Trascrizione completa di AI + IVF = Embryo Predict with Dr. Eduardo Hariton

want to make sure that it's not inferior, and it looked like it was better than the than the embryology. 00:06:00.199 --> 00:06:01.720 So about 5% better. 00:06:01.959 --> 00:06:05.800 People that were older had a bigger difference, so more improvement. 00:06:05.959 --> 00:06:09.959 People who were not doing genetic testing also had more improvement. 00:06:10.120 --> 00:06:12.040 So it was a really reassuring thing. 00:06:12.360 --> 00:06:22.120 We looked at our internal data, we saw that you know, with a lot more embryos, we were seeing the ones that AI would recommend were also looking like they had higher implantation rates. 00:06:22.279 --> 00:06:26.680 So we got very comfortable with saying, well, we want to be at the forefront of technology. 00:06:26.839 --> 00:06:32.680 Let's bring this technology as an option for our patients who want to use that to select that first embryo. 00:06:32.759 --> 00:06:38.199 So now we're the first clinic in the United States that's able to offer that to our patients, and we're very excited about it. 00:06:38.439 --> 00:06:39.079 That's amazing. 00:06:39.160 --> 00:06:39.720 That's amazing. 00:06:39.800 --> 00:06:48.920 And I think I heard you say that that the one of the cohorts that seemed to do better with the AI predict, the embryo predict, was the older patient. 00:06:49.079 --> 00:06:50.279 Did I hear that correctly? 00:06:50.680 --> 00:06:51.319 That's correct. 00:06:51.399 --> 00:06:56.040 And we see more variability in older embryos, you know, because there's different gradings. 00:06:56.199 --> 00:07:03.720 The other thing that we see, same thing when you don't have genetic testing, you're picking from some that are normal and some are normal, you just don't know. 00:07:03.879 --> 00:07:09.560 So the more variability there is, usually the more impact there is of introducing a different way of deciding. 00:07:09.639 --> 00:07:13.800 So not unexpected, but definitely, you know, a group of patients that we want to help. 00:07:14.040 --> 00:07:14.360 Yeah. 00:07:14.600 --> 00:07:24.279 It's been my observation on my side of working with with the the uh reproductive uh endocrinologists is that most are doing genetic testing. 00:07:24.439 --> 00:07:31.399 Um would would it what percentage would you say in in this clinical study chose not to do uh genetic testing? 00:07:31.879 --> 00:07:35.959 Was it and you don't need to give me numbers, but was it a large percentage, a small percentage? 00:07:36.360 --> 00:07:37.800 You I'd say it's a minority. 00:07:37.879 --> 00:07:43.959 Obviously, that changes by you know where in the country we practice, insurance coverage, patient preference. 00:07:44.120 --> 00:07:54.839 I'd say most patients in the United States who are 37 years of older now typically lean towards doing that genetic testing, but there are clinics that are 90 or 100% genetic testing. 00:07:54.920 --> 00:07:58.680 There's some that are probably closer to like 30 to 50 percent. 00:07:58.920 --> 00:08:10.439 But you're correct, the the benefit of the genetic testing tends to be larger as the patient ages because you're helping select from a larger population of embryos that are going to be abnormal. 00:08:10.680 --> 00:08:21.000 So screening out those abnormal embryos matters more when you're screening out 70, 80 percent rather than 30 or 40 percent, like you might when they're younger. 00:08:21.240 --> 00:08:22.040 Right, right. 00:08:22.199 --> 00:08:28.839 And I don't know, I might be asking a question that is not answerable in a podcast, but what does the AI do? 00:08:29.000 --> 00:08:32.120 How does the uh embryo predict predict? 00:08:32.600 --> 00:08:33.720 You know, that's a good question. 00:08:33.879 --> 00:08:37.160 And this is one that we call like the black box problem of AI. 00:08:37.319 --> 00:08:43.720 So there's like, you know, tens of thousands, hundreds of thousands, sometimes millions of pixels in an image. 00:08:43.879 --> 00:08:46.600 And what the AI does is that it learns to recognize. 00:08:46.680 --> 00:08:49.639 So it's been trained on thousands of images of embryos. 00:08:49.799 --> 00:09:00.279 So we give them an image of an embryo and we say this one led to a baby, this one did not lead to a baby, this one did not lead to a baby, these three did, and it starts to see patterns and associations. 00:09:00.360 --> 00:09:07.000 So when it gets a new image, it says, Well, does this one look more like the ones that led to a baby or the ones that did not? 00:09:07.240 --> 00:09:12.839 We can't exactly say this is what it is about this embryo that makes me think that it's better. 