Speaker 1: Hi.
Speaker 2: I'm Diana and I'm Paul, and we've been married for
Speaker 2: about thirteen years. Our journey began twelve years ago. After
Speaker 2: trying to conceive for a year without assistance. We were
Speaker 2: referred to a fertility clinic where we endured vigorous testing
Speaker 2: and were devastated with the diagnosis of PCOS and cryptozoospermia, but.
Speaker 3: That didn't stop us. We had high hopes that IVF
Speaker 3: treatments would help us grow our family. I entered my
Speaker 3: first fair CASELL removal surgery about ten years ago, which
Speaker 3: is unfortunately not successful. Our fertility doctor informed us that
Speaker 3: was such low Seman parameters IUI and even conventional IVF
Speaker 3: wouldn't work for us. Instead, we were advised to pursue
Speaker 3: a then novel way of fertilizing eggs introcytoplasmic sperm injection
Speaker 3: also known as IXI fertilization. However, due to antiquated BMI
Speaker 3: restrictions at our local clinic, Diana was not allowed to
Speaker 3: move forward with an egg retrieval. They explained that the
Speaker 3: anesthesia team did not perform these services on larger bodies
Speaker 3: that we believe this is one of the many ways
Speaker 3: that clinic artificially inflated their success rates. We wanted to
Speaker 3: move forward with an IVF at our local clinic, Diana
Speaker 3: had to lose weight first.
Speaker 2: Spoiler alert, it took me nearly ten years to finally
Speaker 2: lose enough weight to qualify for TIS treatment in our hometown,
Speaker 2: which resulted in wasting a decade of my fertility. Once
Speaker 2: we were finally able to access the care that would
Speaker 2: hopefully help with grow our family, we were warned that
Speaker 2: I likely had bad egg quality due to my age,
Speaker 2: which was thirty nine at the time. After entering ten
Speaker 2: rounds of IVF and countless tests over the past three years,
Speaker 2: we now better understand that our greatest obstacle all along
Speaker 2: was not my weight, my age, or my equality.
Speaker 3: Our biggest obstacle has always been my sperm, which had
Speaker 3: gone ignored by almost every fertility doctor we worked with.
Speaker 3: More specifically, our biggest impediment was the very high level
Speaker 3: of DNA fragmentation present in my sperm, something that we
Speaker 3: discovered after our own research and had to strongly advocate
Speaker 3: for and convince our ARII to even test for. This
Speaker 3: is why, after multiple failed rounds of IVF, I decided
Speaker 3: to move forward with another vericocell removal surgery to help
Speaker 3: overcome our DNA fragmentation issues, this time with the reproductive
Speaker 3: urologist who successfully improved all our semen parameters and as
Speaker 3: a result, improved our final IVF outcomes.
Speaker 2: Over the past three years, we have researched and tried
Speaker 2: everything related to improving our fertility, including losing one hundred pounds,
Speaker 2: trying experimental treatments such as different protocols, fresh embryo transfers,
Speaker 2: reproductive immunology, acupuncture, red light therapy, ovarian PRP, uterine PRP,
Speaker 2: and so much more. We have worked with multiple clinics,
Speaker 2: traveling out of state for the best care for our
Speaker 2: unique needs. In fact, we record this audio from a
Speaker 2: tiny studio apartment in Manhattan as we work with the
Speaker 2: clinic in New York City.
Speaker 3: We've retrieved one hundred eggs from Diana's ovaries through ten
Speaker 3: extremely brutal egg retrievals. We have forty seven embryos which
Speaker 3: resulted in ten blasticists that were genetically tested. Six of
Speaker 3: those are frozen in time, just like Han Solo, ready
Speaker 3: and waiting to be transferred into Diana's uterus.
Speaker 2: Throughout this expedition, we have learned so much about the
Speaker 2: fertility industry, the insurance industry, and each other.
Speaker 3: The biggest and toughest lesson that we have learned while
Speaker 3: immersing ourselves in the world of fertility treatments is that
Speaker 3: efforts do not equal outcomes.
Speaker 2: Still, we publicly share everything that we have learned so
Speaker 2: that others may learn from our mistakes.
Speaker 3: More importantly, we share our stories so that others suffering
Speaker 3: through infertility will know that they are not alone.
Speaker 4: When I turned thirty eight, I decided to have a
Speaker 4: child on my own. I'm a single lady. I had
Speaker 4: just gotten out of a pretty serious relationship and didn't
Speaker 4: really want there to be the pressure of a baby
Speaker 4: hanging over another. So I went in for a consultation
Speaker 4: to find out what was going on with my body.
Speaker 4: Turns out I had pretty good follicle count. I went
Speaker 4: pretty quickly and found a donor. In the meantime, I
Speaker 4: did my own genetic carrier screening and I found out
Speaker 4: I had was a carrier for two rare diseases, and
Speaker 4: the donor I selected had only been screened for one
Speaker 4: of them. One of them was not included on most screens,
Speaker 4: so he actually ended up going back to the sperm
Speaker 4: bank with those results, which was great. So this was
Speaker 4: an anonymous donor, although we did do open ID so
Speaker 4: my daughter spoiler Alert, can reach out when she turns eighteen,
Speaker 4: so that decision is up to her to reach out
Speaker 4: if she wants. So I had one round of IUI,
Speaker 4: which was unmedicated, and then that didn't work. I was
Speaker 4: pretty disappointed and just didn't want to wait any longer,
Speaker 4: just given the amount of time that went between each cycle.
Speaker 4: Of course every month kind of aligning with your menstrual cycle.
Speaker 4: I went to IVF right after that, and at the
Speaker 4: beginning of that second attempt, I got COVID and my
Speaker 4: follicle account was really terrible when we went titcheck at
Speaker 4: the middle of the month, and so we waited for
Speaker 4: another month, which was like that's eight weeks. Then from
Speaker 4: the start, I did about two weeks of shots and
Speaker 4: I had one not so fun episode where I had
Speaker 4: to go on a Sunday to sitting nearby. Didn't have
Speaker 4: a car at the time and had to take a
Speaker 4: bus and a train and had very sore ovaries and
Speaker 4: was super swollen and feeling awful. But I had to
Speaker 4: get one more Gona left pen for I think it
Speaker 4: was the quarter of the remaining dose that I needed
Speaker 4: for that night. And then I did my trigger the
Speaker 4: next week two days later, which was also neebrecking. So
Speaker 4: after that I got about twenty mature eggs. We used
Speaker 4: XY and I eventually ended up with a fair number
Speaker 4: of embryos that were PGT normal. I had two that
Speaker 4: were abnormal that were discarded, and a couple that just
Speaker 4: didn't make it. So I let the embryoagist decide which
Speaker 4: embryo to implant because I didn't want to get the
Speaker 4: sex of the embryos revealed. I did not want to
Speaker 4: make that choice and I wanted to keep as much
Speaker 4: of it kind of normal as possible. That this totally
Speaker 4: bizarre journey to have my daughter. I guess it's not bizarre,
Speaker 4: but it was just different than what I expected. So
Speaker 4: we did it for It was an embryo transfer in November,
Speaker 4: and I found out I was pregnant right after Thanksgiving,
Speaker 4: and I had her last August. So I have my
Speaker 4: beautiful baby and I have several embryos on ice.
Speaker 5: Thank you again, everyone's so so much for sharing your
Speaker 5: stories with us. It it really means so much and
Speaker 5: Aarin and I have been like talking about this sort
Speaker 5: of off the air and just about how appreciative we
Speaker 5: are and how amazing it is to get to to
Speaker 5: learn this, this wide range of experiences and feelings that
Speaker 5: people have about this, and how greatful we are that
Speaker 5: we get to share these with other people as well.
Speaker 5: So yeah, thank you.
Speaker 6: Think we maybe all have an idea of what we
Speaker 6: think IVF might be like, and so many of us
Speaker 6: have absolutely no idea, and it's so different for so
Speaker 6: many of you. So thank you all so much for
Speaker 6: taking the time to write in, to record your stories,
Speaker 6: and to be willing to share such a difficult and
Speaker 6: vulnerable time with so many people.
Speaker 7: We really appreciate it. Yes, well said Hi. I'm erin
Speaker 7: Welsh and I'm erin allman Updike.
Speaker 5: And this is this podcast will kill you.
Speaker 7: We're coming to you with our third of three episodes. Yeah,
Speaker 7: i've yf.
Speaker 5: Yes, if you have not listened to the first two episodes,
Speaker 5: you should go listen to them. You should go try
Speaker 5: showus out, but just for a little bit of context
Speaker 5: in case you're like, I'll do that later after this. Yeah, afterwards,
Speaker 5: this is what you could expect to find in episodes
Speaker 5: one and two. Episode one, we were primarily focused on infertility,
Speaker 5: sort of the concept of infertility and how it has
Speaker 5: changed over space and time and how we evaluate infertility
Speaker 5: today in a biomedical setting.
Speaker 6: Yeah, and then our second episode was focused really on IVF.
Speaker 7: How did we do it?
Speaker 6: Like, how did people come up with IVF, what kind
Speaker 6: of science was required for us to be able to
Speaker 6: make that happen, and what are the steps of IVF.
Speaker 7: Today and then get in today's episode.
Speaker 5: Today's episode is sort of a very i would say,
Speaker 5: like a very surface level overview of the current landscape
Speaker 5: of IVF technology.
Speaker 6: You're going to say a surface level deep dive just
Speaker 6: to like be contrary.
Speaker 5: I do feel like that is like our stick is.
Speaker 8: Yeah.
Speaker 5: Yeah, this is mostly about like from innovation to industry essentially,
Speaker 5: how IVF has become the thing that it is today
Speaker 5: and then also where it might go in the future.
Speaker 7: Yeah.
Speaker 6: Yeah, But before we get into all of that, it's
Speaker 6: still quarantiny time.
