Ep 145 IVF, Part 3: Industry

also known as IXI fertilization. However, due to antiquated BMI restrictions at our local clinic, Diana was not allowed to move forward with an egg retrieval. They explained that the anesthesia team did not perform these services on larger bodies that we believe this is one of the many ways that clinic artificially inflated their success rates. We wanted to move forward with an IVF at our local clinic, Diana had to lose weight first.

which was thirty nine at the time. After entering ten rounds of IVF and countless tests over the past three years, we now better understand that our greatest obstacle all along was not my weight, my age, or my equality.

for and convince our ARII to even test for. This is why, after multiple failed rounds of IVF, I decided to move forward with another vericocell removal surgery to help overcome our DNA fragmentation issues, this time with the reproductive urologist who successfully improved all our semen parameters and as a result, improved our final IVF outcomes.

unique needs. In fact, we record this audio from a tiny studio apartment in Manhattan as we work with the clinic in New York City.

pretty quickly and found a donor. In the meantime, I did my own genetic carrier screening and I found out I had was a carrier for two rare diseases, and the donor I selected had only been screened for one of them. One of them was not included on most screens, so he actually ended up going back to the sperm

bank with those results, which was great. So this was an anonymous donor, although we did do open ID so my daughter spoiler Alert, can reach out when she turns eighteen, so that decision is up to her to reach out if she wants. So I had one round of IUI, which was unmedicated, and then that didn't work. I was pretty disappointed and just didn't want to wait any longer, just given the amount of time that went between each cycle. Of course every month kind of aligning with your menstrual cycle.

I went to IVF right after that, and at the beginning of that second attempt, I got COVID and my follicle account was really terrible when we went titcheck at the middle of the month, and so we waited for another month, which was like that's eight weeks. Then from the start, I did about two weeks of shots and I had one not so fun episode where I had to go on a Sunday to sitting nearby. Didn't have a car at the time and had to take a bus and a train and had very sore ovaries and

was super swollen and feeling awful. But I had to get one more Gona left pen for I think it was the quarter of the remaining dose that I needed for that night. And then I did my trigger the next week two days later, which was also neebrecking. So after that I got about twenty mature eggs. We used XY and I eventually ended up with a fair number of embryos that were PGT normal. I had two that were abnormal that were discarded, and a couple that just

didn't make it. So I let the embryoagist decide which embryo to implant because I didn't want to get the sex of the embryos revealed. I did not want to make that choice and I wanted to keep as much of it kind of normal as possible. That this totally bizarre journey to have my daughter. I guess it's not bizarre, but it was just different than what I expected. So we did it for It was an embryo transfer in November, and I found out I was pregnant right after Thanksgiving,

and I had her last August. So I have my beautiful baby and I have several embryos on ice.

you can find Patreon, lots of things. I know I'm forgetting stuff, but you know what, you did.

intrauterine insemination to improve our chances. We tried several rounds of UI and were finally successful with the birth of our daughter in twenty eighteen. In twenty twenty two, we decided to try again, so we went back to our fertility clinic. We tried two unsuccessful rounds of IUI and then moved on to IVF, as by this time I was nearing forty. We underwent our first day retrieval process last summer. To say that I was unprepared for the

difficulties of undergoing IVF was a huge understatement. To prepare for the retrieval, I had to inject myself with fertility meds multiple times a day. I had to do several internal ultrasounds so the clinic could monitor the growth of my eggs. On the day of the retrieval, I was so hopeful, but again totally unprepared for the experience of the procedure. I was given pain medication, but the process of piercing through my vaginal wall to aspirate the eggs

from my ovaries was excruciating. The retrieval resulted in four embryos which were frozen and sent for PGTA testing, but only a single embryo came back as viable for transfer, so I began the process for embryo transfer, which involved daily intramuscular injections of progesterone in oil. I had a reaction to the oil and ended up with painful, red hot lumps on both of my thighs. We transferred the embryo,

but unfortunately it didn't survive. I was devastated. Our doctor had us try again, this time with a huge increase in medication dosage. I went through the awful process of injections, ultrasounds, and agg retrieval yet again, and this time we got six embryos. We were so hopeful that it would work this time. Unfortunately, none of the embryos were viable, so we couldn't transfer any of them. We were told that my eggs are too damaged and we shouldn't try to

do any further retrievals. Our best hope now is to buy eggs from a donor egg bank, with the hope that we might get a healthy embryo that has at least my husband's DNA. This journey of IVF has been an emotional roller coaster. I've been heartbroken again and again, and now we are left unsure if we will ever have another child.