00:09:13.000 --> 00:09:22.120 We often don't get an explanation, but you know, we have to test it and be very honest about how we collect that data to make sure that we know that. 00:09:22.360 --> 00:09:25.960 So, from our perspective, we don't have the perfect answer. 00:09:26.120 --> 00:09:37.399 We can't say to the patient, I'm picking this one because the AI said this and that, but we can say the AI gives us a score between zero and one, and higher scores are associated with higher pregnancy rates. 00:09:37.559 --> 00:09:40.039 So we would go for a score that's higher. 00:09:40.200 --> 00:09:47.160 And you know, we always worry about you know the AI going rogue, and we do have safeguards in place, right? 00:09:47.240 --> 00:09:52.120 So we know we don't want embryo, we don't want hallucinations with embryo prediction. 00:09:52.519 --> 00:09:53.079 Exactly. 00:09:53.319 --> 00:10:01.799 So you know, the good thing is it's a well-validated tested product, but still we have a protocol where we don't just say let's trust the AI, close our eyes and go for it. 00:10:01.960 --> 00:10:11.559 We say, well, in our data, we have you know what each embryo score, what the predicted value is internally for our embryologist grading. 00:10:11.720 --> 00:10:21.159 And sometimes, you know, we might have an embryo that's a day five AA, and then we have a

day seven BB, and we would expect those embryos to be meaningfully different. 00:10:21.240 --> 00:10:27.000 So that one might be like 65 or 70 percent chance of success, whereas the other one might be 40. 00:10:27.240 --> 00:10:34.600 If the AI tells me that I should go for a BB 7 embryo, day seven embryo, I will say, you know, I'm not sure about that. 00:10:34.759 --> 00:10:41.000 I'm still gonna trust our own clinical judgment, our data, our experience, and we'll go for what we know works really well. 00:10:41.159 --> 00:10:47.559 But when those numbers are pretty close to each other, like they are for most patients, that AI can give us an extra lens. 00:10:47.720 --> 00:10:51.000 So we never say like the AI is picking your embryo. 00:10:51.159 --> 00:10:58.519 We tell our patients we're picking your embryo, but now we have another tool to help support that decision and bring a little bit more evidence. 00:10:59.240 --> 00:10:59.480 Got it. 00:10:59.559 --> 00:11:03.720 So I think I want to repeat so that the viewing and listening audience can really hear this. 00:11:04.039 --> 00:11:09.399 AI is not solely predicting the embryo that will be transferred. 00:11:09.559 --> 00:11:14.039 The embryologist still has a significant role to play in the process. 00:11:14.279 --> 00:11:26.200 And AI is an additive, if I may, if I may, if that's an accurate statement, to to kind of give an additional level of assurance that this is the better of the two embryos to transfer. 00:11:26.600 --> 00:11:27.080 That's right. 00:11:27.159 --> 00:11:40.519 And we call it AI assisted embryo selection, not just AI embryo selection, because it's helping me as the physician, my embryologist as the expert looking under the microscope, and then we add that layer of AI to assist in that decision. 00:11:41.639 --> 00:11:51.559 And at RSC, Reproductive Sciences Center, how how many of your patients have gone through this AI assist process since you brought it on board? 00:11:52.200 --> 00:11:54.919 Well, you know, I don't know the exact number. 00:11:55.080 --> 00:12:04.200 We just launched it about a month ago, and you know, I've had this conversation with, you know, probably like 20 to 50 patients. 00:12:04.440 --> 00:12:07.720 I'd say the great majority are very excited about it. 00:12:07.799 --> 00:12:11.399 You know, some people already have the scores, we're transferring those embryos. 00:12:11.559 --> 00:12:17.320 You know, I'd say a couple have said, you know, I only have one, so it doesn't really help us if we have a limited amount. 00:12:17.480 --> 00:12:20.279 So there's a group of people where it might not make a difference. 00:12:20.600 --> 00:12:28.519 Um, but certainly the ones that are trying to select across multiple embryos, uh, the majority of them have been very excited and want to have that information. 00:12:28.840 --> 00:12:29.399 That's wonderful. 00:12:29.480 --> 00:12:35.000 Yes, and of course, we're in the San Francisco Bay Area, so this this actually has it comes as no surprise, right? 00:12:35.080 --> 00:12:39.799 We are very uh AI um uh affectionate, if you will, right? 00:12:40.279 --> 00:12:42.840 So, and then back to the clinical study. 