152: Future Fertility: Advancements in IVF and Hope for Tomorrow with Dr. Al Yuzpe

Our goal is to help women become pregnant. And our goal when we want women to become pregnant is for them to help have a healthy baby and delivery. And to do that, the best way to do that is through a singleton pregnancy. So together they worked and that's what gave rise to the first IVF baby, Louise Brown, who was born on July the 25th, 1978. Louise has had her own children since then. And now IVF field is evolving and it was used originally to treat him for totally. Now we use it for so many other things. By listening to the Coherence Code podcast, you agree to not use this podcast as medical advice to treat any medical condition, either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code podcast where we explore how the mind and body work together so you can move from stress and intercom conflict to clarity, calm and alignment. My name is Lauren Brown. I'm a doctor of traditional Chinese medicine and a clinical therapist. And through my work, I've seen that healing happens when you remove what gets in the way and allow the body and the nervous system to do what they're just trying to do to heal. Welcome to the Coherence Code podcast. Today we are with Dr. Al Yutzby and I know Al personally. I've worked with him in the Vancouver area since I met him back in 2002. But I want to give an introduction because he has been around from the early days of practicing reproductive medicine. And we're going to get some insight and I'd hear some stories about where this medicine was and where it is and where he thinks it's going. So Dr. Yutzby has been the recipient of a numerous awards including the Canadian Traitling and Andrology Society Award of Excellence in Reproductive Medicine, the Society of Extritions and Gynecologist Presence Award. And this is for a distinguished career in academic reproductive and chronology and in fertility and his dedication to women's health in Canada and abroad. And also the Royal College of Physicians and Surgeon Speakers Award. But Dr. Yutzby is the co-founder and co-director of Olive Fertility Center here in Vancouver BC. They also have clinics in Victoria, Surrey, in Colona and Constantly expanding when I was sitting with him recently at a conference. I found out he had a satellite even in the Prince George area that he's affiliated with. So Olive Fertility Center has great presence in British Columbia which we're fortunate to have. He's Canada's most senior reproductive and immunokinologist which is why I wanted to have a conversation with him because he is the most senior reproductive and immunokinologist in Canada and he's been involved in IVF. Now, when I read it says it's been an IVF for the past 30 years but I don't know when I got posted. So you'll have to kind of correct that. And he's been in the field of infertility for the past 43 years. And again, I don't know when they posted that bio but I think it's been a few years since then. So probably you can tell us when this all started. Now, he received his MD and his master in science and completed his fellowship training in obstetrics and gynecology at Western University in London Ontario. We're both alumni of the Western. During his training, Dr. Yutzby was a fellow of the Medical Research Council of Canada for two years with his research focusing on the development and refinement of fertility, promoting drugs, including clomaphine and human gonadotropin. So a lot of the fertility drugs, he was involved in the early research. So I get questions around that as well. He joined the Western University Faculty of Medicine Department of obstetrics and gynecology in 1970 and passed through the academic ranks of full professor, retired from the University in June of 1995 and he now holds the distinguished academic appointment of Emirates, Professor of Obstetrics and gynecology. Dr. Yutzby then went on to found the Genesis fertility center in Vancouver, British Columbia and then went on to help found all of fertility clinic, which he's involved in until this day. He's pioneered the development of the emergency contraceptive pill. So that's interesting. He went from one one side of the spectrum, the emergency contraceptive pill to fertility, bringing life into the world. And that method is often referred to as the Yutzby method. So if you guys have ever heard of that, the Yutzby method, this is the here's your founder, the inventor, Dr. Al Yutzby. And this this method has been listed by the Canadian Child and Youth Center Coalition as among the 10 Canadian discoveries with the greatest impact or the greatest potential for impact on health outcomes for children in the youth in the last hundred years. Al, thank you for being a guest on the Conscious Fertility Podcast. Thanks, Lauren. It's a pleasure to be here at the hearing, although the sacralase, what I like to do is talk about where we are now, where we came from. Well, let's talk because you were you worked with clomaphine clomid, tell me your role in clomaphine. Like where did this start and what was your role with that drug for ovulation induction? When I started my residency training in 1965 at the University of Western Ontario, my mentor and lifelong friend, Dr. Earl Plunkett, who's the father of reproductive medicine in Canada, in my opinion, told me that he had obtained medical research council fellowship training program for me. And my research was going to be with a new drug that was being developed to make women obviously. Until that point, you should know our ability to treat women for infertility was terrible at the best of terms. We didn't have anything that really worked. We didn't have any treatments for women, other than surgery and most of those things didn't work either. And so this was a revelation at the time. And so I was very happy to have the opportunity to do some basic research on clomaphine, which is the first drug that was developed and the purpose of the drug was to induce ovulation or help women ovulate who didn't ovulate. So it was used in women who had very irregular cycles with ballacistic ovaries. But we didn't know what else it did. So we treated everything and anything with the drug because we knew was safe. So we treated women with endometriosis. We treated women with ovarian cancer and endometrial cancer, all types of things, conditions in gynecology to see what it would really do. And that resulted in my master's thesis and me getting a master of science in medical research because of that work with clomaphine. Now I have a couple of questions around