04:44.240 As this embryo is dividing, every time that these cells divide, there's. 1:04:44.080 --> 1:04:45.600 Going to be little mistakes that happen. 1:04:46.560 --> 1:04:49.360 And so as these little mistakes happen early enough on, 1:04:50.560 --> 1:04:54.600 it is seems more and more likely that what's called mosaicism, 1:04:54.720 --> 1:04:58.400 so different cells actually having a different number of chromosomes, 1:04:59.240 --> 1:05:03.880 might be a part of typical embryogenesis. And there are 1:05:03.920 --> 1:05:10.640 mechanisms in place, because embryogenesis is phenomenally fascinating, that many 1:05:10.680 --> 1:05:15.200 of these blastocysts will self correct later in development or 1:05:15.320 --> 1:05:18.120 in some cases, if this was happening, for example, in 1:05:18.160 --> 1:05:23.240 a uterus, might end in a miscarriage. Right, But when 1:05:23.280 --> 1:05:26.400 we do pre implantation genetic testing, we're taking so few 1:05:26.480 --> 1:05:30.480 cells that we can't tell if something is a mosaic 1:05:30.600 --> 1:05:35.360 or not necessarily, and so what this can end up 1:05:35.360 --> 1:05:40.560 happening is having false positives and also potentially false negatives. 1:05:41.120 --> 1:05:44.040 But the false positive seem to be what in terms 1:05:44.040 --> 1:05:46.960 of like lawsuits and issues that have come up, seem 1:05:47.000 --> 1:05:49.920 to be the biggest issue because what it leads to 1:05:50.120 --> 1:05:54.640 is discarding of embryos that could have been viable, that 1:05:54.680 --> 1:05:59.360 could have been not have an antiploid, which means that 1:05:59.400 --> 1:06:02.200 you're then dis carding embryos and maybe you only had 1:06:02.280 --> 1:06:06.000 two or three viable embryos to begin with, right, But 1:06:06.040 --> 1:06:07.960 the reverse is also true, where you could have a 1:06:07.960 --> 1:06:11.960 falsely negative sample that could end up resulting in a miscarriage, 1:06:12.240 --> 1:06:14.040 and so then you went through this whole cycle and 1:06:14.120 --> 1:06:16.800 thought that this embryo was going to be have a 1:06:16.800 --> 1:06:19.480 good chance of surviving, and then it doesn't. So it 1:06:19.560 --> 1:06:20.560 kind of goes both ways. 1:06:21.000 --> 1:06:23.080 And we do we have any numbers on the rate 1:06:23.120 --> 1:06:26.480 of false positive or false negative I because. 1:06:26.120 --> 1:06:28.160 It varies so much place to place, I don't have 1:06:28.400 --> 1:06:32.680 I don't have numbers on that. Okay, yeah, but that 1:06:32.800 --> 1:06:35.240 is kind of one of I think I didn't realize 1:06:35.280 --> 1:06:38.200 because I had heard a lot about pre implantation genetic 1:06:38.200 --> 1:06:40.320 testing and I kind of thought that it was just 1:06:40.520 --> 1:06:45.400 part of the process of IVF, but it isn't. But 1:06:45.600 --> 1:06:47.720 in a lot of places it actually is, especially if 1:06:47.760 --> 1:06:50.440 you're over a certain age, it's kind of often offered. 1:06:50.520 --> 1:06:52.600 Like you were asking, when is this offered as part 1:06:52.640 --> 1:06:55.960 of the suite. I think it's very possible that that 1:06:56.120 --> 1:06:58.200 is the way that this will go. But right now, 1:06:58.280 --> 1:07:02.400 because you only can takes so much DNA, and we 1:07:02.520 --> 1:07:06.280 only can do so much testing on that DNA, right now, 1:07:06.800 --> 1:07:09.520 the technology doesn't seem to be good enough to have 1:07:09.720 --> 1:07:14.240 like a super super high sensitivity and specificity to be 1:07:14.280 --> 1:07:17.720 able to offer this like across the board as like 1:07:17.800 --> 1:07:20.680 part of the standard practice necessarily or at least when 1:07:20.720 --> 1:07:21.360 it is offered. 