00:12:43.080 --> 00:12:58.200 Uh what I don't know if I can ask the question accurately, but what was the the degree or the percentage the uh of of success in selecting the right um embryo versus a control group? 00:12:58.360 --> 00:13:00.279 Does that did I ask that question properly? 00:13:00.840 --> 00:13:15.000 I would say we're seeing about a 5% increase in the chance of having a pregnancy or baby uh based on using DAI or the average patient, including PGT, non-PGT, older, younger. 00:13:15.240 --> 00:13:15.399 Yeah. 00:13:15.559 --> 00:13:19.320 And this went all the way through to live birth, or was it a positive pregnancy test? 00:13:19.399 --> 00:13:21.559 What was the what was the uh testing criteria? 00:13:21.879 --> 00:13:23.879 The endpoint for the study was live birth. 00:13:24.200 --> 00:13:29.399 But again, just to clarify, the study was not powered to measure superiority. 00:13:29.639 --> 00:13:33.879 So the study is, you know, that's how the FDA studies are usually done. 00:13:34.039 --> 00:13:38.200 It is too big of a cohort that we need to met to get superiority. 00:13:38.360 --> 00:13:42.840 So the the study was like, is one you know better worms than the other? 00:13:43.000 --> 00:13:44.120 They're not inferior. 00:13:44.279 --> 00:13:47.879 So it makes you feel good about the safety of incorporating this. 00:13:48.120 --> 00:13:58.440 And then we have a lot of internal data because we've been taking pictures of embryos, and then we can say, well, if we apply AI to all of these embryos, we know which ones we transfer. 00:13:58.600 --> 00:14:00.840 All of those were based on the embryologists. 00:14:01.080 --> 00:14:06.039 Would the ones that the embryologists have picked versus the ones that the AI would have picked where that differs? 00:14:06.200 --> 00:14:07.159 Is there a difference? 00:14:07.320 --> 00:14:22.600 And we saw that with a sample size that was like 10 times larger, because we do a lot of embryo transfers across not just our clinic, but our whole national network, we saw that that difference still holds, but now we have the power to say that was significant. 00:14:22.759 --> 00:14:25.159 So that's something that we're writing up right now. 00:14:25.320 --> 00:14:35.720 We want to make sure that you know it's not just take our word for it, but we want to submit it to a peer-reviewed journal and be able to, you know, share that with the with the world. 00:14:35.879 --> 00:14:44.200 And, you know, hopefully that will not only just benefit the patients at RSE, but the patients at you know, many, many clinics nationwide and worldwide. 00:14:44.440 --> 00:14:45.720 Yeah, that's amazing. 00:14:45.960 --> 00:14:50.039 Please connect with us for a fertility assessment call at the link below. 00:14:50.279 -->

00:14:53.799 We'd love to learn a bit about you and share our resources. 00:14:54.120 --> 00:14:58.360 And make sure you subscribe to our YouTube channel so that you never miss an episode. 00:14:58.679 --> 00:15:03.399 And is there any additional time frame that that is that is incurred? 00:15:03.480 --> 00:15:15.159 Is it does it take longer to go through the you know, embryologist plus the AISS process, or is transfer time pretty much similar to what it would be if it were just the embryologist grading? 00:15:15.559 --> 00:15:16.440 No, it's similar. 00:15:16.600 --> 00:15:25.720 So once we take that image, all of our patients get a report when we you know freeze or biopsy and freeze those embryos immediately once the process is complete. 00:15:25.879 --> 00:15:33.960 And that can include just the images and the grades, or for patients that want to use the AI, it includes the images, the grades, and the AI scores. 00:15:34.039 --> 00:15:41.639 So the process is the same and it's instantaneous, and then the doctor uses all of those variables to select the right embryo with the patient. 00:15:41.720 --> 00:15:43.720 So there's no increase in time. 00:15:44.039 --> 00:15:44.360 Okay. 00:15:44.519 --> 00:16:03.639 So if a patient were to call on RSD today, tell us what that process looks like for you know, so at from from the from the first call, what because we we see and it's it's the the the experience of IVF uh is quite familiar now, but the process is not that familiar. 00:16:03.799 --> 00:16:07.720 So can you can you walk us through what someone can expect at RSC? 00:16:08.360 --> 00:16:08.679 Sure. 00:16:08.759 --> 00:16:10.200 So we we're very lucky. 00:16:10.360 --> 00:16:13.559 We have um you know a team that has worked very hard. 00:16:13.639 --> 00:16:18.120 I think wait lists and delays tend to be something that we hear a lot about. 