clomid because now one of the other ovulation drugs that's often uses lettrosol. So today we're recording this in late April of 2023. What's your preference for the for an ovulation drug? Is it clomid or lettrosol? And how do you choose? Well, I have a love for clomaphine because it was the beginning of my career. I also have a love for lettrosol because its use in ovulation induction was introduced and pioneered by one of my students and my resident and my former partner, Doc Bob Casper in Toronto. So I have a great respect for that drug and it's closer my heart as well. The advantages of lettrosol are that the multiple pregnancy rate is slower with lettrosol than it is with clomaphine. And as a physician, I can say that we much prefer to have a single turn pregnancy than a multiple pregnancy. And I've seen with clomaphine at pregnancy is highest quintuplets. And so it's not just twins. And the more free this is there are the greater the risk and the pregnancy is to its existence and to the mother, it's her self. So I think that lettrosol is always better to use to begin with the side effects are less as well. But for some people, lettrosol doesn't work and clomaphine does and vice versa. So you have two choices to treat for auditory disorders. Now, we have a third, we have a third. Okay, what's your third? Those two drugs induce the release, the body's own release of a hormone called FSH and LH as well, which are the two hormones, FSH grows eggs and LH triggers the release of the eggs, which is ovulation. We also have those two hormones that we can use as individual hormones. We have FSH, but it has to be given by injection. We don't use the hormone LH. We use a drug that works like LH called HCG, which is a natural hormone that the body produces in pregnancy, but it also has the ability to cause the egg to be released. So there are really three things. Lettrosol, clomaphine, and Gunn added trope and says they called him. - And you had some research in your early days with those drugs as well, no? - Yes, I did, that because when I was doing my research with clomophe and I attended a lecture by Professor Paul Gaines-Zell from Upsah Law University in Sweden who was the pioneer of isolating FSH and treating women with it. And I asked him at the end of his lecture, if he would take me as a research fellow and he said, yes, come July 1st. And that's, I arrived on July 1st, but nobody worked since we knew July, so I didn't start work till August, but I got to see the country. So I did work with that as well in the very beginning. But you have to realize something, you know, I said at the beginning of our discussion, we need to know where we came from. We came in the field of fertility, we came from nothing, we had nothing. We were like the Wright brothers and their little airplane and we didn't have ultrasound, we didn't have hormone tests. I remember when I was in Sweden, Dr. Jimmy Brown in Australia was the first one to produce a test that we could measure estrogen, we measure estrogen routinely now in IVF and in so many other places. And we didn't even have that at the beginning. So we came from really nothing. So was there quite an adventure from then on? And it sounds like you guys are in, like you say, this space-excher compared to where you were in the '60s. I have a question around the auditory drugs, our story and a question. I don't know if you remember this, but once we had a conversation, this is decades, and I was in a wherever your background, your research involved in clomit. And I had asked you about, is it okay for somebody to do consecutive cycles of clomit? And this is part of my question, 'cause I had read and I had heard from other reproductive and immunokinologists that you need to take a break 'cause it will impact the quality of the lining, the thickness of the lining. And you had responded saying, I pretty much helped invent the drug. I think I know how to use the drug. And then you went on to tell me a little bit about when you should or shouldn't take a break for a listener's 'cause that is out there. What is as of today from your background with the research to all the studies and clinical experience with clomit? Is there a time to take a break? 'Cause some of the side effects is how it impacts the lining. How would you use that drug? So somebody be doing multiple cycles without a break. Is there a time in your mind where they move into something like an IVF? Can you give us a practical clinical picture of how you would have somebody use that drug when they take a break and when you would think they, if time and money was an issue, they move on to something else? - That's a good question, Lauren, because the drug is still misunderstood. If someone has a problem with the drug, now what are the problems? Side effects and the most common side effects are hot flushes as far as the way a woman feels. But the others of major side effects is thinning of the lining of the uterus. And if you take a, as you referred to, very fertile soil and converted to sand, and embryo is going to implant as well. So we don't want to change the thickness of the lining of the uterus, which we believe is still very important in conception. And if a woman is not experiencing hot flushes or other side effects, some women will experience things. And sometimes, if somebody experiences something that they haven't experienced before and they're taking a medication, they say, well, that's because of medication, but that's not always the case. But if someone thinks they're having a side effect of the medication and it's uncomfortable, then you need to take a break. But if the lining gets them thinking, if the medication is doing what it's supposed to do, and there are no side effects, then there's no reason why someone can't continue taking one cycle after another. The old concept of saying, you can't take it more than six months, for example. It's not really, there's nothing that's based on that. As a matter of fact, we use chromofin and chromofin can still be used in changing the lining of the uterus that shows premalignant change to removing or getting rid of that premalignant change by inducing ovulation, because that change usually occurs when women are doing ovulate. So there's no restriction as to the length of time. The drug is safe. The biggest problem with chromofin is and in some women, there are multiple pregnancies and multiple pregnancies may seem quite exotic and exciting to some people. But we know that the risks of multiple pregnancies to ins triplets and more are much greater than a singleton