1:07:21.440 --> 1:07:23.040 It doesn't improve live birth rates. 1:07:24.240 --> 1:07:29.640 Okay, But while this process is similar to it is 1:07:29.760 --> 1:07:33.560 separate from a couple of other pre implantation genetic testings 1:07:33.880 --> 1:07:38.880 pgt M, which is pre implantation genetic testing for monogenic disorders, 1:07:39.480 --> 1:07:45.160 and PGTSR, which is testing for structural rearrangements. These are 1:07:45.360 --> 1:07:47.760 the types of genetic testing that would be done if 1:07:47.760 --> 1:07:51.360 an individual or a couple has a very high chance 1:07:51.400 --> 1:07:55.640 of passing on a known genetic disorder, or if they, 1:07:55.800 --> 1:07:59.520 for example, we're having recurrent miscarriage and through their infertility 1:07:59.560 --> 1:08:02.800 evaluation found out that they had a structural rearrangement in 1:08:02.840 --> 1:08:06.640 one of their chromosomes. So this is what someone who 1:08:06.680 --> 1:08:09.920 maybe had a history of Huntington's or sickle cell or 1:08:09.960 --> 1:08:11.360 cystic fibrosis or. 1:08:11.320 --> 1:08:12.840 Things like that would use. 1:08:13.680 --> 1:08:17.880 These are part of the standard suite for people who 1:08:17.920 --> 1:08:21.679 have those because you're looking for just these single gene 1:08:22.040 --> 1:08:25.760 chromosome things, if that makes sense. So it has like 1:08:25.800 --> 1:08:29.599 a different utilization and a different success rate in part 1:08:29.680 --> 1:08:32.680 because the population that you're doing these testing in is 1:08:32.800 --> 1:08:35.919 very specific rather than everyone who's seeking out IVF. 1:08:36.400 --> 1:08:39.320 That makes sense, Yeah, yeah. 1:08:38.720 --> 1:08:43.000 So these pre implantation genetic testing technologies have been incredible 1:08:44.320 --> 1:08:47.040 and still have kind of a lot of work to go. 1:08:48.520 --> 1:08:51.400 And they also, like you were talking about Aaron, kind 1:08:51.400 --> 1:08:54.840 of do open the door to some potentially ethical gray 1:08:55.040 --> 1:08:58.720 areas because these types of technologies are the same ones 1:08:58.760 --> 1:09:02.160 that can be used for things like sex selection, which 1:09:02.200 --> 1:09:04.720 means choosing the sex of your embryo prior to implantation. 1:09:05.479 --> 1:09:09.040 Different countries have implemented different policies on whether or not 1:09:09.120 --> 1:09:12.640 this is an acceptable practice, and there's other things that 1:09:12.680 --> 1:09:16.000 pre implantation genetic testing can be used for. It has 1:09:16.080 --> 1:09:20.160 been used in the past for selecting specific HLA genotypes, 1:09:20.840 --> 1:09:24.040 and this is so that you can select an embryo 1:09:24.800 --> 1:09:29.400 that is born that is compatible genetically identical with their 1:09:29.600 --> 1:09:33.919 HLA type to a previously living child who, for example, 1:09:34.000 --> 1:09:38.080 has a very severe cancer or something like fanconi anemia. 