00:16:18.360 --> 00:16:24.759 And we have made it so that our providers are typically available within a week or so for some. 00:16:24.919 --> 00:16:39.879 Obviously, there's some that have a longer wait list, but for people whose speed is of the essence, they're older, they're stressed about it, or they found out they have a limited number of eggs, they can typically see one of our providers within a week or so, either in person or through telemedicine. 00:16:40.200 --> 00:16:50.279 So typically the first part is starting with a visit with your physician, getting to know them, sharing your history, understanding your goals, what we're trying to accomplish, and setting a plan together. 00:16:50.519 --> 00:16:54.360 On average, it takes about a month to go through the fertility evaluation. 00:16:54.519 --> 00:16:59.320 We're evaluating the ovaries, the tubes, the uterus, and then the sperm. 00:16:59.480 --> 00:17:02.440 And obviously, some people are freezing eggs, they don't need sperm. 00:17:02.600 --> 00:17:08.039 Some people do not need to focus on the uterus because they're trying to save eggs or embryos for the future. 00:17:08.119 --> 00:17:17.159 So it depends on the patient, but generally those are the four parts that we evaluate, and that's a combination of ultrasounds, blood work, and a seminal analysis. 00:17:17.639 --> 00:17:25.079 And oftentimes we layer genetic testing ahead of time to try to prevent genetic diseases like cystic fibrosis or sickle cell. 00:17:25.320 --> 00:17:29.159 Once that workup is complete, then your provider and you can finalize the plan. 00:17:29.400 --> 00:17:34.200 And then, you know, the IVF process takes somewhere in the two to four week range. 00:17:34.360 --> 00:17:48.599 There's usually a synchronization part to get the follicles to start about the same size, about two weeks of growing those follicles and getting those eggs to get larger, and then we do the egg retrieval where we get those eggs out. 00:17:48.920 --> 00:17:58.920 From there, we either freeze them as eggs or we inseminate them and grow them for about a week, and then we'll make embryos that we can either freeze or then biopsy and freeze. 00:17:59.000 --> 00:18:00.920 And this is when the AI takes place. 00:18:01.079 --> 00:18:05.240 It evaluates those embryos for their potential to lead to a baby. 00:18:05.720 --> 00:18:11.480 And then for patients that are freezing, those stay frozen with us until they're ready to start their families. 00:18:11.639 --> 00:18:32.039 For patients that are intending to get pregnant, then typically within a month or two, or once we get enough embryos that we feel like we have enough, not just for baby number one, but to complete their family, then we transition to the transfer phase where we synchronize the uterus to the age of the embryo and we place that embryo into the uterus at a very specific time. 00:18:32.200 --> 00:18:35.079 So, you know, from end to end, it really, really varies. 00:18:35.160 --> 00:18:36.759 Some people go a little slower. 00:18:36.920 --> 00:18:39.559 Sometimes we identify factors that we have to fix. 00:18:39.640 --> 00:18:42.599 So we need to delay a little bit that start of treatment. 00:18:42.759 --> 00:18:47.079 Sometimes we do multiple cycles of harvesting before we're ready for a transfer. 00:18:47.240 --> 00:18:51.319 So it can range, but that's about the average timeline for a patient. 00:18:51.720 --> 00:19:01.559 So it sounds like minimum expect from the day you call to the day your eggs are retrieved and embryos are made, if that's what your choice, about three months. 00:19:01.960 --> 00:19:08.440 I'd say the faster that we do it, if we have to wait for the genetic testing and all of that, be ready, I'd say about two months. 00:19:08.680 --> 00:19:09.079 Two months. 00:19:09.640 --> 00:19:13.480 You know, about a month to get ready, about a month to uh do that. 00:19:13.559 --> 00:19:17.000 And sometimes it lines up a little better based on the phase of the cycle. 00:19:17.160 --> 00:19:21.079 Sometimes, you know, we just miss it by a week and we want to wait