pregnancy. So we want you, our goal is to help women become pregnant and our goal when we want women to become pregnant is for them to have a healthy baby and delivery. And with the lining, as you said, if there's no side effects, if the lining isn't thinning, then they don't really need a break, is the way to know this is just some of the monitoring that you would do then. That's how you would know, 'cause you would look at the lining to see if it's thinning or not. - There's only one way to know if the lining is thin and that's to do an ultrasound. And again, I referred to Dr. Casper in Toronto. He was the one that showed the things and sort of the lining to be important. We know now that that's not 100% true in some cases, but for the most part, it's important. - And now when you talk about the field of reproductive medicine, where you said you basically had no tools, where do you see it today? Where are we today and what excites you? Because are we allowed to tell them around how it will do? Or could you still have the passion? I have to tell our listeners. So I was with Al, Dr. Yusper here at a conference. And he was still like, before the words came out of their mouth, they were talking about a study. And now I would talk about the issue with the study and what's going on. And all of a sudden the person goes, and here's the issues with this study. Then they're talking about recurrent pregnancy loss. And then he threw a stat to me about how many of those women would go on to have pregnancies. And then the person said, and this is how many people go on to go have pregnancies. So in your eight plus decades, you are still loving this medicine. Like you show up still and you share and you're involved. So what are you excited about today? And then next question is what are you excited about tomorrow? First of all, Lauren, let me tell you that if I didn't do what I do now, I'd have to work for a living. I love what I do. And I've been doing it for 53 years. And 53 years ago when we started, I said we didn't have any of what we have now. Well, it's exciting now as we've gone from minimizing the involvement of surgery in fertility promotion. If people should know that a number of years ago, when I first started in obstetrics for the United College, women were having their uterus operated on. If it was, if they were having difficulty and their uterus was retroverted or tip backwards, we know now that a third of women have a uterus tip backwards. We know that a third of women are not infertile. So, but we didn't have anything else. So people were doing these things, these surgical procedures called uterine suspensions, which brought the uterus from this position to this position, not much of an involvement. Women were having multiple, multiple surgeries for endometriosis. And we're still not conceiving. But we didn't have anything else to offer them. So we progressed from there to the medication with chroma-free, and there was introduced in the 1960s, injectable drugs, the FSH drugs, and came to fruition and became approved in the early 1970s. Then we went to laparoscopy. And I always thank my parents for giving birth to me, conceiving me and giving birth to me at the right time. And I was in the right time in the right place. So in the early 1970s, a very close friend of mine who was from Quebec City, was just returning from France doing some studying there. And he learned an operation that nobody knew about here, called Celioscape, or as it was renamed laparoscopy, which is now a household word in surgical procedures. But he brought back the laparoscopy, and he did some postgraduate training before he went to France and learned this from Professor Raoul Palmeur. He learned, he came back to where he had done this training in the States, which was at Johns Hopkins University. And he was trained by the father of reproductive medicine in the United States, our Jones, who passed away at the age of 103, I think. and it was responsible for the first IVF baby. in the United States. And Howard Jones said, "Show me this operation." Is that okay? Is that okay? Did the first lap where I was supposed to be at Johns Hopkins University in 1969? So in 1971, when he came back here, he taught me how to do the procedure and he and I started a training program. And every all the gynecologists in the country had a train with either him or me to learn how to do the procedure. And then we had a window to the abdomen. We didn't have to do a huge abdominal incision. We could see what things were going on. We learned a great deal. And so that was it, other milestone. Then through that organization, there was an organization called the American Association of Gynecologic Laperoscopus. There was a multiple. And Jacques was a founding member, and I was a board member. And there was a guy that came to our meeting. His name was Patrick Steppto. Steppto was doing this procedure in England. And we became friends. And he told us about collecting eggs with the laparoscope. And he was working with a scientist named Robert Edwards at Cambridge England. And he was going to try to fertilize these eggs. So together, they worked. And that's what gave rise to the first IVF baby, Louise Brown, who was born on July the 25th, 1978. And now IVF field is evolving. And it was used originally to treat infertility. We have patients who have genetic diseases that they carry or have a child who has an affected condition, that genetic condition. We can test embryos now genetically. And then now we can preserve fertility by freezing embryos or freezing even eggs before they become embryos. And now we're using artificial intelligence. And artificial intelligence is helping us choose the best eggs. And so yeah, helping us choose the best embryos. We have new ways of growing the embryos. So there's been an incredible evolution. It's going from small motors to rockets. So I wanted to just review some of that. So I wasn't aware. So I've known you for a while since 2002. And I wasn't aware that you were involved in training the laparoscopic procedure here in Canada and BC. I didn't know that was you were involved in that. Well, there were three of us. Jacques Rueu in Quebec City. And I worked together. But Victor Gomesll, who was a professor here in British Columbia and who was a very still, a very close friend of mine, and you were with him on Friday as well. Victor really did the same thing out here on the west coast because I was in London, Ontario at the time. And Victor was the first one to successfully operate on theopic pregnancy through the laparoscopic. Victor