WEBVTT - Ep 144 IVF, Part 2: Invention 0:00:00.520 --> 0:00:00.680 Hi. 0:00:00.920 --> 0:00:03.200 My name's Dominique, and a few years ago I went 0:00:03.200 --> 0:00:06.680 through IBF. I had been married for a while. My 0:00:06.720 --> 0:00:09.800 partner has testicular cancer, so we figured that even though 0:00:09.840 --> 0:00:11.879 we'd been trying for a long time, it might have 0:00:12.000 --> 0:00:15.240 been that previous illness and resulting surgery that was getting 0:00:15.240 --> 0:00:17.640 in the way. Now, we actually ended up splitting up 0:00:17.880 --> 0:00:20.400 for other reasons. But after I had kind of set 0:00:20.400 --> 0:00:23.759 myself up on my own, I just figured, you know, 0:00:23.960 --> 0:00:26.200 mid thirties, I wanted to get on with it. So 0:00:26.239 --> 0:00:29.120 I consulted with my GP and started the process of IBF. 0:00:29.880 --> 0:00:34.400 There were a lot of hormone injections and other things, 0:00:34.440 --> 0:00:39.240 pelvic scans, ultrasounds, oral medications, and everything went pretty well 0:00:39.280 --> 0:00:41.920 for the first little while, but then it started to 0:00:41.960 --> 0:00:44.000 become a little bit more of a roller coaster. So 0:00:44.280 --> 0:00:47.519 my first egg collection day, I had a scan. I 0:00:47.680 --> 0:00:50.640 said I had thirteen really nice follicles. That was what 0:00:50.720 --> 0:00:54.880 the obgian said. I went into surgery. When I woke up, 0:00:54.920 --> 0:00:57.480 they told me all of the follicles had been empty. 0:00:58.440 --> 0:01:00.360 Now I didn't know that this was a thing, but 0:01:01.440 --> 0:01:06.039 there is a syndrome called empty follicle syndrome, where you 0:01:06.120 --> 0:01:07.920 have a lot of fodicles, but they don't actually have 0:01:07.959 --> 0:01:11.880 any eggs in them. I was really devastated. I had 0:01:11.920 --> 0:01:16.320 to go another round with different medications, different dosages, and 0:01:16.360 --> 0:01:19.360 I went in for my next surgery, egg collection surgery, 0:01:19.360 --> 0:01:21.959 with eleven follicles ready to go, and they were able 0:01:21.959 --> 0:01:24.560 to obtain three eggs from those. One of those is 0:01:24.560 --> 0:01:28.640 a dud. Two of them successfully fertilized. Out of those two, 0:01:28.880 --> 0:01:32.520 the first transfer didn't stick, and by this point I 0:01:32.600 --> 0:01:38.039 was actually getting pretty broke. I sold stuffed my motorcycle 0:01:38.120 --> 0:01:41.240 and things to cover these expenses, and I had the 0:01:41.280 --> 0:01:44.960 final transfer about a month later. And now I have 0:01:45.000 --> 0:01:47.400 a four year old. People ask me if I'm going 0:01:47.480 --> 0:01:50.920 to have another one. I don't have any more embryos. 0:01:51.200 --> 0:01:54.360 Follicles are probably not actually making many eggs, and this 0:01:54.440 --> 0:01:56.920 is actually probably the biggest reason why I wasn't able 0:01:56.920 --> 0:01:59.280 to get pregnant beforehand, and I just didn't even know. 0:02:00.280 --> 0:02:02.960 I also found out I had a retroverted uterus throughout 0:02:02.960 --> 0:02:05.920 the process, which was another surprise. So there's a lot 0:02:05.960 --> 0:02:08.160 of things that can come up during IVF that you 0:02:08.280 --> 0:02:11.680 don't necessarily expect, and it can happen just about any stage. 0:02:12.120 --> 0:02:13.440 Yeah, I don't think. 0:02:13.280 --> 0:02:16.480 That people ask if I'm going to have a second 0:02:16.480 --> 0:02:21.200 one if they know my journey. Everybody's IVF journey is 0:02:21.280 --> 0:02:23.680 really really different, but they're all roller coasters. I think 0:02:23.720 --> 0:02:25.560 they all have ups and downs, so that those are 0:02:25.560 --> 0:02:26.160 big or small. 0:02:30.600 --> 0:02:35.200 As a gestational carrier, my view on IVF wide and 0:02:35.280 --> 0:02:39.760 broadly throughout that process. So just a quick comparison for 0:02:39.880 --> 0:02:42.200 my own child, I went off birth control in that 0:02:42.320 --> 0:02:44.960 first month I got pregnant with her, and it was 0:02:45.080 --> 0:02:48.920 very quick to conceive, and and that was it, you know, 0:02:49.000 --> 0:02:50.760 I didn't have to think about it. I didn't have 0:02:50.919 --> 0:02:55.239 to do anything. And so fast forward to when my 0:02:55.320 --> 0:02:57.760 daughter was twelve and I decided to work with a 0:02:57.760 --> 0:03:01.200 a sergucy agency to become a gestational carrier for our family. 0:03:02.280 --> 0:03:06.639 I didn't fully realize that process. I just wanted to help, 0:03:07.680 --> 0:03:11.200 mainly a member of the LGBTQ become a family because 0:03:11.240 --> 0:03:15.200 I knew that that's a struggle for a lot of 0:03:15.560 --> 0:03:18.520 gay men to have children, and so I wanted to 0:03:18.560 --> 0:03:20.920 do that. That was my choice I made, and so 0:03:21.080 --> 0:03:24.360 when I went into that process, I guess I didn't 0:03:24.360 --> 0:03:27.360 think about, like the full what all has to happen? 0:03:27.520 --> 0:03:27.680 Right? 0:03:27.800 --> 0:03:30.519 My husband and I we decided to have a baby, Boom, 0:03:30.639 --> 0:03:35.320 we had a baby. Whereas, especially from the gestational carrier standpoint, 0:03:35.360 --> 0:03:38.440 I had to go through a psychological exam. My husband 0:03:38.480 --> 0:03:42.160 and I had to go through counseling, and we had 0:03:42.160 --> 0:03:46.040 to be like checkboxed that we were okay to do this, 0:03:46.440 --> 0:03:49.440 which I am one percent understand why. But I didn't 0:03:49.480 --> 0:03:51.280 have to do that to have my own child, right, 0:03:51.320 --> 0:03:53.000 And then I had to be made They had to 0:03:53.000 --> 0:03:56.120 make sure I was like compatible with the family that 0:03:56.200 --> 0:03:59.640 I worked with, and so it was such a different experience. 0:04:00.640 --> 0:04:04.720 But then when you get into having to have your uterus, 0:04:04.760 --> 0:04:08.320 your ovaries, your fallopian trips, everything examined very thoroughly to 0:04:08.360 --> 0:04:10.960 make sure they're all functional. I didn't know mine were 0:04:10.960 --> 0:04:14.400 functional prior to that. I mean, I remember the doctor 0:04:14.480 --> 0:04:17.479 giving me the compliment that I had like very nice 0:04:17.560 --> 0:04:21.440 eggs and I could have donated them that kind of comment, 0:04:21.680 --> 0:04:24.400 and I had no clue about that kind of thing 0:04:25.160 --> 0:04:28.880 prior to this experience. And like talking to people who 0:04:28.880 --> 0:04:31.440 I now know who have struggled with IVF, because I 0:04:31.480 --> 0:04:36.200 think my gestational carrier experience has caused people in my 0:04:36.279 --> 0:04:38.200 life to come and talk to me about their own 0:04:38.839 --> 0:04:42.159 struggles with it has really made me empathetic and really 0:04:42.160 --> 0:04:44.800 made me realize how hard it is, because like I 0:04:44.880 --> 0:04:50.080 went through this for somebody else, but it's I can't 0:04:50.080 --> 0:04:52.400 imagine just like going through that. I had to go 0:04:52.440 --> 0:04:54.880 through two cycles because I had one miscarriage and then 0:04:55.360 --> 0:04:57.359 I was pregnant and I carried that baby to term. 0:04:57.720 --> 0:05:00.720 But to go through that month after month after month, 0:05:00.800 --> 0:05:03.599 like the psychological toll it must take on a person, 0:05:04.000 --> 0:05:06.920 and I just like, like I was on hormone suppressants 0:05:06.960 --> 0:05:09.600 and then I was on estrogen and progesterone and I 0:05:09.600 --> 0:05:12.680 had to do shots, which I hate, needles. I can't 0:05:12.680 --> 0:05:15.280 imagine having to do. I think if it had been 0:05:15.360 --> 0:05:17.719 me in a situation at my own child, I might 0:05:17.720 --> 0:05:21.479 have gone down a different path because it's a lot 0:05:21.760 --> 0:05:25.240 to put on a person, and it's so like they're 0:05:25.279 --> 0:05:51.600 so brave for doing it. 0:06:12.839 --> 0:06:17.440 Thank you again so much to the providers of all 0:06:17.480 --> 0:06:20.800 of these first hand accounts. It really is, it's just 0:06:21.920 --> 0:06:23.720 thank you. I don't have the words. 0:06:24.680 --> 0:06:30.640 Yes, seriously, thank you so much. It's yeah, we can't 0:06:30.640 --> 0:06:31.320 thank you enough. 0:06:33.200 --> 0:06:33.400 Hi. 0:06:33.800 --> 0:06:37.040 I'm Aaron Welsh and I'm Erin Allman Updyke. 0:06:36.920 --> 0:06:39.000 And this is this podcast will Kill You. 0:06:39.520 --> 0:06:44.440 Welcome to part two of our three part series on 0:06:44.920 --> 0:06:46.720 infertility and IVF. 0:06:47.440 --> 0:06:50.240 YEP. Part two this is where So if you didn't 0:06:50.279 --> 0:06:54.560 tune in to our first episode in this series, then 0:06:54.720 --> 0:06:58.560 in that episode we talked a lot about infertility, basically 0:06:58.680 --> 0:07:02.520 concepts of infertility, how you can define it, how it 0:07:02.600 --> 0:07:06.320 has changed throughout time, different perceptions of infertility, and then 0:07:06.360 --> 0:07:09.960 what happens if you go in for fertility testing, What 0:07:10.200 --> 0:07:11.920 are the type of tests, what are they going to 0:07:11.960 --> 0:07:15.040 be looking for? How can we categorize infertility in the 0:07:15.040 --> 0:07:20.280 broadest and most non broadway possibles, Like non broadway that's 0:07:20.280 --> 0:07:23.400 a very confusing thing to say, and like broad and 0:07:23.520 --> 0:07:27.880 narrow definitions. How about that? Really just like the full 0:07:27.960 --> 0:07:32.080 gamut of things. And then in today's episode we are 0:07:32.120 --> 0:07:35.480 going to be talking about IVF, and so of course 0:07:35.520 --> 0:07:39.040 infertility is just one of the things that IVF is 0:07:39.200 --> 0:07:42.920 used for often as a treatment, but it's not the 0:07:42.920 --> 0:07:45.160 only thing. And so really we're just going to approach 0:07:45.240 --> 0:07:48.800 this from like, hey, how did it get developed, how 0:07:49.320 --> 0:07:54.000 does it work? What does a typical cycle of IVF entail? 0:07:54.520 --> 0:07:55.040 And so on. 0:07:55.640 --> 0:07:58.320 If you haven't listened to our first part, you don't 0:07:58.360 --> 0:08:01.480 have to to get through this episode, but you should. 0:08:01.640 --> 0:08:03.520 It's a really great episode. Yeah. 0:08:03.560 --> 0:08:05.440 And if you're looking for context and you're really like, 0:08:05.520 --> 0:08:08.320 where's the context, it's there. It's in that episode. 0:08:08.560 --> 0:08:11.960 It is, it is. And also in that first episode 0:08:12.200 --> 0:08:16.560 is where we shared the quarantine y for We sure 0:08:16.640 --> 0:08:22.760 did three parter, which was a work of art. It's 0:08:22.800 --> 0:08:24.720 such a great name, and so if you want to 0:08:24.760 --> 0:08:28.360 know the recipe for that, check our socials, or tune 0:08:28.360 --> 0:08:31.400 into that first episode, or check our website, which is 0:08:31.400 --> 0:08:33.520 also where you can find all kinds of stuff. Aaron 0:08:33.960 --> 0:08:34.600 take us here, so. 0:08:34.559 --> 0:08:37.559 You can find the sources from all of our episodes. 0:08:37.600 --> 0:08:39.840 You can find a link to our Goodreads list. You 0:08:39.840 --> 0:08:42.679 can find Bloodmobile, who does our music. You can find 0:08:42.720 --> 0:08:45.319 our bookshop dot org affiliate account. You can find our 0:08:45.440 --> 0:08:48.959 incredible merch Do you have a head? Can you get 0:08:48.960 --> 0:08:51.560 your hands on it? It's so good. You can find 0:08:51.559 --> 0:08:54.120 transcripts from all of our episodes, which are apparently also 0:08:54.240 --> 0:08:58.360 now available on Apple Podcasts. That's so exciting. There's a 0:08:58.400 --> 0:09:00.720 lot there. This podcast will kill you dot com check 0:09:00.760 --> 0:09:01.400 it out. 0:09:01.400 --> 0:09:05.959 Check it out. Should we just start again? 0:09:06.080 --> 0:09:08.840 I really feel like we should because I'm super excited 0:09:08.880 --> 0:09:11.880 to learn about the history of how IVF was developed. 0:09:11.880 --> 0:09:14.400 Because I know nothing, Aaron. 