1:09:38.200 --> 1:09:40.960 I think that's the example the first time that this 1:09:41.120 --> 1:09:44.519 was used, or some other disorder where they need a 1:09:44.560 --> 1:09:48.519 bone marrow or some other type of transplant, so you 1:09:48.640 --> 1:09:52.960 can choose an embryo that will match that living child 1:09:53.000 --> 1:09:56.479 and then be able to essentially save that child's life 1:09:57.320 --> 1:10:01.479 with their sibling. These are things have happened today and 1:10:01.640 --> 1:10:06.640 are possible because of this technology. And I am not 1:10:06.800 --> 1:10:09.160 here making a judgment to say that one is right 1:10:09.200 --> 1:10:12.599 and one is wrong, etc. But all of these different 1:10:12.640 --> 1:10:17.400 technologies force us as societies to be able to have 1:10:17.520 --> 1:10:23.000 conversations about where the lines end essentially and where the 1:10:23.040 --> 1:10:26.720 gray becomes more black and more white. And that is 1:10:26.840 --> 1:10:30.400 especially true as this technology continues to develop, because the 1:10:30.479 --> 1:10:35.559 things on the horizon for IVF erin are incredible. Of 1:10:35.720 --> 1:10:42.200 like what erin, there are three major areas that IVF 1:10:42.720 --> 1:10:45.160 will go and they're not far off. 1:10:46.160 --> 1:10:49.360 One is mitochondrial transfer. Have you heard of this? 1:10:50.040 --> 1:10:50.240 Oh? 1:10:50.320 --> 1:10:56.840 Yes, have you've heard of the three person IVF? It's incredible. 1:10:57.680 --> 1:11:04.240 This is transferring mitochondria either from one's own cells, but 1:11:04.320 --> 1:11:07.720 from like different cells other than your eggs, or from 1:11:07.760 --> 1:11:11.840 a different person entirely, for example, if you had some 1:11:11.960 --> 1:11:17.640 type of mitochondrial gene disorder and transferring the mitochondria into 1:11:18.360 --> 1:11:23.000 the egg and then using sperm to fertilize that egg. 1:11:23.200 --> 1:11:26.080 And so that's why it's called three person or three 1:11:26.120 --> 1:11:30.240 parent potentially because that mitochondria could come from someone who's 1:11:30.280 --> 1:11:33.280 genetically separate from you, or it could come from different 1:11:33.320 --> 1:11:36.080 cells in the ocite donor's own body. 1:11:37.080 --> 1:11:39.280 But this is amazing. 1:11:39.320 --> 1:11:43.720 I mean, I'm sorry, mitochondria like moving a mitochondria from 1:11:43.760 --> 1:11:49.080 one cell to another, that's amazing. There's more, though, People 1:11:49.080 --> 1:11:52.679 have been working on inducing adult stem cells like our 1:11:52.880 --> 1:11:56.839 skin cells, to become sperm cells and egg cells. 1:11:57.200 --> 1:11:58.879 That is wild. 1:11:59.160 --> 1:11:59.920 It is wild. 1:12:00.120 --> 1:12:04.320 This process is called in vitro gametogenesis or IVG. And 1:12:04.360 --> 1:12:06.640 it sounds like science fiction, but they've already done it 1:12:06.680 --> 1:12:07.160 in mice. 1:12:07.800 --> 1:12:11.280 I mean, everything sounds like science fiction until it's not right. 1:12:11.560 --> 1:12:14.439 I just think about how in Star Trek in like 1:12:14.520 --> 1:12:17.439 the sixties, in the original Star Trek, they didn't have 1:12:17.520 --> 1:12:21.400 sliding doors yet, but all of the doors slid, and 1:12:21.439 --> 1:12:24.680 so they literally had people standing there and like they 1:12:24.720 --> 1:12:27.800 physically moved the doors open whenever they would walk through. 1:12:28.040 --> 1:12:30.559 You know, I just I just remember the cell phone, 1:12:30.600 --> 1:12:32.960 like the transponder or what I can't wrot what it 1:12:33.000 --> 1:12:37.200 was called, but transponders, that's right, was it transponders? Okay, Yeah, 1:12:37.680 --> 1:12:39.599 still a few more steps till we get to Star 1:12:39.680 --> 1:12:41.519 Trek World. But yeah, only. 1:12:44.960 --> 1:12:47.840 And yeah, so this could give someone the capacity to say, 1:12:47.920 --> 1:12:51.280 generate more eggs if you had poor OS quantity, or 