also was one of the world authorities in microsurgery in repair and philopeia tubes. And Victor worked with some of the most incredible microsurgeons in the world in Europe. And he's been rewarded with-- I forget the name of the award. They was presented by the president of France for the world. Other work he's done. He's traveled all over the world with his work. So microsurgery really is the biggest Bailey way, although laparoscopy was important for him to. So grateful for the work that they did. And Victor did. And I didn't know that you're one of the early adopters pioneers in Canada on the East Coast anyhow for this. And then you shared the investment which gets you excited today is you talked about genetic diseases so that you guys can test now so you don't put back an embryo where that kid is going-- that child will have that serious illness so you can prevent those transfers now. You know, this is-- what I look at this thing could be good and the bad. We can do things now that can prevent the transmission of diseases. Take, for an example, undemptive disease. It's a disastrous disease. It's a killer for people who have that disease. And it's a terrible condition. You would think that our provincial government would say, gosh, if we didn't have to treat people with undemptive disease because we didn't have any that had undemptive disease, they would jump at the idea of saying, well, we'll pay for an IVF cycle for you. So you have a maybe that or one or more babies from an IVF cycle that aren't going to have undemptive disease. So you're going to save money down the road. Unfortunately, all the additions are employed now. They don't worry about the future so much. That's been one of the most distressing things that I encountered in this old field in here in British Columbia. And that is the lack of support for people who suffer from infertility, from people who have genetic diseases in some way because IVF is not covered by provincial health care, even these genetic conditions are not-- have treating or preventing the transmission is not covered. And that's a shame. I mean, in 1985, I was still in Ontario. I was able to get the provincial government to fund IVF. And then the federal government, in its great wisdom, set up a Royal Commission. And the Royal Commission report called proceed with care, said that IVF will never work for women with blocked Jews, which wouldn't be further than the truth. But they stopped funding IVF in more recent years. Now they've reestablished the funding, but they fund one cycle of IVF. And other provinces fund IVF as well. Quebec has funded brand other money. Stop now, are funding again. I believe that the government should be funding IVF with refundable tax credits, meaning that the money doesn't come out of the ministry of health. It comes out of the ministry of finance. And if it doesn't come out of the ministry of health, we're not antagonizing everybody who's waiting for treatment who can't get it because we don't have the money to support what they need in the health care system. I don't know how I got in this. Well, we talked about it because of the genetic diseases, and that they're preventable through IVF, where you don't have to have a child with. And it's not only, like you said, disastrous for the individual with this death sentence, but for the people that have to care to watch somebody suffer in deteriorate, that's also a tragic. And you can't imagine to look after these people to it. And I've seen this. One of the most satisfying events that I've ever experienced is a couple where the father carried a gene for a condition called hyper-trophic cardiomyopathy. That's where the heart is affected. The muscle doesn't work properly. And often these young people just dropped it. And this gentleman had hyper-trophic cardiomyopathy. We treated and his wife gave birth in those days. We used to put in two embryos. We probably don't put in a single embryo now in IVF or to avoid multiples, but they had twin pregnancy. And then a few days later, he went on to have a heart transplant. So I think we do good things. - I have a kind of issue, question around that, just to kind of put it into perspective. If somebody has a genetic disorder and you do an IVF, the goal is you're gonna have several embryos and you can test these embryos. So if there is the chance that some of those embryos will have the disease, but some will not. And you're gonna put in the ones that don't. And that's how you're avoiding passing on that hereditary disease. Is that right? - That was true. And you know, this is where we come under criticism. And I suppose it depends on how you look at it. There's morality, there's ethics involved. I remember when when IVF first started, it was a great moral dilemma. And you'd read in the newspaper, now doctors are gonna be able to clone people. You're gonna be able to take one of their blue eyed babies. That's not what we do. And as a matter of fact, I said to Bob Edwards, who was the scientist involved in the beginning of IVF, who received a Nobel Prize for what he did. I said, "Bot, what do you think about the cloning issue?" And he said, "You know, I've never met anybody "with this worth cloning." (laughing) - That was a very good, very good comment. - So Al's been doing this for a long time. I met him in 2002 and I'm gonna share this story on it. I don't know if you remember this, but the reason we met is in 2002. 2002 I've been in practice since 2000 and I thought I wanted to meet Alan his team at the clinic because I provide acupuncture I want to support their patients going through IVF and Alan I event when we met he put me like he put any medical doctor through rounds He questioned me and challenged me which any good health professional doctor does but later on when we got to know each other Over years it took years to develop this relationship You had shared with me that when you when I first sent in a request to connect with your team and your nurses Acupuncture you're you're ready to throw it away and then you saw I had C.A. Now they called it C.P.A And you told me that the only reason you had me come to the office because you had a figure out how somebody who was a chartered Count and get in the beat and acupuncturist so you just wanted to do I don't know if you remember that story But that's when you you're sharing with me in 2002 Well, I remember that by word really intrigued me was How what you did might impact for Gildey at first? I was it's more skeptical than anything else because you know, we've grown up in Western medicine and You