Episode Transcript
[00:00:01] Speaker A: There's a part of the fertility process that most people never really get to see. After all the appointments and planning, the testing, the medications, the procedures, things eventually move into the lab.
[00:00:11] Speaker B: Eggs, sperm, embryos.
[00:00:13] Speaker A: They're handed with so much care, but from the outside, it can start to feel distant, quiet, hard to follow.
Maybe you've been there looking at an embryo report full of numbers and letters you don't quite understand, or. Or hearing the word ICSI and wondering if it's something you actually need or just something everyone gets now. Or maybe you simply found yourself wondering what's really happening once everything's passed off to the lab. There's so much that goes on behind the scenes, and for something so personal, it's strange how disconnected it can feel. Welcome to the Fertility Cafe, where we explore the beautiful complexity of modern family building.
I'm your host, Eloise Drain, and this is a space for honest conversations about surrogacy, egg donation and the journey to parenthood. With expert insights and real stories, we're here to guide you through the medical, legal and emotional aspects of third party family building.
We believe that love has no limits, and neither should parenthood.
Welcome to Fertility Cafe. I'm your host, Eloise Drainage.
We've talked before about the role of the fertility lab, but today we're focusing on the specific details patients are often expected to navigate through. Things like embryo grading, icsi, PGT and cryopreservation.
These aren't just technical processes. They're decisions people have to make, often with limited explanation and a lot on the line. We're also covering the logistics that don't always get discussed about how gametes and embryos are stored, transported and preserved, and what families need to consider for the long term. My guest today is Elise Daniel Barnes. She's a clinical embryologist with more than seven years of experience working in IVF labs. She earned her bachelor's degree in genetics from North Carolina State University and has been actively educating the public about fertility science since 2021.
Her work focuses on improving fertility awareness, countering misinformation, and making complex information more accessible to patients.
So let's get into it. Well, thanks, Elise, for joining me.
[00:02:34] Speaker B: I appreciate it.
[00:02:35] Speaker C: Thank you so much for having me. I'm excited to be here.
[00:02:38] Speaker B: We've been talking about you coming on the podcast for. I think it's been over a year. It has definitely been over.
[00:02:43] Speaker C: Yeah, it's been a while.
[00:02:45] Speaker B: Yeah, yeah, yeah.
[00:02:46] Speaker C: So.
[00:02:47] Speaker B: So I love, first to start with a bit of your background, of what initially led you into, like, the field of embryology.
[00:02:55] Speaker C: So honestly, I think this is a lot of people's experience. It's changed a lot now, which I find interesting. But a lot of, you know, historically embryologists get into the field through like animal science or research.
My background is in genetics and in my last year of undergrad I was like, you know what? I have to do something. Like times, you know college is gonna be over, right? Like I need to decide what I'm gonna do.
You know, I thought about grad school or med school or all, you know, the extra schooling for a while and I was kind of like, I really want a career, at least for now. I need a break from school. I want to do something different.
Always had an interest in reproductive health, women's health. I enjoyed being in the lab, but I didn't like research. It was not my thing. The grant writing, the funding, the whole thing, it was academia in terms of lab work was not for me.
So I tried to find something that I thought would incorporate all of those things. I did. I literally did a Google search. This was for chatgpt could tell me what I would do. So I found embryology. And I was like, this sounds cool. I don't know how to get into this. Do I need to go to med school? You know, the ist at the end makes it sound like, you know, you need some advanced degree. And I found a lot of clinics in my area and was like, I'll reach out to them and see if I can learn more about this field. I don't know. And I reached out to all the clinics in my area and one of them got back to me and was like, hey, we'd love to have you come shadow and see what we do. And it was a great opportunity. And that's when I was like, I think this is for me. I think this is something I want to do.
Anytime they had would have me. I was up there in the clinic trying to learn more. And then my last semester, I was able to work part time. I worked as a lab assistant. So I did lots of people paperwork and you know, charting and cleaning and you know, all the grunt work sort of stuff. And then when I graduated, I was able to move into a full time andrology position and kind of trained up into the lab that way. So some of it was a little bit of luck, some of it was me putting myself out there, but either way it worked out. I'm really glad I found this field because I still think back onto like, what would I have done if I hadn't found this. I think it's such a, such a perfect fit for me. So I'm glad, I'm glad I came across it.
Thanks to Google.
[00:05:07] Speaker B: Yeah, yeah, yeah, yeah, yeah. Which I think too, that a lot of people don't realize, like, embryologists are not MDs exactly.
[00:05:16] Speaker C: Like the ist, like I said, the embryologist at the end, like, people think that we're physicians. I'm definitely not a physician. I am doctor by no means. No PhD, no MD, no PharmD, none of that. I have a bachelor's in genetics and that is, you know, a bachelor's degree in a science is at this point the only requirement. And I will say it's getting a little bit more competitive. People now message me and are like, I'm going to school to become an embryologist, which was not me. I found it like at the end. But some people are pursuing this right off the bat. And so I do think it's becoming more competitive. So we may see that change to more people having masters or PhDs or something. But for now, bachelor's degree will do it.
[00:05:59] Speaker B: Yeah, yeah. And talking about changes, you know, we had before we started the recording, we started talking about how things have changed just in even the last few years in this space.
And I'm curious what some of the things, what some of the changes you've, you know, you've noticed in embryology since you started and whether the science itself or, or how it's been approached and inside fertility clinics, like, what changes have you seen?
[00:06:30] Speaker C: Growth. A lot of growth.
While I mentioned it's getting more competitive, I do. Embryologists are having to do more.
So when IVF kind of started, we couldn't culture to day five. We couldn't do icsi, we couldn't do embryo biopsy. And so embryologists, the workload was a lot lighter.
Embryologists are doing a lot more procedures now than they used to. And we're seeing a lot more patients, a lot more clinics.
So I do think that there's a little bit more pressure than there used to be in terms of doing all of those things with no error, you know, all of that sort of stuff.
But, yeah, new procedures. ICSI is newer. PGT is really the big one. A lot more genetic testing on embryos than we used to do.
And then AI, you know, everyone talks about AI. AI is coming to the lab, too.
We're getting there. I have yet to work at a lab that has AI, you know, in their, their microscopes or their incubators. But I do think it's coming, so we'll, we'll see what that brings.
[00:07:34] Speaker B: But what do you mean, do you, you think. I mean, obviously I know that it's coming, but an AI in an embryology.
[00:07:41] Speaker A: Lab, what does that actually mean?