Speaker 5: It is, and it's still the same Quarantini as our
Speaker 5: first two episodes.
Speaker 7: It's a work of art, it is.
Speaker 5: And if you would like to get the full recipe
Speaker 5: for the quarantiny and non Alcoholic Placy Brita a work
Speaker 5: of art. You should check out our social media channels.
Speaker 5: We've got posted there. Check out our website. We've got
Speaker 5: them posted there. Also on our website. Lots of cool,
Speaker 5: great stuff, you know, transcripts, We've got links to merch
Speaker 5: links to bookshop where you can find all of the
Speaker 5: book books as well as the books that we reference
Speaker 5: for all of our episodes. You can find good Reads lists,
Speaker 5: you can find Patreon, lots of things. I know I'm
Speaker 5: forgetting stuff, but you know what, you did.
Speaker 7: A great job. Check it out this podcastle Tillia dot com.
Speaker 5: Let's get started.
Speaker 7: Let's please eron.
Speaker 6: Tell me about this global landscape because oof, I have
Speaker 6: some ideas about it, but I don't really know.
Speaker 5: Yeah, that's sort of how I ended up. So we'll
Speaker 5: see what the journey that I took to get there
Speaker 5: right after this break.
Speaker 8: Hi, my name is Melissa. I'm forty one years old,
Speaker 8: and my fertility journey started ten years ago. My husband
Speaker 8: and I tried to conceive for two years without success
Speaker 8: before being referred to a fertility clinic. We spent the
Speaker 8: next year undergoing various tests to determine possible causes for
Speaker 8: our inability to get pregnant. We found out that we
Speaker 8: both have fertility issues. Our physician recommended that we try
Speaker 8: intrauterine insemination to improve our chances. We tried several rounds
Speaker 8: of UI and were finally successful with the birth of
Speaker 8: our daughter in twenty eighteen. In twenty twenty two, we
Speaker 8: decided to try again, so we went back to our
Speaker 8: fertility clinic. We tried two unsuccessful rounds of IUI and
Speaker 8: then moved on to IVF, as by this time I
Speaker 8: was nearing forty. We underwent our first day retrieval process
Speaker 8: last summer. To say that I was unprepared for the
Speaker 8: difficulties of undergoing IVF was a huge understatement. To prepare
Speaker 8: for the retrieval, I had to inject myself with fertility
Speaker 8: meds multiple times a day. I had to do several
Speaker 8: internal ultrasounds so the clinic could monitor the growth of
Speaker 8: my eggs. On the day of the retrieval, I was
Speaker 8: so hopeful, but again totally unprepared for the experience of
Speaker 8: the procedure. I was given pain medication, but the process
Speaker 8: of piercing through my vaginal wall to aspirate the eggs
Speaker 8: from my ovaries was excruciating. The retrieval resulted in four
Speaker 8: embryos which were frozen and sent for PGTA testing, but
Speaker 8: only a single embryo came back as viable for transfer,
Speaker 8: so I began the process for embryo transfer, which involved
Speaker 8: daily intramuscular injections of progesterone in oil. I had a
Speaker 8: reaction to the oil and ended up with painful, red
Speaker 8: hot lumps on both of my thighs. We transferred the embryo,
Speaker 8: but unfortunately it didn't survive. I was devastated. Our doctor
Speaker 8: had us try again, this time with a huge increase
Speaker 8: in medication dosage. I went through the awful process of injections, ultrasounds,
Speaker 8: and agg retrieval yet again, and this time we got
Speaker 8: six embryos. We were so hopeful that it would work
Speaker 8: this time. Unfortunately, none of the embryos were viable, so
Speaker 8: we couldn't transfer any of them. We were told that
Speaker 8: my eggs are too damaged and we shouldn't try to
Speaker 8: do any further retrievals. Our best hope now is to
Speaker 8: buy eggs from a donor egg bank, with the hope
Speaker 8: that we might get a healthy embryo that has at
Speaker 8: least my husband's DNA. This journey of IVF has been
Speaker 8: an emotional roller coaster. I've been heartbroken again and again,
Speaker 8: and now we are left unsure if we will ever
Speaker 8: have another child.
Speaker 2: Hi.
Speaker 9: I'm Sarah and our journey to having children was a
Speaker 9: complicated one. My husband and I began trying to fall
Speaker 9: pregnant shortly after marriage. After nearly eighteen months with no conception,
Speaker 9: we went to the GP for preconception testing and discovered
Speaker 9: that my husband had azuspermia feud in conjunction with deranged
Speaker 9: hormone levels. The GP recommended follow up genetic screening, so
Speaker 9: two months later we received the results that he had
Speaker 9: forty seven xx ye Climbfelter syndrome, a condition that often
Speaker 9: results in infertility. We were then referred to a fertility
Speaker 9: clinic where we decided to try a testicular sperm aspiration
Speaker 9: to see if they could find any viable immature sperm.
Speaker 9: None were found. We now knew a sperm donor would
Speaker 9: be required as the only treatment option for non obstructive
Speaker 9: asiospermic male factor infertility in Australia. Or gammic donation has
Speaker 9: to be altruistic, so finding local sperm is very difficult.
Speaker 9: Our specialist suggested we look at known donors, specifically a
Speaker 9: family donor. We decided to approach my husband's brother as
Speaker 9: a potential donor, and we're very grateful that he agreed.
Speaker 9: A known donor pathway is significantly different to a purchase
Speaker 9: sperm pathway and required further genetic screening of myself, the
Speaker 9: donation and freezing of the donor sample, mandatory counseling to
Speaker 9: ensure all parties were aware of the legalities and potential
Speaker 9: emotional mine fields of the situation, and the six month
Speaker 9: cooling off period post donation, which served for testing of
Speaker 9: the donated sample and allowed for change of mind of
Speaker 9: the donor. After those six on months, we were ready
Speaker 9: to finally begin treatment, as is the case with all
Speaker 9: male factor in fertility. After that sperm aspiration procedure, all
Speaker 9: further surgeries, medication and treatment was for the carrying parent.
Speaker 9: Our first collection cycle and fresh embryo transfer was unsuccessful,
Speaker 9: with no additional embryos to freeze. Our second collection cycle
Speaker 9: and fresh embryo transfer was also unsuccessful, however, had also
Speaker 9: produced true embryos to freeze. Here, we took a break
Speaker 9: for a few months before returning for a frozen embryo transfer,
Speaker 9: which was thankfully successful and resulted in our gorgeous baby girl.
Speaker 9: Twelve months after her birth, we returned to the fertility
Speaker 9: clinic to transfer the remaining frozen embryo. Whilst it felt
Speaker 9: strange trying to get pregnant again when it felt like
Speaker 9: we still had a little baby, the knowledge of how
Speaker 9: hard the fertility treatment was men I wanted to rip
Speaker 9: off the band aid, complete the last treatment cycle and
Speaker 9: know with certainty what our family would look like. We
Speaker 9: repeated the same successful frozen transfer protocol, which was again successful,
Speaker 9: and this time we had a beautiful baby boy. With
Speaker 9: twenty months between the kids. We were deep in the
Speaker 9: two under two club and extremely grateful for the treatment
Speaker 9: options that we had been able to utilize to have
Speaker 9: our family. Seven months after having our son, we heard
Speaker 9: from the clinic asking us about the remainder of our
Speaker 9: frozen donated sperm. This is when we decided our family
Speaker 9: was complete and we would discard the remaining samples and
Speaker 9: close the door on our fertility journey. Fertility treatment is
Speaker 9: emotion only, physically and financially taxing, and we're very thankful
Speaker 9: to have come out the other side. With our two
Speaker 9: gorgeous little kids. We are acutely aware that not everyone
Speaker 9: walks away from fertility treatment having had a child.
Speaker 5: Last week. I left off sometime in the nineteen eighties,
Speaker 5: after the number of IVF clinics began to grow rapidly,
Speaker 5: leading to technological improvements, wider applications, and questions about regulation,
Speaker 5: about access, and about the ethics surrounding this technology. Any
Speaker 5: new technological advancement is going to carry with it ethical considerations,
Speaker 5: especially those that are widely used and that have a
Speaker 5: great deal of impact or potential. And what often happens
Speaker 5: is that these technologies and their applications develop faster than
Speaker 5: our regulation of them or even our ability to know
Speaker 5: how we feel about them, Like what do we think
Speaker 5: about them? IVF is no exception. IVF is an incredibly
Speaker 5: powerful technology that has enabled millions of people around the
Speaker 5: world to fulfill their dreams of having children. I mean,
Speaker 5: think about that, like that is it is truly amazing?
Speaker 7: It is incredible, Like it is so cool and incredible.
Speaker 5: Yes, it absolutely this is not hyperbole. Revolutionized reproductive technology
Speaker 5: around the globe like before IVF, after IVF very clear
Speaker 5: line and so of course a technology as powerful as
Speaker 5: IVF will carry with it substantial ethical implications and questions
Speaker 5: of regulation. Just as we're still working out the kinks
Speaker 5: of IVF technology, we're still figuring out how to best
Speaker 5: regulate this industry and how to protect everyone involved and
Speaker 5: where the future might take us. And today, I want
Speaker 5: to go through some of the ethical considerations or questions
Speaker 5: of regulation of IVF that have emerged over the history
Speaker 5: of this technology. I'm not going to present pros and cons.