know we didn't know where I was training or working nobody knew anything about Traditional Chinese medicine you open my eyes some things. I think that are very important You know if you're gonna have a garden you might as well have the best soil you can have If you say to me, I think I still believe that if you say to me I'm going to help you get pregnant I mean, no if you're gonna help you get pregnant I know that you're gonna get me in the best shape to get pregnant and I think that's really important and I've seen this time and time again That you fertilize the soil you're an urge of the soil and I'd rather stick a plant in In your soil than in the sand. All right, well I think that's really important and you open my eyes to that right or And and I must say I'm not the easy person in the world to change my mind No, well at the beginning as I said I was pretty in a hurry to get me out of this a lunch and learn that first day and I was persistent and then about Five years into practicing and working with mutual patients. You once said I'm surprised you're still here I didn't think you didn't think this acupuncture thing was stick around. I'm pretty surprised you're here now where It's 2023 and it was 2002 so we're almost 20 20 plus years into this and You know that soil idea we bring the watering of the soil so blood flow bringing down those inflammatory stress hormones and we saw at a talk that we're at high cortisol levels and pregnancy right so and supporting the bodies absorption and nutrients and calming calming the nervous system There's so many things and it's been the integration and to see you know how you share how you seen where it's evolved In 2002 there was no communication between the reproductive endocrinologist IVF clinics and with the So the patient was kind of negotiating both health professionals and now at all of you guys patient-centered care we go on site to do the acupuncture And we communicate with all the doc so we really make sure we're on the same side and and we have the ability to even disagree to find out the best approach for this as we learn about each other styles for that patient and again, it's been your support, you know because being the leader of the clinic when You have that openness and and at least you had the curiosity right to say a skeptical I don't get this but let's see how this if this could help our patients and we can start seeing some evidence Let's let's get open to it. So thank you. I'm not the only one I must say that my partners Some of them were more eager to embrace the concept than I was at the beginning, but we're all very supportive and One of the most important things is treating patients Having the patients be happy and having the patient be comfortable that they know they're in the right place And that's one of the things that really is important in when patients are choosing a clinic that they're going to attend Choosing a clinic that's going to meet an individual's needs is just as important as what the clinic has to offer And I think that's really important Agreed and that's where you get that individualized medicine and that's where our Integration has helped with that because of the patients I did care and together We kind of get a very holistic approach to them where we're taking care of most of their needs and supporting them in making that decision and in the education Aspect of it. I have a couple of follow-up questions just about If you can share a bit we were talking about how you guys can scream for genetic disorders You touched on that now technology has egg freezing because back in the day the freezing technique wasn't so good So the eggs couldn't freeze and thought well and then with vitrification It's become much better for both embryos and egg freezing and now for example Two ways one is I've seen it multiple times where a woman has been diagnosed with cancer You guys often will come in and support them and get those eggs out and she's with a partner create embryos So she can go in to have her cancer treatments without damaging her eggs and then women that aren't ready to have a family Haven't found Mr. Wright women are now coming to you to freeze eggs so they can continue to do their careers or Wait for the person they actually want to spend their life with before they create embryos and so that's great investment advancements as well You talked about Mr. Wright. There's not even Mr. Leftson Yeah, no, I think this has been a great investment because who am I I remember again when I was training and We would see young women before they were even 20 years old would come to end the doctor would say you have Endometriosis and the patients say so what do I do the doctor would say go get pregnant? Well, you know, we know the pregnancy helps endometriosis But you know that's so impractical. That's the same thing today with women who are Employed or pursuing a career or pursuing their education It's really unfair for anybody to say well go ahead and get pregnant now when it's not the right time and You know for some of them we know that fertility decreases as women become older and So for some of them if there's an issue that they want the best of both the world They want to have their ability to conceive at the rate that they are now at their age and not later But they don't want to be pregnant now so we can preserve their fertility and if a woman has a partner We preserve embryos if they don't have a partner we preserve eggs and The analogy I use and it's that analogy because nobody freezes cake ingredients But my analogy is you want to have a cake You can use their freeze all the ingredients and then when you're ready to have the cake You thought the ingredients and hope that they'll make a cake or you can freeze embryos Which is equivalent of freezing the cake? Because usually when you freeze the cake and your thought the cake comes out okay So you know there's a difference and what works for one woman doesn't work the same for another one And you have seen where most of the transfers were day three fresh To now you grow them out the blastasis and most of your transfers are now frozen Have you found from your experience? There's the data that you can quote but your clinical experience are you getting better pregnancy rates and live birth rates from frozen transfers versus fresh transfers? For your audience that are listening to this and Replacing in embryo on day three the embryo has only developed to Approximately six-day cells if they're growing a little faster they may be ten cells But you don't know the potential of that