[00:07:45] Speaker C: For now, the most used like software when it comes to AI is for embryo selection. So which embryo are we going to choose for transfer? Right now the embryologists choose, we choose based on, you know, day developed PGT testing, if there is any, and morphology. So what the embryo looks like with the amount of data that we have now from these time lapse incubators that give us a picture of the embryo every 10 minutes, which we didn't used to have, AI is able to take all that data and say based on what we know about, you know, all of these different pregnancies or all of these different failed cycles, this is the embryo we think you should choose for transfer.
I, I don't think it's to the point yet where it's really making a difference in terms of pregnancy rates for patients. I don't think it's there yet, but I do think it will get there and I don't think it will be much longer before it's there. So I think that's one of the reasons why clinics have been slow to add AI capabilities into their labs is it's an added cost. And you know, physicians don't, and embryologists don't want to add additional costs to patients if it's not improving things.
And so I think people are a little wary of adding some of these things if it's not like across the board. We know this is improving pregnancy rates. We know this is a value to our patients because why it's already so expensive. Why are we going to charge them.
[00:09:09] Speaker B: Extra for this if it's not going.
[00:09:11] Speaker C: To add anything for them?
[00:09:14] Speaker B: Yeah, for sure. And I know, I mean, and I know you've been actively speaking out about misinformation in the fertility space and, and I think the whole, you know, adding AI, it's going to make things better. And you know, everybody talks about how all of these things and all of these changes are going to make it better for the fertility patient and blah, blah, blah. I'm just going to keep my thoughts to myself on that one. But so what, what are some examples that you're really, that really concern you, you know, especially when it comes to affecting patient decisions?
[00:09:52] Speaker C: Oh, this one's, this is such a loaded question. Because I think the biggest one that I always start with is that IVF doesn't guarantee you a baby, neither does freezing your eggs. And so I think that's one that I feel like has gotten a little bit more awareness now. People don't just assume I'm gonna IVF is gonna be successful for me because it is kind when patients find that out that they're like, oh, this doesn't just work all the time. And we're like, no. Patients that do. Some patients do multiple cycles, some patients walk away with no, you know, baby after, you know, half a dozen cycles. So I think that one's becoming more common.
The one that I've been seeing recently is similar when it comes to egg freezing. So people, because they're freezing eggs and not necessarily trying to conceive in that moment, they're preserving their fertility for later. They don't realize that egg freezing is also not a guarantee.
Again, it's a chance in the future to have a child, but it does not guarantee, you know, that you're going to have a baby. Not all of those eggs are going to survive. They're not all going to fertilize. It's the same attrition that we see, you know, albeit slightly different. But with ivf, you know, we're. We can't guarantee anything. And so I really wish we had that conversation earlier in the process so that people who are preserving their fertility or considering IVF know, maybe I should freeze another set of eggs or consider freezing embryos, or maybe I should plan for potentially multiple IVF cycles or be open to other things, because this is. This may not. This doesn't guarantee me anything.
And I see that a lot, especially with egg freezing. Patients come back and they're like, oh, this wasn't successful. Like I banked, you know, I had this whole thing in my mind that this was going to be here for me in a decade. And I put all of my hopes and dreams in those eggs. And it doesn't always work out that way, unfortunately.
[00:11:45] Speaker B: And the thing back to just that real fast is 10 years ago, when you froze your eggs, things are drastically different from to now of vitrification of how things are frozen, of how all of that was happening 10 years ago to now, and how technology has drastically changed from then to now.
[00:12:08] Speaker C: Yeah, 100%. And techniques have gotten better and media has gotten better. And so someone freezing their eggs now versus someone who froze their eggs 10 years ago are probably going to have different outcomes in terms of success.
[00:12:22] Speaker A: For sure.
[00:12:24] Speaker B: So let's talk about embryo grading, because I can promise you on a weekly basis, we'll get intended parents that call us and say, we have five A4BB, A5A B, A4, whatever.
And which one should you.
We should be able to get pregnant. And I'm just like, well, well, well, first, we're not a medical facility, so go ask your doctor.
But I think people need to understand kind of the grading.
[00:13:01] Speaker A: So can you walk us through how.
[00:13:03] Speaker B: Grading works and what it really tells us, like, because I think there's just a lot of misinformation that people just don't really understand.
[00:13:15] Speaker C: Absolutely. And it is one of my most asked questions as well. It's a very common question.
And I always find it interesting that it's like one of the one things that's not talked about in this process, which I get. There's so much information. We can't. It's hard to get it all in there. But okay. So when we grade embryos, we are grading them based on what we see in the microscope. We want to grade embryos at a certain stage in development. It's called the blastocyst stage. And we are looking at three things during this stage.
So every embryo has this shell around it, which we call the zona pellucida.
That shell kind of protects the embryo during development, but the embryo ultimately has to hatch out of that shell to implant into the uterus. And so as that embryo grows, that shell gets thinner and thinner. The blastocele cavity, which is kind of just the hole in the embryo. The, you know, it's 3D. So that. That. That center part gets larger and larger. And so the first thing that we're looking at is the expansion, which is that number in the grading system. And we're looking at that blastocele cavity and that zona.
So usually see a number, one through six.
Threes, fours and fives are very, very common. And that really tells us more of the maturity of the embryo than whether it's good or bad. I don't like to really consider the extra expansion good or bad because we're. We're looking at more of how large is the embryo, how big is that blastocele cavity, how thin is that zona as it gets larger and larger?
So eventually, you know, as the embryo gets more and more cells, that zona gets really, really thin, it starts to hatch out of that zona. And that's what we consider a 5. So a 3 is expanded, a 4 is fully expanded, meaning any second that embryo is going to start coming out of that zona. 5 is hatching. If you ever see pictures of an embryo that looks like it's pinched in the middle. A lot of people are like, oh, my gosh, it's splitting. It's not splitting. It is actually coming out of the zona there. We call that hatching. That is a 5 on the grading scale. And then when it's fully out of that zona, we call that a six. So that is the number in the grading system.
The first letter corresponds to the icm. That stands for inner cell mass.
That is what becomes the baby. If you ever see pictures of embryos, there's usually like a bunch of cells and then there's like a ball of cells somewhere.
That ball of cells is the icm.
It is graded on a letter scale, like in school, abc.
