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The Future of Fertility Care Is More Personal Than Ever
32 Plays9 hours ago
AI, embryo technology, and personalized fertility treatment are changing the future of fertility care, but what does that actually mean for patients?
In this episode, reproductive endocrinologist Dr. Meir Olcha breaks down how fertility care is evolving through AI-assisted technology, precision medicine, embryo imaging, and more individualized approaches to IVF treatment.
We also discuss why human connection, transparency, and patient advocacy still matter just as much as innovation, especially in a process that can often feel overwhelming and uncertain.
In this conversation, we cover:
* how AI is already being used in fertility care
* the future of embryo selection and IVF technology
* what personalized fertility treatment actually means
* balancing innovation with realistic expectations
* fertility care for LGBTQ intended parents
* how patients can navigate misinformation online
* why individualized care matters in IVF, surrogacy, and egg donation journeys
Whether you’re considering IVF, exploring surrogacy or egg donation, preserving your fertility, or simply curious about where reproductive medicine is headed, this episode offers an honest and hopeful look at what’s changing in fertility care, and what patients should really pay attention to.
CONNECT WITH DR. MEIR OLCHA
Website: https://www.iperchfertility.com
Instagram: @meirolchamd @perchfertility
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Transcript
AI's Impact on Fertility Care
00:00:00
Speaker
AI is already changing fertility care. From embryo imaging to personalized IVF treatment plans, technology is evolving. But what do these changes actually mean for patients trying to grow their families?
00:00:15
Speaker
And maybe more importantly, how do you balance innovation with care that still feels human?
Personalization in Fertility Treatment
00:00:22
Speaker
Everyone's biology is a little bit different, and we know that outcomes are going to be different. if if you give everyone the same protocol In today's episode, reproductive endocrinologist Dr. Mara Olscha breaks down what's actually changing in fertility treatment right now, what patients should really be paying attention to, and why personalized care still matters just as much as innovation.
00:00:49
Speaker
We talk about AI in fertility care, embryo selection, precision medicine, and how fertility treatment may become more individualized in the future.
00:01:00
Speaker
Enjoy.
Introduction to Families Out Loud
00:01:03
Speaker
This episode of Create a Happy Family is brought to you by Families Out Loud. Families Out Loud is a nonprofit organization dedicated to supporting and uplifting families on their path to parenthood through community, education, and advocacy. By creating safe, inclusive spaces and connecting families with resources and support, they help ensure every family feels seen, valued, and empowered.
00:01:28
Speaker
Learn more at familiesoutloudevents.com.
Dr. Olscha's Journey into Reproductive Medicine
00:01:35
Speaker
Dr. Oltschek, before we dive in to where fertility care is going, I'd love to start with just what drew you reproductive medicine in the first place.
00:01:48
Speaker
I was very nerdy and kind of geeky, loved a lot of tech stuff and reproductive medicine. endocrinology and infertility kind of combines the best of all those worlds. When you are watching in a microscope and you're kind of seeing life form in front of your eyes, where you're seeing that sperm in the egg combine and the cells are dividing in front of you, to me, that's the coolest thing in the world. And I'm very privileged to be in this field. And I can't imagine why anyone would want to be any other kind of doctor, but that's, so yeah, I mean, that's what drew me in.
00:02:22
Speaker
Yeah, for sure. Oh, and you're so right. It's like, it it is truly just the coolest thing with it being one of the fastest growing, innovative, constantly changing. It's just so, he just, he was like, it's just so fun. It's just so fun to be here.
00:02:37
Speaker
Like a lot of different facets to a REI or infertility medicine, yeah even in the last 20 years, and the kind of things that we're seeing and and even in the outcomes, they're just significantly better. And every year we are able to do things that are raising the pregnancy rates dramatically compared to what they were like the year before.
00:03:01
Speaker
Yeah, which is so amazing. is amazing, yeah. Before we get into just some of that fun nitty gritty, I mean, you have built your career around helping people navigate some of just the most complex and emotional moments in family building as you look at fertility care What feels most different to you from even just a few years ago? You know, I think that there's ah ah there's a couple things going
Normalization of IVF and Cultural Shifts
00:03:34
Speaker
on.
00:03:34
Speaker
First of all, just in terms of the clinical work, we are really seeing a change in how people are accepting ivf as just like a normal part of having a child and building a family.
00:03:51
Speaker
ah yeah that has really changed in the last 10 or 15 years to the to the point where before, if you asked, and this is like a silly one, but if you ask someone to write ah like a Google review, people were really afraid of doing that 10 years ago or 15 years ago because they didn't really want other people to know that.