embryo Or what the potential of that embryo is to get to the point where it can implant an embryo where it implants is called the blastasis That is a cell with hundreds are a number of hundreds of cells and It is you know totally different than a day three embryo We can only transfer embryos or replace embryos into the uterus on day three or on day five We know that day six or seven is not good So we transfer on day three or day five before doing a fresh embryo So if the embryo is only six-day or ten cells on day three I Want to be sure that I'm giving that patient the best chance She has a becoming pregnant so I want to transfer it on day five You know that the cake is there not the ingredients Some embryos are still not fully developed by day five and so we can continue to grow them in the laboratory for Another day or two to day six or day seven and many embryos that we freeze are Day six embryos or blastasis or day seven blastasis and we don't Transfer those fresh So I personally prefer to grow all the embryos if they don't get to where we want them to get them They stop growing the pain that's hard to build for the patients of swallow at that point, but at least we're not putting it in having a failed cycle of freezing some other day, three embryos and the patient coming back two years later and they don't work. So I'm a forepollum of their transferring. They five embryos if the patient wants a fresh embryo transfer, if it's at the right point, if not, I think we should grow all the embryos to blast the system for reason. And then what I think is at the time of this recording, I don't know when somebody's listening to this, so maybe what we're about to share is like old news, but today, this artificial intelligence, because that's just really starting to ramp up in the IVF and reproductive medicine field. What are you guys using it for now? And what do you, what's your insight, what your thinking's going to happen in the future, how this is going to help, men and women have children with this AI? Well, artificial intelligence is amazing what it can do. And it's just based on rather than one or two experiences, they're based on 100,000 or a million experiences when you pull all that information. And what they do in artificial intelligence when they're assessing eggs and embryos is they photograph them and a photograph to look at so many things in the field that we don't even think about or see. So to me, the biggest development so far has been to evaluate the eggs. And I think that's really important. Say you were a patient coming to me to preserve your fertility and you say I like to have two or three children, but not for another five years. So we treat you with IVF and you get nine or 10 eggs, let's say with artificial intelligence, we can now evaluate those eggs and say that based on artificial intelligence, your chance of this egg becoming fertilized, forming a blastocyst, which is the end stage of embryo development before we put it in. And the chance of having a pregnancy is X percent. Well, these are still just estimates, but if I say to you, look, you got 10 eggs and four of these have the potential to make a pregnancy at the most or three. And you say I want three children, you say, well, I better do another cycle and freeze some more eggs. So I think it has some really important and important role to play in assessing egg potential. It probably has the same with embryos, but we haven't been using it with embryos to this point. We don't do this. There are companies that had programs that we use in the photographs too, and they gave you the results. We will also be able to do that in the laboratory. In the laboratory, they'll be able to assess the eggs and the embryos as they're developing. So artificial intelligence is going to play a major role in the evaluation. And what people do in the evaluation of their eggs and their embryos and what we, and even with experiments, select in the best sperm. And then what they will do as a result of what that information provides. Because now when you are looking to choose the best looking embryo, there's, you know, you look at your image using your eyes, or you have to do somewhat of an invasive procedure and take some cells and send those away to get tested for your screening. And the future of this for embryos, I hope is that through a non-invasive photograph that you'll be able to be able to pick those embryos in that same way. Well, the non-invasive issue is a whole different issue. We have a procedure called PGTA. As pre-implantation genetic testing, the A stands for Annual Poetry, which is too much or too little chromosome material. And every cell has, that's been fertilized, every human cell has 46 chromosomes. But there are a lot of errors in chromosome numbers and separation because, quote, when the cells unite and then divide, there are errors that occur. And when these errors occur, you can get what they call Annual Poetry. And with a number of those annual, it either won't work or it'll cause a miscarriage or it'll cause in certain chromosomes, like chromosome 13, 18, 21. They can cause abnormalities, but the pregnancy will go on to deliver and you can have an abnormal baby as a result. So with the non-invasive testing, we can do that PGTA without making opening into the embryo and taking out some cells for that form that placenta, not interfere with the embryo and that's what we do now and it's quite safe for the embryo. But if we don't have to do that at all, it's much easier to just get a few cells from the culture medium that's the liquid that the embryos are growing in and just take a few of those cells and study those instead of invading the embryo. So can I want to unpack that a little bit? Because currently the most common procedure is the PGTA where the biopsy, some of the cells and send it away and what I'm hearing you share is there's even a newer procedure that you are doing at all of that's non-invasive where you're not touching the embryo whether the part that's going to become the baby or the well you don't do that now, the part that becomes the placenta, you're not touching that and you are now taking cells from the the medium, the the culture that the embryo is in and that is what you're testing. Can you can you elaborate a bit? Yeah, that's exactly what we do, but the what we have done is Dr. Nacuda in our clinic has been spearheading a research project where we've been looking at these cells and seeing how they compare with what we get with the embryo that we'd biopsy did well. So we have a comparison. So in your