We want to see a nice sized icm. We don't want it to be too small. We want it nice and compacted. We don't want it kind of spread out or flat. And we don't want to see it extruding a lot of dead cells, which the embryo can do. The embryo can say, this is abnormal. I want to get rid of it. And it'll extrude them out. But after a while it's like, why? Why do you keep extruding so many cells? It's not good. We don't want to see that. So that's the first letter. The second letter, again, ABC scale, that corresponds to the trophectoderm. Those are all the other cells surrounding the icm. And the trophectoderm is the part of the embryo that becomes the placenta. That is also the part of the embryo that we remove cells from when we do PGT testing.
So keep that in mind if we ever start talking about P, where we take the cells from us from the trophectoderm. For trophectoderm, we like to see. I like to tell people it's like cobblestone street. We want to see lots of cells. We don't want to see bald spots. Or again, the embryo extruding cells that it doesn't like.
And, you know, all three of those parts come together to make the grade. A number and two letters. And then that's how you get the 4bb or the 5a, b or all of those.
[00:16:55] Speaker B: I love that explanation. Love it, Love it. Well, so how much weight, though, should people give to the embryo grades when they're making decisions about which one to transfer?
[00:17:07] Speaker C: So we, I mean, we grade them for a reason.
I do think people can get hung up on the embryo grades at the end of the Day. It's a selection tool for us. There is some correlation between embryo grade and pregnancy rates. But it's not enough for us to say this AA is going to make a baby and this BC is not going to make a baby. That's not how it works. But when we give them a grade, we do that to select the best looking one. It also does not correlate with genetic normalcy. So that that AA embryo, we can't guarantee that it's normal. I see so many times where I'll see the worst quality embryo be genetically normal and the best quality embryo be abnormal.
So I like to think of it as a selection tool. We do choose the best looking embryo to give you the best shot because there is kind of a slight correlation.
Um, but I also like to tell people if we froze it, we think it's worth transferring. I can tell you right now, I'm not wasting my time freezing an embryo that I don't think is worth transferring. It's a waste of my time, it's a waste of your time, it's a waste of everybody's time. I'm freezing embryos that I think are worth transferring. If I wouldn't, if I didn't freeze them, then they weren't worth transferring.
And the other thing is, grading is very subjective. Something that I grade an aa, someone else may grade a bb, but it's the same embryo. That doesn't mean it has a different chance of pregnancy. I just graded something slightly different. And that's why we see somewhat of a correlation, but not enough for us to give specifics on pregnancy rates. Because it's the same embryo, but someone else could be grading it differently. Does that mean it has a different pregnancy rate? No, it's the same embryo.
So something. A couple of things to keep in mind with grading, definitely take with a grain of salt. We do use it for selection, but it's not the end all be all for, you know, for pregnancy.
[00:18:48] Speaker B: What is the freezing process? So, okay, you've created these embryos, they've gotten to blastocystate and now you need to freeze them.
What do you do? Do you like put it on, just put it on ice and say, okay, we're good to go and we're done.
[00:19:04] Speaker C: Yeah, it's actually not a super long process.
We moved from slow freezing, that's a new advancement, to vitrification. And vitrification is really not the same thing as freezing. We want to avoid the formation of ice crystals.
So really the embryo is in more of a glass like state.
Ice crystals are bad for embryos. They're bad for cells because they're pointy. When ice, you know, when water freezes, it's pointy and it will burst cells and kill cells. So we don't. We want to avoid that. So what we actually do, we walk the embryo through a couple steps of media that has different concentrations of sugar and cryoprotectant to force the embryo to get rid of all of the fluid that it has, replace that with cryoprotectant media, and then rapidly vitrify it in liquid nitrogen. So that reduces the amount of ice crystal formation and has really, really improved the survivability of embryos in, you know, cryopreservation, in the preservation process. So before, embryos didn't survive that process as well when it was slow freezing. And now, I mean, Most clinics have 98, 99% embryo survival.
It really has improved success, success rates across the board. So it's not as much freezing as it is, you know, cryopreservation, vitrification. We're removing, you know, the ice crystal formation part of it.
[00:20:33] Speaker B: Yeah. So we can't take it and like, put it in our freezer and say it's frozen until we.
[00:20:37] Speaker C: Ready to. Correct.
Correct. There are no freezes.
[00:20:41] Speaker B: I did have somebody ask me that question before.
[00:20:44] Speaker C: It's all liquid nitrogen. So no actual, like, freezers are in place.
[00:20:48] Speaker B: Yeah, no, exactly.
So you mentioned PGT earlier.
Can you break down the different types? Like, there's. I know there's PGT A, there's PGT M, there's pgtsr. Like, how do, how do you know which one to use and what is it and all of the things.
[00:21:08] Speaker C: Absolutely. So PGT stands for pre implantation genetic testing. And like you said, there's AM sr, there's a couple other ones out there now, but the most common is pgta. So pre implantation genetic testing for aneuploidy.
So that is very different from monogenetic disorders, which is M. So when you first go to your clinic, you may be asked if you want to do carrier screening. I did carrier screening when I froze my eggs. It was really interesting.
Carrier screening.
[00:21:38] Speaker B: Talk about you freezing your eggs in a second, but go ahead.
[00:21:41] Speaker C: Yes, we will, we will. I just slip that in there.
Carrier screening tells you whether you or your partner are a carrier for a genetic disease. So that would be something that you and your partner could pass to an embryo. So sickle cell cystic fibrosis, Huntington's disease.
There's a. A bunch of. A bunch of Them now they test for like 500 and something or 800. There's so many now that you can test for. If it comes back that you and your partner are both a carrier for this disorder, that means that your child has a chance of having that genetic disease.
Carriers typically do not show the symptoms, but if both partners have or carriers, excuse me, your child could actually have the symptoms, have the disease. So PGTM pre implantation genetic testing for monogenic disorders allows us to test for those things that you and your partner could pass to your child.
Again, this is fairly uncommon. PGTM is not our most common, but I wanted to start with that one because I feel like it's easier to explain.
PGT A tests for aneuploidy, chromosomal abnormalities that happen during the growth of the embryo, not something that is passed from parent to child. So we're talking about things like down syndrome, trisomy 18, trisomy 13, Klinefelter's sex chromosomes disorder, something that is not passed from parent to child. And our risk increases as we get older for aneuploidy. Aneuploidy. So our bodies are, as we get older, are not as good at separating those chromosomes. So, you know, if you think back to high school biology, those chromosomes come together to make more cells. Then, you know, your body splits them in half. And then the whole process, you know, it replicates it and splits them as you get older. Okay, maybe both of them go to one side or one and a half goes, and this other piece goes.