Speaker 5: I'm not going to make value judgments. I just want
Speaker 5: to touch on a few areas, not all of the areas,
Speaker 5: not comprehensively, because I think that this story in general,
Speaker 5: the regulatory landscape of IVF, is an important It's a
Speaker 5: necessary part of the story or history of IVF and
Speaker 5: its future. This is a really complex topic with so
Speaker 5: much nuance, and we're not ethicists or policy experts or
Speaker 5: anything in IVF. We're just going to try our best
Speaker 5: like we always do, and I'm going to focus primarily
Speaker 5: on the regulation, access, and innovation side of things. If
Speaker 5: you live in the US, I'm sure you've come across
Speaker 5: recent headlines about the Alabama Supreme Court ruling in February
Speaker 5: of this year that frozen embryos can be considered children
Speaker 5: in that state. The short term and long term implications
Speaker 5: of this ruling are not yet clear, and I'm sure
Speaker 5: that in the next few months leading up to the election,
Speaker 5: we'll see more discussion about this and about the other
Speaker 5: ways that political groups and religious organizations are trying and
Speaker 5: sometimes succeeding, to push an agenda ultimately aimed at controlling
Speaker 5: people's bodies and choices. Banning IVF is just one part
Speaker 5: of this wider movement to reaffirm gender roles, restrict access
Speaker 5: to healthcare, reinforce cycles of poverty, and control people's bodies.
Speaker 5: And it feels truly dystopian to be watching this unfold
Speaker 5: and gain traction, like I both can't believe but also
Speaker 5: sadly can believe that it's happening right in front of us.
Speaker 5: But today, we're not going to debate when life begins,
Speaker 5: or what should or shouldn't be considered a child and
Speaker 5: be granted personhood, or even what an embryo is, because
Speaker 5: there are actually many definitions of embryo that very globally
Speaker 5: and we're not going to debate these things because first,
Speaker 5: you can't really debate what comes down to essentially fundamental
Speaker 5: disagreements over closely held beliefs, like I believe to my
Speaker 5: core that abortion is healthcare and that IVF should not
Speaker 5: be banned. I cannot imagine entertaining any argument trying to
Speaker 5: convince me otherwise. And secondly, in the rest of the world,
Speaker 5: discussions of the ethics of IVF have moved beyond the
Speaker 5: question of whether or not IVF should be done and
Speaker 5: onto how it should be done. And so that's what
Speaker 5: I'm going to touch on today. But first, let's go
Speaker 5: back to the early years of IVF to see how
Speaker 5: it grew, with a special emphasis on the US, because
Speaker 5: that will get us to the current landscape of IVF.
Speaker 5: The early nineteen eighties established that IVF seemed here to stay,
Speaker 5: and by the end of the decade, nearly two hundred
Speaker 5: clinics offered IVF in the US, and an estimated thirty
Speaker 5: thousand women in the US had sought pregnancy using IVF.
Speaker 5: By the end of the nineteen eighties.
Speaker 7: Thank you, Yeah, I was like, wait, wait, wait, wait, year.
Speaker 5: Again, but attempts to develop clear federal regulation for IVF
Speaker 5: fell short. Other countries had come up with licensing bodies
Speaker 5: to regulate research and treatment with committees consisting of people
Speaker 5: with varying backgrounds and expertise, and the US tried this
Speaker 5: but didn't get as far as formalizing the committee's recommendations
Speaker 5: even when there was consensus, and in the meantime, the
Speaker 5: IVF industry in the US continued to grow. There were
Speaker 5: those guidelines from the Society for Assisted Reproductive Technology that
Speaker 5: I mentioned last week, but no requirement to follow them.
Speaker 5: As of the late nineteen eighties, any licensed physician could
Speaker 5: open an IVF clinic. You didn't have to be a
Speaker 5: board certified reproductive endocrinologist or even an obgyn, and this
Speaker 5: showed in the range of live birth rates in clinics.
Speaker 5: More established clinics with highly experienced reproductive endocinologist reported rates
Speaker 5: of twenty percent, more than double the national average of
Speaker 5: nine percent, and twenty one percent of all clinics in
Speaker 5: the US in nineteen eighty eight did not have a
Speaker 5: single live birth.
Speaker 7: Wow.
Speaker 5: Yeah, And that isn't to say that twenty one percent
Speaker 5: of all clinics were terrible and just like exploiting people
Speaker 5: and taking their money, but that perhaps the entire field
Speaker 5: might benefit from best practice guidelines that would protect the
Speaker 5: interests and health of everyone involved, from practitioners to patients.
Speaker 5: The calls for more regulation both then and now didn't
Speaker 5: just come from the outside, like people working on the
Speaker 5: outside of IVF, but also those who were most intimately
Speaker 5: involved in this work. In the nineteen eighties, IVF practitioners
Speaker 5: knew that this booming field could be severely harmed by
Speaker 5: just a handful of physicians who saw IVF as an
Speaker 5: opportunity to exploit rather than help. Without guidelines, the field
Speaker 5: could grow increasingly market driven, with private clinics competing for
Speaker 5: clients by doctoring their or not being fully transparent about
Speaker 5: their rates of live birth. Ultimately, it was fear of exploitation,
Speaker 5: along with a scandal, that helped to inspire the first
Speaker 5: major piece of regulation for IVF in the US. Even
Speaker 5: though Cecil Jacobsen, the physician at the heart of the scandal,
Speaker 5: did not offer IVF, he did defraud many people at
Speaker 5: his reproductive health practice and also used his own sperm
Speaker 5: to impregnate patients, saying it was anonymous donation. He was
Speaker 5: one of those Yeah.
Speaker 6: Is he is this the one that that podcast is
Speaker 6: about the retrievals?
Speaker 5: Yeah, no, that retrievals is something else.
Speaker 7: I'm sorry. Wow, okay, yeah.
Speaker 5: Yeah, there are there's more than one, more than one.
Speaker 7: Okay, great, yeah, very very great.
Speaker 5: It's wonderful. Yeah, and Cecil Jacobson was sentenced to five
Speaker 5: years in prison.
Speaker 7: Five years okay, yep, yeah.
Speaker 5: There's some. He also did some other really horrible thing
Speaker 5: thanks to some of his patients. I won't even get
Speaker 5: into it, but you know, just give them a Google.
Speaker 5: But finally, in nineteen ninety two, the Fertility Clinics Success
Speaker 5: Rate and Certification Act was passed, largely in the name
Speaker 5: of consumer protection, to require that clinics be transparent about
Speaker 5: their procedure success rates. So this is straight from the
Speaker 5: CDC website. This act quote mandates that clinics performing art
Speaker 5: annually provide data for all procedures performed to the Centers
Speaker 5: for Disease Control and Prevention and sets forth definitions and
Speaker 5: reporting requirements. CDC is required to use these data to
Speaker 5: report and publish clinic specific success rates and certification of
Speaker 5: embryo laboratories.
Speaker 8: End quote.
Speaker 5: So what I'm not sure about is how those rates
Speaker 5: or which of those rates are communicated to IVF clients.
Speaker 5: Is it a clinic wide average, does it inclclude people
Speaker 5: experiencing infertility or people who seek IVF for other reasons.
Speaker 5: Is it across all ages? How much of it is
Speaker 5: influenced by the decision tree to use IVF, Like depending
Speaker 5: on the person seeking treatment, some clinics may jump straight
Speaker 5: to IVF, while others may explore less expensive, less involved options.
Speaker 6: First, I don't have answers to that, but the CDC
Speaker 6: does have a really awesome interactive way that you can
Speaker 6: look up all of the clinics in your area, like
Speaker 6: by zip code, and so you can at least see
Speaker 6: some of the rates, and they have a lot of
Speaker 6: disclaimers on there about what it counts for and what
Speaker 6: it doesn't account for and all of that kind of stuff.
Speaker 5: So yeah, it's definitely like, yeah, I think that is
Speaker 5: a really important tool to have, Yeah, at I get
Speaker 5: starting it at least, yeah, to get And I think
Speaker 5: it sometimes can put that the onus of research on
Speaker 5: the person who is doing this, and that's that's challenging.
Speaker 5: And also I don't know, as someone who has never
Speaker 5: sought IVF, I don't know how easy or difficult or
Speaker 5: like how different clinics interact with you.
Speaker 6: Right, Well, and I'm sure yeah, it's all going to
Speaker 6: also vary, like which one, if any take your insurance,
Speaker 6: how much does your insurance cover, how much does this
Speaker 6: one cost versus that one costs. Like it's all just
Speaker 6: a huge web, you know, and you just are stuck in.
Speaker 5: It, and you're just suck in it. And then there's
Speaker 5: egg freezing, which is a totally separate procedure that I
Speaker 5: think more recently at least, we have gotten better numbers on.
Speaker 5: But in the beginning, it was sort of like, here's
Speaker 5: this hypothetical scenario that we're going to do. And a
Speaker 5: lot of these egg freezing programs were started by people
Speaker 5: who didn't have necessarily backgrounds in medicine or reproductive medicine.
Speaker 5: And I know that, like you know, I'm sure that,
Speaker 5: as you'll talk about, we have a better grasp on
Speaker 5: what egg freezing looks like. But it can also be
Speaker 5: measured in many, many, many different ways, so it's complicated.
Speaker 5: And the other thing about this act is that there
Speaker 5: aren't clear consequences for the clinics that don't participate in
Speaker 5: reporting to the CDC. Ninety percent do in the US,
Speaker 5: and the bottom line is that this is still a
Speaker 5: market driven enterprise. Estimated at five point three four billion
Speaker 5: dollars in the US in twenty twenty four.
Speaker 7: Just in the US.
Speaker 5: Just in the US, yeah, oh boy. Yeah. And so
Speaker 5: I think what it comes down to for a lot
Speaker 5: of people is that opportunities exist for clinics to massage
Speaker 5: their results to stand out from the competition because of
Speaker 5: the way that a lot of this is market driven.
Speaker 5: But it is untrue that IVF in the US is
Speaker 5: completely unregulated wild West. In some ways, there are stricter
Speaker 5: reporting requirements for IVF than there are for other medical
Speaker 5: procedures in the US who don't have to report cess rates. Granted,
Speaker 5: it is less regulated than in other countries, especially those
Speaker 5: that have national healthcare systems, but legislation does exist, and
Speaker 5: it's not just the nineteen ninety two Act that helps
Speaker 5: to protect consumers. Some US states have accreditation and inspection laws.