research you are biopsying like PGTA and at the same time you're looking at the cultural fluid. Yeah, okay. So that's just research and we don't know where we're going yet. We don't if they're not equivalent if the non-invasive method is not as accurate then it's not as good because we don't want to miss things. But have you do you have any that or any sense of what it's looking like when you compare? Well, it seems to be fairly correlated but you know until the studies finish it's very hard to give an opinion. It's good. We would love to be able to not invade the embryo. One for not invading the embryo. Two for reducing the amount of work that the embryologists have to do in the laboratory. I don't know what people were, whether people realize you know everybody thinks about the doctors and the nurses in IVF. The laboratory is the heart of a IVF clinic. And the laboratory are the people that deal with the eggs, deal with the embryos, grow the embryos, biopsy the embryos. They are so much involved in. I wish there was some better way that we can recognize these people than we do because they're behind the scenes. They're in in the locked up laboratory where nobody else can tread. Sorry. I think. Well, let's let's honor them a bit now and talk a little bit about what they're doing. And as you said, it's the heart of the of the clinic is the lab and your embryologist from egg retrieval. So the doctor you guys retrieve the eggs and then you give it to the the the lab. How long from getting the egg, disseminating, hoping it fertilizes, like all the stuff they have to do before they put it in to do its thing and grow over the next five days. How long is it per egg on average? How long is per egg? Or per per per retrieval. How long do when somebody has their eggs retrieved? Are they done with their eggs in five minutes or is it, you know, how long until they they put it into culture because they had to strip the eggs and they had disseminate. There's a procedure that we do in IVF called X-C. X-C is where we inject the sperm in the egg. IVF, we just add the sperm to the eggs and let the sperm do their own thing. But X-C make sure that one sperm gets into the two and egg. And we use X-C in cases of sperm factors that are causing the fertility problem. We do it in the genetic testing because we don't want a whole bunch of sperm stuck on an egg, which can confuse the genetic testing of the embryo in the future. But it depends on what you're doing, melore, and as through the length of time. When the eggs are retrieved, they go into the laboratory and the first thing the embryologist does is look for the eggs. And that isn't the easy process by any means. And the eggs are in place in a joint incubator that has a microscope that's controlled for temperature and humidity and carbon dioxide and oxygen content and so on. And then once they find the eggs, then it depends on whether they're going to be doing IVF or whether they're going to be doing XC. If they're doing IVF, they are taken by the embryologists and the sperm, which has been prepared by our laboratory in the Andrology Department. That's the sperm part of the laboratory. They take a specific number of sperm and add it to the eggs and these are placed in little petri dishes in little droplets of oil that keep the air away, the humidity away from them and they are checked the next day to see whether the egg is fertilized. If they're doing XC, the egg is surrounded by a collar or cells that nourish during development and do XC, they first have to get rid of all those cells, which they do by specific techniques that they use. And then they take a single sperm and they inject a single sperm directly into the egg in a very specific way away from the nucleus, the DNA content of the cell and it's done and we're quite meticulously and this takes a great deal of skill. This is an instrument that's hydraulic and we have two of these in our laboratory and they are several hundred thousand dollars each. People want to know why is IVF expensive. IVF is expensive because we have a lot of people that we have to pay, we have to pay rent but we have very expensive equipment as well. And with your embryologists in the lab, as you shared, skill and focus and patience because they're spending a lot of time with those eggs in embryo. So a good shout out to all the embryologists and andrologists that work in all these IVF clinics as you wanted to share. Well that's true and I have to pay homage to our laboratory director, Dr. Salab Del Gadear. We've been doing this for many, many years and is at extensive experience. There is no school for embryologists. They're all trained by apprenticeship and he has trained all of our embryologists. I think we're, we have a total of ten embryologists now at all of our close eight or ten and these are highly trained people, Dr. Abdel Gadear and at least two of the other embryologists are PhDs, their master's degrees are well trained people. So they don't come from being a chermic panic to a embryologist in the day. They're highly trained and they have to pass through the different skills that they perform before they move on to the next step. And so we're going to, we're getting ready to wrap up and I just wanted to share with our audience that we've been talking to the most senior reproductive and arcanologist in Canada. And we've heard how Al has gone from in the early days when everything was surgery and they didn't have much to offer to be involved in the invention or the drug of clomad early in the research with the good and how to trope in the youths be method. So that that emergency contraceptive pill is your invention, right? That's part of your, your invention and as well, training people, laparoscopic surgery being one of the early adopters and pioneers of that small group of people when it came to Canada. You know, Lauren, there is no end to what we're going to be able to do. I can't even, I guess what the world would be like in the field of fertility promotion. I think one thing we didn't touch on and then I want to cut me off when you think we were at a time. But to me, I mentioned that earlier choosing fertility clinic is not like just walking into the first clinic you do. When people shop for cars, they don't necessarily go to one dealer when they are shopping for clothing, they may not go to one store. And I think it's the same thing with IVF clinics. Not every IVF clinic is for you. And I think that your patients need to meet their physicians and say, this is what I think I need. I need to be able to speak with you or email you or