results in infertility. We were then referred to a fertility clinic where we decided to try a testicular sperm aspiration to see if they could find any viable immature sperm. None were found. We now knew a sperm donor would be required as the only treatment option for non obstructive asiospermic male factor infertility in Australia. Or gammic donation has to be altruistic, so finding local sperm is very difficult. Our specialist suggested we look at known donors, specifically a

family donor. We decided to approach my husband's brother as a potential donor, and we're very grateful that he agreed.

A known donor pathway is significantly different to a purchase sperm pathway and required further genetic screening of myself, the donation and freezing of the donor sample, mandatory counseling to ensure all parties were aware of the legalities and potential emotional mine fields of the situation, and the six month cooling off period post donation, which served for testing of the donated sample and allowed for change of mind of

the donor. After those six on months, we were ready to finally begin treatment, as is the case with all male factor in fertility. After that sperm aspiration procedure, all further surgeries, medication and treatment was for the carrying parent. Our first collection cycle and fresh embryo transfer was unsuccessful, with no additional embryos to freeze. Our second collection cycle and fresh embryo transfer was also unsuccessful, however, had also

produced true embryos to freeze. Here, we took a break for a few months before returning for a frozen embryo transfer, which was thankfully successful and resulted in our gorgeous baby girl. Twelve months after her birth, we returned to the fertility

clinic to transfer the remaining frozen embryo. Whilst it felt strange trying to get pregnant again when it felt like we still had a little baby, the knowledge of how hard the fertility treatment was men I wanted to rip off the band aid, complete the last treatment cycle and know with certainty what our family would look like. We repeated the same successful frozen transfer protocol, which was again successful, and this time we had a beautiful baby boy. With

twenty months between the kids. We were deep in the two under two club and extremely grateful for the treatment options that we had been able to utilize to have our family. Seven months after having our son, we heard from the clinic asking us about the remainder of our frozen donated sperm. This is when we decided our family was complete and we would discard the remaining samples and

close the door on our fertility journey. Fertility treatment is emotion only, physically and financially taxing, and we're very thankful to have come out the other side. With our two gorgeous little kids. We are acutely aware that not everyone walks away from fertility treatment having had a child.

great deal of impact or potential. And what often happens is that these technologies and their applications develop faster than our regulation of them or even our ability to know how we feel about them, Like what do we think about them? IVF is no exception. IVF is an incredibly powerful technology that has enabled millions of people around the world to fulfill their dreams of having children. I mean, think about that, like that is it is truly amazing?

where the future might take us. And today, I want to go through some of the ethical considerations or questions of regulation of IVF that have emerged over the history of this technology. I'm not going to present pros and cons. I'm not going to make value judgments. I just want to touch on a few areas, not all of the areas, not comprehensively, because I think that this story in general, the regulatory landscape of IVF, is an important It's a necessary part of the story or history of IVF and

its future. This is a really complex topic with so much nuance, and we're not ethicists or policy experts or anything in IVF. We're just going to try our best like we always do, and I'm going to focus primarily on the regulation, access, and innovation side of things. If you live in the US, I'm sure you've come across recent headlines about the Alabama Supreme Court ruling in February of this year that frozen embryos can be considered children

in that state. The short term and long term implications of this ruling are not yet clear, and I'm sure that in the next few months leading up to the election, we'll see more discussion about this and about the other ways that political groups and religious organizations are trying and sometimes succeeding, to push an agenda ultimately aimed at controlling

people's bodies and choices. Banning IVF is just one part of this wider movement to reaffirm gender roles, restrict access to healthcare, reinforce cycles of poverty, and control people's bodies. And it feels truly dystopian to be watching this unfold and gain traction, like I both can't believe but also sadly can believe that it's happening right in front of us.