Speaker 5: And then there's also the US legal system, which allows
Speaker 5: patients to sue clinics and doctors for medical malpractice. But
Speaker 5: litigation is reactive, and so it still allows for the
Speaker 5: potential for exploitation or abuse within fertility clinics. Instances of
Speaker 5: doctors using their own sperm to impregnate clients without their
Speaker 5: knowledge or consent, not providing adequate care during procedures, or
Speaker 5: ignoring pain so that that podcast, The Retrievals by Cereal
Speaker 5: tells the story of how women underwent these painful surgical
Speaker 5: procedures at an IVF clinic, where a nurse had swapped
Speaker 5: out fentanyl for saline solution, but no one believed that
Speaker 5: the women were actually experiencing pain. They were like, no,
Speaker 5: this is normal amount of pain, but really they were
Speaker 5: undergoing procedures that with.
Speaker 7: Emily they would be pain.
Speaker 5: Yeah. Control, Yeah, I haven't listened to it, but it
Speaker 5: sounds rage inducing and well done. Yeah, or some clinics
Speaker 5: will not properly inform of risks involved or things like
Speaker 5: extreme And it also leaves open things like extreme deviation
Speaker 5: from the standard of medical care, such as when a
Speaker 5: doctor transferred twelve embryos into a woman named Natalie Suliman,
Speaker 5: resulting in the world's first surviving octopletz octomom as. We
Speaker 5: probably remember that doctor's license was later revoked, But again, like,
Speaker 5: how do we better protect against misuse or abuse from
Speaker 5: the outset? I don't know. The added regulation and threat
Speaker 5: of litigation did not dampen enthusiasm for IVF in the
Speaker 5: US during the rest of the nineteen nineties and into
Speaker 5: the two thousands from the book Pursuit of Parenthood Quote.
Speaker 5: Between nineteen ninety nine and twenty fifteen, the volume of
Speaker 5: treatment in America's fertility centers, measured by the number of
Speaker 5: egg retrieval cycles, went up more than two and a
Speaker 5: half times to nearly two hundred and thirty two thousand
Speaker 5: retrieval cycles, about eighty percent of them with the intent
Speaker 5: to achieve a pregnancy and the rest for the purpose
Speaker 5: of freezing and banking the resulting embryos for future use.
Speaker 5: Just under sixty one thousand women gave birth after being
Speaker 5: treated that year in twenty fifteen, for an overall take
Speaker 5: home baby rate of about thirty three percent, up from
Speaker 5: about twenty five percent in nineteen ninety nine end quote.
Speaker 5: And patient makeup at these clinics was also changing, with
Speaker 5: more single women and same sex couples using ibas, as
Speaker 5: well as an increase in traditional and gestational surrogacy, egg donation,
Speaker 5: and so on. These trends were not happening just in
Speaker 5: the US, but also globally, and they have led to
Speaker 5: continued discussion and heated debate over how to best regulate
Speaker 5: some IVF practices, and so here's where I want to
Speaker 5: move more generally into the global landscape of IVF to
Speaker 5: touch on some of the questions that have been raised
Speaker 5: about practices within IVF beyond consumer protection and clinic transparency
Speaker 5: laws about things like surrogacy, egg and sperm donation IVF
Speaker 5: for single parents or same sex couples age cutoffs. These
Speaker 5: laws vary globally, which has led to people traveling to
Speaker 5: other countries to seek fertility treatment, called cross border reproductive
Speaker 5: care or fertility tourism. The US, for instance, is one
Speaker 5: of a handful of countries where paid or commercial is legal.
Speaker 5: India used to be a very popular destination for surrogacy
Speaker 5: due to its lower cost, but they have since banned
Speaker 5: foreign couples seeking surrogacy. Other countries permit only altruistic surrogacy,
Speaker 5: where the cost of medical care and other pregnancy related
Speaker 5: expenses are covered but no additional fees, and in some
Speaker 5: countries surrogacy of any kind is illegal. This variation in
Speaker 5: surrogacy laws reflects discussions around whether paid surrogacy always carries
Speaker 5: with it the risk of exploitation, whether the transactional nature
Speaker 5: of paid surrogacy better protects both commissioning parents and surrogate
Speaker 5: by more clearly outlying expectations. How to deal with the
Speaker 5: fact that pregnancy is inherently risk laden and can be
Speaker 5: especially so with IVF if multiple embryos implant, or what
Speaker 5: to do when the unexpected happens. Commissioning couples divorcing during
Speaker 5: the surrogacy, pregnancy, pregnancy loss, health issues developing during pregnancy,
Speaker 5: or as a result of pregnancy, people changing their mind midway.
Speaker 5: There was one case where a genetic scan revealed that
Speaker 5: one of the fetuses that a surrogate was carrying had
Speaker 5: TRISO only twenty one down syndrome, and the commissioning couple
Speaker 5: only adopted the twin without the condition. Then that led
Speaker 5: to a lot of other issues. It was it was
Speaker 5: like a long, really long drawn out process. Wow that
Speaker 5: this in general is a very complicated topic, as is
Speaker 5: the commodification of sperm, eggs, and embryos, similar to gestational
Speaker 5: surrogacy or traditional surrogacy. Countries have varying laws regarding sperm
Speaker 5: and egg donation or sale, and this is another reason
Speaker 5: that people travel across borders for reproductive care. Then there's
Speaker 5: anonymous donation as in is there still such a thing
Speaker 5: as anonymity with the advent of ancestry testing, Yeah yeah.
Speaker 5: Discussion has also arisen over the use of frozen eggs, sperm,
Speaker 5: or fertilized eggs after a couple splits, or if someone
Speaker 5: dies in situations where there is no written documentation indicating
Speaker 5: the wishes of the deceased, how should posthumous reproduction be
Speaker 5: allowed to proceed or should it? I came across one
Speaker 5: high profile case where a couple died in a car
Speaker 5: accident and their two sets of parents engaged the services
Speaker 5: of a gestational carrier to carry their grandchild from frozen
Speaker 5: embryos from the deceased couple, So four years after the
Speaker 5: couple had died, their baby was born.
Speaker 7: Wow.
Speaker 5: Yeah. There are a lot of a lot of stories
Speaker 5: similar to that. Okay, you know, frozen sperm, frozen eggs,
Speaker 5: commissioning a gestational carrier. Yeah yeah. And then finally, recent
Speaker 5: technological advancements like gene editing where people can select for
Speaker 5: sex or other advertised quote unquote like designer babies. These
Speaker 5: have also raised questions along the lines of just because
Speaker 5: we can, does that mean we should? It's still very
Speaker 5: early days when it comes to the practical application of
Speaker 5: gene editing technologies such as Crisper to human embryos, but
Speaker 5: it is in our future, quite possibly are very near future, right,
Speaker 5: and many people have called for discussion and regulations now
Speaker 5: to start drawing lines between what is considered acceptable use
Speaker 5: of this technology and what could be considered misuse. Beyond
Speaker 5: how IVF is done or how the practice is regulated,
Speaker 5: is the question of access. I've already talked about how
Speaker 5: most stories featuring IVF tend to have a quote unquote
Speaker 5: happy ending resulting in a baby, and stories where IVF
Speaker 5: didn't work out aren't highlighted as much. But even more
Speaker 5: silenced are the stories where people can't seek out IVF
Speaker 5: due to economic, insurance or geographic reasons, or reasons pertaining
Speaker 5: to their identity, whether that's marital status, sexual orientation, age, etc.
Speaker 5: Sometimes referred to as socially infertile. The WHO and the CDC,
Speaker 5: among other organizations around the world, classify infertility as a disability,
Speaker 5: but in the US, insurance companies are not required in
Speaker 5: all states to cover or offer coverage for IVF. Some
Speaker 5: clinics offer IVF lotteries where people can enter to win
Speaker 5: a free cycle and of course, lack of access to
Speaker 5: IVF disproportionately impacts people of color and poor people. To
Speaker 5: quote American sociologists, law professor, and social justice advocate Dorothy Roberts, quote,
Speaker 5: the people in the United States most likely to be
Speaker 5: infertile are poor, black, and poorly educated. Most couples who
Speaker 5: use IVF and other high tech procedures are white, highly educated,
Speaker 5: and affluent.
Speaker 1: End quote.
Speaker 5: This problem of access extends globally, with resource poor countries
Speaker 5: tending to have lowest access to assisted reproductive technologies like IVF.
Speaker 5: Laws and regulations that limit or remove reproductive rights, whether
Speaker 5: that's access to contraceptives, abortion, fertility treatments without exception, have
Speaker 5: a disproportionate impact on the poor and disadvantaged. We may
Speaker 5: not know what's going to happen in the future, but
Speaker 5: that much we do know, right.
Speaker 7: That has been clear for a very long time.
Speaker 5: That is established.
Speaker 7: We haven't fixed that problem yet.
Speaker 5: It's still in existence in perpetuity. Yes, the history, the regulation,
Speaker 5: the technology. It's such a hugely, vastly complex topic and
Speaker 5: may become even more so in the coming decades with
Speaker 5: the incorporation of new technologies. Figuring out how to regulate
Speaker 5: a constantly evolving technology is challenging but essential. IVF holds
Speaker 5: so much potential. It has given so many people the
Speaker 5: children they have always wanted, and it has helped to
Speaker 5: expand our definition of what constitutes a family in a
Speaker 5: really beautiful way. And it also forces us to examine
Speaker 5: our feelings about what the limits of this technology are
Speaker 5: or what they should be in the future. And it's
Speaker 5: okay to not know how you feel about all these
Speaker 5: different aspects of IVF, like posthumous reproduction or gene editing.