contact you. Can you tell me how you do that? Can you tell me about your success rates? One of the biggest things that absolutely drives me crazy is when people talk about its success rates. When you buy a car, they always tell you get the miles per gallon. They don't, some don't tell you it's feet per second and miles per gallon, they kill me just for hour and you know the numerator and the denominator that you want to know about. Is this pregnancy rates that you're taking? Is it a clinical pregnancy rate? In other words, is there a fetus and a heartbeat? What are you talking about? A live birth? They're or a non-ongoing pregnancy. They're all different. And you know, you need to know per what? Is it for embryo transfer, for cycle initiative? Because a lot of people start to cycle, but a lot of the statistics aren't given to you unless you have a embryo that's put back. So know these things and invest. One isn't any better than the other as long as you know how to compare them. Otherwise, how can you judge if this clinic is for you? And then is this patient or is this service of the clinic offer patient center? Is the patient the center of things? You may want to look at the costs that are associated with the treatment. But be sure that you're looking to see that you're comparing the same things because many clinics will hide their costs of certain things in other areas and they'll get that information. You need to know all kinds of things that are suitable to what are going to make you happy. And not every clinic is right for every patient. And if you're not happy with the physician, say you need to see a different physician. I know there are people that didn't want to see me. I practice very differently than my younger colleagues. My younger colleagues are very polite. I'm old. I say what I say. Those that can tolerate me are okay with me, but those that can't like someone else. You want a female physician. But there are some clinics that don't have females. And for having a female physician's important to you, then make sure the clinic you go to has a female physician. And so on and express your feelings. And if you know sometimes females are on call or working that day, what do I do? And you deal with the male physician that they think about all of those things before you commit to a specific clinic. And I know you care what the patients and you're sharing this. And you're also sharing this because you know all the fertility checks all those boxes. And so it's easy for you to ask patients to do that because you know your clinic will check those boxes off for that patient-centered care. And evidence of that is, again, one of the early adopters of the multidisciplinary or integrative approach where with acubellance in our clinic, starting to support the patients together in those early days. And so much so that we go on side at all of them. So patients that they want naturopathic and Chinese medicine acupuncture, you're open. And we have that cross professional discussion for the patients. So again, they get that holistic approach, integrative approach. And you check those boxes, patient-centered care. And you're boring from Chinese medicine because we call it individualized care as well. So everybody doesn't get treated the same because nobody is the same. And that's personal. And it's really important to you to hit another important point. Patients will say, "Well, my friend did this or my friend did that. I wanted to do that too." Not everybody is the same. Everybody is an individual. And what you do with one is not necessarily with what you do with another. So we're going to wrap up here. How I could continue talking and with continue talking and telling stories forever. I just think of all the history. We used to do talks together in the early days as well. And that was always fun. And then I brought, I remember Dr. Kaylee came along and she gave a talk with you. And at first, because you didn't know her, you were not sure you're going to be comfortable with that. And then after you said, "She's smarter than you. Can I do all my talks with her?" So as they say, "How says it as it is?" That's it. That's it. Anything back. And she has smarter than I am. I agree. I'm going to do a conversation for what you've done for us. And I know I've influenced you because you named your two sons the same as you. my two sons. We didn't know this but my kids and Al are the same. We both have two boys, the same names except that the names are reversed based on age. So his oldest is the name of my youngest and his youngest is the name of my oldest. But yet we are children and name the same. So I forgot about that but I had forgotten about that as we're having this conversation. Well thanks Lauren for asking me to participate in this. I'm not sure that anybody's learned anything but it was fun, uh, right collecting a lot of the old times. I, you know, I enjoy history and I think it's important to know where we come from, came from because it helps us know where we're going and, um, and it's nice to talk to somebody firsthand that was there versus somebody else tell me it. So it was a pleasure to have you come on the conscience fertility podcast to give us a little history and to share with patients some tips and ideas when choosing clinics and explaining some of the, the difficulty in lethargy and clomad and the lying issue and just where you see things going that I know our listeners may not be aware of, especially the artificial intelligence, uh, picking, looking at eggs when you freeze them and also the part about what you're the research you're doing looking at the culture medium to screen embryos versus, um, hopefully not needing to, um, biopsy the embryo. So I'm sure at the time of this recording that people are going to be listening to this, this is going to be some new information 10 years from now, this will be another little history podcast, of course. We'll, I hope you're around. We hope so too. You'll be in your ninth decade by then. So, um, be, be pleasure. So should we, we'll set up a date in our calendar for a 10 year, a little reunion for our podcast and we'll do another interview. I'll make a note of it. Thank you. Thanks, wow. Thank you for spending this time with us on the coherence code podcast. I'm Dr. Lauren Brown and I will see you next week for another conversation on coherence and healing. If this conversation resonated with you, please like, subscribe or follow the show and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect, and stay connected. Welcome to the coherence code podcast.