00:04:10
Speaker
they were building a family through IVF or through surrogacy or through egg donation. And today that's much different. think people are much more open about it. We've got Facebook groups. um And it's just not taboo. It's not different. It's just another, another thing that that's just another way to have a baby. So that, that,
00:04:32
Speaker
mindset has changed dramatically. And I think it's really amazing and great and nice to know that sort of society has started to accept this as not, not kind of like a blame game. There's nothing wrong with you, right? This is just, it's a little hurdle and it's normal and it's okay to do IVF. It's okay to use a surrogate. It's okay if you need to use an egg donor and these are just like, okay things. So I think there's been a huge change there. um There is also another like really big change kind of in the same vein of women that are interested in preserving their fertility, because again, that was something that wasn't really commonly done in the early 2000s. And we're seeing young women who are working and really trying to move forward in their career and delaying having a child. And now they're very open about freezing their eggs and they're kind of
00:05:29
Speaker
Looking to freeze their eggs, then they're driven to it and they're not feeling embarrassed that they're even going to have to do this procedure and they're talking to their friends about it. Right. So like like that, again, same kind of mindset, but it's really cool to see that cultural change, at least in this country.
00:05:46
Speaker
Yeah, no, 100%. I couldn't agree more. I feel like, I mean, for something that is, you know, one in six, for it to, in some respects, you have some who are still really quiet about it. And then like you said, you have others who are like, oh yeah, I'm freezing my eggs at this time. Oh yeah, me too. Or, you know, just that kind of, and like you said, that cultural shift.
00:06:07
Speaker
Yeah. So I think, you know, from, from that perspective, those are really cool changes that i've seen since coming into the field about maybe like 10 or 12 years ago.
Technological Advances in Fertility Labs
00:06:17
Speaker
um And then we've seen a lot of change in the laboratory. And some of this can get like really granular, but kind of like bigger bigger picture, bigger scope things are a lot more technologies being used and development of a lot of technologies. There's a lot more money going into how to improve outcomes, kind of things that
00:06:40
Speaker
are looking at best practices and how to standardize practices across clinics so that outcomes are a little bit more even.
00:06:51
Speaker
whether that's in the technology that's used to grow embryos and incubators, and there's a lot been changed in that space. There have been things that have changed just in terms of the the kind of media and the reagents that we use in the laboratory. Even some of the instrumentation that we're using has changed in the last 10 years to make things better.
00:07:12
Speaker
Certainly, the quality of optics like microscopes and lasers that we're using has improved even the last 10 years. And now we're starting to see even sort of like the flood of AI technologies coming in that are able to interpret all these and actually give us some feedback so we know how to improve on the outcome.
00:07:33
Speaker
Yeah. Oh my gosh. I'm so excited to talk to you about that because I, yes, I have so many questions about that. But before we get there, i you know, I know you said you there's like standards of care, you know, within the laboratory and things like that. I also know one of the things that, you know, makes you just such a beloved RE is you really put patients at the center of just their care. And you talk a lot about the kind of individualized experience. What does that actually mean for someone that is starting a journey?
00:08:15
Speaker
Um, you know, I guess like I, I take a little bit of a different approach, maybe like, you know, first of all, I practice at a lower volume clinic where kind of a, um, a boutique kind of concierge care. We treat everyone like family here. we know everyone that's coming in We're not a factory style clinic. And, and I'm not saying that that's bad or good. It's just, you know, it's just different. And yeah.
00:08:37
Speaker
And maybe it's, good for some, but bad for others, right? So you kind of have to find a place that I think you feel most comfortable in as a patient. But I do think that for me, whether you're patient undergoing IVF with your own eggs, you're a donor that's coming through our program and you're donating your eggs, you're a surrogate, right? Like I treat everyone the same, like as if they're our own patients. It's not really, there's no question that, oh, well she's a surrogate, so we're going to treat her differently, or she's an egg donor. We're going to treat, like we really treat everyone the same. And I think that's really important. I think
00:09:14
Speaker
patience Appreciate that. And, you know, probably one of the most important things that I've, that i try to do and that I think sometimes is difficult at larger clinics is we try to be as transparent as we can with patients. So it's not like a black box. So they they, you know, they come in, they do their ultrasound, they do their blood work, they leave, they have no clue what's going on, right? We we don't like that because when things are a black box and they're not transparent, you get anxious, you get nervous, and you're not sure, is this is this good that I have five follicles? Is it not good? Like, is this a good thing, right? So, we you know, i try to do my best to
00:09:50
Speaker
don't give people as much time as possible and really set their expectations, let them understand what's going on, talk to them about the protocol and be as transparent as possible. And I think that, you know, that i think that goes a long way.