But today, we're not going to debate when life begins, or what should or shouldn't be considered a child and be granted personhood, or even what an embryo is, because there are actually many definitions of embryo that very globally and we're not going to debate these things because first, you can't really debate what comes down to essentially fundamental disagreements over closely held beliefs, like I believe to my core that abortion is healthcare and that IVF should not

be banned. I cannot imagine entertaining any argument trying to convince me otherwise. And secondly, in the rest of the world, discussions of the ethics of IVF have moved beyond the question of whether or not IVF should be done and onto how it should be done. And so that's what I'm going to touch on today. But first, let's go back to the early years of IVF to see how it grew, with a special emphasis on the US, because that will get us to the current landscape of IVF.

The early nineteen eighties established that IVF seemed here to stay, and by the end of the decade, nearly two hundred clinics offered IVF in the US, and an estimated thirty thousand women in the US had sought pregnancy using IVF. By the end of the nineteen eighties.

IVF industry in the US continued to grow. There were those guidelines from the Society for Assisted Reproductive Technology that I mentioned last week, but no requirement to follow them. As of the late nineteen eighties, any licensed physician could open an IVF clinic. You didn't have to be a board certified reproductive endocrinologist or even an obgyn, and this showed in the range of live birth rates in clinics.

More established clinics with highly experienced reproductive endocinologist reported rates of twenty percent, more than double the national average of nine percent, and twenty one percent of all clinics in the US in nineteen eighty eight did not have a single live birth.

involved in this work. In the nineteen eighties, IVF practitioners knew that this booming field could be severely harmed by just a handful of physicians who saw IVF as an opportunity to exploit rather than help. Without guidelines, the field could grow increasingly market driven, with private clinics competing for clients by doctoring their or not being fully transparent about

their rates of live birth. Ultimately, it was fear of exploitation, along with a scandal, that helped to inspire the first major piece of regulation for IVF in the US. Even though Cecil Jacobsen, the physician at the heart of the scandal, did not offer IVF, he did defraud many people at his reproductive health practice and also used his own sperm to impregnate patients, saying it was anonymous donation. He was one of those Yeah.

CDC website. This act quote mandates that clinics performing art annually provide data for all procedures performed to the Centers for Disease Control and Prevention and sets forth definitions and reporting requirements. CDC is required to use these data to report and publish clinic specific success rates and certification of embryo laboratories.

And I know that, like you know, I'm sure that, as you'll talk about, we have a better grasp on what egg freezing looks like. But it can also be measured in many, many, many different ways, so it's complicated. And the other thing about this act is that there aren't clear consequences for the clinics that don't participate in reporting to the CDC. Ninety percent do in the US, and the bottom line is that this is still a

market driven enterprise. Estimated at five point three four billion dollars in the US in twenty twenty four.

procedures in the US who don't have to report cess rates. Granted, it is less regulated than in other countries, especially those that have national healthcare systems, but legislation does exist, and it's not just the nineteen ninety two Act that helps to protect consumers. Some US states have accreditation and inspection laws. And then there's also the US legal system, which allows

patients to sue clinics and doctors for medical malpractice. But litigation is reactive, and so it still allows for the

potential for exploitation or abuse within fertility clinics. Instances of doctors using their own sperm to impregnate clients without their knowledge or consent, not providing adequate care during procedures, or ignoring pain so that that podcast, The Retrievals by Cereal tells the story of how women underwent these painful surgical procedures at an IVF clinic, where a nurse had swapped out fentanyl for saline solution, but no one believed that

the women were actually experiencing pain. They were like, no, this is normal amount of pain, but really they were undergoing procedures that with.

resulting in the world's first surviving octopletz octomom as. We probably remember that doctor's license was later revoked, But again, like, how do we better protect against misuse or abuse from the outset? I don't know. The added regulation and threat of litigation did not dampen enthusiasm for IVF in the US during the rest of the nineteen nineties and into the two thousands from the book Pursuit of Parenthood Quote.