0:09:15.480 --> 0:09:18.200 I mean, I know a little bit more than nothing, 0:09:18.640 --> 0:09:22.840 So let me tell you yourself. Credit we'll see. Right 0:09:22.960 --> 0:09:25.760 after this break, I will get into it. 0:09:42.440 --> 0:09:44.440 We were a little older than I would say many 0:09:44.480 --> 0:09:46.559 people are when they decide they want to start trying 0:09:46.600 --> 0:09:48.800 for a baby, and I had done one of those 0:09:48.800 --> 0:09:51.720 at home fertility tests a couple years prior and found 0:09:51.720 --> 0:09:53.679 out that my ovarian reserves were lower than. 0:09:53.679 --> 0:09:54.760 Average for my age. 0:09:55.120 --> 0:09:57.560 So when my husband and I started trying to get pregnant, 0:09:57.880 --> 0:10:00.520 I figured it would take a couple months and we'd 0:10:00.600 --> 0:10:04.000 nail it eventually. I was also very fortunate that at 0:10:04.040 --> 0:10:06.160 the time I was working at a company that offered 0:10:06.200 --> 0:10:10.800 significant fertility treatment benefits. So after six months and no pregnancy, 0:10:10.960 --> 0:10:13.040 I was able to schedule an appointment with our preferred 0:10:13.040 --> 0:10:15.920 fertility clinic, where they ordered a barrage of tests for 0:10:16.000 --> 0:10:18.480 me and my husband. We found out at that time 0:10:18.520 --> 0:10:21.240 that not only are my ovarian reserves low, but that 0:10:21.320 --> 0:10:24.040 my husband's sperm count and sperm motility are really low 0:10:24.080 --> 0:10:27.680 as well. Essentially, doctors gave us a one percent chance 0:10:27.720 --> 0:10:31.319 of conceiving naturally. The first IVF. 0:10:31.000 --> 0:10:31.560 Round we did. 0:10:31.760 --> 0:10:34.640 The doctors put me on the catalac of treatment. They 0:10:34.640 --> 0:10:37.000 gave me a strict schedule of a high dose of drugs, 0:10:37.040 --> 0:10:39.160 trying as hard as they could to get my ovaries 0:10:39.200 --> 0:10:44.840 to produce enough mature eggs for retrieval, fertilization, and implantation. Unfortunately, 0:10:45.080 --> 0:10:48.040 even with all that medication, my ovaries produced only three 0:10:48.120 --> 0:10:50.559 eggs for retrieval, and only two of them were mature 0:10:50.679 --> 0:10:53.679 enough to be fertilized, and only one of those embryos 0:10:53.720 --> 0:10:57.040 made it to day three after fertilization, So they scheduled 0:10:57.040 --> 0:11:00.240 my embryo implantation that day to give the fertilized egg 0:11:00.280 --> 0:11:02.520 the best shot at growing and attaching in my uterus, 0:11:02.559 --> 0:11:05.040 since we had no backup eggs or embryos that could 0:11:05.040 --> 0:11:09.360 be frozen. That embryo resulted in a chemical pregnancy where 0:11:09.400 --> 0:11:12.160 it had attached. I got a positive early pregnancy test, 0:11:12.280 --> 0:11:14.920 and then it was lost. We tried another round of 0:11:14.960 --> 0:11:18.040 IVF a couple months later, this time with far less medication, 0:11:18.160 --> 0:11:21.120 since the doctors figured I'd only produce three eggs regardless, 0:11:21.640 --> 0:11:25.120 and this time my ovaries produced only one egg, resulting 0:11:25.160 --> 0:11:28.840 in a canceled retrieval and a failed IVF cycle. My 0:11:28.920 --> 0:11:31.480 husband and I decided to stop IVF at that time 0:11:31.559 --> 0:11:33.560 and are now determining if we want to go any 0:11:33.559 --> 0:11:36.480 other routes to grow our family. The whole time, I 0:11:36.520 --> 0:11:39.160 knew our chances were maybe slim, but going through the 0:11:39.160 --> 0:11:43.280 process ourselves and seeing the actual stats, percentages, and chances 0:11:43.320 --> 0:11:45.920 to get pregnant, keep a pregnancy, and then deliver a 0:11:45.960 --> 0:11:48.559 baby were wild. In a world that told me how 0:11:48.600 --> 0:11:50.960 easy it was to get pregnant, turns out it is 0:11:51.000 --> 0:11:52.840 actually pretty difficult for some people. 0:11:57.360 --> 0:12:01.080 Hi, I'm Adrian. One thing that needs more discourse is 0:12:01.120 --> 0:12:06.040 the complex miasma of emotions IVF creates. For example, I 0:12:06.120 --> 0:12:09.280 felt torn about sending this in because so many people 0:12:09.360 --> 0:12:13.920 struggle with IVF, and my husband and I were incredibly lucky. 0:12:14.000 --> 0:12:16.840 We had six genetically normal embryos and went two for 0:12:16.920 --> 0:12:21.480 two with successful transfers. It's a miracle. But I don't 0:12:21.480 --> 0:12:24.559 feel comfortable talking to other people who did IVF because 0:12:24.679 --> 0:12:28.319 so many times their experience was so much harder than 0:12:28.320 --> 0:12:31.560 mine that I feel I should just shut up. But 0:12:31.800 --> 0:12:34.200 at the same time, I can't talk to anyone who 0:12:34.240 --> 0:12:38.400 conceived naturally because they do not understand the stress and 0:12:38.520 --> 0:12:42.480 darkness that comes with IVF, the pain of watching everyone 0:12:42.520 --> 0:12:46.040 around you get pregnant, the oppressive anxiety of will it 0:12:46.120 --> 0:12:50.320 work this time, the constant needles doctors, meds, and having 0:12:50.320 --> 0:12:53.920 to juggle work at the same time. I'm a wildly 0:12:54.000 --> 0:12:57.480 successful example of IVF, and it was still one of 0:12:57.480 --> 0:13:00.760 the most difficult times in my life, not to mention 0:13:00.880 --> 0:13:03.720 the special hell it is trying to get pregnant by committee. 0:13:04.280 --> 0:13:07.599 I had a transfer canceled and postponed indefinitely because of 0:13:07.640 --> 0:13:10.160 a hurricane, and I had to go to a different clinic. 0:13:10.720 --> 0:13:14.319 This meant months went by, more paperwork, and I had 0:13:14.360 --> 0:13:17.640 to do all the medical tests again. That's not something 0:13:17.679 --> 0:13:20.440 people who conceive naturally have to give a second thought about. 0:13:21.280 --> 0:13:25.319 In short, IVF sucks, and it's a miracle that I'm 0:13:25.320 --> 0:13:53.480 thankful for every day. 0:13:53.559 --> 0:13:58.080 In Part one of this series, I explored infertility throughout history, 0:13:58.600 --> 0:14:01.720 how people wrote about it, who wrote about it, what 0:14:01.840 --> 0:14:05.559 explanations did people come up with? And I ended up 0:14:05.720 --> 0:14:10.120 just like summarizing the entire twentieth century by saying, like, 0:14:10.280 --> 0:14:14.280 as our scientific and medical understanding of infertility and fertility grew, 0:14:14.400 --> 0:14:18.080 infertility began to be increasingly seen as a thing for 0:14:18.160 --> 0:14:24.760 science to overcome first with surgeries, hormonal regulation, especially as 0:14:24.760 --> 0:14:28.080 our understanding of undercnology grew in the early twentieth century, 0:14:28.640 --> 0:14:33.600 artificial insemination, and ultimately leading to IVF and the first 0:14:33.640 --> 0:14:38.720 IVF babies born in nineteen seventy eight. Today, I want 0:14:38.760 --> 0:14:42.240 to get into that journey to IVF by talking about 0:14:42.320 --> 0:14:46.480 how this technology was developed, the foundational research that made 0:14:46.520 --> 0:14:50.320 it possible, and what happened when this pie in the 0:14:50.360 --> 0:14:55.000 sky idea became reality. Framing it that way makes it 0:14:55.080 --> 0:14:58.040 kind of sound like developing IVF to treat infertility was 0:14:58.080 --> 0:15:01.840 the goal all along, all roads lead to IVF, but 0:15:01.960 --> 0:15:06.880 that really wasn't the case, huh. Much of this research 0:15:07.080 --> 0:15:11.760 came out of a desire to understand how human reproduction worked, 0:15:12.320 --> 0:15:17.920 including IVF and the applications, including using IVF for reasons 0:15:18.000 --> 0:15:21.160 other than infertility, which is a big part of IVF. 0:15:21.640 --> 0:15:25.800 These applications kind of arose later on. It's just something 0:15:25.840 --> 0:15:27.360 I want to put out there because I feel like 0:15:27.400 --> 0:15:29.520 we tend to think of IVF as like and this 0:15:29.560 --> 0:15:32.000 has been the end goal and this is the thing 0:15:32.040 --> 0:15:36.160 that IVF is used for, and that is really an oversimplification. 0:15:36.240 --> 0:15:39.920 It's leaving a lot of the story out interesting. 0:15:40.240 --> 0:15:43.920 Yeah, So, because we're doing this episode out of our 0:15:44.000 --> 0:15:47.160 usual order, I don't get to benefit from having the 0:15:47.160 --> 0:15:51.240 biology of IVF already so thoroughly explained by you Erin, 0:15:51.520 --> 0:15:54.360 and so I know that we'll get there later on 0:15:54.600 --> 0:15:58.680 in the episode. But for the purposes of the history 0:15:58.680 --> 0:16:00.960 section today, I'm going to lay out the steps of 0:16:01.000 --> 0:16:04.680 IVF in the most basic way that I could think of. 0:16:05.560 --> 0:16:10.240 At the core of it, IVF in vitro fertilization in vitro, 0:16:10.400 --> 0:16:14.640 meaning in glass outside of the organism. It consists of 0:16:14.760 --> 0:16:20.200 four basic steps. Number one, retrieving an egg or multiple eggs. 0:16:20.560 --> 0:16:25.560 Number two fertilizing that egg with sperm. Number three culturing 0:16:25.600 --> 0:16:28.520 the fertilized egg for a while until it turns into 0:16:28.640 --> 0:16:32.720 a cluster of cells called a blasticist. And number four 0:16:32.960 --> 0:16:37.600 transferring the blasticist or blastocysts into a uterus where it 0:16:37.600 --> 0:16:41.240 will hopefully implant and develop into an embryo, a fetus, 0:16:41.280 --> 0:16:42.800 and then ultimately a baby. 0:16:43.400 --> 0:16:46.520 Yeah, one hundred percent. We'll get into so much more 0:16:46.560 --> 0:16:49.480 detail later on, but that's a good basic. 0:16:50.160 --> 0:16:53.560 So these are the basic steps that scientists and clinicians 0:16:53.600 --> 0:16:56.200 had to figure out in order to get to nineteen 0:16:56.240 --> 0:16:59.680 seventy eight, which makes it sound like a whole lot 0:16:59.760 --> 0:17:03.320 of blurt than it actually is, because like it is 0:17:03.440 --> 0:17:07.480 so complex. I also feel like it sounds so harsh. 0:17:07.520 --> 0:17:09.359 I know it does, but it's like, here are these 0:17:09.400 --> 0:17:12.040 four basic steps. Just figure this out. Just you know, 0:17:12.320 --> 0:17:16.040 retrieve an egg. Just how do you do that? Fertilize 0:17:16.080 --> 0:17:19.239 the egg with sperm? That took a lot culturing, you know, 0:17:19.320 --> 0:17:20.720 like all of these things took a long time to 0:17:20.760 --> 0:17:24.520 figure out. And it was really decades, decades of work, 0:17:24.880 --> 0:17:29.600 of trial and error, of collaboration between scientists and physicians, 0:17:30.119 --> 0:17:34.800 and of really courageous participation by so many volunteers and 0:17:34.920 --> 0:17:37.960 patients to get all of these kinks worked out in 0:17:38.080 --> 0:17:41.920 this process, which like also they're not fully worked out. 0:17:42.040 --> 0:17:46.200 But even still, even in nineteen seventy eight, or especially 0:17:46.200 --> 0:17:49.160 in nineteen seventy eight, there was no certainty that this 0:17:49.280 --> 0:17:54.200 would become a standard treatment and an industry, or this 0:17:54.320 --> 0:17:58.000 industry that it has grown into. And it also took 0:17:58.080 --> 0:18:02.320 a detailed and thorough under standing of human reproduction, not 0:18:02.440 --> 0:18:06.000 just the role of major organs like the uterus or ovaries, 0:18:06.560 --> 0:18:10.160 but also at the cellular level, at the hormonal level, 0:18:10.200 --> 0:18:13.640 at the genetic level, and how these things work together 0:18:13.920 --> 0:18:18.880 to lead to the development of embryos into fetuses into infants. 0:18:20.240 --> 0:18:24.879 It's incredible, it's really cool. By the middle of the 0:18:24.960 --> 0:18:28.600 nineteenth century, studies in anatomy and physiology started to shed 0:18:28.680 --> 0:18:31.760 light on how the reproductive system worked, but this was 0:18:31.800 --> 0:18:34.320 mostly at the organ level, with things visible to the 0:18:34.400 --> 0:18:38.800 naked eye. Scientists had known about eggs and sperm since 0:18:38.920 --> 0:18:41.679 the sixteen seventies, but it took another one hundred and 0:18:41.680 --> 0:18:44.879 fifty years for people to understand how the two work together. 0:18:45.720 --> 0:18:48.919 Was the sperm just food for the egg? Was the 0:18:48.920 --> 0:18:49.800 egg passive? 0:18:49.880 --> 0:18:51.960 That was actually thought at one point, which is kind 0:18:51.960 --> 0:18:55.680 of fascinating. Yeah, much much much like a little pac man. 0:18:55.840 --> 0:19:02.560 Yes, yes, was the egg passive fertile soil in which 0:19:02.640 --> 0:19:07.040 the seed is planted. The nineteenth century clarified things, in 0:19:07.119 --> 0:19:11.200 part with Gregor Mendel and others showing that parents contribute 0:19:11.240 --> 0:19:15.040 equal heritable material to offspring. Wow. 0:19:15.119 --> 0:19:17.920 I don't think that I ever thought about people knowing 0:19:18.359 --> 0:19:21.720 that eggs and sperm exist before they knew about DNA 0:19:22.040 --> 0:19:28.320 and like chromosomes, and oh wow, that is so interesting. 