Speaker 5: It's complex stuff. And if it were easy to come
Speaker 5: to a consensus or know that this is you know,
Speaker 5: this is the dividing line, then we would have already
Speaker 5: done that at this point, like at least country to country. Instead,
Speaker 5: what we can do, I think is some self reflection.
Speaker 5: We can listen, we can learn, and we can ask questions.
Speaker 5: And so I'll end with a question, Aaron, what can
Speaker 5: you tell us about the potential future of IVF.
Speaker 6: Oh, I can tell you a little bit and maybe
Speaker 6: a lot right after this break.
Speaker 10: Hi, my name is Madeline Kronfeld. My story is about
Speaker 10: egg retrieval and freezing, because that's what I'm in the
Speaker 10: middle of doing. When I turned thirty eight in August
Speaker 10: twenty twenty three, I found myself in a situation that
Speaker 10: I didn't expect. I was single, with no prospects of
Speaker 10: a partner, and desperately wanting to be a mother one day.
Speaker 10: I've always wanted children, and I've always been in long
Speaker 10: term relationships, so I just assumed it would happen. I
Speaker 10: was married and divorced before I turned thirty, and then
Speaker 10: in a year's long relationship after that that I thought
Speaker 10: was going to lead to marriage and kids when it didn't.
Speaker 10: And after the death of my mom in May twenty
Speaker 10: twenty three, I decided that I had to take matters
Speaker 10: into my own hands and start the egg freezing process.
Speaker 10: Given my age and test results, it's expected that I
Speaker 10: need to do three to four cycles to freeze the
Speaker 10: twenty five to thirty eggs that the fertility clinic recommends.
Speaker 7: At more than fifteen.
Speaker 10: Thousand dollars per cycle, this would have been entirely cost
Speaker 10: prohibitive when I was younger. Of course, I would have
Speaker 10: had more eggs at that point, so maybe only one
Speaker 10: or two cycles. But even at a time when I'm
Speaker 10: more equipped to afford a large portion of this on
Speaker 10: my own. It's incredibly draining on my bank account and
Speaker 10: my emotions. So far, I've done two egg retrievals, one
Speaker 10: in February twenty twenty four and the second very recently
Speaker 10: in April twenty twenty four. Between those, I have seven
Speaker 10: frozen eggs. I'm happy to have any, but I'm also
Speaker 10: really disappointed that I don't have more. So I've been
Speaker 10: on this insane roller coaster of emotions, which is not
Speaker 10: helped by the extra hormones coursing through me. I plan
Speaker 10: on doing one more round and then I'll reassess things
Speaker 10: with my doctor. What's getting me through it is knowing
Speaker 10: that I'm actually doing something, even if I never need
Speaker 10: to use these frozen eggs or I do and it
Speaker 10: doesn't actually result in a viable pregnancy. I know that
Speaker 10: I'm privileged in the sense that I have an incredible
Speaker 10: support system of family and friends around me. I have
Speaker 10: the savings to afford it because my insurance doesn't cover
Speaker 10: any of this, I have the flexibility with my schedule.
Speaker 5: To do it.
Speaker 10: And I live in in Northern Virginia, which is a
Speaker 10: big metro area where there are excellent fertility resources. I
Speaker 10: feel really strongly that IVF, IUI, egg freezing, and any
Speaker 10: other fertility treatments are really empowering, whether you do it
Speaker 10: with a partner or on your own. Right now, I'm
Speaker 10: doing it on my own, and I really hope that
Speaker 10: one day I have a child again, whether it's from
Speaker 10: one of these frozen eggs or naturally. But I can't
Speaker 10: wait to tell them how much I wanted them in
Speaker 10: my life.
Speaker 1: Hi, my name is Mallorie, and I'm going to share
Speaker 1: my experience with IVF. My husband and I started trying
Speaker 1: to get pregnant after a year of marriage. We thought
Speaker 1: it would be easy, we were both young, healthy. Fast
Speaker 1: forward two years and we had tried natural conception, we
Speaker 1: had tried clomid, and finally IUI all without a pregnancy,
Speaker 1: so we started our first round. I injected myself with
Speaker 1: a cocktail of hormones to stimulate my ovaries and got
Speaker 1: to experience all the fun side effects waking, bruising, bloating, headaches,
Speaker 1: massive mood swings. I had blood work and vaginal ultrasounds routinely,
Speaker 1: and was finally told to give myself the last injection
Speaker 1: of hCG to stimulate my ovaries to ovulate the next morning,
Speaker 1: I went under anesthesia for the egg retrieval. However, I
Speaker 1: woke up to my husband telling me it didn't work.
Speaker 1: We had to repeat the injection and the procedure again
Speaker 1: in two days. The second time, they were able to
Speaker 1: retrieve about twenty eggs from my ovaries.
Speaker 7: But after this.
Speaker 1: Second procedure, I kept feeling worse and worse. I had
Speaker 1: severe nausea, vomiting, lack of appetite, abdominal tenderness, and bloating
Speaker 1: to the point I looked six months pregnant. When I
Speaker 1: finally couldn't take a deep breath, I went to the er.
Speaker 1: I was diagnosed with ovarian hyperstimulation syndrome, an exaggerated response
Speaker 1: in thevaries that caused swelling and leakage of the blood
Speaker 1: vessels into the abdominal cavity. They drained about three liters
Speaker 1: off my abdominal cavity at the bedside. Spent the night
Speaker 1: in the hospital because that promptly tanked my blood pressure,
Speaker 1: and then went home with a drain the next day
Speaker 1: to keep removing fluid over the next week. Two months later,
Speaker 1: we did have frozen embryos and planted. I gave myself
Speaker 1: progesterone injections into my buttock every day for twelve weeks,
Speaker 1: and thankfully, our daughter was born healthy without complications. Two
Speaker 1: years later, after using our last chromosomally normal embryo, my
Speaker 1: son was born. I found IVF to be incredibly difficult physically, mentally,
Speaker 1: and emotionally. I wish fertility and the possibilities of infertility
Speaker 1: had been discussed more when I was younger, and I
Speaker 1: had been better prepared. I'm a healthcare provider in women's health,
Speaker 1: and I feel there's been a massive shift in awareness
Speaker 1: and perception of infertility. The rise of women finding platforms
Speaker 1: to vocalize their experiences with IVF and infertility has had
Speaker 1: major effects. I applaud the spread of information and the
Speaker 1: empowering and cathartic nature of women sharing their stories and
Speaker 1: forming communities. But I see women almost daily who are
Speaker 1: terrified that they're infertile and won't have children because of
Speaker 1: what they've seen or heard. I think it's so important
Speaker 1: to provide accurate, honest information. None of us have a
Speaker 1: crystal ball to see what the future of our fertility holds,
Speaker 1: and while there are some tests that can give insight
Speaker 1: into general reproductive health, The fact of the matter is,
Speaker 1: for most people, we never know how easy or heart
Speaker 1: it will be to get pregnant until we start trying.
Speaker 6: So let's start with how many babies are born via IVF,
Speaker 6: shall we?
Speaker 7: Yeah?
Speaker 5: Yeah.
Speaker 6: In twenty twenty four, most papers that I read, most
Speaker 6: figures say that the total number of humans that have
Speaker 6: been born as a result of IVF, like total globally
Speaker 6: is ten million people.
Speaker 5: That's amazing, I know, isn't that incredible? Yeah? Wow?
Speaker 6: We had people wrote who wrote in who were quote
Speaker 6: unquote test two babies. Yeah, help themselves, and like that's
Speaker 6: that's incredible, like that it it still absolutely blows my
Speaker 6: mind that this is possible, like it is. It is
Speaker 6: so fascinating and everything that we went through in the
Speaker 6: last episode about all of the steps that had to
Speaker 6: happen for us to be able to have IVFB a reality,
Speaker 6: and now that it is becoming something that for a
Speaker 6: lot of people, though, as we'll talk about, not for everyone,
Speaker 6: but for a lot of people, is an attainable possibility.
Speaker 7: Like, it's incredible, We've come so far.
Speaker 6: In twenty twenty two, globally it was estimated that well, globally,
Speaker 6: it was reported that over seven hundred and fifty thousand
Speaker 6: babies were born just in twenty twenty two. And that
Speaker 6: is to the kind of global registry of all places
Speaker 6: that report out their their figures and their numbers. But
Speaker 6: just like in the US, it's not required, and so
Speaker 6: it's thought that this is an underestimate. So it's possible
Speaker 6: that the real number was possibly closer to a million.
Speaker 6: Is what the paper that I read said. Okay, that's
Speaker 6: a huge number of people every year.
Speaker 7: That's wow.
Speaker 5: Yeah.
Speaker 7: What I will also.
Speaker 6: Say is that this is from a reported three million
Speaker 6: art cycles each year, three million cycles of IVF or
Speaker 6: IVF with ICSI to get seven hundred and fifty thousand babies.
Speaker 6: So when you think about what so many people have
Speaker 6: had to go through, when you have heard so many
Speaker 6: of these first hand accounts, and so many of more
Speaker 6: of you who wrote in a lot of these art
Speaker 6: cycles are often required before there is a baby. So
Speaker 6: this is a massively huge industry. Like you kind of
Speaker 6: highlighted aarin and these numbers, this seven hundred and fifty
Speaker 6: thousand babies, these three million art cycles, they're not split
Speaker 6: in an equal fashion. We see that in the US,
Speaker 6: and we see that globally. On a small scale. Here
Speaker 6: in the US, in twenty eight art accounted for I'm
Speaker 6: not calling it art today, it's calling an art last time,
Speaker 6: feeling a little spicy. Art accounted for zero point four
Speaker 6: percent of babies that were born in Puerto Rico and
Speaker 6: five percent of babies born in Massachusetts in the UOW
Speaker 6: that's like the biggest scale that we see.