Between nineteen ninety nine and twenty fifteen, the volume of treatment in America's fertility centers, measured by the number of egg retrieval cycles, went up more than two and a half times to nearly two hundred and thirty two thousand retrieval cycles, about eighty percent of them with the intent to achieve a pregnancy and the rest for the purpose of freezing and banking the resulting embryos for future use.

Just under sixty one thousand women gave birth after being treated that year in twenty fifteen, for an overall take home baby rate of about thirty three percent, up from about twenty five percent in nineteen ninety nine end quote. And patient makeup at these clinics was also changing, with more single women and same sex couples using ibas, as well as an increase in traditional and gestational surrogacy, egg donation,

and so on. These trends were not happening just in the US, but also globally, and they have led to continued discussion and heated debate over how to best regulate some IVF practices, and so here's where I want to move more generally into the global landscape of IVF to touch on some of the questions that have been raised about practices within IVF beyond consumer protection and clinic transparency laws about things like surrogacy, egg and sperm donation IVF

for single parents or same sex couples age cutoffs. These laws vary globally, which has led to people traveling to other countries to seek fertility treatment, called cross border reproductive care or fertility tourism. The US, for instance, is one of a handful of countries where paid or commercial is legal. India used to be a very popular destination for surrogacy due to its lower cost, but they have since banned

foreign couples seeking surrogacy. Other countries permit only altruistic surrogacy, where the cost of medical care and other pregnancy related expenses are covered but no additional fees, and in some countries surrogacy of any kind is illegal. This variation in surrogacy laws reflects discussions around whether paid surrogacy always carries with it the risk of exploitation, whether the transactional nature of paid surrogacy better protects both commissioning parents and surrogate

by more clearly outlying expectations. How to deal with the fact that pregnancy is inherently risk laden and can be especially so with IVF if multiple embryos implant, or what to do when the unexpected happens. Commissioning couples divorcing during the surrogacy, pregnancy, pregnancy loss, health issues developing during pregnancy, or as a result of pregnancy, people changing their mind midway.

There was one case where a genetic scan revealed that one of the fetuses that a surrogate was carrying had TRISO only twenty one down syndrome, and the commissioning couple only adopted the twin without the condition. Then that led to a lot of other issues. It was it was like a long, really long drawn out process. Wow that this in general is a very complicated topic, as is the commodification of sperm, eggs, and embryos, similar to gestational

surrogacy or traditional surrogacy. Countries have varying laws regarding sperm and egg donation or sale, and this is another reason that people travel across borders for reproductive care. Then there's anonymous donation as in is there still such a thing as anonymity with the advent of ancestry testing, Yeah yeah.

Discussion has also arisen over the use of frozen eggs, sperm, or fertilized eggs after a couple splits, or if someone dies in situations where there is no written documentation indicating the wishes of the deceased, how should posthumous reproduction be

allowed to proceed or should it? I came across one high profile case where a couple died in a car accident and their two sets of parents engaged the services of a gestational carrier to carry their grandchild from frozen embryos from the deceased couple, So four years after the couple had died, their baby was born.

we can, does that mean we should? It's still very early days when it comes to the practical application of gene editing technologies such as Crisper to human embryos, but it is in our future, quite possibly are very near future, right, and many people have called for discussion and regulations now to start drawing lines between what is considered acceptable use of this technology and what could be considered misuse. Beyond how IVF is done or how the practice is regulated,

is the question of access. I've already talked about how most stories featuring IVF tend to have a quote unquote happy ending resulting in a baby, and stories where IVF didn't work out aren't highlighted as much. But even more silenced are the stories where people can't seek out IVF due to economic, insurance or geographic reasons, or reasons pertaining to their identity, whether that's marital status, sexual orientation, age, etc.