00:10:02
Speaker
Yeah, no, 100%. I mean, all of those words are something that are that just as an agency, 100% are like, oh, those are our values. Transparency. It's so important in this industry with you know surrogacy, with egg donation, with intended parents to not be a number. You are a person going through something. You need to know what's going on. Nobody wants to feel in the dark, especially with something that can be so, like you said, it's anxiety inducing for sure. Definitely if you are an intended parent and you're going through a surrogacy journey, already there's like a little bit of a distance there because sure the surrogate is at home, right? You're at your own house. You're not seeing them every day necessarily. And so you're kind of relying on the clinic to make sure that things are going well and you want to be as informed as possible. And you want that reassurance that things are actually moving along the way they're supposed to.
00:10:57
Speaker
listen Absolutely. Yeah. With, I mean, obviously fertility care is it it can be so protocol driven.
00:11:07
Speaker
What does it look like with this idea of moving away from kind of that one size fits all approach and really moving toward like that, like I said, that more personalized approach?
Precision Medicine in Fertility Care
00:11:20
Speaker
Yeah, I'd probably say that this is, you know it's kind of like as a whole, what we call this general concept is kind of for what we call precision medicine, basically, right? How can we be more precise? And, you know, you say personalized, but it's kind of the same thing. Yeah. um And what we're really saying is if we have three different people in front of us, are are there any markers, plug-in and whether it's in our head or using some systems, make sure that we create the proper protocols for that individual because everyone is going to be different. Everyone's biology is a little bit different. And we know that outcomes are going to be different if, you if you give everyone the same protocol that what you're, you know, you're not really maximizing the outcome for that specific patient.
00:12:16
Speaker
So, you know, there's like two ways of getting around this. One is your own internal gut and experience as a physician. and maybe part of that is your training and um how diverse your patient population has been in the last 10 years that you've been practicing. Right. And what kind of things did you see in fellowship? So like part of that is kind of the subjective artistry of clinical practice. And I think being in a smaller, more kind of boutique-ish clinic here, I have the luxury of not having to follow, you know, the...
00:12:59
Speaker
X way of doing it. And you can put whatever center you want there, whether it's like Cornell or Columbia or you know, whatever center, like some, some centers have like their way, like their protocol, um which is good when you have a lot of big doctor, like a lot of doctors, because it's, know, you want to minimize the variability a little bit, but of course it's nice to be able to have the flexibility to use your own artistic, we'll call it like artistic, um i don't know, knowledge to kind of paint the picture that you want to paint with the patient. And that's how I see it, right? I like I look at the whole patient, I look at their history, their past cycles, if they've had any, their ag reserve. And then we sort of like paint this picture on our head of what we think is going to be the best protocol that fits them.
00:13:48
Speaker
So that's kind of part one, a little bit hard to explain and and definitely relies on experience. And then part two, which I also utilize and I utilize them kind of in combination is, well, how can we take the technology that's available to us in the field and use that to facilitate painting that picture as well? Right. And there are some great AI and software technologies where you can input into the system, your consult note and their past history and their age and you know their AMH level, and then it will output what it thinks right are the right protocols for this patient. And it might even show you protocol one, two, three, four, and then show you, well, if you did protocol one, this is likely your outcome. if you did protocol two, this is likely your outcome. And that's how we really become much more precise. So we take a little bit of the artwork and a little bit of the sort of
00:14:47
Speaker
science see big data stuff and we put it together, at least here, and that's how we come up with our protocols. Okay. This is so fascinating to me because I have to say there's a part of me that's like, I'm okay with chat GPT making me my grocery list, but I get a little nervous about this idea of plugging in, you know, just a couple of things and being like, all right, here's my protocol. Like, tell me, get into the nitty gritty about like with it for me and just kind of help me understand what does that actually look like in practice? Yeah. so um, you know, chat GPT takes information from,
00:15:22
Speaker
all over the the web right so rights not validated data. That's the problem. And that's why when you have patients that are on ChatGPT and they're looking at, you know, is this procedure painful? And and it's going to say, yeah, this procedure is really painful, whereas like it may not be, right? Sure. ChatGPT is kind of taking stuff from talked about like Facebook groups to Google searches to Twitter, right? And it's taking all this data that I wouldn't call it validated data, whereas the AI platforms that we have what happens is they are only given validated data sets to use. So it's not like it's going on the internet or using some chat GPT algorithm to figure out what your best IVF protocol is. What's happening is that the the software developer developers are actually taking real world outcomes across hundreds of thousands of IVF cycles. And they're putting that into the
00:16:21
Speaker
system as sort of like the database from what it learns from now we know that we're relying on validated data to make the decision and like i said it's a combination of both right it's like you don't just do what the computer says you you use the computer to kind of help guide you a little bit and make sure that your thought process is actually um really well correlated with like out with validated outcome data So you still definitely have that critical thinking piece for sure, but it's almost like a faster way to get a hold of maybe a medical journal that you haven't gotten to yet.