That's what we are checking for with aneuploidy.
So that's most often for patients who are over the age of 35, have recurrent pregnancy loss, or may have, you know, an other indication of needing that testing. That is the most common. Patients who are not carriers of something do not have to do PGTM because they're not care. They're not. They're looking for something specific with pgtm. With PGT A, they're looking for something that is more, more common and something that you wouldn't know that you would pass to a child unless you test them for it, if that makes sense.
PG SR is pre implantation genetic testing for structural rearrangements. So someone who has a balanced translocation or an inversion, a structural rearrangement in their chromosomes that could cause unbalanced chromosomes in their embryo or child. That's what we would be testing for. With that, you also have to know that you have a transloc or another structural rearrangement before you do that testing. So potentially a patient who has recurrent pregnancy loss, they may do a test called a karyotype, meaning they are looking at your chromosomes to see if they are balanced or unbalanced. And then you would do PGTSR if they were unbalanced. Again, that one's also not very common. PGT A is by far the most common.
That, yeah, that's very, very common.
PGTM I only see a handful of cases.
[00:25:06] Speaker B: Do you, do you think though that the, the whole PGT testing sometimes is over relied on or offered without enough context?
[00:25:17] Speaker C: 100%. 100% I PGT is not a bad test. I want people to know that. But it has limitations and I do think that it's overused. There are things that I wish patients knew before they decided to do pgt and I do think patients should talk to genetic counselor before they decided to pgt because a lot of times they're talking to a genetic counselor after they've already done the testing and they're finding out all of these limitations after they've already, they've already done it. It's too late to be like, well, I wish I hadn't done this. If I had known these things before, I wouldn't have done it again. It's not a bad test. There are times where I do think it's worth doing, but it's not a perfect test. So it's not 100% accurate.
Remember, we are testing the trophectoderm and the trophectoderm. We're taking cells from that part of the embryo. That's the part of the embryo that becomes the placenta. How concordant is that with the part of the embryo that becomes the baby?
We don't know that testing is. There's a couple research papers out there on it.
There can be noise in the testing.
The technician makes a difference on outcomes in terms of pgt.
If the embryologist doesn't get intact cells, maybe the cells are damaged in some way due to either the quality of the embryo or the technique. In terms of embryo biopsy, how they're rinsing those cells, do they get the cells into the tube?
Every PGT testing company has a different platform. Are they using SNP array? Are they using next gen sequencing? What are the difference in those things? Does that matter in terms of your testing? All of those things are not talked about enough and should be talked about before you decide to do that testing. I definite talking to a genetic counselor. They are so, so versed on all of those things. And can give you a good idea of whether the testing is right for you or not.
It's also not cheap. And we have seen instances where mosaic embryos or potentially abnormal embryos make babies.
Yeah. The other thing is it does not guarantee you a healthy baby.
Just because the embryo is, you know, PGT normal does not mean that you will guarantee the health of your child.
There's a lot of things and PGT doesn't test for everything. So you can have, you know, the, A very common question I get about PGT is I had a PGT normal embryo. It was a 4AA. It was a great quality embryo. You know, the genetic testing was normal, but I still had a miscarriage or I still didn't get pregnant. Why, like I thought that was. I did everything I could do. PGTA is testing for large chromosomal abnormalities. Something else could have been happening on a, on a, on a gene level that, that PGTA cannot test for is testing for large chunks, not small individual genes. So it, there are a lot of things that I think patients should take into consideration. And that's a conversation to have with a genetic counselor. For sure.
[00:28:14] Speaker B: Yeah. And I, and I'm glad you're sharing all of this because we get a lot of times where with our surrogates will say, well, I only want to work with an intended parent that has tested embryos.
And I think it's just because it's something that's now been, you know, in the space and everybody is talking about it. So everybody is just going to assume that, you know, tested embryos is guaranteed or close to guaranteed. And so therefore it has to work.
[00:28:46] Speaker C: Yeah, yeah. And that's definitely not always the case.
[00:28:50] Speaker A: Yeah.
[00:28:51] Speaker B: And, and you know, and I'm curious too about, because you talked about mosaic embryos.
Like what about scenarios where someone ends up with only low grade embryos or mosaic embryos? I mean, how should they think about, you know, their next steps?
[00:29:09] Speaker C: I always recommend, again, a genetic counselor.
As much as I know about PGT, they know 10 times more. They know they can give you specifics. So a lot of times when you have a mosaic embryo, it will tell you it's mosaic in this specific chromosome.
I don't know enough about genetics to know what that impact could be.
It's also, you know, can depend on the platform. So there are some who say that one platform is better, you know, SNP versus next gen sequencing in terms of mosaic embryos. And they can tell you whether the mosaicism is true mosaicism or whether it's noise due to the testing platform. There's so many little things that I don't understand about PGT that a genetic counselor does, and that is the person you should be talking to about those things.
You know, is this something safe for trans. For, you know, if. The other thing I like to tell people is, you know, what is your ultimate family vision? If you've got one low mosaic embryo and you want three kids, you're probably going to do another egg retrieval anyway.
Or, you know, if you've only got the one and you only want one, hey, you know, maybe this is a conversation of, do I go ahead and do this one before I consider another embryo or egg retrieval, or do I go into another egg retrieval? You know, all of those things are important, important to talk about with the genetic counselor and with your physician, because I think sometimes you're so in the thick of it that you can forget the big picture. Like, what is my ultimate vision here? Is this getting me closer to that vision or not? Because if it's not, then maybe I need to step back a little bit and think of the bigger picture and consider other things.
I think, you know, every patient is different. It's just important to have people on your care team that can help guide you closer to your goal at the end of the day. And so I think that's a time where you really rely on all the members of your care team to help you make that decision.
[00:31:11] Speaker B: Yeah, for sure. For sure. So I want to flip this a little bit. Kind of talk about your personal story a little. And we had talked about you going through and freezing some eggs. Did you freeze eggs or embryos?
[00:31:28] Speaker C: I froze eggs. And I think people were a little surprised about that because I am happily married.
And so people were like, why didn't you make embryos with your husband? And I'm like, I wanted to preserve my fertility, not our fertility. I think that is a different conversation.
I also. There's a whole video on it if you want to check it out. Because people were, I think, understandably surprised. But I. There was a lot. There was. I thought about it a lot before we decided on eggs.
One thing was expense. It's way more expensive to make embryos. You have to make a lot more decisions. Do we want to do icsi, do we want to do pgt, you know, all of these things. But I think the overarching thing for me was I don't know if I want to have children.