Sometimes referred to as socially infertile. The WHO and the CDC, among other organizations around the world, classify infertility as a disability, but in the US, insurance companies are not required in all states to cover or offer coverage for IVF. Some clinics offer IVF lotteries where people can enter to win a free cycle and of course, lack of access to

IVF disproportionately impacts people of color and poor people. To quote American sociologists, law professor, and social justice advocate Dorothy Roberts, quote, the people in the United States most likely to be infertile are poor, black, and poorly educated. Most couples who use IVF and other high tech procedures are white, highly educated, and affluent.

really beautiful way. And it also forces us to examine our feelings about what the limits of this technology are or what they should be in the future. And it's okay to not know how you feel about all these different aspects of IVF, like posthumous reproduction or gene editing. It's complex stuff. And if it were easy to come to a consensus or know that this is you know, this is the dividing line, then we would have already

done that at this point, like at least country to country. Instead, what we can do, I think is some self reflection. We can listen, we can learn, and we can ask questions. And so I'll end with a question, Aaron, what can you tell us about the potential future of IVF.

term relationships, so I just assumed it would happen. I was married and divorced before I turned thirty, and then in a year's long relationship after that that I thought was going to lead to marriage and kids when it didn't. And after the death of my mom in May twenty twenty three, I decided that I had to take matters into my own hands and start the egg freezing process.

Given my age and test results, it's expected that I need to do three to four cycles to freeze the twenty five to thirty eggs that the fertility clinic recommends.

frozen eggs. I'm happy to have any, but I'm also really disappointed that I don't have more. So I've been on this insane roller coaster of emotions, which is not helped by the extra hormones coursing through me. I plan on doing one more round and then I'll reassess things with my doctor. What's getting me through it is knowing that I'm actually doing something, even if I never need to use these frozen eggs or I do and it

doesn't actually result in a viable pregnancy. I know that I'm privileged in the sense that I have an incredible support system of family and friends around me. I have the savings to afford it because my insurance doesn't cover any of this, I have the flexibility with my schedule.

so we started our first round. I injected myself with a cocktail of hormones to stimulate my ovaries and got to experience all the fun side effects waking, bruising, bloating, headaches, massive mood swings. I had blood work and vaginal ultrasounds routinely, and was finally told to give myself the last injection of hCG to stimulate my ovaries to ovulate the next morning, I went under anesthesia for the egg retrieval. However, I woke up to my husband telling me it didn't work.

We had to repeat the injection and the procedure again in two days. The second time, they were able to retrieve about twenty eggs from my ovaries.

off my abdominal cavity at the bedside. Spent the night in the hospital because that promptly tanked my blood pressure, and then went home with a drain the next day to keep removing fluid over the next week. Two months later, we did have frozen embryos and planted. I gave myself progesterone injections into my buttock every day for twelve weeks, and thankfully, our daughter was born healthy without complications. Two years later, after using our last chromosomally normal embryo, my

son was born. I found IVF to be incredibly difficult physically, mentally, and emotionally. I wish fertility and the possibilities of infertility had been discussed more when I was younger, and I had been better prepared. I'm a healthcare provider in women's health, and I feel there's been a massive shift in awareness and perception of infertility. The rise of women finding platforms to vocalize their experiences with IVF and infertility has had

major effects. I applaud the spread of information and the empowering and cathartic nature of women sharing their stories and forming communities. But I see women almost daily who are terrified that they're infertile and won't have children because of what they've seen or heard. I think it's so important

to provide accurate, honest information. None of us have a crystal ball to see what the future of our fertility holds, and while there are some tests that can give insight into general reproductive health, The fact of the matter is, for most people, we never know how easy or heart it will be to get pregnant until we start trying.

mind that this is possible, like it is. It is so fascinating and everything that we went through in the last episode about all of the steps that had to happen for us to be able to have IVFB a reality, and now that it is becoming something that for a lot of people, though, as we'll talk about, not for everyone, but for a lot of people, is an attainable possibility.

Is what the paper that I read said. Okay, that's a huge number of people every year.

this is a massively huge industry. Like you kind of highlighted aarin and these numbers, this seven hundred and fifty thousand babies, these three million art cycles, they're not split in an equal fashion. We see that in the US, and we see that globally. On a small scale. Here in the US, in twenty eight art accounted for I'm not calling it art today, it's calling an art last time,

feeling a little spicy. Art accounted for zero point four percent of babies that were born in Puerto Rico and five percent of babies born in Massachusetts in the UOW that's like the biggest scale that we see.