Speaker 5: That is quite a range.
Speaker 7: Yeah, it's illustrative.
Speaker 6: Globally, half of all people who have infertility or who
Speaker 6: are dealing with difficulty conceiving or infertility don't even gain
Speaker 6: access to medical treatment, and in many cases people are
Speaker 6: seeking care for years before they can actually get access.
Speaker 6: That's true in the US, that's true in Europe, but
Speaker 6: this is especially true in low and middle income countries.
Speaker 6: And like you mentioned, Aaron, race and ethnicity are hugely
Speaker 6: impactful in terms of who has access to infertility services,
Speaker 6: both because of systemic disparities in like economics and access
Speaker 6: to healthcare, but also because of the biases of our
Speaker 6: healthcare system and the burdens of the infertility treatment process itself,
Speaker 6: and on top of that social stigmatization or distrust of
Speaker 6: the medical establishment.
Speaker 7: Like there's a.
Speaker 6: Lot of layers of barriers to good infertility treatment, especially
Speaker 6: for marginalized communities in the US and globally. But we
Speaker 6: have come an incredibly long way in terms of the
Speaker 6: technology itself, and so I want to kind of focus
Speaker 6: on what some of those advancements have been, both for
Speaker 6: the good and for the how do we do this
Speaker 6: going forward? Yeah, And what's interesting I think in going
Speaker 6: through and reading all of this about like, how has
Speaker 6: IVF changed since the early days. Some of the hugest
Speaker 6: advances in IVF in recent decades are now so commonplace
Speaker 6: that they're actually just part of the IVF process that
Speaker 6: I described last episode, So they wouldn't even be considered like, Ooh,
Speaker 6: this brand new, super exciting on the edge thing. It's like, no,
Speaker 6: that's just how we do IVF now. Yeah, But I
Speaker 6: want to highlight them because there were incredible advancements in
Speaker 6: the last few decades. ICSI is one of them, and
Speaker 6: that again is interra cite, a plasmic sperm injection allowing
Speaker 6: for one single sperm to fertilize one single egg like
Speaker 6: via a tiny needle. This has allowed for successful IVF
Speaker 6: in the face of very severe male factor infertility, which
Speaker 6: was not possible before this.
Speaker 7: That's major.
Speaker 6: We talked last episode about blasticist stage implantation, that is,
Speaker 6: growing the embryo or whatever you want to call it
Speaker 6: until it gets to day five, where it becomes that
Speaker 6: blasticist that wasn't the norm before. And this not only
Speaker 6: allows for more successful implantation, but it also allows for
Speaker 6: the testing of embryos because there's enough cells there to
Speaker 6: be able to take some to be able to test.
Speaker 6: This has allowed for a variety of genetic testing methods,
Speaker 6: which I want to spend a little bit of time
Speaker 6: on because some of them are still a lot more
Speaker 6: controversial than I realized, and some of them are just
Speaker 6: amazing for people living with certain genetic conditions. But I
Speaker 6: also just want to mention single embryo transfer as kind
Speaker 6: of like a novel occurrence. And this is possible today
Speaker 6: in part because of the things that I just mentioned ICSI,
Speaker 6: blasticist transfer, being able to do genetic testing, which has
Speaker 6: increased the success rates of each cycle of IVF, but
Speaker 6: single embryo transfer also substantially decreases the risks to both
Speaker 6: the person carrying the pregnancy and the fetus, so that
Speaker 6: has also been like a pretty huge technological advancement, and
Speaker 6: then there are a whole bunch more And you mentioned Aaron,
Speaker 6: how as a marketplace driven phenomenon, part of what IVF
Speaker 6: clinics have to do is get clients, and so a
Speaker 6: lot of them will offer a range of add ons
Speaker 6: that they recommend or offer to patients that could potentially
Speaker 6: help their chances of having a live birth. And this
Speaker 6: is not just true in the US, this is across
Speaker 6: the globe. But the big thing that I learned about
Speaker 6: a lot of these add on procedures is that many
Speaker 6: of them have little to know evidence that they're actually
Speaker 6: going to improve the chances of having a live birth,
Speaker 6: and in some cases they could even be harmful. So
Speaker 6: I want to go into what some of those are
Speaker 6: and kind of like break down some of the data
Speaker 6: on what things are really potentially helpful and what things
Speaker 6: are maybe just still in the stage of research and
Speaker 6: yet they're already being used in practice. So this includes
Speaker 6: things like assisted hatching. I don't know if you came
Speaker 6: across that, Aaron, No, I did not. I When I
Speaker 6: came across this, I was like, Wow, I've never felt
Speaker 6: more like a chicken hatching. Okay, assisted hatching, This has
Speaker 6: not great evidence. From what I can tell, it's a
Speaker 6: little bit unclear. Maybe it works, the data seems poor
Speaker 6: on kind of all sides, whether it supports it or
Speaker 6: whether it's not beneficial. But basically what it is is
Speaker 6: it's using a laser or something to drill a little
Speaker 6: bit into this blasticism prior to implantation to because the
Speaker 6: blastistis because in order for implantation to happen, the blasticist
Speaker 6: has to kind of break out of what's called the
Speaker 6: zona pellucida in order to implant in the uterus. So
Speaker 6: it's basically like making a little crack in that to
Speaker 6: hopefully improve the chances of implantation.
Speaker 5: Assisted hatching.
Speaker 6: Assisted hatching is what it sounds like. There's not great
Speaker 6: evidence for it though, So it's one of those where
Speaker 6: perhaps in certain situations, if you've had a lot of
Speaker 6: failed implantations or something like that, could it be beneficial.
Speaker 7: Maybe. But I think, and this is.
Speaker 6: True for a lot of these potential add ons, is
Speaker 6: that if they're offered as just a suite of items,
Speaker 6: I can imagine if you are someone who has tried
Speaker 6: so many different things, of course you're going to try
Speaker 6: anything that someone says could be beneficial, and so I
Speaker 6: think that's where these things can become really problematic if
Speaker 6: they're not well regulated.
Speaker 5: Okay, So I have a question about assisted hatching. Okay,
Speaker 5: you said that there's not good evidence. Is there evidence
Speaker 5: in one direction or another? Or is it just so
Speaker 5: context dependent, like is there a trend toward assisted hatching
Speaker 5: being potent potentially like decrease rates of success.
Speaker 7: It's a good question.
Speaker 6: I read a Cochran review about it, which basically said
Speaker 6: that the quality of data that we have is so
Speaker 6: poor that you can't come to any conclusion one way
Speaker 6: or the other.
Speaker 5: Okay, I see, but given the fact that it's sold
Speaker 5: as an add on where it's like maybe.
Speaker 7: Maybe it's going to help you, But yeah, how much
Speaker 7: is it?
Speaker 5: And in the US do insurance companies cover this?
Speaker 6: Such a good question, Aaron, I didn't even look into
Speaker 6: the like numbers of prices on this because it varies
Speaker 6: so much like state to state, country to country insurance insurance.
Speaker 6: I would guess that anything beyond like a quote unquote
Speaker 6: standard cycle of IVF is probably not covered by most insurances,
Speaker 6: but I don't know.
Speaker 7: For sure because I didn't look it up.
Speaker 6: Okay, Yeah, And there's more things too. There's certain special
Speaker 6: culture media that some facilities might use that they call
Speaker 6: it sometimes embryo glue that supposedly makes the embryo more
Speaker 6: likely to implant. Not a lot of data for anything
Speaker 6: like that. There's something called endometrio scratching, which is exactly
Speaker 6: what it sounds like, scratching the endometrium to try and
Speaker 6: help implantation. There's not any substantial amount of evidence that
Speaker 6: that is going to increase.
Speaker 7: Live birth rates.
Speaker 6: Then there are things that the evidence is a little
Speaker 6: bit more specific and nuanced, So that's things like elective
Speaker 6: freeze only cycles that would be rather than trying to
Speaker 6: do a cycle of IVF where you implant the embryo
Speaker 6: right after that five days, you freeze all of the embryos,
Speaker 6: and then you plan for a cycle later. This doesn't
Speaker 6: seem to increase the chance of a live birth, that
Speaker 6: is not what the data shows, but it can decrease
Speaker 6: the risk of ovarian hyperstimulation syndrome, so it's kind of
Speaker 6: a trade off. And then we get into pre implantation
Speaker 6: genetic testing as a part of IVF, and I want
Speaker 6: to spend a little bit of time here because it's
Speaker 6: become a huge part of the IVF process.
Speaker 5: Before we do this real quick? Can I just ask
Speaker 5: a question about these add ons?
Speaker 4: Yeah?
Speaker 5: Please, I'm very so.
Speaker 6: There's also more, like there was so many more that
Speaker 6: I found.
Speaker 7: Yeah, there's more.
Speaker 5: I guess is there a certain point or threshold of
Speaker 5: evidence or something when an add on becomes part of
Speaker 5: the procedure, you know, like and then how are how
Speaker 5: are take home baby rates quote unquote reported? Oh you
Speaker 5: know based on add ons? Like can you do that
Speaker 5: for a clinic where you say, okay, well what is
Speaker 5: this add on? How does that change the rate? Versus that? Like,
Speaker 5: are those things communicated clearly?
Speaker 7: And these questions?
Speaker 5: Yeah, I guess I yeah, Nah, I don't have.
Speaker 7: An answer to those questions. They're very good questions.
Speaker 6: I really when I'm looking these things up to see
Speaker 6: what's the data on X, Y and z, I like
Speaker 6: full disclosure. I used a lot of up to date
Speaker 6: to get sources. But then I also was looking at
Speaker 6: Cochrane reviews to see because they do a lot of
Speaker 6: looking at all of the data that exists and what's
Speaker 6: the quality of the data. So there is IVF that's
Speaker 6: being done on the regular through these clinics and then
Speaker 6: there's IVF that is still being done at teaching institutions
Speaker 6: and academic institutions where they're collecting data for research on
Speaker 6: these things, so that is where the data is going
Speaker 6: to come from to then determine is this new or
Speaker 6: novel technology going to become a part of standard practice.