And if we do decide to have children, you know, we would go the spontaneous pregnancy route first, and then Move to frozen eggs or ivf, if that was something that we wanted to do. And so I didn't want to have embryos frozen that I may never use, especially in the political climate we're in now. I may not have the same control over those embryos now as I do I could potentially have in the future. And so I was like, I don't want to risk that. I think the other thing that people don't like to talk about, but I see all the time in the lab, because I'm the one who looks at those consents on what happens if you die. What happens if this. What happens is that I. I do that stuff all day. And the amount of couples that get divorced and they're fighting over their embryos, and this is this person's only chance. They're. They're too old now to have. To. Have to do another cycle to create other embryos. And this is their only chance at a biological child. And their partner says, no, you're not allowed to use them. I. Absolutely not. This was my. I want to preserve my chance. Chance. My chance.
Preserving our chance together is just a completely different conversation to me. And I had, after I posted that video, the amount of people who reached out to me that were like, I'm in court right now fighting to use these embryos, and I was not gonna do all that. I was not gonna do all that if this is my only shot. I don't want that taken away from somebody else, you know, by somebody else. I just. I wasn't willing to do that.
[00:33:40] Speaker B: Wow. Yeah. That is. That is an agreement. A amazing point to. To definitely think about. So.
Yeah, that. That is.
[00:33:48] Speaker C: It was a lot.
[00:33:50] Speaker B: Yeah, for sure. No, that. I mean, that is a perfect.
Perfect information to be sharing because the majority of people don't think about it, you know, especially when you're married, you think, like, everything is hunky dory and it's all wonderful until it's not. So.
[00:34:03] Speaker C: Exactly. Same thing with the prenup, you know. Yeah. Prenups for a reason.
[00:34:07] Speaker B: Yeah, yeah, yeah, yeah. And I mean, and obviously, you know, you clearly, you froze your eggs. Did you do anything to help improve your egg quality? And, you know, before doing the retrieval, did you do anything, you know, did you take vitamins? You know, you seeing all these supplements and all these things about, take this because it's going to improve your egg quality. Or, you know, go here, because you do this, and it's going to improve your egg quality. Exercise is going to improve your egg quality. Like, did you do any of that, especially from a lab perspective.
[00:34:45] Speaker C: So I did try to improve my lifestyle and I did add supplements. Now, I always like to preface this with, like, egg quality is complex and you are born with all the eggs you're ever going to have.
So where does that quality start? Is it when you're literally in your mom's uterus because that's when they're being developed? Or, you know, does it start early on as soon as you're born? Like, at what point is it you even make a change? And so I do think there's a lot of pressure put on people to improve egg quality. By no means. I'm not saying that it's not worth reducing toxins and exercising regularly and eating well and overall trying to improve your lifestyle, stopping smoking, all of those things, because an improved lifestyle is good all around. It's going to improve things. Right. But there's only. We can only improve things to some extent.
And I really don't want patients, because patients that are trying to conceive are already very vulnerable. I don't like them being taken advantage of when it comes to buy this supplement, drink this detox tea and all of that bullshit.
So I am very much like, do what you can do. Let's not put pressure on yourself. If you want a slice of pizza and a glass of wine on a Friday, it is not going to, you know, put it down the drain. It's just not. It's not going to tank your entire cycle. So, yes, I did try to improve things. I cut back on alcohol, which was something I wanted to do anyway. I did add supplements. There is some research to things like CoQ10 and vitamin D and some of the other ones. But if someone's trying to sell you a magic pill, it's not happening. There's no magic pill. There is no magic pill. And so I think there's a. You can have a healthy amount without feeling this weight of having to be perfect about everything, because that's unrealistic.
[00:36:40] Speaker B: And, and like you said, it is literally, truly about you. Just the lifestyle and all of the things that you have going on. And I mean, and if you already have low ovarian reserve, yeah, there's probably some things that you can do, but you taking supplements and standing upside down and, you know, and all of the things that I have seen and some of the nonsense that I have seen on social media, I'm just like, oh, God, why? No, no, yeah, just don't.
[00:37:09] Speaker C: And I think it's so predatory when, when people do I mean, look, I take my vitamins and I took my vitamins, but like it's, it starts to get icky. You know, I've seen the ads, I've seen the other stuff and you know, at some point it's like you're, you know, you're preying on people who are, who are vulnerable and, and I don't, I don't love that. But yeah, starting with the healthy lifestyle, I think it's obviously you're never going to be able to out supplement you drinking a bottle of wine a day.
So let's start there. And we can add in some other stuff too.
[00:37:41] Speaker B: And we talk a lot about eggs, but what about sperm? I mean, they obviously men don't have to go through nearly as much as women have to. But there's something to be said too about sperm quality, quantity, all of the things, and lifestyle factors too, 100%.
[00:38:01] Speaker C: And I think there is more room for improvement in sperm because sperm, you're not born with, all the sperm you're ever going to have, it generates every, you know, 75 days or so.
So that means if you are, you know, improving your lifestyle, you can see improvements in sperm quality and, you know, sperm health, all of those things.
Again, it starts with lifestyle.
And we usually tell people to give it three months because it takes that long for the sperm to improve, to go from stem cell immature sperm to, you know, mature swimming sperm.
So it, I always tell people, if y' all are making changes, if you are making changes, your partner should be making changes too. Let's cut back on smoking and vaping. You know, smoking weed, any other recreational drugs, alcohol, even things like excessive cycling or excessive running, like, you know, anything to an unhealthy amount is not going to be good. Let's both eat a little bit better. Let's both exercise regularly. Let's, you know, reduce, you know, the toxins around. I think that's a big one that people forget about like the candles and the laundry detergent and all of that sort of stuff. I think it's great to do it as a couple. This is a two person thing. Infertility impacts affects both people often. And so let's do this together. We're going to be raising this child together. Let's, let's prepare ourselves together. This is something we're doing together.
I'm big on that. It's a two person, it's a two person thing here.
[00:39:33] Speaker B: Yep. Yeah, for sure.
You mentioned Ixi, so.
And I know that there's a lot of people that have no idea what ICSI actually is.
When it's necessary. Can you kind of mention and give more detail on what it is? When is it necessarily necessary? And are there cases where ICSI should be used, not be used? Like, what is your thoughts?
[00:40:05] Speaker C: I have a lot of thoughts.