And like you mentioned, Aaron, race and ethnicity are hugely impactful in terms of who has access to infertility services, both because of systemic disparities in like economics and access to healthcare, but also because of the biases of our healthcare system and the burdens of the infertility treatment process itself, and on top of that social stigmatization or distrust of the medical establishment.

IVF changed since the early days. Some of the hugest advances in IVF in recent decades are now so commonplace that they're actually just part of the IVF process that I described last episode, So they wouldn't even be considered like, Ooh, this brand new, super exciting on the edge thing. It's like, no, that's just how we do IVF now. Yeah, But I want to highlight them because there were incredible advancements in

the last few decades. ICSI is one of them, and that again is interra cite, a plasmic sperm injection allowing for one single sperm to fertilize one single egg like via a tiny needle. This has allowed for successful IVF in the face of very severe male factor infertility, which was not possible before this.

This has allowed for a variety of genetic testing methods, which I want to spend a little bit of time on because some of them are still a lot more controversial than I realized, and some of them are just amazing for people living with certain genetic conditions. But I also just want to mention single embryo transfer as kind

of like a novel occurrence. And this is possible today in part because of the things that I just mentioned ICSI, blasticist transfer, being able to do genetic testing, which has increased the success rates of each cycle of IVF, but single embryo transfer also substantially decreases the risks to both the person carrying the pregnancy and the fetus, so that has also been like a pretty huge technological advancement, and then there are a whole bunch more And you mentioned Aaron,

how as a marketplace driven phenomenon, part of what IVF clinics have to do is get clients, and so a lot of them will offer a range of add ons that they recommend or offer to patients that could potentially help their chances of having a live birth. And this is not just true in the US, this is across

the globe. But the big thing that I learned about a lot of these add on procedures is that many of them have little to know evidence that they're actually going to improve the chances of having a live birth, and in some cases they could even be harmful. So I want to go into what some of those are and kind of like break down some of the data on what things are really potentially helpful and what things are maybe just still in the stage of research and

yet they're already being used in practice. So this includes things like assisted hatching. I don't know if you came across that, Aaron, No, I did not. I When I came across this, I was like, Wow, I've never felt more like a chicken hatching. Okay, assisted hatching, This has not great evidence. From what I can tell, it's a little bit unclear. Maybe it works, the data seems poor on kind of all sides, whether it supports it or

whether it's not beneficial. But basically what it is is it's using a laser or something to drill a little bit into this blasticism prior to implantation to because the blastistis because in order for implantation to happen, the blasticist has to kind of break out of what's called the zona pellucida in order to implant in the uterus. So it's basically like making a little crack in that to hopefully improve the chances of implantation.

a trade off. And then we get into pre implantation genetic testing as a part of IVF, and I want to spend a little bit of time here because it's become a huge part of the IVF process.

the quality of the data. So there is IVF that's being done on the regular through these clinics and then there's IVF that is still being done at teaching institutions and academic institutions where they're collecting data for research on these things, so that is where the data is going to come from to then determine is this new or novel technology going to become a part of standard practice.

Right now, all of those things that I mentioned, with the exception of pre implantation testing, which we'll get into more detail on, but all of those other ones that I mentioned are not part of a standard IVF procedure, so that is why they're considered as add ons. And again there are more One source that I found that was very helpful, especially as like a patient facing resource was actually out of the UK and it's a website.

I'll link to it on our website, but it had really great pictorial graphics of all of the different types of add ons and what the evidence was, whether it was evidence that it could be helpful, whether it was evidence that could be harmful, or whether there just wasn't really good evidence for it one way or the other. And it had like a green or a red or a question mark or whatever.

afford to do so. And then it's it is really interesting because even if we don't have good data now, in the future, we hopefully will have better data to be like, oh, this shouldn't be an add on, this should be part of standard practice, or this doesn't do anything exactly its exacts. Time to get to those things. Yeah, which is still it's just still so complicated.