Speaker 6: Right now, all of those things that I mentioned, with
Speaker 6: the exception of pre implantation testing, which we'll get into
Speaker 6: more detail on, but all of those other ones that
Speaker 6: I mentioned are not part of a standard IVF procedure,
Speaker 6: so that is why they're considered as add ons. And
Speaker 6: again there are more One source that I found that
Speaker 6: was very helpful, especially as like a patient facing resource
Speaker 6: was actually out of the UK and it's a website.
Speaker 6: I'll link to it on our website, but it had
Speaker 6: really great pictorial graphics of all of the different types
Speaker 6: of add ons and what the evidence was, whether it
Speaker 6: was evidence that it could be helpful, whether it was
Speaker 6: evidence that could be harmful, or whether there just wasn't
Speaker 6: really good evidence for it one way or the other.
Speaker 6: And it had like a green or a red or
Speaker 6: a question mark or whatever.
Speaker 7: So that was a really helpful resource.
Speaker 6: And some of them, you know, you click on it
Speaker 6: and it'll say, well, in this particular scenario, it could
Speaker 6: be beneficial, where in all of these other situations we
Speaker 6: just don't have any evidence for.
Speaker 5: It, right, I mean, and it's a really interesting thing.
Speaker 5: But because, like you said, if you've tried this before,
Speaker 5: or you just want this to do, you desperately want
Speaker 5: this to work, then it seems like, okay, yeah, you
Speaker 5: would try anything that you possibly could if you can
Speaker 5: afford to do so. And then it's it is really
Speaker 5: interesting because even if we don't have good data now,
Speaker 5: in the future, we hopefully will have better data to
Speaker 5: be like, oh, this shouldn't be an add on, this
Speaker 5: should be part of standard practice, or this doesn't do
Speaker 5: anything exactly its exacts. Time to get to those things. Yeah,
Speaker 5: which is still it's just still so complicated.
Speaker 6: It is because you're you're living through you're living through
Speaker 6: a time where things are changing so rapidly that we
Speaker 6: don't have all of the answers.
Speaker 7: And that is true for pre implantation testing.
Speaker 6: So pre implantation genetic testing it goes by a few
Speaker 6: different names. There used to be kind of two different suites.
Speaker 6: One that was called pre implantation genetic testing, or PGT
Speaker 6: pg T, and one that was pre implaytion diagnosis or PGD. Okay,
Speaker 6: now they have split those and they're all called PGT,
Speaker 6: but then they have different letters after them. So I
Speaker 6: want to go through what each of them are, because
Speaker 6: what's important is that the three different main kinds of
Speaker 6: pre implantation genetic testing are used for very different things,
Speaker 6: and so the research is actually very different on the
Speaker 6: utility of these different things. Pre implantation genetic testing PGT
Speaker 6: A this is the first one, and that's pre implantation
Speaker 6: genetic testing for annuploid anti employde is when you have
Speaker 6: a different number of chromosomes than most people extra or
Speaker 6: one missing. So this type of genetic testing is the
Speaker 6: type that tests the embryo to make sure that there
Speaker 6: are the correct number of chromosomes, so it's looking for
Speaker 6: trisomes or other annuploides. This is things like Edward syndrome
Speaker 6: or Down syndrome, et cetera. In most of the literature
Speaker 6: that I read, this is still kind of on the
Speaker 6: line of a more experimental and research procedure, but it
Speaker 6: is very very commonly used in clinical practice. There isn't
Speaker 6: data that it improves live birth outcomes. And there's a
Speaker 6: lot of reasons that go into this. Part of the
Speaker 6: thought is that something that can happen as this embryo
Speaker 6: is dividing. And I'm sorry if this is getting too nerdy,
Speaker 6: but I find this really fascinating, but.
Speaker 5: Never apologized for being.
Speaker 6: As this embryo is dividing, every time that these cells divide, there's.
Speaker 7: Going to be little mistakes that happen.
Speaker 6: And so as these little mistakes happen early enough on,
Speaker 6: it is seems more and more likely that what's called mosaicism,
Speaker 6: so different cells actually having a different number of chromosomes,
Speaker 6: might be a part of typical embryogenesis. And there are
Speaker 6: mechanisms in place, because embryogenesis is phenomenally fascinating, that many
Speaker 6: of these blastocysts will self correct later in development or
Speaker 6: in some cases, if this was happening, for example, in
Speaker 6: a uterus, might end in a miscarriage. Right, But when
Speaker 6: we do pre implantation genetic testing, we're taking so few
Speaker 6: cells that we can't tell if something is a mosaic
Speaker 6: or not necessarily, and so what this can end up
Speaker 6: happening is having false positives and also potentially false negatives.
Speaker 6: But the false positive seem to be what in terms
Speaker 6: of like lawsuits and issues that have come up, seem
Speaker 6: to be the biggest issue because what it leads to
Speaker 6: is discarding of embryos that could have been viable, that
Speaker 6: could have been not have an antiploid, which means that
Speaker 6: you're then dis carding embryos and maybe you only had
Speaker 6: two or three viable embryos to begin with, right, But
Speaker 6: the reverse is also true, where you could have a
Speaker 6: falsely negative sample that could end up resulting in a miscarriage,
Speaker 6: and so then you went through this whole cycle and
Speaker 6: thought that this embryo was going to be have a
Speaker 6: good chance of surviving, and then it doesn't. So it
Speaker 6: kind of goes both ways.
Speaker 5: And we do we have any numbers on the rate
Speaker 5: of false positive or false negative I because.
Speaker 6: It varies so much place to place, I don't have
Speaker 6: I don't have numbers on that. Okay, yeah, but that
Speaker 6: is kind of one of I think I didn't realize
Speaker 6: because I had heard a lot about pre implantation genetic
Speaker 6: testing and I kind of thought that it was just
Speaker 6: part of the process of IVF, but it isn't. But
Speaker 6: in a lot of places it actually is, especially if
Speaker 6: you're over a certain age, it's kind of often offered.
Speaker 6: Like you were asking, when is this offered as part
Speaker 6: of the suite. I think it's very possible that that
Speaker 6: is the way that this will go. But right now,
Speaker 6: because you only can takes so much DNA, and we
Speaker 6: only can do so much testing on that DNA, right now,
Speaker 6: the technology doesn't seem to be good enough to have
Speaker 6: like a super super high sensitivity and specificity to be
Speaker 6: able to offer this like across the board as like
Speaker 6: part of the standard practice necessarily or at least when
Speaker 6: it is offered.
Speaker 7: It doesn't improve live birth rates.
Speaker 6: Okay, But while this process is similar to it is
Speaker 6: separate from a couple of other pre implantation genetic testings
Speaker 6: pgt M, which is pre implantation genetic testing for monogenic disorders,
Speaker 6: and PGTSR, which is testing for structural rearrangements. These are
Speaker 6: the types of genetic testing that would be done if
Speaker 6: an individual or a couple has a very high chance
Speaker 6: of passing on a known genetic disorder, or if they,
Speaker 6: for example, we're having recurrent miscarriage and through their infertility
Speaker 6: evaluation found out that they had a structural rearrangement in
Speaker 6: one of their chromosomes. So this is what someone who
Speaker 6: maybe had a history of Huntington's or sickle cell or
Speaker 6: cystic fibrosis or.
Speaker 7: Things like that would use.
Speaker 6: These are part of the standard suite for people who
Speaker 6: have those because you're looking for just these single gene
Speaker 6: chromosome things, if that makes sense. So it has like
Speaker 6: a different utilization and a different success rate in part
Speaker 6: because the population that you're doing these testing in is
Speaker 6: very specific rather than everyone who's seeking out IVF.
Speaker 5: That makes sense, Yeah, yeah.
Speaker 6: So these pre implantation genetic testing technologies have been incredible
Speaker 6: and still have kind of a lot of work to go.
Speaker 6: And they also, like you were talking about Aaron, kind
Speaker 6: of do open the door to some potentially ethical gray
Speaker 6: areas because these types of technologies are the same ones
Speaker 6: that can be used for things like sex selection, which
Speaker 6: means choosing the sex of your embryo prior to implantation.
Speaker 6: Different countries have implemented different policies on whether or not
Speaker 6: this is an acceptable practice, and there's other things that
Speaker 6: pre implantation genetic testing can be used for. It has
Speaker 6: been used in the past for selecting specific HLA genotypes,
Speaker 6: and this is so that you can select an embryo
Speaker 6: that is born that is compatible genetically identical with their
Speaker 6: HLA type to a previously living child who, for example,
Speaker 6: has a very severe cancer or something like fanconi anemia.
Speaker 6: I think that's the example the first time that this
Speaker 6: was used, or some other disorder where they need a
Speaker 6: bone marrow or some other type of transplant, so you
Speaker 6: can choose an embryo that will match that living child
Speaker 6: and then be able to essentially save that child's life
Speaker 6: with their sibling. These are things have happened today and
Speaker 6: are possible because of this technology. And I am not
Speaker 6: here making a judgment to say that one is right
Speaker 6: and one is wrong, etc. But all of these different
Speaker 6: technologies force us as societies to be able to have
Speaker 6: conversations about where the lines end essentially and where the
Speaker 6: gray becomes more black and more white. And that is
Speaker 6: especially true as this technology continues to develop, because the
Speaker 6: things on the horizon for IVF erin are incredible. Of
Speaker 6: like what erin, there are three major areas that IVF
Speaker 6: will go and they're not far off.
Speaker 7: One is mitochondrial transfer. Have you heard of this?
Speaker 1: Oh?
Speaker 6: Yes, have you've heard of the three person IVF? It's incredible.