another three. 00:19:21.160 --> 00:19:23.079 So there's a little variability there. 00:19:23.160 --> 00:19:29.720 But I would expect that from first visit to egg retrieval, the fastest is about you know four to six weeks. 00:19:29.799 --> 00:19:31.319 Most people take two to three months. 00:19:31.559 --> 00:19:31.799 Okay. 00:19:31.960 --> 00:19:32.359 All right. 00:19:32.519 --> 00:19:39.319 And then for the for the listeners and viewers, what should they expect in terms of you? 00:19:39.559 --> 00:19:42.759 You mentioned somebody sometimes you need to go through multiple retrievals. 00:19:43.000 --> 00:19:49.640 How how often or what percentage of time does a per do you find that a person needs to go through multiple retrievals? 00:19:49.799 --> 00:19:52.119 Or is that just too vague a question? 00:19:52.599 --> 00:19:54.839 Well, it really depends on the patients and their goals. 00:19:55.000 --> 00:20:04.200 So, you know, some some physicians might say you need 20 eggs for a baby, or you need, you know, five embryos for a baby, or whatever it is, and it really variables. 00:20:04.680 --> 00:20:12.039 Um I'd say the things that make it go faster are you're younger and you have more eggs, and then the opposite makes it go a little bit slower. 00:20:12.279 --> 00:20:14.519 It really depends on a patient's goals. 00:20:14.920 --> 00:20:20.200 Sometimes you're focused on baby number one, so we don't really need to save any excess embryos. 00:20:20.359 --> 00:20:25.640 Sometimes we meet someone that might still be young, but their ovarian reserve is quite diminished. 00:20:25.720 --> 00:20:34.519 So we're trying to protect their fertility and making sure that when they come back for baby number two or baby number three, we're not we might be out of X by then. 00:20:34.599 --> 00:20:38.440 So we're trying to save that to minimize the chances that they struggle later. 00:20:38.599 --> 00:20:40.599 So it's very personalized. 00:20:40.759 --> 00:20:49.160 The average fertility patient does about two to three cycles, but there are some patients that get very lucky and finish in one and we're happy with those goals. 00:20:49.319 --> 00:20:55.480 Sometimes it takes more than three, and that's okay as long as we we're making progress and we continue to improve. 00:20:55.640 --> 00:21:02.200 And as you know, unlike trying at home, where it's unfortunately a binary answer, you're either pregnant or not pregnant. 00:21:02.440 --> 00:21:09.160 The nice thing about going through this process, which is not the fun way to have a baby, is that we get a lot more feedback along the way. 00:21:09.400 --> 00:21:15.960 We know how many eggs grew, do we see a fertilization issue, what does the quality of the embryos look like? 00:21:16.119 --> 00:21:19.960 We can find things along the way that we might be able to tweak and improve. 00:21:20.039 --> 00:21:37.079 So we're constantly iterating on our plans and our protocols to really personalize that treatment to the patient in front of us, whether it's endometriosis, a lining problem, a male factor issue, we really want to understand what's going on with this couple and do what we can to optimize the treatment plan for them. 00:21:37.319 --> 00:21:47.079 Yeah, and I would venture to say, just from my own patient population, you know, what those who are trying to conceive naturally, it's not as much fun when they're trying to conceive naturally either. 00:21:47.400 --> 00:21:49.079 And they're coming in because they're struggling. 00:21:49.160 --> 00:21:52.519 It every month feels like a real crisis. 00:21:52.759 --> 00:22:09.960 Whereas when someone is going through an egg freezing or an or an embryo freezing, that crisis doesn't, once they've made that decision, it's everything doesn't feel quite so on the line because they've got the support of science to really help help with their end goal. 00:22:10.039 --> 00:22:28.440 They can have fun at other times, but but for the for baby making, it's uh it's I I I have I have found the patients have such relief once they find that they're that they're you know have accepted that you know IVF or you know for either egg freezing or embryo uh freezing is is their way to go. 00:22:28.759 --> 00:22:40.119 In in your bio, which you had mentioned that you are, or I had mentioned that you are involved in a couple of um startups and then you know innovation and and uh uh other other kinds of services. 00:22:40.200 --> 00:22:45.000 Is there anything that you can share with us about what might be coming down the pipeline? 00:22:45.160 --> 00:22:53.480 Like one thing I'm thinking of is gee, is there a future in AI for uh for eggs versus embryos? 00:22:54.039 --> 00:22:55.000 Yeah, absolutely. 00:22:55.079 --> 00:22:57.720 I mean, I think one of my biggest focuses is AI. 00:22:57.799 --> 00:23:04.119 So I work with a couple of AI companies helping them think about product development, A-Life, the one that we use being one of them. 00:23:04.200 --> 00:23:13.480 So for full disclosure, I am an advisor to them and I've been helping them for over five years think about these products, help understand what they need, how do we help more patients? 