but then they have different letters after them. So I want to go through what each of them are, because what's important is that the three different main kinds of pre implantation genetic testing are used for very different things, and so the research is actually very different on the

utility of these different things. Pre implantation genetic testing PGT A this is the first one, and that's pre implantation genetic testing for annuploid anti employde is when you have a different number of chromosomes than most people extra or one missing. So this type of genetic testing is the type that tests the embryo to make sure that there are the correct number of chromosomes, so it's looking for trisomes or other annuploides. This is things like Edward syndrome

or Down syndrome, et cetera. In most of the literature that I read, this is still kind of on the line of a more experimental and research procedure, but it is very very commonly used in clinical practice. There isn't data that it improves live birth outcomes. And there's a lot of reasons that go into this. Part of the thought is that something that can happen as this embryo is dividing. And I'm sorry if this is getting too nerdy, but I find this really fascinating, but.

a uterus, might end in a miscarriage. Right, But when we do pre implantation genetic testing, we're taking so few cells that we can't tell if something is a mosaic or not necessarily, and so what this can end up happening is having false positives and also potentially false negatives.

But the false positive seem to be what in terms of like lawsuits and issues that have come up, seem to be the biggest issue because what it leads to is discarding of embryos that could have been viable, that could have been not have an antiploid, which means that you're then dis carding embryos and maybe you only had two or three viable embryos to begin with, right, But the reverse is also true, where you could have a falsely negative sample that could end up resulting in a miscarriage,

and so then you went through this whole cycle and thought that this embryo was going to be have a good chance of surviving, and then it doesn't. So it kind of goes both ways.

is the way that this will go. But right now, because you only can takes so much DNA, and we only can do so much testing on that DNA, right now, the technology doesn't seem to be good enough to have like a super super high sensitivity and specificity to be able to offer this like across the board as like part of the standard practice necessarily or at least when it is offered.

and PGTSR, which is testing for structural rearrangements. These are the types of genetic testing that would be done if an individual or a couple has a very high chance of passing on a known genetic disorder, or if they, for example, we're having recurrent miscarriage and through their infertility evaluation found out that they had a structural rearrangement in one of their chromosomes. So this is what someone who maybe had a history of Huntington's or sickle cell or cystic fibrosis or.

Different countries have implemented different policies on whether or not this is an acceptable practice, and there's other things that pre implantation genetic testing can be used for. It has been used in the past for selecting specific HLA genotypes, and this is so that you can select an embryo that is born that is compatible genetically identical with their HLA type to a previously living child who, for example, has a very severe cancer or something like fanconi anemia.

I think that's the example the first time that this was used, or some other disorder where they need a bone marrow or some other type of transplant, so you can choose an embryo that will match that living child and then be able to essentially save that child's life with their sibling. These are things have happened today and

are possible because of this technology. And I am not here making a judgment to say that one is right and one is wrong, etc. But all of these different technologies force us as societies to be able to have conversations about where the lines end essentially and where the gray becomes more black and more white. And that is especially true as this technology continues to develop, because the

things on the horizon for IVF erin are incredible. Of like what erin, there are three major areas that IVF will go and they're not far off.

And so that's why it's called three person or three parent potentially because that mitochondria could come from someone who's genetically separate from you, or it could come from different cells in the ocite donor's own body.

have talked about on this podcast before as well. The things that people are working on are incredible, and societies are going to have to reckon with what the ethical implications of all of these things are and how we decide that they are regulated.

like we talked about, you know, off off camera, uterine transplants. Yeah, just like so many things that have completely open the door, and it's like it's opened the door and a little bit of opening the door to a world of amazing possibilities and a little Pandora's box at the same time in terms of regulation and in terms of technology evolving faster than our imagination can see, like where it will go and how it will be used, And it's just it really forces us to confront sort of our own

feelings about these things that we don't know where they're going. And it's not just IVF, it's ai AI. You know, it's like what cell phones have given us.

it was like, this is a thing that will allow people who are not able to have children to have children, right. And that wasn't really as much in the US. And so I think that like and also, I mean, there are a myriad of reasons why the US reacted differently than other parts of the world in terms of IBF and still does today. And so on and so forth. But I think that has been a really fascinating discussion that a lot of people, yeah, have that I've seen a lot sort of come up more recently too.

but that's that is IVF. We've come so far, we have so far to go. I've learned so much.

egg freezing and all of these different things that it's like IVF is not just IVF, it is a one million bajillion things.