Speaker 6: This is transferring mitochondria either from one's own cells, but
Speaker 6: from like different cells other than your eggs, or from
Speaker 6: a different person entirely, for example, if you had some
Speaker 6: type of mitochondrial gene disorder and transferring the mitochondria into
Speaker 6: the egg and then using sperm to fertilize that egg.
Speaker 6: And so that's why it's called three person or three
Speaker 6: parent potentially because that mitochondria could come from someone who's
Speaker 6: genetically separate from you, or it could come from different
Speaker 6: cells in the ocite donor's own body.
Speaker 7: But this is amazing.
Speaker 6: I mean, I'm sorry, mitochondria like moving a mitochondria from
Speaker 6: one cell to another, that's amazing. There's more, though, People
Speaker 6: have been working on inducing adult stem cells like our
Speaker 6: skin cells, to become sperm cells and egg cells.
Speaker 5: That is wild.
Speaker 7: It is wild.
Speaker 6: This process is called in vitro gametogenesis or IVG. And
Speaker 6: it sounds like science fiction, but they've already done it
Speaker 6: in mice.
Speaker 5: I mean, everything sounds like science fiction until it's not right.
Speaker 6: I just think about how in Star Trek in like
Speaker 6: the sixties, in the original Star Trek, they didn't have
Speaker 6: sliding doors yet, but all of the doors slid, and
Speaker 6: so they literally had people standing there and like they
Speaker 6: physically moved the doors open whenever they would walk through.
Speaker 5: You know, I just I just remember the cell phone,
Speaker 5: like the transponder or what I can't wrot what it
Speaker 5: was called, but transponders, that's right, was it transponders? Okay, Yeah,
Speaker 5: still a few more steps till we get to Star
Speaker 5: Trek World. But yeah, only.
Speaker 6: And yeah, so this could give someone the capacity to say,
Speaker 6: generate more eggs if you had poor OS quantity, or
Speaker 6: if you had cancer, or like, just so many possibilities, right,
Speaker 6: and then, like you mentioned, Aaron, the improvements in gene
Speaker 6: editing and crisper technology that opens so many doors for
Speaker 6: not only IVF, but so many medical conditions that we
Speaker 6: have talked about on this podcast before as well. The
Speaker 6: things that people are working on are incredible, and societies
Speaker 6: are going to have to reckon with what the ethical
Speaker 6: implications of all of these things are and how we
Speaker 6: decide that they are regulated.
Speaker 7: And I mean the royalty, not me and you.
Speaker 5: My goodness, Yeah, it really stretches the limits of imagination
Speaker 5: in terms of like what is possible, what could be possible?
Speaker 5: Things that I didn't know about until doing these episodes. Yeah,
Speaker 5: like we talked about, you know, off off camera, uterine transplants. Yeah,
Speaker 5: just like so many things that have completely open the door,
Speaker 5: and it's like it's opened the door and a little
Speaker 5: bit of opening the door to a world of amazing
Speaker 5: possibilities and a little Pandora's box at the same time
Speaker 5: in terms of regulation and in terms of technology evolving
Speaker 5: faster than our imagination can see, like where it will
Speaker 5: go and how it will be used, And it's just
Speaker 5: it really forces us to confront sort of our own
Speaker 5: feelings about these things that we don't know where they're going.
Speaker 5: And it's not just IVF, it's ai AI. You know,
Speaker 5: it's like what cell phones have given us.
Speaker 7: You know, it's how much are they listening to me? Always?
Speaker 5: It's they're always always.
Speaker 7: No, it really is.
Speaker 6: It's it's like you said, it's just the it is
Speaker 6: the ability of technology to develop so rapidly and then
Speaker 6: come online so rapidly, and us have to then look
Speaker 6: around and realize, oh, what does this mean for me
Speaker 6: and for us as a society.
Speaker 7: And who decides that, right, That's the important question.
Speaker 6: And then especially when it comes to things like this
Speaker 6: is who gets access and who decides who gets access.
Speaker 6: I read a really interesting paper that was really making
Speaker 6: an argument for access to infertility treatment and including IVF
Speaker 6: specifically as a human right. Yes, and it was framing
Speaker 6: it in a way that I had never really considered before,
Speaker 6: and it was.
Speaker 7: Just so, it's so interesting.
Speaker 5: Well, and that is actually what if you compare contrast,
Speaker 5: I didn't really get into this, but if you compare
Speaker 5: contrast sort of the reception to IVF in the years
Speaker 5: following nineteen seventy eight, it seemed to, at least from
Speaker 5: what I read, be more quickly embraced and normalized in
Speaker 5: the UK, where a lot of the physicians who were
Speaker 5: beginning to practice IVF, including that team that first, you know,
Speaker 5: led to the first IVF baby in the world, they
Speaker 5: really their stance was a right to reproduction right, and
Speaker 5: it was like, this is a thing that will allow
Speaker 5: people who are not able to have children to have children, right.
Speaker 5: And that wasn't really as much in the US. And
Speaker 5: so I think that like and also, I mean, there
Speaker 5: are a myriad of reasons why the US reacted differently
Speaker 5: than other parts of the world in terms of IBF
Speaker 5: and still does today. And so on and so forth.
Speaker 5: But I think that has been a really fascinating discussion
Speaker 5: that a lot of people, yeah, have that I've seen
Speaker 5: a lot sort of come up more recently too.
Speaker 6: And there's still so many differences in who gets access
Speaker 6: to IVF in this country versus that country.
Speaker 7: Even in I was reading I don't.
Speaker 6: Know why, but about Italy, their rules that they made
Speaker 6: in like the early two thousands were super super restrictive,
Speaker 6: and so then they've had to like work really hard
Speaker 6: to repeal those to an extreme, and it's just, yeah,
Speaker 6: it's just it varies so so much place to place still,
Speaker 6: and that's just reflective of how many different people feel
Speaker 6: so differently about so many aspects of something like IVF. Yeah,
Speaker 6: and controlling women's bodies as an example, yes, yeah, but yeah,
Speaker 6: but that's that is IVF. We've come so far, we
Speaker 6: have so far to go. I've learned so much.
Speaker 5: We've learned so much, and also there is so much
Speaker 5: more that we didn't even begin.
Speaker 7: Totally to talk about.
Speaker 5: I think this was for me such a meaningful topic
Speaker 5: to research about because, like we've talked about, I had
Speaker 5: this conception of IVF in my head, this perception like
Speaker 5: I knew, Okay, this is what it was, this is
Speaker 5: how it worked, all of these different things, and not
Speaker 5: really it just is layers upon layers upon layers. Even
Speaker 5: though I feel like we could have done so much more.
Speaker 7: We always will feel that way.
Speaker 5: I always will feel that way. I do feel like
Speaker 5: this was a really meaningful topic to do, and I
Speaker 5: am just really appreciative of the amount of literature that
Speaker 5: exists out there, how many layers are involved in IVF
Speaker 5: and so many different facets, but especially always coming back
Speaker 5: to these first hand accounts, and like the incredible range
Speaker 5: of experiences and emotions and feelings and outcomes and everything
Speaker 5: that people have with IVF and fertility and infertility and
Speaker 5: egg freezing and all of these different things that it's
Speaker 5: like IVF is not just IVF, it is a one
Speaker 5: million bajillion things.
Speaker 6: Yeah, we are just really grateful that we get to
Speaker 6: do this as a job and talk about these things
Speaker 6: and learn about these things and cover this topic. And
Speaker 6: cannot thank you all enough for sharing your stories with us.
Speaker 6: And I hope that through these three episodes everybody feels
Speaker 6: like they got something out of this, because I know
Speaker 6: that I certainly did selfishly.
Speaker 5: Same.
Speaker 7: Yeah, also selfishly but same.
Speaker 5: And if you want to get even more out of
Speaker 5: these sources, We've got so many. I have a bunch
Speaker 5: of papers that have more detail on this, but I
Speaker 5: will also shout out a couple of the books again.
Speaker 5: One is called The Pursuit of Parenthood by Margaret marsh
Speaker 5: and Wanda Ronner, and then the other book is called
Speaker 5: IVF and Assisted Reproduction, a Global History by Sarah Ferber,
Speaker 5: Nikola Marx and Vera Mackey.
Speaker 6: I will definitely post the link to that website that
Speaker 6: I mentioned. So many papers from, like the CDC Vital
Speaker 6: Statistics Report, to papers on pre implantation genetic diagnoses, like
Speaker 6: so many, so so much data our website. This podcast
Speaker 6: will kill you dot com. Under the episodes tab you
Speaker 6: will find the list of all of our sources from
Speaker 6: this episode and every single one of our episodes. That's
Speaker 6: where you can find it.
Speaker 5: Thank you to Bloodmobile for providing the music for this
Speaker 5: episode and all of our episodes.
Speaker 6: Thank you to Leanna Scolacci and Tom bray Foco for
Speaker 6: the incredible audio mixing.
Speaker 5: Thank you to Exactly Right.
Speaker 7: And thank you to you listeners. We really hope that
Speaker 7: you enjoyed this journey. With us.
Speaker 5: Yeah yeah, we hope that you learned something.
Speaker 7: Hopefully yeah yeah.
Speaker 5: And a special thank you, of course to our wonderful,
Speaker 5: lovely generous patrons. We we truly do appreciate your support,
Speaker 5: like it, yeah we did. It really means a lot.
Speaker 6: Also, do you guys still want like a series on
Speaker 6: pregnancy because we're planning that.
Speaker 5: Yeah, let us know.
Speaker 7: Is it too much? Have we gone too far?
Speaker 5: I mean it'll be like sick months from now?
Speaker 7: So yeah yeah yeah yeah yeah anytime soon.
Speaker 5: Yeah, well until next time, wash your hands, you filthy animals.
Speaker 2: M