00:23:13.640 --> 00:23:17.240 So it's very excited to see these products come back to fruition. 00:23:17.400 --> 00:23:21.880 There's other companies that look use AI to help patients predict how many eggs they might get. 00:23:21.960 --> 00:23:24.680 So, to answer your question of what does that look like? 00:23:25.079 --> 00:23:26.599 How many cycles might I need? 00:23:26.759 --> 00:23:31.079 You know, if I get the average of what I expect, what would my chances look like? 00:23:31.240 --> 00:23:40.519 So they help find patients that look like them and then give them more personalized predictions so we can help a patient, not just say, What does the average 33-year-old do? 00:23:40.759 --> 00:23:48.839 But it's like a 33-year-old with your diagnosis, your AMH, your ovarian reserve, your

sperm parameters, on average those like this. 00:23:48.920 --> 00:23:51.240 So they can make a more educated decision. 00:23:51.400 --> 00:23:57.079 There are companies, there's a company called Future Fertility, for example, they try to do something similar with eggs. 00:23:57.160 --> 00:24:11.640 So one of the challenges we have is when someone freezes eggs, we know their age and we know the number of eggs, and we can give them the average across those patients of how many babies they might have or how many eggs might make it to embryos. 00:24:11.880 --> 00:24:20.039 So when I think about the eggs, it's really challenging because sometimes we do better, but sometimes we do worse. 00:24:20.119 --> 00:24:29.240 And oftentimes those women don't find out that their eggs didn't do as well as we hoped for until they're 38 or 40 or whenever they come back to use them. 00:24:29.319 --> 00:24:33.880 And by that time, their ability to make more eggs might be more limited. 00:24:34.279 --> 00:24:39.319 And so getting a better clue of how good those eggs are is helpful. 00:24:39.480 --> 00:24:45.799 And future fertility has a model that helps you predict out of your eggs how many blastoces you're going to get. 00:24:46.039 --> 00:24:49.240 And it is better than just saying, on average, you get this. 00:24:49.400 --> 00:24:58.359 So that's an option that some are using for um for kind of freezing eggs and you know getting a better estimate of success. 00:24:59.640 --> 00:25:20.119 This question is kind of out of left field, but do you find that that uh that women who are going through um and uh egg retrievals will choose to do like one bank of embryos and then just freeze eggs for for the remaining, or are they uh making embryos for for you know the whole the whole batch? 00:25:20.519 --> 00:25:21.400 That's a great question. 00:25:21.480 --> 00:25:25.559 And I think it really depends on the woman, their relationship status, their goals. 00:25:25.720 --> 00:25:31.079 I was just having this exact conversation with the patient right before this uh recording. 00:25:31.319 --> 00:25:37.000 So this is a patient that is in that relationship, and she wants to save embryos. 00:25:37.079 --> 00:25:42.279 This is her committed partner, but we are also pragmatic and we know divorce rates are about 50%. 00:25:42.599 --> 00:25:47.240 And no one's thinking about divorce when they're preserving their fertility or trying to get pregnant. 00:25:47.319 --> 00:25:51.000 But the reality is that a lot of our patients might end up in that situation. 00:25:51.240 --> 00:26:03.079 You know, I try not to be morbid during the consult, but I say to my patients, no, this is fact that yeah, male, yeah, male partners can continue to get someone pregnant at 35 or 40 or 45 or 50. 00:26:03.160 --> 00:26:09.640 So we as males don't have the same biological clock, but my female patients do feel that a lot more acutely. 00:26:09.720 --> 00:26:11.720 So I talk to them about the trade-offs. 00:26:11.880 --> 00:26:14.599 So when we get eggs, we preserve flexibility. 00:26:14.680 --> 00:26:19.640 If that relationship is going strong and that woman wants to use them with their current partner, wonderful. 00:26:19.720 --> 00:26:21.640 Those eggs will be there and we can do that. 00:26:21.799 --> 00:26:25.000 The downside of eggs is that we lose a little bit of visibility. 