0:19:28.119 --> 0:19:33.680 Right, because it's like, how are these things put together? Oh? 0:19:33.720 --> 0:19:38.040 That is so incredibly fascinating to think about Aaron. 0:19:38.040 --> 0:19:43.640 It's amazing. But even still, the nitty gritty of mammalian 0:19:43.720 --> 0:19:49.320 reproduction was largely a mystery, since fertilization and implantation and 0:19:49.400 --> 0:19:55.120 development all happened internally out of sight like you couldn't, 0:19:55.200 --> 0:19:57.120 whereas like a lot of the other chasearch was done 0:19:57.119 --> 0:20:01.480 with like reptiles for instance. Yeah, researchers like Walter Heap 0:20:01.640 --> 0:20:05.399 and Albert Broshet didn't let that stop them though. In 0:20:05.520 --> 0:20:09.399 eighteen ninety one, Heap transferred rabbit embryos from one rabbit 0:20:09.440 --> 0:20:13.639 to another, and that rabbit became pregnant and delivered baby 0:20:13.720 --> 0:20:17.640 rabbits or kids. As I learned that they're called. How cute. 0:20:18.520 --> 0:20:23.280 It's very cute, very cute. Cool, but not in vitro fertilization. 0:20:24.400 --> 0:20:28.000 A few decades later, in nineteen thirteen, Albert Broschet was 0:20:28.040 --> 0:20:35.200 the first to successfully culture mammalian blasticists before implantation. Also cool, 0:20:35.560 --> 0:20:40.160 still not in vitro fertilization. Things were moving steadily but slowly. 0:20:41.080 --> 0:20:43.320 In the first few decades of the twentieth century, the 0:20:43.359 --> 0:20:47.320 field of reproductive biology seemed to attract more interest from 0:20:47.560 --> 0:20:52.160 science fiction enthusiasts than it did from biologists. The public 0:20:52.200 --> 0:20:57.480 seemed particularly interested in the idea of ectogenesis, so fertilization 0:20:57.640 --> 0:21:00.000 and gestation, completely outside the box. 0:21:00.800 --> 0:21:01.800 Brave New World. 0:21:02.240 --> 0:21:05.440 Exactly, I was, That's my next line. In nineteen thirty two, 0:21:05.640 --> 0:21:10.680 Aldus Huxley published Brave New World. And this book opens 0:21:10.760 --> 0:21:14.840 with a description of the Central London Hatchery and Conditioning Center, 0:21:15.240 --> 0:21:18.480 which is basically a baby factory, complete with artificial wounds. 0:21:19.119 --> 0:21:21.359 And I know, like, I'm how many times have you 0:21:21.400 --> 0:21:26.080 seen Brave New World mentioned in papers about IVF? Yeah, 0:21:26.119 --> 0:21:27.639 every single one? 0:21:28.200 --> 0:21:30.800 Right, you can't, well, not everyone that I read, but 0:21:31.160 --> 0:21:31.800 I could see it. 0:21:31.960 --> 0:21:38.640 Yes, it is. It is persistent. And Aldus Huxley probably 0:21:38.640 --> 0:21:42.200 got this idea from conversations with his brother Julian, who 0:21:42.240 --> 0:21:46.760 was a scientist, and Gregory Pinkis, who was an endocrinologist 0:21:46.840 --> 0:21:50.560 that helped to create the first oral contraceptive pill and 0:21:50.720 --> 0:21:53.720 also did a lot of work of really important work 0:21:53.760 --> 0:21:56.600 on IVF and rabbits. I'll talk a little bit more 0:21:56.640 --> 0:22:01.240 about him. Yeah. The popularity of Brave New World reflected 0:22:01.359 --> 0:22:05.639 this growing sense of disillusionment with technology. People no longer 0:22:05.720 --> 0:22:08.360 believed as they had at the turn of the century 0:22:08.480 --> 0:22:12.560 that technology would solve all of life's woes. War and 0:22:12.680 --> 0:22:16.960 economic downturn had tipped the scales from assisted reproductive technologies 0:22:17.080 --> 0:22:21.600 being perceived as part of a utopian future to these 0:22:21.600 --> 0:22:25.679 technologies being a sign of our ultimate downfall. And maybe 0:22:25.800 --> 0:22:29.879 that's dramatic, but maybe not, because consider what happened to 0:22:29.960 --> 0:22:34.960 Gregory pinkis so. Pincus was appointed assistant professor of biology 0:22:35.000 --> 0:22:38.200 at Harvard in nineteen thirty one, where he did research 0:22:38.240 --> 0:22:41.639 on in vitro fertilization in rabbits and studied the hormonal 0:22:41.720 --> 0:22:46.240 changes that lead to one mature egg being released each month. 0:22:47.040 --> 0:22:50.760 In nineteen thirty six, his work and his claim that 0:22:50.880 --> 0:22:54.560 he and colleague ev Nsman were the first to successfully 0:22:54.600 --> 0:22:58.520 demonstrate IVF and rabbits. That claim was later challenged by 0:22:58.520 --> 0:23:02.680 people who couldn't replicate it. I'm not sure it's yeah. 0:23:03.000 --> 0:23:05.359 There's a lot of claims and a lot of skepticism 0:23:05.880 --> 0:23:10.040 throughout this whole history, but this his work. Pinkus's work 0:23:10.400 --> 0:23:14.719 drew the attention of the popular press, mostly falling somewhere 0:23:14.720 --> 0:23:20.399 between speculative and negative reaction Wise, some journalists imagined a 0:23:20.440 --> 0:23:24.359 world where human children would be brought into the world 0:23:24.440 --> 0:23:27.880 by a host mother not related by blood to the child, 0:23:28.520 --> 0:23:32.240 eventually leading down the slippery slope of eugenics, where quote 0:23:32.280 --> 0:23:35.840 advocates of race betterment might urge such procedures for men 0:23:35.880 --> 0:23:41.359 and women of special aptitudes, physical, mental, or spiritual end quote. 0:23:41.480 --> 0:23:45.040 Others warned, what would happen to the men if this 0:23:45.200 --> 0:23:50.119 science were applied to humans? Quote? In the resulting world, 0:23:50.320 --> 0:23:54.280 man's value would shrink. It is conceivable that the process 0:23:54.320 --> 0:23:58.840 would not even produce males. The mythical land of the 0:23:58.840 --> 0:24:03.280 Amazons would then come to life, a world where women 0:24:03.320 --> 0:24:10.720 would be self sufficient. Man's value precisely zero. End quote. 0:24:12.800 --> 0:24:16.639 That is so telling, Aaron, Wow, isn't it? 0:24:16.720 --> 0:24:22.439 That is so telling? Wow? IVF will create the world 0:24:22.600 --> 0:24:25.640 of the Amazons. 0:24:24.720 --> 0:24:27.760 Where women are self sufficient and so men's value is zero. 0:24:29.800 --> 0:24:34.920 It's I mean again, there's so many layers here, so. 0:24:34.760 --> 0:24:40.239 Many layers, so many And Pinkus himself wasn't interested in 0:24:40.359 --> 0:24:44.280 these broader implications of the research that he was conducting. 0:24:44.320 --> 0:24:46.920 He just wanted to do his experiments and like learn more. 0:24:48.240 --> 0:24:51.280 But that didn't matter. The negative press was enough to 0:24:51.280 --> 0:24:55.359 get him denied tenure at Harvard and let go Wow, 0:24:55.600 --> 0:24:58.720 and that wasn't the end for IVF or for Gregory Pinkus, 0:24:58.720 --> 0:25:01.400 who would go on to help create the birth control pill, 0:25:02.119 --> 0:25:06.080 along with the next name in our IVF story, John Rock, 0:25:06.160 --> 0:25:09.359 a gynecologist at the Free Hospital for Women Boston and 0:25:09.440 --> 0:25:13.880 Harvard Medical School. Rock had come across the rabbit IVF 0:25:13.920 --> 0:25:17.919 paper by Pinkus and became fascinated so much so that 0:25:18.000 --> 0:25:21.679 he decided to work on IVF. He teamed up with 0:25:21.840 --> 0:25:25.040 Miriam Menken, who had been a research assistant working on 0:25:25.119 --> 0:25:28.240 hormones with Pinkus at Harvard before he was kicked out, 0:25:29.160 --> 0:25:33.040 And I just I kind of love that, and also 0:25:33.119 --> 0:25:36.840 her story is really interesting and like, definitely at least 0:25:36.840 --> 0:25:39.919 go to her Wikipedia page and check it out. But 0:25:40.000 --> 0:25:43.440 the third member of their team was pathologist Arthur Hertig, 0:25:43.760 --> 0:25:49.080 and together these three performed groundbreaking research in reproductive biology 0:25:49.240 --> 0:25:53.400 in three big areas. The first area was capturing the 0:25:53.440 --> 0:25:57.360 timing of ovulation, which would prove to be super helpful 0:25:57.400 --> 0:26:01.000 in IVF later on for egg retrieval, but also for 0:26:01.160 --> 0:26:05.399 artificial insemination, which began to be more popular around this time. 0:26:06.240 --> 0:26:09.560 And the second area was in describing the early stages 0:26:09.680 --> 0:26:12.760 of human embryonic development, which they did at a time 0:26:12.800 --> 0:26:17.240 when really no one knew how anything worked before even 0:26:17.240 --> 0:26:22.080 the development of the ultrasound wow, which is wild. And 0:26:22.160 --> 0:26:25.400 the third was in the fertilization of human eggs outside 0:26:25.400 --> 0:26:28.800 of the body, and so to do this they enlisted 0:26:28.800 --> 0:26:32.000 the help of women who were set to undergo hysterectomies, 0:26:32.440 --> 0:26:36.400 and they performed the surgeries just before the volunteers ovulated 0:26:36.520 --> 0:26:38.800 so that they could extract as many eggs as possible, 0:26:39.840 --> 0:26:44.119 And after getting the donated tissue, Menken would run like 0:26:44.359 --> 0:26:47.600 literally run up and down flights of stairs over to 0:26:47.680 --> 0:26:50.520 the lab where she would begin trying to fertilize these 0:26:50.600 --> 0:26:55.520 eggs outside of the body in vitro. But after years 0:26:55.640 --> 0:26:58.880 and over one hundred and thirty eggs exposed to sperm 0:26:59.160 --> 0:27:03.480 out of the eight hundred they collected, nothing seemed to work. 0:27:04.560 --> 0:27:08.880 And then one day in nineteen forty four, exhausted from 0:27:09.040 --> 0:27:12.679 staying up late with her baby, Menkin only washed the 0:27:12.760 --> 0:27:17.040 sperm once as opposed to the usual three times, and 0:27:17.200 --> 0:27:20.280 later she returned to see that the egg had divided 0:27:20.400 --> 0:27:24.360 into two cells, and they repeated this a couple more 0:27:24.400 --> 0:27:28.520 times with the revised protocol with fewer washes, and took pictures, 0:27:29.280 --> 0:27:34.000 and I feel obligated to include this, like this is 0:27:34.000 --> 0:27:37.200 a well actually that I'm going to throw in here. 0:27:38.200 --> 0:27:40.960 There does seem to be some debate on whether that 0:27:41.160 --> 0:27:45.840 actually represented fertilization, since people later realized that freshly ejaculated 0:27:45.880 --> 0:27:49.359 sperm actually needs to spend a period of time in 0:27:49.400 --> 0:27:52.280 the genital tract before they're ready for fertilization, in a 0:27:52.320 --> 0:27:55.720 process called capacitation. I don't know, I'm not really clear 0:27:56.560 --> 0:27:58.920 on this, but some people have been like, Okay, maybe 0:27:58.920 --> 0:28:02.400 the egg just divided without being fertilized, which also has 0:28:03.440 --> 0:28:07.760 been known to happen or seen to happen. But yeah, okay, 0:28:08.280 --> 0:28:12.520 I don't know. That's like my little pedantic well, actually. 0:28:12.160 --> 0:28:14.199 All have them, Yeah we do, we do. 0:28:15.160 --> 0:28:19.920 But in any case, this was huge news all over 0:28:19.920 --> 0:28:25.600 the news outlets, just like global headlines. Rock immediately saw 0:28:25.640 --> 0:28:29.400 the potential application of IVF for treatment of infertility, and 0:28:29.640 --> 0:28:32.720 as did all of these news outlets, and he and 0:28:32.840 --> 0:28:38.040 Menken received dozens of letters from women all over hopeful 0:28:38.080 --> 0:28:40.680 that they could use this new technology to help them 0:28:40.920 --> 0:28:45.200 have children. Rock personally replied to many of these letters 0:28:45.240 --> 0:28:48.280 with like cautious optimism and was like, maybe someday we're 0:28:48.280 --> 0:28:50.480 not quite there yet, But he also took the time 0:28:50.520 --> 0:28:54.440 to explain the science and I just appreciate that I 0:28:54.440 --> 0:28:59.880 don't know. And by and large, the public response to 0:29:00.280 --> 0:29:05.240 this announcement seemed positive. The war had just ended, and 0:29:05.280 --> 0:29:08.560 this is also like primarily US specific, but like the 0:29:08.600 --> 0:29:12.840 war had just ended, the economy was booming, pro natalism 0:29:13.000 --> 0:29:17.280 was in full force, and IVF was going to solve 0:29:17.400 --> 0:29:22.920 the problem of involuntary childlessness. Over the next couple of decades, 0:29:23.440 --> 0:29:26.800 things were kind of quiet on the human side of IVF, 0:29:27.120 --> 0:29:30.360 but some researchers were exploring the technique and other animals, 0:29:30.880 --> 0:29:34.800 and in nineteen fifty nine, doctor Min Chua Chang successfully 0:29:35.040 --> 0:29:39.400 used IVF in a rabbit to produce kits nineteen fifty 0:29:39.480 --> 0:29:44.640 nine nineteen fifty nine. The enthusiasm for IVF in humans 0:29:44.720 --> 0:29:48.480 began to die down by the end of the nineteen sixties, 0:29:49.280 --> 0:29:52.400 in part due to a lack of progress, in part 0:29:52.520 --> 0:29:56.160 due to rejection of technology sort of across the board, 0:29:56.720 --> 0:29:59.480 and in part due to a decline in pro natalism. 