ICSI stands for intracytoplasmic sperm injection. It is a newer technique. I mean, it's probably been used for the last 20 years or so, but in comparison to all of IVF, it's, you know, it's newer. It is when we inject one sperm into the egg as opposed to culturing the egg in a drop of sperm.
It was really developed for patient with, patients with male factor infertility. So patients who have low sperm concentration, poor motility.
It. I do again, think it's something that is overused.
I think patients like the peace of mind of knowing that the sperm is getting into the egg. With conventional or traditional insemination, we can't guarantee that we put them like, with each other, but we, the sperm still has to get through cells and into the egg. But when we look at the research, we see similar success rates. And so, you know, it is one of those things where practices probably make a little more money on it and so they may push it for either, you know, efficiency purposes in their lab or for monetary purposes. I'm not saying it's a bad, a bad procedure. Again, it's still, I do it a lot, it's very common.
But I think when you look at other countries, we do IXI more than anybody else. Our healthcare system is also very different than other people, than other countries. So when you look at like Europe and, and the UK and places that have government funding for this sort of treatment, they don't pay for things that aren't medically necessary because the government's paying for it. So they're like, if you don't have an indication for needing this, we're not going to pay for it. Versus here. It's very different because it's, it's still very much out of pocket for a lot of patients. And so they're like, we're gonna do it all.
Now. The risk of not doing ICSI is failed fertilization. That's what people talk about. They're like, well, with conventional insemination, yeah, sperm can look good, egg can look good, but we still, you know, there still can be failed fertilization because sperm has to have all the right mechanisms, they have to bind correctly and all of these things.
But again, the research shows the chance of fail Fertilization is fairly low. The amount that the, the, you know, the chance of it, of, of conventional insemination not working is uncommon. And so even clinics that do conventional insemination, a lot of them will do splits. So you'll have 20 eggs, 10 of them get conventional insemination and 10 of them get ICSI.
I don't know, it's.
Look, I enjoy doing ICSI. It's one of my favorite procedures like to do as an embryologist. I think it's so fun. It's like a, you know, it sounds weird, but it's kind of like a video game. You have to have a lot of skill to catch the sperm and do the whole thing. So I enjoy doing it as a procedure, but I do think we start to drift into, well, this is what's easiest for the lab, so let's do that. Or, you know, it's easier to just tell the patient, this is what we do.
So it's something to talk about with your doctor. Is this something that you guys offer?
Why do you think this is better for me?
Let's take a deep dive into the research because it shows very similar success rates. And if it saves a patient money, you know, sometimes I lean towards, let's.
[00:43:28] Speaker B: Save some money for the patient, for sure. I mean, is there like some, is there risks or trade off? Patients should be aware of when, you know, ICSI is used routinely because you said you guys do a split sometimes. And when you do a split in 10 and 10, do you see similar outcomes?
[00:43:47] Speaker C: We do see similar outcomes.
I have to look back at the research anecdotally, which again, is not research. This is just what I see in the lab. That doesn't necessarily mean that that's what people see across the board.
Sometimes I see slightly better blast development with conventional insemination compared to icsi. There are risks with everything that we do. So there's a risk that with conventional there's no fertilization. There's a risk with ICSI that we have no fertilization. There's a risk with ICSI that we damage eggs in the process. We kill eggs because they're fragile. They're really too fragile for icsi, and conventional would be better. So it's kind of about weighing the risks versus the reward versus the pocketbook.
And I think a lot of people go ICSI because that's just what their clinic does.
But I do think it's something that is not needed as often as we do it Now. There is some I'd have to look in General IVF babies have slightly higher rates of, like, birth defects, childhood cancers, and a couple other things. Now I'm talking slightly higher. Like, I'm not talking about IVF. Babies have like, 20% higher chance. That's not. That's not what I'm saying. But when you look at the research, it is slightly higher. And there's a reason that once you're pregnant after ivf, it's considered a higher risk pregnancy because we do see slightly higher instances, even if it's 1%. I mean, that's a subset of people that are having those things. And so all those things are important to keep in mind. I don't know if it's different between ICSI or conventional. I'd have to look into that.
But I think all those things are important to talk about with your doctor if you have concerns about one or the other, like, give me the info. I want to learn more.
Come with those questions and let's have a conversation about it. For sure.
[00:45:39] Speaker B: Yeah. And don't just assume this is exactly what it needs to be, because this is what the doctor said.
[00:45:45] Speaker C: Exactly. Like I said, some clinics are like, we just do this because it's easier. And I'm like, that doesn't seem.
I get it to an extent because, look, I'm in the lab. So when things are easier for me, I'm like, okay, this is nice. But I'm also like, to what extent do you allow that personalized care? So some clinics are more willing to do. To make exceptions or tweak things for specific patients, and some are not. So you have to take that into consideration. What, what with whatever clinic you're going to.
[00:46:13] Speaker B: Yeah, definitely.
So now let's talk about what happens when either egg, sperm, embryos, whatever, and they need to be shipped, you know, whether it's to. From a clinic in the same city to a different state or even a country. Like, how do they typically get handled? You know, like, what's the safeguards that are in place? And I mean, obviously we've worked with intended parents that have shipped their embryos different places, even from outside of the country. And people talk about, well, we need to know what the medium or the media is, and we need to know what the vitrification process was and blah, blah, blah. So, you know, when we get people all the time, they're like, well, I.
[00:46:56] Speaker A: Don'T want to ship my embryos because.
[00:46:57] Speaker B: What happens if it gets damaged? And, you know, then I'm. Then it's. I'm lost and, you know, whatever. So what is your thoughts.
[00:47:06] Speaker C: So I think it's kind of two different things. So the part about the actual shipping part.
Embryos are in eggs and sperm are stored in liquid nitrogen, dewar, maybe three feet tall, you know, just big enough to, like, hug sort of thing.
And they're filled with liquid nitrogen. When we ship eggs, embryo, sperm, they're actually shipped in a smaller version of that same tank. We cannot ship through FedEx or UPS in actual liquid nitrogen. So it shipped on liquid nitrogen vapor. So once you add liquid nitrogen to a tank, it holds what's called a charge. So it holds that temperature and those liquid nitrogen vapors for a certain amount of time. Usually it's 15 days.
So everything is loaded into that mini version of the same tank that it's stored in and then shipped overnight. So the chances of something happening between then are very low.