1:12:51.640 --> 1:12:56.200 if you had cancer, or like, just so many possibilities, right, 1:12:57.120 --> 1:13:00.320 and then, like you mentioned, Aaron, the improvements in gene 1:13:00.479 --> 1:13:06.080 editing and crisper technology that opens so many doors for 1:13:06.120 --> 1:13:09.600 not only IVF, but so many medical conditions that we 1:13:09.640 --> 1:13:12.960 have talked about on this podcast before as well. The 1:13:13.000 --> 1:13:21.880 things that people are working on are incredible, and societies 1:13:21.920 --> 1:13:24.120 are going to have to reckon with what the ethical 1:13:24.160 --> 1:13:28.000 implications of all of these things are and how we 1:13:28.080 --> 1:13:30.080 decide that they are regulated. 1:13:30.120 --> 1:13:32.240 And I mean the royalty, not me and you. 1:13:33.360 --> 1:13:40.280 My goodness, Yeah, it really stretches the limits of imagination 1:13:40.760 --> 1:13:44.080 in terms of like what is possible, what could be possible? 1:13:44.200 --> 1:13:49.840 Things that I didn't know about until doing these episodes. Yeah, 1:13:49.880 --> 1:13:56.799 like we talked about, you know, off off camera, uterine transplants. Yeah, 1:13:57.160 --> 1:14:02.040 just like so many things that have completely open the door, 1:14:02.200 --> 1:14:05.320 and it's like it's opened the door and a little 1:14:05.320 --> 1:14:08.160 bit of opening the door to a world of amazing 1:14:08.240 --> 1:14:11.679 possibilities and a little Pandora's box at the same time 1:14:11.800 --> 1:14:15.960 in terms of regulation and in terms of technology evolving 1:14:16.000 --> 1:14:20.120 faster than our imagination can see, like where it will 1:14:20.200 --> 1:14:23.760 go and how it will be used, And it's just 1:14:24.320 --> 1:14:27.559 it really forces us to confront sort of our own 1:14:27.640 --> 1:14:30.200 feelings about these things that we don't know where they're going. 1:14:30.240 --> 1:14:34.479 And it's not just IVF, it's ai AI. You know, 1:14:34.600 --> 1:14:37.000 it's like what cell phones have given us. 1:14:37.320 --> 1:14:40.679 You know, it's how much are they listening to me? Always? 1:14:40.880 --> 1:14:42.559 It's they're always always. 1:14:43.000 --> 1:14:43.760 No, it really is. 1:14:43.800 --> 1:14:46.280 It's it's like you said, it's just the it is 1:14:46.320 --> 1:14:51.240 the ability of technology to develop so rapidly and then 1:14:51.840 --> 1:14:55.679 come online so rapidly, and us have to then look 1:14:55.720 --> 1:14:59.479 around and realize, oh, what does this mean for me 1:14:59.760 --> 1:15:02.080 and for us as a society. 1:15:02.520 --> 1:15:06.439 And who decides that, right, That's the important question. 1:15:06.920 --> 1:15:09.160 And then especially when it comes to things like this 1:15:09.240 --> 1:15:13.200 is who gets access and who decides who gets access. 1:15:13.400 --> 1:15:17.880 I read a really interesting paper that was really making 1:15:17.960 --> 1:15:23.479 an argument for access to infertility treatment and including IVF 1:15:23.560 --> 1:15:28.160 specifically as a human right. Yes, and it was framing 1:15:28.160 --> 1:15:30.360 it in a way that I had never really considered before, 1:15:30.400 --> 1:15:30.880 and it was. 1:15:30.920 --> 1:15:32.840 Just so, it's so interesting. 