0:30:00.360 --> 0:30:04.480 But that happens to be when significant progress on the 0:30:04.560 --> 0:30:08.280 technique began to be made in nineteen seventy three and 0:30:08.400 --> 0:30:13.800 nineteen seventy five, researchers reported the first IVF pregnancies, although 0:30:13.800 --> 0:30:17.040 they only lasted a few days, and the first IVF 0:30:17.120 --> 0:30:22.320 babies were just around the corner. Robert Edwards, Patrick Steptoe, 0:30:22.560 --> 0:30:26.760 and Jean Purdy formed a powerful IVF team in England 0:30:26.840 --> 0:30:29.240 that had spent a good deal of the nineteen seventies 0:30:29.280 --> 0:30:32.880 working on this technique, leading to a chemical pregnancy in 0:30:32.960 --> 0:30:35.760 nineteen seventy five that turned out to be ek topic. 0:30:36.800 --> 0:30:40.800 But this heartbreaking result did show them that they were 0:30:40.920 --> 0:30:43.960 on the right path, and a few years and a 0:30:44.000 --> 0:30:47.360 few tweaks to the protocol later, and they tried out 0:30:47.400 --> 0:30:49.960 their new method on a few people at their clinic. 0:30:50.720 --> 0:30:54.840 Nine months later, on July twenty fifth, nineteen seventy eight, 0:30:55.600 --> 0:30:59.760 the second person they tried this out on, Leslie Brown, 0:31:00.160 --> 0:31:04.200 gave birth to Louise Brown, the world's first IVF baby. 0:31:05.400 --> 0:31:08.600 That is very cool. 0:31:08.600 --> 0:31:14.360 It's amazing. Yeah yeah, And Louise's birth was like a 0:31:14.640 --> 0:31:19.239 total media circus. Oh I bet, I mean Leslie had 0:31:19.280 --> 0:31:22.760 to constantly move houses and hospitals. There was a bomb 0:31:22.760 --> 0:31:24.720 scare to the hospital to try to get a picture 0:31:24.760 --> 0:31:27.400 of her. People would dress up as window cleaners to 0:31:27.480 --> 0:31:29.360 try to like, find out which room she was in 0:31:29.400 --> 0:31:30.840 and get a picture for the papers. 0:31:31.240 --> 0:31:32.160 Oh my god. 0:31:32.360 --> 0:31:37.480 And the cesarean was filmed to show that Leslie had 0:31:37.520 --> 0:31:42.400 no phallopian tubes in anticipation of people doubting that it 0:31:42.560 --> 0:31:46.040 was actually like IVF Wow. Wow. 0:31:46.360 --> 0:31:49.160 Also, did they do a cesarean just because of that? 0:31:49.160 --> 0:31:51.479 That might be more detail, but I don't know. 0:31:52.160 --> 0:31:53.120 That's fascinating. 0:31:53.160 --> 0:31:57.160 I don't know. Yeah, amazing though. 0:31:57.320 --> 0:31:57.960 Wow. 0:31:58.000 --> 0:32:01.000 And in twenty ten, Robert Edwards was awarded a Nobel 0:32:01.080 --> 0:32:04.560 Prize for his work. Steptoe and Purdy had both died 0:32:04.600 --> 0:32:10.240 and it's not awarded posthumously. Only ten weeks after Louise 0:32:10.320 --> 0:32:15.000 Brown was born, Kanyupriya Agarwal was born in India. The 0:32:15.040 --> 0:32:18.360 second test two baby quote unquote, as they began to 0:32:18.360 --> 0:32:22.680 be called, led by a team consisting of Subas Mukerjee, 0:32:22.840 --> 0:32:29.000 Sunit Mukerjee, and Saraj Kanti Badachara. Whereas Steptoe, Edwards and 0:32:29.080 --> 0:32:33.360 Purdy relied on natural cycles of ovulation, the team in 0:32:33.360 --> 0:32:37.040 India used drugs to induce ovulation and then froze the 0:32:37.120 --> 0:32:39.040 embryo before implanting it. 0:32:39.640 --> 0:32:40.040 Wow. 0:32:40.120 --> 0:32:42.920 I think it is so interesting to see these different 0:32:43.400 --> 0:32:47.320 methodologies and how like which clinic uses what and I 0:32:47.360 --> 0:32:49.920 don't know. I guess you'll talk about sort of what 0:32:49.920 --> 0:32:53.040 what are the different pros and cons? But many different 0:32:53.080 --> 0:32:57.520 ways to get a result? I think, yeah, yeah, so 0:32:57.960 --> 0:33:01.000 you don't. You don't always see this birth mentioned in 0:33:01.160 --> 0:33:05.800 histories of IVF, because almost immediately after it was met 0:33:05.840 --> 0:33:09.800 with skepticism it was described as a fluke, as experimental 0:33:10.040 --> 0:33:14.440 and likely to be a standalone And this might have been. 0:33:14.560 --> 0:33:18.240 This reaction might have been because the Indian team allegedly 0:33:18.280 --> 0:33:22.200 carried out the work somewhat secretively and without formal approval, 0:33:23.280 --> 0:33:28.160 but it wasn't a fluke or fraudulent. That didn't matter though, 0:33:28.200 --> 0:33:31.560 to the institutions where Subas Mukerjee, who was the team 0:33:31.640 --> 0:33:36.760 leader worked. Mukerjee was sent to an ophthalmology institute where 0:33:36.880 --> 0:33:40.680 he couldn't do He couldn't do any work, but it 0:33:40.760 --> 0:33:43.200 was just as a way to be like, we're preventing 0:33:43.240 --> 0:33:46.040 you from doing any of the work that you actually 0:33:46.120 --> 0:33:50.400 want to do. He was forbidden to present his IVF 0:33:50.480 --> 0:33:55.360 research or participate in conferences, and in July of nineteen 0:33:55.400 --> 0:33:57.600 eighty one, he took his own life. 0:33:58.640 --> 0:34:00.360 Oh my god, yeah, not. 0:34:01.040 --> 0:34:05.920 Awful, awful, awful. The nineteen seventy eight birth of Kanye 0:34:05.960 --> 0:34:09.520 Pria Agarwal was really only recognized in nineteen ninety seven, 0:34:09.760 --> 0:34:13.480 I read, and it's so it's still sort of making 0:34:13.520 --> 0:34:19.920 its way into these global histories of IVF. After these 0:34:20.160 --> 0:34:24.200 two nineteen seventy eight births, several more followed. The first 0:34:24.320 --> 0:34:28.000 Australian IVF birth was in nineteen eighty and the next year, 0:34:28.120 --> 0:34:31.680 nineteen eighty one, the first American IVF baby was born. 0:34:32.520 --> 0:34:36.080 But even with these births, IVF was by no means 0:34:36.120 --> 0:34:41.800 a sure thing technologically speaking, financially speaking, and in terms 0:34:41.880 --> 0:34:46.520 of regulation. The news of these first IVF babies was 0:34:46.560 --> 0:34:51.560 met with a lot of feelings, some very pro, some 0:34:51.800 --> 0:34:57.240 very anti, but rarely indifferent. The potential that IVF held 0:34:57.600 --> 0:35:02.600 good bad other was and is tremendous. And we'll get 0:35:02.600 --> 0:35:04.919 into some of these things next week. But I want 0:35:04.920 --> 0:35:07.840 to wrap up today's history section with a brief look 0:35:07.880 --> 0:35:10.719 at when IVF came to the US and how that 0:35:10.840 --> 0:35:15.120 set a precedent for IVF becoming a mostly private pay 0:35:15.160 --> 0:35:20.160 for services institution, a market driven enterprise for better or worse. 0:35:21.200 --> 0:35:23.880 After the birth of Louise Brown and the other early 0:35:24.000 --> 0:35:27.680 IVF babies. The US realized that IVF might be here 0:35:27.719 --> 0:35:31.120 to stay, so they began to call for congressional hearings 0:35:31.120 --> 0:35:35.000 to discuss the implications of IVF and policies for how 0:35:35.040 --> 0:35:39.600 treatment and research should be regulated. Should IVF research or 0:35:39.680 --> 0:35:45.080 research involving embryos be allowed to receive federal funds? That 0:35:45.280 --> 0:35:49.280 question has been debated for years, and there is currently 0:35:49.320 --> 0:35:53.040 a ban on federal funding for research involving embryos in 0:35:53.120 --> 0:35:56.319 the US, but for quite a long period of time 0:35:56.400 --> 0:36:00.320 it was anticipated that it would be allowed. To verify, 0:36:00.560 --> 0:36:04.759 the research is still allowed to be conducted, it's just 0:36:04.880 --> 0:36:07.560 that it can't be federally funded. The funding has to 0:36:07.600 --> 0:36:11.880 come from other sources, just throwing that out there. In 0:36:11.920 --> 0:36:14.600 the late nineteen seventies, when it was looking like federal 0:36:14.600 --> 0:36:19.000 funds would be approved, two researchers, slash clinicians and married 0:36:19.040 --> 0:36:24.040 couple Georgiana Seeger Jones and Howard Jones, left Johns Hopkins 0:36:24.160 --> 0:36:27.640 University for Eastern Virginia Medical School where they could pursue 0:36:27.760 --> 0:36:31.799 IVF research. Their story is actually really cute and it 0:36:31.840 --> 0:36:33.960 goes back like really far and there are like cute 0:36:34.040 --> 0:36:38.040 letters during the war. Anyway, Georgiana was a pioneering, highly 0:36:38.080 --> 0:36:42.360 accomplished reproductive endocrinologist and her husband, Howard, trained as a 0:36:42.400 --> 0:36:46.719 general surgeon and then specialized in gynecology so that he 0:36:46.719 --> 0:36:50.799 could work closely with his wife, and for years they 0:36:50.840 --> 0:36:54.600 worked together, sharing a lab, an office, even a desk, 0:36:55.400 --> 0:36:59.600 and Robert Edwards from the England IVF team actually trained 0:36:59.600 --> 0:37:03.120 with them for a while. But not being willing to 0:37:03.200 --> 0:37:06.279 wait for federal funding for IVF to be approved, they 0:37:06.320 --> 0:37:09.840 would still have been waiting, they decided that this technique 0:37:10.040 --> 0:37:13.400 was enough in demand that they could seek private funds 0:37:13.480 --> 0:37:17.880 and charge for services. In nineteen eighty one, the first 0:37:17.880 --> 0:37:20.560 IVF baby in the US was born from their clinic. 0:37:21.160 --> 0:37:25.560 Each couple had to meet the following criteria youth under 0:37:25.600 --> 0:37:31.440 thirty five, good health, bad fallopian tubes, a husband, and 0:37:31.520 --> 0:37:34.200 the unspoken one was that you had to have money. 0:37:35.920 --> 0:37:38.920 Each couple had to shell out around four thousand dollars 0:37:39.000 --> 0:37:43.520 in nineteen eighty dollars or fifteen thousand dollars in today's dollars, 0:37:43.800 --> 0:37:47.520 but the cost didn't keep people from flocking to the clinic. 0:37:48.360 --> 0:37:52.360 Other IVF programs in the US followed shortly, first primarily 0:37:52.440 --> 0:37:56.400 at medical schools, then in community hospitals, in partnership with 0:37:56.560 --> 0:38:04.040 private infertility practices, and finally in independent centers. Despite urging 0:38:04.200 --> 0:38:07.080 from the American Fertility Society to come up with federal 0:38:07.120 --> 0:38:12.920 guidelines and oversight for these clinics, progress was slow. The 0:38:12.960 --> 0:38:16.880 most they could do, like the Society was establish a subgroup, 0:38:17.080 --> 0:38:21.080 the Society for Assisted Reproductive Technology, and required clinics to 0:38:21.160 --> 0:38:25.160 follow particular standards if they wanted to be SAAR Team members. 0:38:26.080 --> 0:38:28.560 But there was no way to enforce these guidelines, and 0:38:28.600 --> 0:38:32.480 the number of clinics grew steadily, in part because of 0:38:32.520 --> 0:38:36.800 the appeal of no strict regulation, or really no regulation. 0:38:37.640 --> 0:38:41.640 The introduction of the vaginal ultrasound probe made things easier 0:38:41.800 --> 0:38:45.560 for IVF, which required only local anesthesia and meant a 0:38:45.600 --> 0:38:49.799 surgeon and operating room were no longer required, and this 0:38:49.920 --> 0:38:54.080 marked the end of many relationships between private IVF clinics 0:38:54.120 --> 0:38:57.920 and academic medical centers in the US, and it enabled 0:38:57.960 --> 0:39:02.560 even more growth, which led to, among other things, improvements 0:39:02.560 --> 0:39:06.600 in technique and application for IVF, so people not just 0:39:06.680 --> 0:39:12.640 with tubal factor infertility, but also endometriosis, unexplained infertility, male 0:39:12.680 --> 0:39:18.120 factor infertility, genetic conditions, same sex couples, single parents, and 0:39:18.440 --> 0:39:23.440 so much more. Age restrictions began to be raised. Intracytoplasmic 0:39:23.480 --> 0:39:28.040 sperm injection was introduced at ICSI, as was egg and 0:39:28.080 --> 0:39:32.360 embryo freezing, and many clinics began to incorporate donor eggs 0:39:32.360 --> 0:39:38.360 and embryos and gestational and traditional surrogacy. IVF was bringing 0:39:38.640 --> 0:39:41.960 more and more people the children they had always wanted, 0:39:42.480 --> 0:39:46.640 and as the number of clinics grew globally, as technological 0:39:46.640 --> 0:39:51.239 advancements were made, more questions were being asked about the 0:39:51.280 --> 0:39:57.000 financials of IVF, about access, about ethics, about transparency from clinics, 0:39:57.480 --> 0:40:01.080 about what the future could hold. That's what we'll be 0:40:01.120 --> 0:40:05.279 getting into next week. But for now, Aarin, I'll hand 0:40:05.320 --> 0:40:07.919 it over to you to tell us all about how 0:40:08.040 --> 0:40:09.160 IVF works. 