00:26:25.160 --> 00:26:37.000 We don't know how many are gonna thaw on average about 90 to 95 percent, how many are gonna fertilize on average 70 to 90 percent, and how many are gonna progress to blastosis, which really varies by age. 00:26:37.240 --> 00:26:47.400 When we're making embryos, we get that feedback, and it's not that freezing eggs and embryos is that much different in the end result, but that feedback comes to us right away. 00:26:47.720 --> 00:27:15.880 We find out fertilization the next day, we found out the blastosis a week later, and if we're doing genetic testing within a couple of weeks, we have the end result, and it's still not guaranteed, we still have to use those blastosis to get someone pregnant, but we're a lot closer to our goal of a baby with a genetically tested euploid blastosis, so we can give a bit more certainty to the patient that we didn't fall off the curve during the culture process or we didn't get super unlucky on the genetic testing. 00:27:16.039 --> 00:27:20.039 So when I tell my patients is you know, do you want some certainty? 00:27:20.200 --> 00:27:23.400 Do you want more flexibility, or do you want a bit on both? 00:27:23.559 --> 00:27:27.960 And together we decide based on all those factors what's the right plan for her? 00:27:28.119 --> 00:27:29.640 Do we want to do half and half? 00:27:29.799 --> 00:27:32.200 Do we want to prioritize one or the other? 00:27:32.359 --> 00:27:41.000 Or sometimes if the numbers are low, some patients do end up doing multiple cycles where we focus on one, on embryos for one and then on eggs for the other. 00:27:41.319 --> 00:27:42.039 Got it, got it. 00:27:42.119 --> 00:27:53.160 Yes, I was attending um one of the one of the um the the or uh national organizations and there was a whole conversation about by by a legal representative on this very very topic. 00:27:53.240 --> 00:28:07.000 And so I was uh thinking about AI, thinking, oh gosh, if we could really hone in on eggs quality, you know, the the the likelihood of eggs turning into viable pregnancies, that would make this decision perhaps a little bit easier. 00:28:07.160 --> 00:28:11.000 It wouldn't just be flexibility versus some level of certainty. 00:28:11.319 --> 00:28:11.640 Yeah. 00:28:12.039 --> 00:28:13.079 So hopefully we'll get there. 00:28:13.240 --> 00:28:13.960 Hopefully we'll get there. 00:28:14.200 --> 00:28:14.599 I hope so. 00:28:14.839 --> 00:28:15.720 Yes, yes. 00:28:16.039 --> 00:28:28.039 Well, is I I want to be mindful of your time and of the viewers' time, but I also want to make sure that there's nothing that I

have missed in the conversation that you want to say, ah, but I really want people to know this and think about that. 00:28:29.240 --> 00:28:32.279 No, I mean, I think we covered a lot about embryo selection. 00:28:32.359 --> 00:28:36.920 I think certainly we've worked hard to uh stay at the vanguard of medicine. 00:28:37.000 --> 00:28:46.599 We don't want to be too early, but we certainly want to be able to use the tools that we have at our disposal to help our patients find their babies as quickly as we can. 00:28:46.759 --> 00:28:49.960 So I think this is one of those many technologies. 00:28:50.119 --> 00:28:51.880 We're proud to be able to offer it. 00:28:51.960 --> 00:28:53.799 And certainly it's not for everyone. 00:28:53.880 --> 00:28:58.920 We want to make sure that our patients get to pick how and what they engage with across the process. 00:28:59.160 --> 00:29:02.039 But I'm excited that we're able to finally offer this. 00:29:02.119 --> 00:29:11.160 It's been a long time coming, and I think it's definitely gonna improve the chances for a lot of our patients and hopefully help more families grow, which is our ultimate goal. 00:29:11.400 --> 00:29:11.880 Absolutely. 00:29:11.960 --> 00:29:19.559 And and did I hear you say that you that still RSC is is the sole clinic that is doing this at this point? 00:29:19.960 --> 00:29:21.480 I believe so across the US. 00:29:21.559 --> 00:29:24.519 I'm sure there will be more to come because the data is very exciting. 00:29:24.680 --> 00:29:29.720 But as far as I know, uh as of now, I think we're still the only one that can do this. 00:29:29.880 --> 00:29:34.440 Because this technology, it's I don't think it's even been three months since the FDA approved it. 00:29:34.519 --> 00:29:35.559 So it's uh brand new. 00:29:35.880 --> 00:29:36.440 That's amazing. 00:29:36.599 --> 00:29:58.039 So then, therefore, if people who are out of the San Francisco Bay Area think, oh gosh, I would like this added layer of of um of certainty or to use AI for embryo predict for embryo predict, um, do you are you taking patients from you know out of state or other parts of the state because California is a pretty big state? 