I do think there's so many more options in terms of shipping now than there used to be. So you can get insurance for your tanks. You can split up your tank. So if you have 10 embryos, you can send five on Thursday and five on Friday. Like, just in case they're, you know, they're not all in the same tank. If something were to happen, you can get monitoring in the tank. So most Companies now have 24,7 monitoring. Like, if you use CryoPort or Cryo Future 1, there's so many now someone is monitoring those tanks at all times, and they know exactly where they are. They know the temperatures at all times. Some, I think, even have cameras, which I'm like, there's nothing really exciting to see. But they could, you know, they could see if there was something they, you know, needed to look at. And so shipping has gotten so much safer. I mean, things do happen. With everything we do, there is a risk. With every single thing we do, there is a risk from egg retrieval to stripping eggs. I mean, it's all a risk. Our goal is to minimize that risk as much as possible. And I think the shipping companies have done a really good job of doing that. There's options to either send them via FedEx or UPS or have a medical courier take them. So there's lots of different options out there. Whatever makes you feel the safest when it comes to you talking about, like, oh, we need to know what media it's in or device or whatever. That's more for the embryologist who's receiving the samples. So we have to review all of that paperwork before it comes in. Because there's so many different devices and media that the embryos can be frozen in and on. And so we want to make sure we're comfortable with the device. We have the media that's needed. So we either need to order that media, we may need to do remedial training to make sure we are familiar with the device.
Because you don't want to ship us stuff that we don't know how to use that is a risk. Risk for you. We don't want to accept stuff that, that we don't know how to use and then damage something or lose something or, you know, you know, mess up your cycle. And so we ask for all that information beforehand to make sure that we're comfortable with everything before we accept them. You know, you don't want to get here today or transfer. And we're like, well, we don't really know what we're doing, you know, and all protocols are different, all the media is different. And so we review all of that beforehand. I actually have straws here. So if you're watching and not just listening, this is what we freeze. This is one of the devices that we freeze embryos on. It's a tiny, it's called a straw. I'll do the 2016 makeup hand and that little black tip at the end, that's typically where the embryo or eggs are frozen. And so all these are different. Like this one is super bendy. It has this really long cap on it versus other ones.
I broke this one. But this is, you know, something different. There's, there's half a dozen of these that are different. And so we just want to know what they are because they're all different. You know, you want to be prepared when, when, you know, you get stuff shipped in. So that's really the reason why we ask for that information beforehand is so we can be prepared when the embryos come in.
[00:51:12] Speaker B: So now what about the whole storage, like long, you know, obviously you have, have frozen eggs now people freeze egg, sperm, embryos.
And when it comes to long term storage, you know, how do clinics manage storage, tracking and preservation over time? And all of the things like how do people know like my embryos are going to, or my eggs are going to be safe or my sperm is going to be safe sitting in this whatever.
[00:51:44] Speaker C: So that has been, I think, a pain point for a lot of clinics because when they, when this started, we couldn't freeze as much stuff. So we didn't get as many embryos. We couldn't freeze them as well. And so we didn't have every patient having stuff in storage. It wasn't as big of a problem. We have more patients coming through, we're able to freeze things better. Patients get more embryos. And so storage started to become a really big problem for a lot of clinics. There are a lot of. But that also, you know, brought technology and innovation, which is exciting.
So the first thing I like to point out, because this was such a big misconception when I was freezing my eggs, because other countries do it differently. Eggs and embryos and sperm can be stored forever. They are good in liquid nitrogen, essentially forever. As long as all the tanks are managed properly, there's no tornado that comes and messes things up. They can be stored forever and they should be able to be thawed and be just fine.
What we do, there's a couple different things you can do.
It is a requirement now through accreditation, you know, accrediting bodies, cap, joint commission, ASRM guidelines, whatever, that you have some sort of tank management system in terms of alarms, all those sorts of things. We don't hear about tank failures like we used to. I remember when I first started in the field, my lab director was an expert witness in a tank failure case because he was very familiar with how the tanks worked and they called him in to talk about how the tanks work. We don't really hear that stuff anymore. And that's because we, there were so many that we had to crack down on that and put in regulations.
So tanks have to be measured. Like you can either put in a yardstick and measure the physical level of liquid nitrogen a few times a week. We fill them a certain amount of times a week. They all have monitors on them, either level based monitors. So if the liquid nitrogen level gets below a certain amount in alarms, the temperature gets above a certain amount in alarms or the weight gets below a certain amount, meaning that there's less liquid nitrogen in it and it alarms.
Tank management has become very, very streamlined compared to what it used to be.
And many clinics are deciding to store patient samples off site site. Because I have been places that have 55 tanks, 60 tanks, and these take all day to fill and manage an inventory. And so a lot of companies have said, send your stuff here. This is all we do. All we do is is manage patient samples and make sure everything is safe. And so a lot of clinics are like, this is so much work for us. We are going to send this to someone who, this is their entire job to manage to manage cryopreserve specimens.
And so that has, has solved a lot of issues for people. And it's very, very uncommon to have tank, tank failure issues now with all of the technology that's come out.
[00:54:37] Speaker B: But what about these families that have created these embryos? And they are just sitting there for years and years and years and years and years and nobody, just, nobody comes to get them.
[00:54:48] Speaker C: So a lot of clinics do now have abandoned like what they call like abandoned embryo policies.
So when you sign your IVF consensus, there's usually something in there about storage. So it's like if we don't hear from you, if you don't pay storage with X within X amount of years and we've sent X number of communications, certified mail, all of these things, then this is what will happen to your embryos. ASRM has guidelines on that as well.
Because that is a big problem is what they call quote unquote abandoned embryos. Patients don't come back for them or something has happened or, you know, we can't get in contact with them for some reason. We have to have some sort of policy in place.
And so look at that. If you're, if you're doing ivf, there's, there is likely some sort of policy in the consents that you have signed about, you know, quote unquote abandoned embryos. If you change addresses, you need to be telling your clinic where you are at. I mean, most communication is done, you know, over email or portal or something now. But we still send certified letters at some point. If we can't get in contact you, we have to send certified mail saying that we tried to reach out to you and we have to document all those things before we can do anything with those embryos. So that does. That does still happen often.
[00:56:04] Speaker B: Yeah.
Are there like common misunderstandings or concerns you hear from patients about shipping or storage? That is just like, no, that's not quite right.
[00:56:18] Speaker C: I think the biggest one is that they're going to like expire.