0:40:09.520 --> 0:40:12.520 Excellent. I can't wait to kind of go over what 0:40:12.600 --> 0:40:30.080 it looks like today just after this break. Hi. 0:40:30.200 --> 0:40:33.080 My name is Yohanna, and in February of twenty twenty three, 0:40:33.120 --> 0:40:35.759 I give birth to our daughter, who was conceived with 0:40:35.840 --> 0:40:39.920 intrauterine insemination using donor sperm. When my partner and I 0:40:39.960 --> 0:40:42.120 first talked about getting pregnant, we had to do a 0:40:42.120 --> 0:40:45.480 lot of googling, a lot of reading and a lot 0:40:45.480 --> 0:40:48.520 of talking to our fertility specialists to figure out what 0:40:48.560 --> 0:40:51.760 our options are for a same sex couple and how 0:40:52.160 --> 0:40:54.279 the logistics of it all work, the ins and out 0:40:54.440 --> 0:40:59.920 of getting the sperm, genetic testing, and the different ways 0:41:00.120 --> 0:41:03.879 of getting the sperms inside of my uterus. So we 0:41:03.920 --> 0:41:07.880 wound up going with intrauterine insemination, which is really just 0:41:07.920 --> 0:41:11.000 inserting the sperm through the cervix with a long needle 0:41:11.040 --> 0:41:14.400 directly into the uterus. The chances of pregnancy are slightly 0:41:14.480 --> 0:41:19.080 higher than with just intercourse, but not super high, so 0:41:19.600 --> 0:41:22.720 that's usually the first step, and then if that doesn't 0:41:22.719 --> 0:41:25.799 work after a few cycles, the next step would be 0:41:25.960 --> 0:41:31.000 using medication to boost fertility, and then after that is 0:41:31.160 --> 0:41:35.160 IVF and mutual fertilization. So we did all of the 0:41:35.280 --> 0:41:39.080 prep stuff. We did genetic testing, we bought sperm off 0:41:39.080 --> 0:41:43.879 a sperm bank, and we also did genetic counseling, which 0:41:43.920 --> 0:41:48.240 is required because they just want to kind of gauge 0:41:48.280 --> 0:41:50.719 how you would deal with having a donor conceived child, 0:41:50.800 --> 0:41:53.080 how you would talk about that with friends and family, 0:41:53.120 --> 0:41:55.120 and of course, most importantly, how you would talk about 0:41:55.160 --> 0:41:58.600 that with your child. So, after all of that prep 0:41:58.600 --> 0:42:03.160 work was done. I'd been charting my cycles and tracking 0:42:03.200 --> 0:42:08.280 my ovulation, and then once it was regular, I alerted 0:42:08.320 --> 0:42:12.759 the fertility clinic when I was ovulating, and we got 0:42:12.760 --> 0:42:16.840 the sperm transported from the storage facility to the fertility clinic, 0:42:16.920 --> 0:42:19.839 and I went in for my first insemination. The first 0:42:19.880 --> 0:42:23.480 one didn't take, so we did a second one the 0:42:23.520 --> 0:42:26.840 next cycle, and that one did take and I became pregnant. 0:42:27.719 --> 0:42:30.680 So the first few weeks they monitored my pregnancy at 0:42:30.719 --> 0:42:34.160 the fertility clinic. They did a couple of tests to confirm, 0:42:34.200 --> 0:42:37.399 they did the first ultrasound there, and then I was 0:42:37.520 --> 0:42:43.359 released into regular prenatal care with my regular obgyn, and 0:42:43.560 --> 0:42:46.439 I wound up having a great pregnancy and giving birth 0:42:46.520 --> 0:42:50.919 to an amazing baby. Our daughter is fifteen months now, 0:42:51.480 --> 0:42:55.319 and she is absolutely the best. And I am so 0:42:55.560 --> 0:42:58.680 glad and so grateful for all of the support that 0:42:58.719 --> 0:43:01.160 we had and for the fact that we have that 0:43:01.239 --> 0:43:03.959 option and that that was something that we were able 0:43:04.000 --> 0:43:06.880 to do to have our baby, and to live in 0:43:06.920 --> 0:43:11.799 a state where most people are supportive and understanding and 0:43:11.840 --> 0:43:15.239 where we didn't have to fight very hard to make 0:43:15.280 --> 0:43:19.320 this a reality for us. It's been a really amazing 0:43:19.360 --> 0:43:23.839 experience and I'm really proud to be part of the 0:43:25.640 --> 0:43:31.239 of the IUI community of having used as system reproductive 0:43:31.239 --> 0:43:34.719 technology and having had the chance to have that in 0:43:34.719 --> 0:43:39.560 my life to help bring our child. 0:43:41.680 --> 0:43:44.480 My name is Lilian and I'm an IVF long holer. 0:43:45.000 --> 0:43:48.120 My husband and I started trying to conceive in twenty seventeen, 0:43:48.280 --> 0:43:51.920 soon after I turned thirty two. After two miscarriages. We 0:43:52.000 --> 0:43:55.480 began IVF treatment in twenty eighteen after I was diagnosed 0:43:55.520 --> 0:43:59.760 with diminished ovarian reserve. We've done eleven IVF retrieval cycles 0:43:59.760 --> 0:44:03.200 to pay embryos, four retrievals in twenty nineteen, three in 0:44:03.239 --> 0:44:06.040 twenty twenty and four in twenty twenty two, and two 0:44:06.080 --> 0:44:09.040 frozen embryo transfers, one in twenty nineteen and one in 0:44:09.040 --> 0:44:12.480 twenty twenty three. We've experienced a total of seven pregnancy 0:44:12.520 --> 0:44:17.520 losses through unassisted spontaneous conceptions and frozen embryo transfers, including 0:44:17.520 --> 0:44:20.399 the seventeen week fetal demise of our daughter conceived through 0:44:20.400 --> 0:44:23.480 IVF tank in March twenty twenty, and have had no 0:44:23.680 --> 0:44:27.640 live births throughout the years of IVF treatments and multiple surgeries. 0:44:27.680 --> 0:44:33.200 I was diagnosed with endometriosis suspected adnomiosis, gestational trophiblastic disease, 0:44:33.560 --> 0:44:37.359 autoimmune disease that attacks my reproductive organs and pregnancies, and 0:44:37.440 --> 0:44:41.839 Asherman syndrome following multiple miscarriages. We've completed IVF with three 0:44:41.840 --> 0:44:45.520 different clinics, two conventional clinics and one specialty clinic that 0:44:45.719 --> 0:44:49.080 uses mini IVF, both in and out of state, worked 0:44:49.080 --> 0:44:52.719 with a reproductive immunologist out of state, and consulted with 0:44:52.800 --> 0:44:57.640 almost a dozen reproductive endocrinologists specializing in recurrent pregnancy loss 0:44:57.640 --> 0:45:02.680 and endometriosis across the country. However, despite pursuing every evidence 0:45:02.680 --> 0:45:05.880 based treatment and if you not so evidence based, my 0:45:05.960 --> 0:45:08.520 body is unable to sustain a pregnancy to term and 0:45:08.600 --> 0:45:12.240 live birth, even with the perceived quote guarantee of IVF 0:45:12.320 --> 0:45:15.239 resulting in a live baby. A critical factor in our 0:45:15.239 --> 0:45:17.840 pursuit of IVF was having insurance coverage, which made a 0:45:17.920 --> 0:45:21.080 huge difference in our treatment options because we weren't limited 0:45:21.120 --> 0:45:23.439 to what we could afford at the time. Since most 0:45:23.480 --> 0:45:26.080 of our IVF was covered by insurance, we didn't deplete 0:45:26.080 --> 0:45:29.640 our savings then, which allows us to now pursue gestational surrogacy. 0:45:29.840 --> 0:45:33.120 Following the suggestions of our physicians and the limits my 0:45:33.200 --> 0:45:35.920 husband and I agreed we'd reached, which we called our 0:45:35.960 --> 0:45:39.480 heartbreak tolerance. We are grateful for the opportunity to try 0:45:39.480 --> 0:45:43.360 to have a biological child through IVF with gestational surrogacy, 0:45:43.560 --> 0:45:47.359 and we grieve everything we've been through. There aren't many 0:45:47.400 --> 0:45:50.880 stories from long haulers who've suffered multiple miscarriages like myself, 0:45:51.120 --> 0:45:53.640 for whom IVF doesn't end with the live baby, because 0:45:53.680 --> 0:45:58.200 our stories are sad, but we do exist. 0:46:23.840 --> 0:46:29.200 So you walked us through aarin four main steps of IVF, 0:46:29.320 --> 0:46:31.040 or at least four main things that had to be 0:46:31.080 --> 0:46:35.279 figured out to be able to do IVF. So I'm 0:46:35.280 --> 0:46:38.879 going to break it down into five just to make 0:46:38.920 --> 0:46:43.239 it a little bit more extra. Honestly, some of the 0:46:43.280 --> 0:46:46.000 sources that I read broke it up into like nine steps, 0:46:46.000 --> 0:46:48.640 and I'm like, that's not wrong. It's just like, let's 0:46:49.080 --> 0:46:50.000 chill with the detail. 0:46:50.120 --> 0:46:52.880 Okay. I mean, it's all a balance, right, It's. 0:46:52.760 --> 0:46:56.120 All we're going to conflate some Okay, Well, let's keep going, 0:46:56.239 --> 0:46:59.440 shall we. This is going to be kind of the 0:46:59.480 --> 0:47:03.799 main person of art in general. Art in general, and 0:47:03.840 --> 0:47:06.640 again I mentioned this in the last episode, but art 0:47:06.760 --> 0:47:12.000 is anything where eggs and embryos are being handled outside 0:47:12.120 --> 0:47:16.600 of the human bod, so this includes IVF. It includes 0:47:16.760 --> 0:47:21.400 IVF with ICSI or that interra cytoplasmic experm injection. It 0:47:21.440 --> 0:47:25.320 also even includes things like egg and embryo freezing, even 0:47:25.400 --> 0:47:29.240 without the in vitro fertilization part of it, and again 0:47:29.600 --> 0:47:32.560 those other less common procedures that people don't do as 0:47:32.600 --> 0:47:37.160 much anymore today. So how do the steps of this work? 0:47:37.640 --> 0:47:41.400 Because the steps for all of these different procedures start 0:47:41.440 --> 0:47:45.080 out in many cases the same, and I caveat this 0:47:45.200 --> 0:47:48.880 as of course, each cycle of IVF is going to 0:47:48.880 --> 0:47:53.880 be very individualized. So these are just like broad overview steps. 0:47:54.760 --> 0:47:57.920 But step one, and this is the step erin that 0:47:58.200 --> 0:48:03.200 didn't happen in your cycle, I guess in your description. 0:48:03.680 --> 0:48:06.600 And that's because it doesn't didn't always happen, though it 0:48:06.680 --> 0:48:10.520 pretty much always happens today. But step one is to 0:48:10.640 --> 0:48:17.400 overstimulate your ovaries to produce a whole ton of eggs. Right, 0:48:17.960 --> 0:48:22.919 So typically we produce and ovulate only one egg per 0:48:23.000 --> 0:48:27.360 menstrual cycle. Sometimes two and multiple eggs do start to 0:48:27.440 --> 0:48:31.640 develop during each menstrual cycle, but typically only one kind 0:48:31.680 --> 0:48:34.680 of comes all the way to the point of being ovulated. 