1:15:33.479 --> 1:15:36.839 Well, and that is actually what if you compare contrast, 1:15:36.920 --> 1:15:38.759 I didn't really get into this, but if you compare 1:15:38.800 --> 1:15:42.000 contrast sort of the reception to IVF in the years 1:15:42.040 --> 1:15:45.400 following nineteen seventy eight, it seemed to, at least from 1:15:45.400 --> 1:15:50.679 what I read, be more quickly embraced and normalized in 1:15:51.160 --> 1:15:54.880 the UK, where a lot of the physicians who were 1:15:54.920 --> 1:15:59.360 beginning to practice IVF, including that team that first, you know, 1:15:59.520 --> 1:16:03.400 led to the first IVF baby in the world, they 1:16:03.520 --> 1:16:07.040 really their stance was a right to reproduction right, and 1:16:07.280 --> 1:16:09.080 it was like, this is a thing that will allow 1:16:09.160 --> 1:16:13.479 people who are not able to have children to have children, right. 1:16:13.760 --> 1:16:16.280 And that wasn't really as much in the US. And 1:16:16.320 --> 1:16:18.240 so I think that like and also, I mean, there 1:16:18.240 --> 1:16:22.120 are a myriad of reasons why the US reacted differently 1:16:22.200 --> 1:16:24.240 than other parts of the world in terms of IBF 1:16:24.280 --> 1:16:27.200 and still does today. And so on and so forth. 1:16:27.240 --> 1:16:33.040 But I think that has been a really fascinating discussion 1:16:33.120 --> 1:16:35.679 that a lot of people, yeah, have that I've seen 1:16:35.720 --> 1:16:37.839 a lot sort of come up more recently too. 1:16:38.000 --> 1:16:42.920 And there's still so many differences in who gets access 1:16:43.280 --> 1:16:46.519 to IVF in this country versus that country. 1:16:46.720 --> 1:16:48.400 Even in I was reading I don't. 1:16:48.200 --> 1:16:51.720 Know why, but about Italy, their rules that they made 1:16:51.760 --> 1:16:54.920 in like the early two thousands were super super restrictive, 1:16:55.040 --> 1:16:57.639 and so then they've had to like work really hard 1:16:57.680 --> 1:17:02.280 to repeal those to an extreme, and it's just, yeah, 1:17:02.320 --> 1:17:06.120 it's just it varies so so much place to place still, 1:17:06.160 --> 1:17:09.840 and that's just reflective of how many different people feel 1:17:09.960 --> 1:17:15.800 so differently about so many aspects of something like IVF. Yeah, 1:17:15.840 --> 1:17:22.280 and controlling women's bodies as an example, yes, yeah, but yeah, 1:17:22.360 --> 1:17:28.160 but that's that is IVF. We've come so far, we 1:17:28.240 --> 1:17:31.400 have so far to go. I've learned so much. 1:17:32.000 --> 1:17:35.320 We've learned so much, and also there is so much 1:17:35.400 --> 1:17:37.800 more that we didn't even begin. 1:17:37.600 --> 1:17:39.160 Totally to talk about. 1:17:40.000 --> 1:17:45.160 I think this was for me such a meaningful topic 1:17:45.439 --> 1:17:49.639 to research about because, like we've talked about, I had 1:17:49.640 --> 1:17:54.680 this conception of IVF in my head, this perception like 1:17:54.760 --> 1:17:56.600 I knew, Okay, this is what it was, this is 1:17:56.640 --> 1:17:59.800 how it worked, all of these different things, and not 1:18:00.080 --> 1:18:04.920 really it just is layers upon layers upon layers. Even 1:18:04.960 --> 1:18:08.240 though I feel like we could have done so much more. 1:18:09.040 --> 1:18:10.160 We always will feel that way. 1:18:10.320 --> 1:18:12.400 I always will feel that way. I do feel like 1:18:12.439 --> 1:18:15.040 this was a really meaningful topic to do, and I 1:18:15.080 --> 1:18:20.519 am just really appreciative of the amount of literature that 1:18:20.600 --> 1:18:24.799 exists out there, how many layers are involved in IVF 1:18:24.840 --> 1:18:29.080 and so many different facets, but especially always coming back 1:18:29.120 --> 1:18:32.880 to these first hand accounts, and like the incredible range 1:18:32.880 --> 1:18:36.320 of experiences and emotions and feelings and outcomes and everything 1:18:36.680 --> 1:18:42.320 that people have with IVF and fertility and infertility and 1:18:42.400 --> 1:18:44.800 egg freezing and all of these different things that it's 1:18:44.840 --> 1:18:48.360 like IVF is not just IVF, it is a one 1:18:48.520 --> 1:18:50.360 million bajillion things. 