00:29:58.440 --> 00:30:16.039 Yeah, I mean, people come to us even before Embryo Predict, we had people that came to us from all over the US, you know, internationally from China, Singapore, sometimes from Europe, that come because they like our outcomes, they look on SART, they appreciate our success rates and what our doctors do. 00:30:16.119 --> 00:30:17.000 So we have that. 00:30:17.160 --> 00:30:21.720 We have seen a little bit more interest in people coming and saying, I really want to use this technology. 00:30:21.880 --> 00:30:23.799 I don't know where it's coming through my coast. 00:30:24.119 --> 00:30:25.559 So, you know, I'd like to start. 00:30:25.640 --> 00:30:32.680 And a lot of those patients, you know, they can see us remotely, we can work them up, you know, through Quest and Lab Corp at home seminal analysis. 00:30:32.759 --> 00:30:42.519 So a lot of that process happens there, and then they start their monitoring cycle from home, and then they come here for about a week or so around the retrieval. 00:30:42.680 --> 00:30:47.319 So we try to make it as least disruptive as possible to their day-to-day life. 00:30:47.559 --> 00:30:49.720 So we do have a good number of those patients coming. 00:30:50.039 --> 00:31:01.000 That's important, and I want to make sure that the viewers and listeners understand that you're not going to have to fly in and out of the San Francisco Bay Area for your diagnostic testing and for you know for your stims. 00:31:01.079 --> 00:31:05.640 Uh, you're gonna be able to just come on in for your retrieval, correct? 00:31:06.039 --> 00:31:06.440 Correct. 00:31:06.519 --> 00:31:14.440 Yeah, I mean, we typically I would say you want to come in a couple of ultrasounds before I get really picky about picking the perfect day to get those eggs out. 00:31:14.519 --> 00:31:16.839 I want to make sure that I can look at those follicles. 00:31:16.920 --> 00:31:17.880 We have those levels. 00:31:17.960 --> 00:31:21.319 So towards the end of the stimulation, I prefer if patients come. 00:31:21.400 --> 00:31:21.559 Yeah. 00:31:21.799 --> 00:31:34.440 Realistically, they only need to be here for the retrieval, but I usually will have people come a couple of days before to kind of pick that perfect day, get their egg retrieval, and then people usually fly out one to two days after. 00:31:34.680 --> 00:31:36.119 Yeah, so it's so it's one trip. 00:31:36.279 --> 00:31:37.960 So they're not having to fly in and out. 00:31:38.279 --> 00:31:40.599 So it's not one day, but it's one trip. 00:31:40.680 --> 00:31:54.599 So you show up a a couple of days based upon you know um the the the tests come that coming in, you show up a couple of days before anticipated retrieval so that you have control over you know trigger shot. 00:31:54.680 --> 00:31:57.240 Now it's go time and and we'll be retrieving soon. 00:31:57.640 --> 00:31:58.119 That's right. 00:31:58.359 --> 00:31:59.240 Excellent, excellent. 00:31:59.400 --> 00:31:59.880 Well, Dr. 00:31:59.960 --> 00:32:02.200 Heritan, again, thank you, thank you, thank you for your time. 00:32:02.359 --> 00:32:14.839 Thank you for your ingenuity and and and interest in creating these new ways of improving the field, because as you say, it's only about 50 years old, and there's been so much advancement. 00:32:15.000 --> 00:32:21.240 I've been doing it for now 24 years on my side, supporting this whole field. 00:32:21.319 --> 00:32:26.920 Um, and the and the advancements have been remarkable, and yet there's still so much more that can be done. 00:32:27.000 --> 00:32:33.480 So I'm excited to um to to continue to shadow you and learn about these as as time unfolds. 00:32:33.880 --> 00:32:34.359 Absolutely. 00:32:34.440 --> 00:32:36.119 And thank you, Susan, for your partnership. 00:32:36.279 --> 00:32:40.359 You've held so many patients, and it's always wonderful to take care of people together. 00:32:40.680 --> 00:32:42.039 I agree, thank you so very much. 00:32:42.200 --> 00:32:44.680 And so, viewers, listeners, again, thank you for your time. 00:32:44.839 --> 00:32:50.599 We know it can be held anywhere, and we appreciate you taking the time to be in this conversation. 00:32:50.759 --> 00:33:03.400 And if this conversation triggers a thought of, oh, my friend, my coworker, my neighbor, please pass this podcast along, and all of the information for RSD will be in the show notes and Dr. 00:33:03.480 --> 00:33:19.240 Heriton and Embryo Predict, it's all up through in the website as well, so that you'll be able to collect your information and then contact RSD at your earliest opportunity because you might be the one person in making the referral to someone else that helps them realize they're doing the family.