0:48:35.600 --> 0:48:40.040 But for IVF to have a real chance at being successful, 0:48:40.080 --> 0:48:43.960 you have to boost this number in large part because 0:48:43.960 --> 0:48:49.319 there is attrition at every step in this cycle. So 0:48:50.120 --> 0:48:55.800 that process of overstimulation involves often a lot of needles, 0:48:56.280 --> 0:49:00.239 but definitely a lot of hormones. This is one of 0:49:00.280 --> 0:49:02.280 the first places where there's going to be a huge 0:49:02.320 --> 0:49:07.239 variety of variation in what the specifics of each algorithm 0:49:07.239 --> 0:49:10.040 are going to be, Like the specific drugs that are 0:49:10.040 --> 0:49:12.040 going to be used is going to be very person 0:49:12.200 --> 0:49:16.320 and patient and doctor specific. So I'm not going to 0:49:16.360 --> 0:49:19.640 get into all of that, but all of these are 0:49:19.640 --> 0:49:23.759 doing the same basic thing, all of these various hormones, 0:49:23.760 --> 0:49:25.879 and there's a number of different options that you can 0:49:26.040 --> 0:49:31.800 use trick your body into readying for ovulation a whole 0:49:31.840 --> 0:49:38.520 bunch of eggs at once, and this process often starts 0:49:38.680 --> 0:49:42.840 the month before in order to get your body ready 0:49:43.320 --> 0:49:48.680 to next month start this process of inducing a whole 0:49:48.680 --> 0:49:52.239 bunch of eggs to be ready for ovulation. That whole 0:49:52.280 --> 0:49:56.480 process often takes about two weeks, but again it starts before, 0:49:57.280 --> 0:49:59.480 like the month before, so we're talking already like a 0:49:59.560 --> 0:50:03.600 multiple week process. And then we get to step two 0:50:04.239 --> 0:50:07.720 and that is taking the eggs out. Yeah, so egg 0:50:07.800 --> 0:50:12.959 removal usually starts with yet another hormone injection the day 0:50:13.120 --> 0:50:17.239 or so before the egg removal process, and that's to 0:50:17.320 --> 0:50:20.360 help the eggs mature at the correct rate to be 0:50:20.560 --> 0:50:25.160 ready for aspiration. And the aspiration process takes place in 0:50:25.520 --> 0:50:29.720 usually a doctor's office or at a hospital under ultrasound guidance, 0:50:29.800 --> 0:50:34.480 which you mentioned aaron, where they take an ultrasound and 0:50:34.560 --> 0:50:41.120 a very long needle, hopefully under mild ivy sedation, though 0:50:41.360 --> 0:50:46.000 not always, and they use that to not always, it 0:50:46.080 --> 0:50:49.319 is standard practice to do ivy sedation, but I think 0:50:49.360 --> 0:50:51.920 in some cases, either for patient preference or for a 0:50:52.000 --> 0:50:54.319 number of reasons, they might not, and they might use 0:50:54.480 --> 0:50:59.239 like a regional anesthesia or something like that. Okay, yeah, 0:50:59.600 --> 0:51:02.400 but they use this really long needle to through the 0:51:02.480 --> 0:51:06.080 back of the vaginal wall aspirate out as many of 0:51:06.120 --> 0:51:10.719 those ripe and ready eggs as possible. While this is 0:51:10.800 --> 0:51:16.640 happening Step three, potentially your sperm donor or your partner 0:51:17.120 --> 0:51:20.719 is leaving their sperm sample or it is being defrosted 0:51:20.920 --> 0:51:24.720 from the freezer. These sperm have to then be washed 0:51:24.880 --> 0:51:28.520 and checked to pick the healthiest sperm. To pick the 0:51:28.560 --> 0:51:31.120 ones most likely to be able to fertilize the egg, 0:51:32.320 --> 0:51:36.640 and then comes the in vitro part step four. The 0:51:36.680 --> 0:51:41.080 eggs and the sperm unite, and this process can go 0:51:41.120 --> 0:51:45.319 one of two ways. So traditional IVF throws all of 0:51:45.320 --> 0:51:47.960 the sperm in with all of the eggs, and the 0:51:48.000 --> 0:51:51.040 sperm are going to fertilize the eggs in a similar 0:51:51.080 --> 0:51:55.279 way that they would in the reproductive tract. Or there's 0:51:55.600 --> 0:52:01.640 ICSI interra cydoplasmic sperm injection, which is fascinating and exactly 0:52:01.680 --> 0:52:05.600 what it sounds like. It's injecting using a very very 0:52:05.719 --> 0:52:10.080 very tiny needle, one single sperm directly into the egg. 0:52:11.440 --> 0:52:15.920 And then that fertilized egg is grown in culture for 0:52:16.040 --> 0:52:19.719 between three and five days until it reaches either the 0:52:19.760 --> 0:52:24.400 cleavage stage or the blasticist stage. And the final step, 0:52:24.560 --> 0:52:28.800 step five, is that this blasticist is transferred back into 0:52:28.840 --> 0:52:33.160 the uterus via a long catheter tube that goes up 0:52:33.280 --> 0:52:37.759 through the cerfax towards the top of the uterus and 0:52:38.280 --> 0:52:43.360 is deposited there either one or a number of blasticists. 0:52:44.400 --> 0:52:48.360 Most people then still need to keep taking some form 0:52:48.440 --> 0:52:52.240 of hormone, either injections or oral medications for the first 0:52:52.239 --> 0:52:56.640 few days or weeks of that potential pregnancy to try 0:52:56.680 --> 0:52:59.759 and get it to stick. This is especially true in 0:52:59.840 --> 0:53:04.640 US using frozen embryo cycles because you haven't just ovulated, 0:53:04.719 --> 0:53:07.680 and so you have no corpus lutium of which to speak, 0:53:07.719 --> 0:53:12.680 which is the hormone producing part of your ovary. That's 0:53:12.800 --> 0:53:17.520 IVF in like a very small nutshell, And shout out 0:53:17.600 --> 0:53:21.360 to pen Medicine's Patient facing website because I thought that 0:53:21.560 --> 0:53:25.319 was the most comprehensive but detailed breakdown of IVF that 0:53:25.360 --> 0:53:27.120 I found on a patient facing website. 0:53:27.360 --> 0:53:30.280 I have a couple questions if I met me, Okay, 0:53:31.560 --> 0:53:38.120 picking the sperm, what differentiates one sperm from another? Like 0:53:38.520 --> 0:53:41.360 you said, pick the good sperm or whatever you said, 0:53:41.480 --> 0:53:42.440 the highest quality. 0:53:43.800 --> 0:53:47.320 So that's a good question. It's mostly based on morphology, 0:53:47.480 --> 0:53:49.879 and so it's looking at the sperm under very high 0:53:49.960 --> 0:53:54.960 powered microscopes. And there are other techniques, like more advanced 0:53:55.000 --> 0:53:57.239 techniques that people might be piloting or that can be 0:53:57.320 --> 0:53:59.400 used in some cases, but in general, it's looking at 0:53:59.400 --> 0:54:01.960 the morphology of the sperm and that's how you make 0:54:02.040 --> 0:54:05.120 your decision, okay, on which sperm to pick? 0:54:05.440 --> 0:54:11.080 Okay, all right, so let's timeline this. So you you 0:54:11.120 --> 0:54:15.880 go in for fertility testing, you decide IVF is the 0:54:15.920 --> 0:54:20.719 next step. IVF either with or without ICSI you get 0:54:20.760 --> 0:54:24.560 seen by someone, hopefully not like six months later, although. 0:54:24.320 --> 0:54:26.319 I probably months later, but anyways, huh. 0:54:26.480 --> 0:54:30.880 Anyways, you you get seen by someone who starts this process, 0:54:30.920 --> 0:54:34.160 you start taking hormones how you know. So you mentioned 0:54:34.160 --> 0:54:37.640 that it's like a few weeks of hormones for stimulation 0:54:37.800 --> 0:54:41.520 and then egg retrieval and then like what is the time, 0:54:41.640 --> 0:54:44.319 like what is a typical cycle time? 0:54:44.520 --> 0:54:47.600 Yeah, a lot of times it's cited that that a 0:54:47.680 --> 0:54:52.520 typical cycle length of IVF is about six weeks. Okay, 0:54:54.160 --> 0:54:57.080 but like you just mentioned, that doesn't account for all 0:54:57.320 --> 0:55:02.759 of the other time. But that is typically about the 0:55:02.840 --> 0:55:05.160 length of one typical cycle. And again it might vary 0:55:05.160 --> 0:55:08.839 depending on what protocol you're using. There's like longer protocols 0:55:08.880 --> 0:55:13.960 and there's shorter protocols, because it all depends on what 0:55:14.200 --> 0:55:17.040 the side effects and things that you're trying to manage 0:55:17.080 --> 0:55:26.279 really are. How many blasticists, how many blastoicists at what stage? 0:55:26.520 --> 0:55:35.080 Okay, good question. The transfer, Yeah, that is a loaded question. 0:55:36.880 --> 0:55:45.239 So historically multiple blastoists were transferred almost always with IVF, 0:55:46.320 --> 0:55:49.439 and that's because I mentioned that there is attrition at 0:55:49.480 --> 0:55:53.319 every stage of the IVF process, and there really is. 0:55:53.440 --> 0:55:56.800 In fact, about ten percent of IVF cycles are stopped 0:55:56.920 --> 0:56:01.799 before you even get to egg retrieval, and then you'll 0:56:01.800 --> 0:56:06.520 get you know, X number of eggs. Some percent of 0:56:06.560 --> 0:56:10.440 those eggs won't be fertilized for one reason or another, 0:56:11.320 --> 0:56:14.919 and then some percentage of those fertilized eggs won't make 0:56:14.960 --> 0:56:19.160 it all the way to the blasticis stage, especially, and 0:56:19.600 --> 0:56:24.120 some of those blasticists won't manage to implant or therefore 0:56:24.360 --> 0:56:30.200 won't cause a pregnancy, so to kind of help counteract that, 0:56:30.560 --> 0:56:35.960 especially historically kind of actually before we got to blasticis 0:56:36.000 --> 0:56:39.080 stage culture, because it used to be more common that 0:56:39.160 --> 0:56:42.080 IVF happened at day three, which is when you're still 0:56:42.080 --> 0:56:46.839 in what's called the cleavage stage, then multiple blasticism would 0:56:46.840 --> 0:56:52.240 be transferred during that IVF process. Today, what's called single 0:56:52.239 --> 0:56:55.719 embryo transfer is actually a lot more common, and in 0:56:55.760 --> 0:57:00.120 some places it's like the recommended, if not required, thing 0:57:00.160 --> 0:57:04.080 to do. And that's because the risk of multiple pregnancies 0:57:04.280 --> 0:57:08.040 is significantly higher than the risk of a singleton pregnancy, 0:57:08.080 --> 0:57:12.200 that is, twin or triplet pregnancies are significantly higher risk 0:57:12.320 --> 0:57:16.880 than a singleton pregnancy. So in some cases, single embryo 0:57:16.960 --> 0:57:20.680 transfer has become the kind of norm in most places, 0:57:21.720 --> 0:57:24.360 But it all just depends on the situation. Because you 0:57:24.400 --> 0:57:28.800 can also imagine, especially in maybe an older couple who 0:57:28.960 --> 0:57:32.680 only has either a certain amount of money left to 0:57:32.720 --> 0:57:37.040 be able to do more transfers because each transfer costs money, 0:57:37.720 --> 0:57:40.600 or who only has a certain amount of time or 0:57:40.680 --> 0:57:43.480 a certain number of embryos that are left, then they 0:57:43.640 --> 0:57:47.920 might opt for a multiple embryo transfer. So there's kind 0:57:47.920 --> 0:57:49.920 of a lot. There's a lot that goes into that 0:57:50.000 --> 0:57:53.240 decision of how many embryos to transfer. The lowest risk 0:57:53.360 --> 0:57:56.720 in terms of like birth risk and risk of the 0:57:56.760 --> 0:57:59.720 pregnancy is going to be a single embryo transfer, but 0:58:00.080 --> 0:58:03.120 with multiple embryos you might have a greater chance at 0:58:03.200 --> 0:58:07.880 a live birth. Okay, I also just want to this 0:58:07.920 --> 0:58:09.480 is a little bit pedantic, but. 0:58:11.200 --> 0:58:15.000 I'm around It's okay. Yeah. 0:58:15.360 --> 0:58:20.440 IVF terminology pretty much universally refers to this process as 0:58:20.600 --> 0:58:24.919 embryo transfer, and that's fine. That has become the kind 0:58:24.960 --> 0:58:30.920 of norm. It's not accurate though, and I do feel like, 0:58:31.560 --> 0:58:36.400 especially as politicians start making decisions about what they think 0:58:36.440 --> 0:58:40.840 constitutes a person and who does not constitute a person. 0:58:41.680 --> 0:58:45.320 It's kind of important to point out that in this process, 0:58:46.120 --> 0:58:49.880 what we are talking about is a clump of cells 0:58:50.520 --> 0:58:53.320 that has been growing for five to six days. In 0:58:53.440 --> 0:58:59.880 culture media, this particular stage of development is it's fast. 0:59:00.800 --> 0:59:05.280 It's one cell layer thick that forms about a ball 0:59:05.920 --> 0:59:09.800 that has a fluid filled portion, and then one section 0:59:09.920 --> 0:59:12.840 of it that's about three to four cell layers thick. 0:59:12.960 --> 0:59:17.320 So in total we're talking about two hundred or so cells, 0:59:18.320 --> 0:59:21.320 and this little part of the blastocyst that's three to 0:59:21.400 --> 0:59:25.080 four cell layers thick. That is what will become an 0:59:25.120 --> 0:59:30.160 embryo upon implantation in the uterus. There's number of steps 0:59:30.160 --> 0:59:33.480 that have to happen. Usually around days nine to ten 0:59:34.080 --> 0:59:37.760 is when it is then becoming an embryo, which will 0:59:37.760 --> 0:59:42.320 then eventually develop into a fetus and then eventually a baby. 0:59:42.920 --> 0:59:46.439 And so I do think that these terms are kind 0:59:46.480 --> 0:59:50.160 of important because they help us conceptualize what we're really 0:59:50.240 --> 0:59:53.960 talking aboutte So I just want to point that out, 0:59:53.960 --> 0:59:56.960 but I'll probably say embryo transfer because that's what literally 0:59:57.000 --> 0:59:58.040 all the literature says. 0:59:58.160 --> 1:00:01.920 It's what all the literature says, but I think I 1:00:02.080 --> 1:00:04.160 was surprised, and I'm going to talk about this a 1:00:04.200 --> 1:00:08.640 little bit next episode, but not very much, but that globally, 1:00:08.720 --> 1:00:11.440 the definition of embryo varies quite a bit. 1:00:12.320 --> 1:00:13.080 That's interesting. 