1:18:50.640 --> 1:18:53.640 Yeah, we are just really grateful that we get to 1:18:54.160 --> 1:18:56.800 do this as a job and talk about these things 1:18:56.800 --> 1:19:00.040 and learn about these things and cover this topic. And 1:19:00.800 --> 1:19:05.240 cannot thank you all enough for sharing your stories with us. 1:19:05.320 --> 1:19:10.719 And I hope that through these three episodes everybody feels 1:19:10.720 --> 1:19:12.680 like they got something out of this, because I know 1:19:12.760 --> 1:19:14.520 that I certainly did selfishly. 1:19:15.360 --> 1:19:15.719 Same. 1:19:16.080 --> 1:19:18.200 Yeah, also selfishly but same. 1:19:20.400 --> 1:19:22.600 And if you want to get even more out of 1:19:22.640 --> 1:19:28.040 these sources, We've got so many. I have a bunch 1:19:28.040 --> 1:19:31.599 of papers that have more detail on this, but I 1:19:31.680 --> 1:19:34.240 will also shout out a couple of the books again. 1:19:34.520 --> 1:19:37.719 One is called The Pursuit of Parenthood by Margaret marsh 1:19:37.760 --> 1:19:41.519 and Wanda Ronner, and then the other book is called 1:19:41.720 --> 1:19:45.679 IVF and Assisted Reproduction, a Global History by Sarah Ferber, 1:19:45.840 --> 1:19:47.840 Nikola Marx and Vera Mackey. 1:19:48.680 --> 1:19:51.120 I will definitely post the link to that website that 1:19:51.160 --> 1:19:54.800 I mentioned. So many papers from, like the CDC Vital 1:19:54.800 --> 1:19:59.800 Statistics Report, to papers on pre implantation genetic diagnoses, like 1:20:00.439 --> 1:20:04.559 so many, so so much data our website. This podcast 1:20:04.600 --> 1:20:06.800 will kill you dot com. Under the episodes tab you 1:20:06.840 --> 1:20:09.080 will find the list of all of our sources from 1:20:09.120 --> 1:20:13.360 this episode and every single one of our episodes. That's 1:20:13.360 --> 1:20:14.080 where you can find it. 1:20:14.680 --> 1:20:17.320 Thank you to Bloodmobile for providing the music for this 1:20:17.400 --> 1:20:19.480 episode and all of our episodes. 1:20:20.040 --> 1:20:22.680 Thank you to Leanna Scolacci and Tom bray Foco for 1:20:22.720 --> 1:20:24.160 the incredible audio mixing. 1:20:24.640 --> 1:20:26.080 Thank you to Exactly Right. 1:20:26.720 --> 1:20:30.760 And thank you to you listeners. We really hope that 1:20:30.840 --> 1:20:33.120 you enjoyed this journey. With us. 1:20:33.280 --> 1:20:36.920 Yeah yeah, we hope that you learned something. 1:20:36.960 --> 1:20:39.200 Hopefully yeah yeah. 1:20:39.240 --> 1:20:42.600 And a special thank you, of course to our wonderful, 1:20:42.720 --> 1:20:46.879 lovely generous patrons. We we truly do appreciate your support, 1:20:46.960 --> 1:20:48.920 like it, yeah we did. It really means a lot. 1:20:49.640 --> 1:20:51.680 Also, do you guys still want like a series on 1:20:51.760 --> 1:20:53.519 pregnancy because we're planning that. 1:20:54.360 --> 1:20:55.840 Yeah, let us know. 1:20:56.920 --> 1:20:58.559 Is it too much? Have we gone too far? 1:20:59.000 --> 1:21:00.639 I mean it'll be like sick months from now? 1:21:00.680 --> 1:21:02.679 So yeah yeah yeah yeah yeah anytime soon. 1:21:03.040 --> 1:21:09.080 Yeah, well until next time, wash your hands, you filthy animals. 1:21:30.240 --> 1:21:30.280 M