A lot of people be like, well, what are you going to do with your eggs after 10 years? And I'm like, they'll still be in storage. So I, I realized that that's, that, that the frozen eggs are only good for 10 years thing came from other countries will only allow you to store with them for 10 years. That's very different than them being good for 10 years. They just say after 10 years you can't store with us anymore. But like that's not the case here. You can store here forever. They're going to be good forever.
That was like a storage policy in another country and that like kind of leaked over here. And I was like, where Are people getting that? They are good forever. They can stay in storage forever. Like, if I wanted to keep my eggs frozen for 50 years, I could.
So I think that's the biggest misconception that I hear.
Shipping people just get nervous about shipping, which is so fair. I understand that for sure.
I think the risk, again, the risk is, is low for that.
And I think understanding how shipment works is, is important. If that's something that you're concerned about, ask the shipping company. Who, who handles this? Is it a courier? Is it FedEx? You know, who, what. How do you guys monitor your tanks? Does someone monitor them? You know, ask those questions because they should have an answer for you.
[00:57:36] Speaker B: Yeah, yeah, no, for sure. I mean, and, and probably moving to the end, you're talking about embryos and eggs and all of that. But let's say we now have this baby.
You know, another question that we get is about cord blood preservation, you know, especially during people thinking about it while they're fertility planning and, and, but not everyone understands what it is. I mean, and I know that this is not necessarily your expertise, but is there where you can explain the basics of what it's being preserved and why does it matter? Is it needed?
[00:58:17] Speaker C: Absolutely. So cord blood is the blood that is in the umbilical cord after birth. You can also typically preserve tissue as well.
And it has a lot of stem cells. And so people will freeze them in case their child or them or sibling needs some sort of stem cell treatment in the future. So there's a lot of research that goes on with different types of diseases.
You know, sickle cell is a really common one for stem cell treatment, different cancers and other diseases.
You can go back to those frozen cells and blood and use that for different sorts of stem cell treatment. And so that's why people consider freezing cord blood and core tissue is for potential use in the future for patients who are of mixed race or minorities. It is very difficult to find stem cell matches from like a donor, you know, like you're donating, you know, similar to like someone donating a kidney or something like that.
It is very difficult to find matches for, for minorities and for mixed race people. And so a lot of people have turned to, well, I'm gonna freeze stem cells, you know, my, my child's stem cells for them or for me or for their sibling in the future if, if for some reason they needed something for treatment. So it's, it's kind of an up and coming science in terms of stem cell research.
But I, there have been a lot of, of. Of great, you know, discoveries and innovation that have come from stem cell research. I know they like, cured someone of hiv, like not that long ago with stem cell stem cells. So it, you know, there's a lot of research coming on that, on that side of things.
[01:00:02] Speaker B: Is it, is it expensive?
[01:00:05] Speaker C: I think it ends up being more about storage. So it's. I would think of it like you're storing your embryos, so you're paying a storage fee. You know, there's an upfront cost to, you know, preserve the cells and the tissue and then you're paying storage on it. So similar to your embryos, you're paying an upfront fee to create the embryos and then you're paying yearly to pay, you know, for that storage. A lot of the sperm banks and egg banks offer that for, for free or discounted price. They are, they've partnered with like a cord banking company and you can get either discounted cord blood banking or storage because you use their sperm donor or egg donor. So if you're someone who's using like third party gametes or, you know, donor gametes, I would look into that because a lot of them have partnered with, with those companies and you may be able to get it for free or reduce price, if that's something that you're interested in.
[01:00:59] Speaker B: Yeah. Yeah, that is great to know. Well, Elise, I mean, thank you for being here, obviously, and I appreciate, you know, the way that you've broken things down and made.
It's so much easier to understand.
Is there kind of like things that, as people are listening or thinking about it or whatever that, that you want them to know that we didn't really touch on or that we touched on and you just want to kind of reiterate.
[01:01:30] Speaker C: I guess the biggest. One of the, one of the things for me is think about your lab. When you're choosing a clinic.
So much of the, the, the money that you're spending is on the lab. And the lab has a huge impact on your success.
So take that into consideration. Ask questions about the lab. I have a whole free guide on my website on it that breaks down. These are some things you should think about. A lot of people think, okay, this clinic's just the closest to me, or it's the one that takes my insurance. I'm just gonna go there or I'm gonna research this doctor. I want to make sure I go to the specific doctor. You need a solid physician and a solid lab.
It makes a difference. It 100% makes a difference. So don't Forget about the lab. I know I'm super biased as being an embryologist, but I've seen it firsthand that I'm like, you have to take in consideration the lab. If you're someone who wants to freeze eggs. Eggs. And your lab freezes eggs twice a year, you may want to choose a different lab. Choose a lab that, that works with someone like you all the time, does the procedures that you're wanting all the time.
Look at those things. Look at how well they're staffed.
There's a whole bunch of stuff you should consider, but take that into consideration when you are choosing your clinic, because it's important you have a choice in where you get your care.
[01:02:48] Speaker B: Absolutely. So when. Where should folks, you know who want to keep learning from you or follow the work you're doing? Where's the best place for them to find you?
[01:02:58] Speaker C: Yeah, you can find me on Instagram at Alessandriologist TikTok as well. I am. I do respond to DMs. I am not a provider and will not give you medical advice.
I will also not grade your embryos. I get that question a lot. It's very difficult to do from a picture. But if you guys have questions or just want to say hello or want some support, I do answer DMs and love to hear your stories. It's been fun talking to people over DMS that I've been talking to for years, and they send me pictures of their babies and I'm like, oh, my gosh, that is crazy that you like. I followed this journey of yours through Instagram. I mean, it's wild. So those. Don't hesitate to reach out. I'm super friendly, I promise.
And yeah, those are the. Those are the places you can find me.
[01:03:40] Speaker B: And we'll make sure too, that we link all of it into the show notes so that, you know, they can easily find it with no problem.
[01:03:46] Speaker C: Perfect.
[01:03:47] Speaker A: Well, thank you so much for joining me.
[01:03:48] Speaker B: I really appreciate it. It was an amazing conversation.
And I, I also, I mean, even after all these years, like I say, you. You always are learning something. You have to in this space.
[01:03:59] Speaker C: Oh, yeah. I feel the same way. I still feel like there's so much for me to learn. So thank you so much for having me. I really appreciate it was such a fun time.
[01:04:07] Speaker B: Well, thank you.
[01:04:08] Speaker A: And to everyone listening, thank you for joining me today on Fertility Cafe. If you found this episode helpful, please subscribe, rate and share with someone who might benefit. And remember, remember, love has no limits. Neither should parenthood.