1:00:13.480 --> 1:00:18.600 So I believe it is Spain that the an embryo, 1:00:18.640 --> 1:00:22.360 it's only an embryo if it is implanted in the uterus, 1:00:22.360 --> 1:00:26.680 like the uterus is an essential part of that terminology, 1:00:26.720 --> 1:00:28.920 whereas I think that's not necessarily the case in a 1:00:28.920 --> 1:00:32.720 lot of other places, or at least like in casual usage. 1:00:32.800 --> 1:00:36.160 Yeah right, Yeah, it's kind of that difference in casual 1:00:36.240 --> 1:00:40.600 uses versus like strict scientific usage. But I just feel 1:00:40.600 --> 1:00:44.280 like it's important to point out. So, yeah, So that's 1:00:44.280 --> 1:00:47.760 like the main process of IVF, and I think you 1:00:47.800 --> 1:00:49.840 can lay it out and make it sound like, well, 1:00:49.880 --> 1:00:53.800 it's not that big of a deal. It's a huge deal. 1:00:53.800 --> 1:00:57.360 It's a huge deal. It's a huge process. 1:00:57.960 --> 1:01:03.360 It's a long process, and there are so many steps 1:01:03.360 --> 1:01:07.600 in which it can go poorly, and there are some 1:01:07.680 --> 1:01:10.080 really important risks that I think that we have to 1:01:10.160 --> 1:01:14.920 talk about with IVF, not just with IVF the process, 1:01:15.160 --> 1:01:20.680 but also with an IVF pregnancy. So there are risks 1:01:20.680 --> 1:01:24.880 associated with the surgical procedures involved in IVF, like the 1:01:24.920 --> 1:01:29.640 aspiration and potentially the embryo transfer as well. These risks 1:01:29.680 --> 1:01:32.840 are the kinds of risks associated with any surgical procedure, 1:01:32.920 --> 1:01:36.560 things like bleeding or infection or injury. These risks exist, 1:01:36.760 --> 1:01:40.320 they tend to be very small. The other major risk 1:01:40.520 --> 1:01:45.680 of IVF as a process is something called ovarian hyperstimulation 1:01:45.840 --> 1:01:51.800 syndrome or OHSS. This the risk I see cited usually 1:01:51.800 --> 1:01:55.880 as between one and five percent, but it really can vary. 1:01:55.960 --> 1:02:00.040 But this is a life threatening complication of that. In 1:02:00.440 --> 1:02:03.600 process of stimulating the ovaries to make a whole bunch 1:02:03.640 --> 1:02:04.800 of eggs all at once. 1:02:05.360 --> 1:02:07.280 What happens, What happens? 1:02:07.360 --> 1:02:12.600 Yeah, yeah, So symptom wise, what happens is significant abdominal bloating, 1:02:13.240 --> 1:02:18.960 ovarian enlargement acieties, which means fluid in the abdomen, and 1:02:19.080 --> 1:02:23.800 all of these things can result in significant electrolyte imbalances 1:02:24.640 --> 1:02:27.320 that can then also lead to decrease to urine output, 1:02:27.440 --> 1:02:33.520 kidney failure, and hypercoagulability respiratory distress. This can be very 1:02:33.600 --> 1:02:39.040 severe and life threatening. We don't fully understand the exact 1:02:39.120 --> 1:02:42.840 causes and mechanisms of this, but it's thought that it's 1:02:42.880 --> 1:02:46.480 a result of the ovary responding to this like supra 1:02:46.600 --> 1:02:53.040 physiologic doses of hormones signaling ovulation, that what it results 1:02:53.040 --> 1:02:56.840 in is really large scale vasodilation, so all of your 1:02:56.880 --> 1:03:03.200 blood vessels dilating, and that causes this increased capillary permeability. 1:03:03.240 --> 1:03:06.280 So basically all your vessels like get really wide and 1:03:06.400 --> 1:03:10.320 then permeable, so that fluid can shift from inside of 1:03:10.320 --> 1:03:13.120 your blood vessels to the outside of your blood vessels. 1:03:13.520 --> 1:03:17.280 And these fluid shifts are things that happen during pregnancy, 1:03:17.440 --> 1:03:21.880 but in a much different and slower fashion, And so 1:03:22.000 --> 1:03:24.280 this is something that's happening at a very fast and 1:03:24.320 --> 1:03:25.880 like super physiologic rate. 1:03:27.000 --> 1:03:32.040 Did this happen before IVF or before like you know, 1:03:32.200 --> 1:03:33.480 stimulating with hormones. 1:03:34.280 --> 1:03:37.080 So it's something that is specific to the process of 1:03:37.280 --> 1:03:40.520 ovarian stimulation, so it can happen in other ways, but 1:03:40.560 --> 1:03:44.280 it's totally like an iatrogenic like a we do this 1:03:44.440 --> 1:03:46.880 piece someone by stimulating the over east. 1:03:46.920 --> 1:03:52.080 Yeah, it's a twentieth century and beyond condition. Okay, okay, okay, interesting. 1:03:51.720 --> 1:03:54.400 One hundred percent. It can be prevented, and in some 1:03:54.520 --> 1:03:57.840 cases you can some tests can kind of try and 1:03:57.920 --> 1:04:01.760 help predict who might be at higher risk for ovarian 1:04:01.840 --> 1:04:05.320 hyperstimulation by looking at like things like ovarian reserve and 1:04:05.600 --> 1:04:07.720 seeing if someone is likely to be a really good 1:04:07.800 --> 1:04:11.120 responder versus a poor responder. So you can try and 1:04:11.160 --> 1:04:14.479 like predict that and then pick a protocol that puts 1:04:14.560 --> 1:04:17.600 you at lower risk of hypersimulation syndrome. 1:04:17.960 --> 1:04:20.880 And so what happens if you develop this, like how 1:04:20.920 --> 1:04:22.120 do you manage it? 1:04:22.720 --> 1:04:26.040 Often people have to be hospitalized, especially if it's severe, 1:04:26.200 --> 1:04:29.560 to be really closely monitored, have their fluid balance like 1:04:29.680 --> 1:04:32.200 checked and regulated and things like that. But it kind 1:04:32.240 --> 1:04:35.120 of just depends on the severity. Almost always what it 1:04:35.200 --> 1:04:38.840 means is it could mean like a cessation of the protocol, 1:04:38.920 --> 1:04:41.479 so like having to stop the IVF at the point 1:04:41.480 --> 1:04:44.520 that you're at. But almost always what it does mean 1:04:45.000 --> 1:04:48.000 is that if you were planning on a fresh embryo transfer, 1:04:48.440 --> 1:04:51.240 So we talked about that whole process of IVF, kind 1:04:51.240 --> 1:04:53.520 of assuming that at the end of it you take 1:04:53.560 --> 1:04:57.240 those embryos and put them directly into the uterus. But 1:04:57.280 --> 1:05:01.160 the other option is to freeze them. And so if 1:05:01.200 --> 1:05:04.880 someone develops ovarian hyperstimulation, then almost certainly they're going to 1:05:04.920 --> 1:05:08.680 have to have those embryos frozen because they have to 1:05:08.720 --> 1:05:11.160 have that condition managed before you can go on to 1:05:11.240 --> 1:05:13.000 then complete the steps of IVF. 1:05:13.240 --> 1:05:18.360 Okay, is it too early to ask about like rates 1:05:18.560 --> 1:05:20.880 of all of this or like breakdown of rates or 1:05:21.000 --> 1:05:23.640 and you know, like it's just I don't even know 1:05:23.680 --> 1:05:25.800 how to begin to ask these questions. 1:05:26.080 --> 1:05:27.880 It's such a good question, and it's funny because I 1:05:28.280 --> 1:05:31.000 have I kind of put a lot of that initially 1:05:31.080 --> 1:05:33.640 in our next episode, but I would be happy to 1:05:33.720 --> 1:05:37.080 talk about it at this episode as well too. But 1:05:37.280 --> 1:05:40.960 first I want to talk about the risks of IVF pregnancies. 1:05:41.160 --> 1:05:42.160 Yes, that's right. 1:05:42.840 --> 1:05:45.840 Sorry, because I think that this is something that isn't 1:05:46.480 --> 1:05:51.520 widely known, is that there are risks inherent to a 1:05:51.560 --> 1:05:56.160 pregnancy that's conceived with ART or IVF, and we don't 1:05:56.280 --> 1:06:00.480 fully understand the mechanisms behind this risk and some of 1:06:00.520 --> 1:06:05.000 these are still a little bit controversial. So out the 1:06:05.040 --> 1:06:08.320 outset pregnancy, and we're going to do a whole series 1:06:08.360 --> 1:06:13.400 on pregnancy. Don't worry. Pregnancy is a very risky state 1:06:13.440 --> 1:06:19.400 of being. It is physiologically incredibly demanding. It's associated with 1:06:19.480 --> 1:06:24.680 significant morbidity and mortality. It is not a riskless condition. 1:06:25.480 --> 1:06:29.320 But what's interesting is that it seems that IVF pregnancies 1:06:29.640 --> 1:06:36.480 are also a bit riskier than spontaneous conception pregnancies as well. Specifically, 1:06:36.720 --> 1:06:39.840 we see in some studies an up to fifty percent 1:06:39.960 --> 1:06:45.960 increased risk of hypertensive disorders including pre eclampsia, and an 1:06:46.080 --> 1:06:50.760 up to fifty percent increase risk of gestational diabetes, and 1:06:50.840 --> 1:06:56.080 these risks seem to differ between frozen embryo transfers compared 1:06:56.080 --> 1:07:02.880 to fresh embryo transfers. Again, we don't fully understand the 1:07:03.000 --> 1:07:06.720 mechanisms behind this, and it might have something to do 1:07:06.800 --> 1:07:09.800 with whether or not there is like a corpus lutium 1:07:10.040 --> 1:07:13.840 like I mentioned that's in the ovary, but we don't 1:07:13.880 --> 1:07:17.880 really know. There also seems to be an increased risk 1:07:18.040 --> 1:07:23.040 of abnormal placentation, and that's especially true in fresh embryo cycles. 1:07:23.280 --> 1:07:26.040 So that means that the placenta is either implanting in 1:07:26.120 --> 1:07:29.560 a place that's a little bit more risky in the uterus, 1:07:29.600 --> 1:07:32.760 like overlying the cervix or something like that, or in 1:07:32.800 --> 1:07:36.280 some cases invading a little bit too far into the 1:07:36.400 --> 1:07:41.120 uterus than is typical. And those kinds of abnormal placentations 1:07:41.160 --> 1:07:44.360 can put somebody at higher risk of hemorrhage during delivery 1:07:44.480 --> 1:07:47.960 or after delivery. And then there also seems to be 1:07:48.080 --> 1:07:53.520 an increased risk of severe outcomes like stroke or blood 1:07:53.560 --> 1:07:58.080 clots or ICU admission kind of in the postpartum period, 1:07:58.320 --> 1:08:00.960 which seem to be higher in iv F or ART 1:08:01.840 --> 1:08:06.480 pregnancies compared to spontaneous conception. And that does include after 1:08:06.560 --> 1:08:10.400 controlling for things like maternal age or comorbidities that might 1:08:10.480 --> 1:08:11.640 affect those risks. 1:08:11.920 --> 1:08:17.840 And is it the same for like gestational carriers versus. 1:08:18.680 --> 1:08:21.160 No, that's a very good question. I didn't see data 1:08:21.200 --> 1:08:24.760 on that specifically, but I would think so because all 1:08:24.800 --> 1:08:29.120 of the data just looks at IVF in general. But 1:08:29.160 --> 1:08:31.360 it's a really good that's a really good question. Just 1:08:31.400 --> 1:08:33.479 I don't know that we have enough data on that 1:08:33.720 --> 1:08:35.920 specific subset of IVF. 1:08:36.439 --> 1:08:38.840 Okay, I have. I have a few more questions about this, Okay, 1:08:38.880 --> 1:08:41.839 thank god to me. So what is I'm not asking 1:08:41.840 --> 1:08:44.599 for like specific numbers on all this, but like higher 1:08:44.720 --> 1:08:48.559 risk is relative? Like what is the degree? Is it 1:08:48.680 --> 1:08:50.400 substantially twice? You know? 1:08:50.520 --> 1:08:53.200 Like, yeah, it's a good nu it's a good question. 1:08:53.240 --> 1:08:56.160 I didn't see numbers for the like especially the later 1:08:56.320 --> 1:08:59.040 like maternal outcomes. I didn't find exact numbers on those. 1:08:59.120 --> 1:09:03.040 They just say slightly increased risk. For hypertensive disorders and 1:09:03.080 --> 1:09:05.679 gestational diabetes, we see like an up to fifty percent 1:09:05.800 --> 1:09:08.080 risk in some of the meta analyzes that I looked at, 1:09:08.800 --> 1:09:10.280 but a lot of the others they just say, like 1:09:10.360 --> 1:09:13.040 a slightly increased risk. I don't have a good number 1:09:13.080 --> 1:09:14.800 on it, okay, which is disappointing. 1:09:15.280 --> 1:09:19.080 One of the things that I'm wondering about is IVF 1:09:19.160 --> 1:09:24.479 pregnancies I would assume are more closely monitored throughout every 1:09:24.560 --> 1:09:29.559 step of the way. Does that mean that the likelihood 1:09:29.560 --> 1:09:33.000 of capturing some of these things is much higher? And 1:09:33.040 --> 1:09:36.560 so is that accounting possibly for some of these differences 1:09:36.600 --> 1:09:37.040 and risk. 1:09:38.560 --> 1:09:46.320 It's an interesting question. I don't I don't expect so, okay, 1:09:46.439 --> 1:09:52.200 because these are things that you're going to probably catch 1:09:52.240 --> 1:09:57.160 at delivery. If not, you know, maybe you hopefully you 1:09:57.200 --> 1:09:59.439 would catch it sooner in the cases of things like 1:10:00.040 --> 1:10:03.800 yer intensive disorders or gestational diabetes. But yeah, it's an 1:10:03.840 --> 1:10:07.559 interesting question. They definitely are monitor a lot more closely, 1:10:09.120 --> 1:10:12.200 but I don't know that that would necessarily result in 1:10:12.240 --> 1:10:15.479 an increased like a perceived increased risk that isn't a 1:10:15.520 --> 1:10:19.200 real risk. I guess if that makes sense, Okay, And 1:10:19.240 --> 1:10:24.040 we talked already about the risk of multiple pregnancies as 1:10:24.280 --> 1:10:29.040 a risk because of multiple blastocyst transfer. But what I 1:10:29.160 --> 1:10:34.240 also learned is that the rate of monozygotic twins, that is, 1:10:34.280 --> 1:10:40.960 like identical twins, is also significantly higher in IVF pregnancies. 1:10:41.280 --> 1:10:45.080 And I do have numbers on this, okay. The baseline 1:10:45.240 --> 1:10:50.320 rate in spontaneous conception pregnancies of identical twins is like 1:10:50.360 --> 1:10:54.479 zero point four percent. It's super low. It's between two 1:10:54.560 --> 1:10:58.920 and three percent in IVF. Wow. And we don't know 1:10:58.960 --> 1:11:02.400 what the mechanism is. The thought is maybe because in 1:11:02.439 --> 1:11:05.200 an identical twin pregnancy, what has to happen is that 1:11:06.280 --> 1:11:11.040 during the development the blasticist. Usually I always thought of 1:11:11.080 --> 1:11:13.000 it as the zygote. I don't think I even realized 1:11:13.000 --> 1:11:16.720 it could happen like post blasticis stage. But the blasticist 1:11:16.880 --> 1:11:21.240 or the zygote prior to that divides into two separate 1:11:22.000 --> 1:11:28.120 blasticists or two separate zygotes, rather than implanting two genetically 1:11:28.160 --> 1:11:31.599 different blasticists. And that's how you end up with identical twins. 1:11:32.479 --> 1:11:34.760 So we don't know what the mechanism of this is 1:11:35.120 --> 1:11:38.320 the thought is maybe it's related to the culture media 1:11:38.400 --> 1:11:44.479 that's used. Maybe it's related to the timing of the transfer. Again, 1:11:44.680 --> 1:11:49.679 absolute risks still very low, but significantly higher than the 1:11:49.720 --> 1:11:52.360 population level, which I think is so interesting. 1:11:52.520 --> 1:11:55.640 That's fascinating. Yeah, that's fascinating. 1:11:56.280 --> 1:12:00.680 And so you asked earlier aarin like, what's the what 1:12:00.720 --> 1:12:03.720 are some rates here? What are some numbers here? I 1:12:03.760 --> 1:12:06.439 don't have numbers on like the percent of attrition at 1:12:06.439 --> 1:12:09.400 every stage in this because that is going to vary 1:12:09.520 --> 1:12:12.280 so much person to person. There's not like a generalizability 1:12:12.360 --> 1:12:15.439 on like what's the chance that if you have X 1:12:15.520 --> 1:12:18.960 number of eggs or x number of embryos that you're 1:12:19.000 --> 1:12:21.479 going to be able to have a live birth. I 1:12:21.520 --> 1:12:24.559 don't have those numbers. It's going to vary a lot 1:12:24.600 --> 1:12:29.599 person to person. But there's obviously a huge question of 1:12:29.680 --> 1:12:33.320 like what's the overall success rate, Like if you go 1:12:33.439 --> 1:12:36.920 through this whole IVF process, what are the chances that 1:12:37.000 --> 1:12:39.960 you are going to have a baby at the end 1:12:40.000 --> 1:12:44.599 of it? Right, we don't have numbers on that either, 1:12:46.080 --> 1:12:50.040 And it is in part because it's going to vary 1:12:50.200 --> 1:12:54.559 so much person to person, but it's also in part 1:12:54.680 --> 1:12:57.919 because it's going to vary so much location to location. 1:12:59.479 --> 1:13:03.240 And there's some really interesting papers that I read that 1:13:03.280 --> 1:13:06.599 are looking at, like how do we even define what 1:13:06.840 --> 1:13:11.120 a success rate actually is? Are we talking about, like 1:13:11.200 --> 1:13:15.920 what is the live birth rate per cycle? And usually 1:13:15.960 --> 1:13:20.479 when we say per cycle, we're meaning like one embryo 1:13:20.840 --> 1:13:25.320 transfer or do we mean per retrieval where you might 1:13:25.479 --> 1:13:30.320 have to do multiple embryo transfers after that one retrieval? 1:13:31.080 --> 1:13:34.400 And also, are we talking about the success rate of 1:13:34.560 --> 1:13:38.840 like first berths or if people then are going through 1:13:38.880 --> 1:13:41.360 IVF to try and have a second child. Are we 1:13:41.400 --> 1:13:45.200 looking at total births? Are we combining fresh and frozen 1:13:45.240 --> 1:13:48.920 cycles or are we separating those two out there's so 1:13:49.240 --> 1:13:55.080 much nuance it's almost it's almost impossible. And that being said, 1:13:55.240 --> 1:13:59.240 people cite rates like most websites, most papers say like 1:13:59.560 --> 1:14:01.760 up to four twenty percent of cycles of IVF will 1:14:01.800 --> 1:14:06.000 result in a live birth, and that's a huge generalization, 1:14:07.400 --> 1:14:10.520 and if you look at global numbers, it's actually also 1:14:10.560 --> 1:14:14.960 a real overestimation because just we'll talk more about global 1:14:15.040 --> 1:14:19.080 numbers next episode. But what it has been reported to 1:14:19.200 --> 1:14:23.799 the institution, this large international institution that tries to monitor 1:14:24.000 --> 1:14:28.960 IVF globally in twenty twenty one, they reported about three 1:14:29.240 --> 1:14:33.320 million cycles of IVF and about seven hundred and fifty 1:14:33.400 --> 1:14:37.280 thousand babies A little bit more, okay, so that Aaron 1:14:37.400 --> 1:14:40.680 math is about twenty five percent as a success rate 1:14:40.760 --> 1:14:46.519 per cycle. The CDC has a very interesting calculator where 1:14:46.520 --> 1:14:50.200 you can input your individual data and it'll estimate your 1:14:50.200 --> 1:14:53.120 probability of a live birth, and you can break it 1:14:53.160 --> 1:14:56.200 down by like one two or more retrievals and one 1:14:56.240 --> 1:14:59.200 two or more transfers, which I think is really interesting 1:14:59.280 --> 1:15:02.559 and paints some more realistic picture, though it is still 1:15:02.600 --> 1:15:04.679 going to vary like place to place. 1:15:05.320 --> 1:15:08.599 That's fascinating because that is exactly what I was thinking. 1:15:08.800 --> 1:15:12.120 There should be something like that out there, because it's 1:15:12.160 --> 1:15:16.840 like there are so many variables that can affect all 1:15:16.920 --> 1:15:19.760 of this, and you could put in all of that, 1:15:20.240 --> 1:15:24.040 all of your your own data, and still like will 1:15:24.080 --> 1:15:30.720 that number be accurate high or like you know, it's yeah, yeah. 1:15:30.479 --> 1:15:32.519 It's it's interesting. We'll put a link to it. People 1:15:32.520 --> 1:15:38.880 can check it out. It's still just an estimate, but yeah, 1:15:39.479 --> 1:15:44.280 So that really is IVF in a nutshell, and. 1:15:44.840 --> 1:15:47.759 It's a pretty big nut It's a very large nut 1:15:48.880 --> 1:15:50.000 with a very large shell. 1:15:51.600 --> 1:15:54.439 And what I do want to just kind of say 1:15:54.479 --> 1:15:57.280 as we wrap up this episode, before we get into 1:15:57.360 --> 1:16:01.760 like the changes in technology and the industry that has 1:16:01.880 --> 1:16:05.280 been born of IVF, what I just want to take 1:16:05.320 --> 1:16:09.640 a moment to acknowledge is that I tried, but I 1:16:09.680 --> 1:16:14.080 still don't think that this medical description does a really 1:16:14.160 --> 1:16:18.479 good job of encompassing what it is like to go 1:16:18.640 --> 1:16:25.759 through this whole process, especially when you want a baby 1:16:26.439 --> 1:16:30.120 very badly. And so because of that, I really just 1:16:30.160 --> 1:16:34.120 want to say thank you again so much to everyone 1:16:34.320 --> 1:16:37.160 who took the time to write in and share your 1:16:37.200 --> 1:16:41.000 story and record yourselves and share it with us and 1:16:41.040 --> 1:16:44.639 with everyone that is listening, because one of the things 1:16:44.680 --> 1:16:48.000 that I hear over and over again is just how 1:16:48.080 --> 1:16:52.360 hard this experience is, regardless of what the outcome is, 1:16:52.479 --> 1:16:55.439 for so many people. And so I just want to 1:16:55.439 --> 1:16:58.240 say again, thank you so much for sharing your stories. 1:16:59.080 --> 1:17:01.559 And we'll get to talk a lot more about what 1:17:01.600 --> 1:17:04.200 IVF looks like on a larger scale and a less 1:17:04.240 --> 1:17:07.520 personal scale next episode. 1:17:07.800 --> 1:17:11.920 Yeah, well, said Aaron, I agree, I agree entirely. Like 1:17:12.160 --> 1:17:15.720 the I think one of the things that has been 1:17:15.800 --> 1:17:18.280 so incredible, like we keep saying thank you, thank you, 1:17:18.320 --> 1:17:20.720 thank you, But just also I think for us to 1:17:20.840 --> 1:17:25.040 hear the range of experiences, the range of ways that 1:17:25.080 --> 1:17:29.000 this can feel, is really powerful and really important to 1:17:29.120 --> 1:17:32.519 remember that it's not just one thing. It's like, there 1:17:32.520 --> 1:17:38.479 are commonalities and maybe that is reassuring or helps, you know, 1:17:38.600 --> 1:17:43.200 with sense of belonging or you know, not feeling so isolated. 1:17:43.680 --> 1:17:45.400 But then there are things where it's like, maybe that's 1:17:45.439 --> 1:17:47.479 not that way, and so it's like, I think that's 1:17:47.720 --> 1:17:51.920 That's what I just keep circling back to, is how 1:17:51.960 --> 1:17:55.680 important it is to understand that there's it's not just 1:17:55.760 --> 1:17:58.000 one thing, it's not just one feeling, it's not just 1:17:58.160 --> 1:18:02.559 one experience, and it's many, many, many, many different things. 1:18:02.960 --> 1:18:03.200 Yeah. 1:18:03.520 --> 1:18:12.240 Yeah, sources sources on that, Yeah, I have two main 1:18:12.640 --> 1:18:15.439 ones that I have several, but I have two main 1:18:15.479 --> 1:18:19.000 ones that I read for this. One is a book 1:18:19.520 --> 1:18:25.280 called The Pursuit of Parenthood by Margaret marsh and Wanda Ronner, 1:18:25.920 --> 1:18:29.639 and the other is a book by Sarah Ferber, Nikola 1:18:29.720 --> 1:18:33.760 Marx and Vera Mackey called IVF and Assisted Reproduction, a 1:18:33.840 --> 1:18:34.759 Global History. 1:18:35.520 --> 1:18:38.160 Like I mentioned in the last episode, a lot of 1:18:38.160 --> 1:18:41.880 my sources ended up overlapping for these episodes, but a 1:18:41.880 --> 1:18:45.280 few that were particularly helpful for this episode was that 1:18:45.439 --> 1:18:47.760 textbook that I used in last episode, which was the 1:18:47.840 --> 1:18:51.120 Johns Hopkins Manual of Gynecology and Obstetrics. There's a few 1:18:51.160 --> 1:18:55.800 chapters in there for details on the risks of IVF pregnancies. 1:18:55.840 --> 1:18:59.280 There was a paper in BMC Pregnancy and Childbirth from 1:18:59.320 --> 1:19:03.679 twenty twenty one untitled Assistive Reproductive Technology and Hypertensive Disorders 1:19:03.680 --> 1:19:06.759 of Pregnancy Systematic Review and meta Analysis, and a few 1:19:06.880 --> 1:19:10.639 other papers as well. We will post the sources from 1:19:10.640 --> 1:19:15.000 this episode and all of our episodes on our website, 1:19:15.040 --> 1:19:18.160 this podcast will Kill You dot com under the episodes tap. 1:19:18.920 --> 1:19:21.559 Thank you to Blowmobile for providing the music for this 1:19:21.680 --> 1:19:23.680 episode and all of our episodes. 1:19:24.600 --> 1:19:27.400 Thank you to Leanna Scuialacci and Tom Briy Fogel for 1:19:27.479 --> 1:19:29.000 the incredible audio mixing. 1:19:29.360 --> 1:19:31.719 Thank you too, exactly right, and thank. 1:19:31.520 --> 1:19:33.840 You to you listeners. We hope that this is a 1:19:33.880 --> 1:19:36.800 fun episode. We hope you've got enough in you for 1:19:37.000 --> 1:19:40.840 one more episode, because we've got it coming to you. 1:19:41.000 --> 1:19:45.200 We've got it coming yeah next week, I believe, so 1:19:45.640 --> 1:19:48.960 you know, stay tuned. Yeah, and a big thank you, 1:19:49.240 --> 1:19:53.280 as always to our fantastic patrons you know, thank you, 1:19:53.439 --> 1:19:56.679 thank you, thank you. Your support means everything so much. 1:19:56.840 --> 1:19:57.200 Thank you. 1:19:58.160 --> 1:20:00.599 Until next time, wash your hands. 1:20:01.040 --> 1:20:02.080 You filled the animals. 1:20:08.360 --> 1:20:12.320 Um um. 1:20:15.600 --> 1:20:30.520 Um um um um