00:17:01
Speaker
Yeah. And I think it also provides a little reassurance because ah more often what I'll find is, okay, this is the protocol I want to put someone on and the software actually kind of agreed right away. Right. So it's a little bit of a reassuring thing there.
00:17:15
Speaker
um and I think that's, you know, it's it's nice to have that. Yeah, for sure. well yes, absolutely. I love collaborating on projects and things. And, you know, it is nice to have a team sit there and kind of tell you, well, yeah, this is great. Or actually, have you thought about, you know, this may be possibility.
00:17:34
Speaker
What's when it says you you had said, you know, it kind of like spits out like protocol one, two, three, four. Right. Are you at that point, is that where you're going to, you know, your own gut or how do you kind of decipher? guess that's like your baseline, right? So that's like your starting point. And then from there you put in your little tweaks, right? Like my own recipe, right? Which is going to be slightly different from other people's recipes. For sure.
00:18:03
Speaker
And, you know, hopefully that, that the combination of the two will get the patient the best outcomes. Yeah, yeah. We'll get right back to the show in just a moment. But if there's one thing we believe at Egg Donor and Surrogate Solutions, it's that building a family through egg donation or surrogacy should never feel transactional.
00:18:22
Speaker
For over 18 years, we've helped hopeful parents, surrogates, and egg donors navigate this process with education, transparency, and relationship-centered support every step of the way. We believe people deserve honest information, thoughtful guidance, and a team that truly sees the human side of this journey. If you'd like to learn more about our agency or explore working with our team, visit createahappyfamily.com.
00:18:50
Speaker
All right, let's get back to the show. What, and I know you said you just outcome success rates have, they've just steadily gone up over the year. Has there been an assessment on kind of some of these AI tools and the success rate from there? i guess, you know, should, where should patients feel encouraged by something like this? Yeah. So, you know, this is like an ever developing field, right? I mean, like it for sure is. And
00:19:23
Speaker
I don't know that, I mean, we are far away from the point where we can say, hey, I can just do it all. think we're very far from there. um I it depends on what aspects of the journey that you're using the technology is going to maybe give you, like the answer might be a little bit different for yeah whatever aspect you're looking at.
AI in Embryo Selection and Protocol Creation
00:19:45
Speaker
There is some interesting data that's come out recently on, for example, there's some ai platforms that look
00:19:54
Speaker
at the images of the embryos once they're sort of fully developed. And if you're someone that you're trying to figure out, you know, do I put in embryo number one or two or three or four? Traditionally, what we would do is we would ask the embryologist to look at the embryos and kind of grade them based on how they look. Yeah. um that's That's kind of like looking at a painting though, right? and And while there are some objective criteria, a lot of that is subjective. And I think we know that if we show the same embryo to five different embryologists you might get five slightly different answers. Probably they'll all be in the same range. Like no one's going say this is a really bad embryo and this is a really great embryo. But, you know, you might have some slight variations there.
00:20:38
Speaker
And, you know, there are now some softwares that are out there that look at the embryos and help kind of prioritize based on again a standardized validated image set to see and try to assist the embryologist and the doctor in um counseling the patient on which embryo is better, essentially. right so So that technology, i think, is developing really nicely.
00:21:05
Speaker
And there is one study that came out very recently, about a month ago, which was a non-inferiority study, which basically said that the doctor was at least as good as an embryologist.
00:21:16
Speaker
So not better, but at least we're at the point where we have some digital software that might be almost as good as an embryologist. And I think to me, that means that like in five years, we are probably going to get to the point where maybe the software is better, right? um or Or at the very least, if you've got...
00:21:36
Speaker
a number of embryologists and some are newer and some are more senior, right? Like this is some interesting technology that you could help a more junior embryologist kind of get better, right? Because they're sort of using the software to help them develop their, you know, their, their own sort of appreciation of whether an embryo is going to have a high or low potential. Mm-hmm.
00:21:58
Speaker
Mm-hmm. No, that's fascinating. i'm Kind of a selfish question, but you know ah a lot of times kind of the general standard, like particularly with surrogates is, you know if you have a if you have three failed transfers, that's it.
00:22:16
Speaker
A clinic's not really, you know you're you're now kind of too high risk, if you will. Sure. With technology like this, because a lot of times you'll have you know maybe a surrogate will come back or you know even a just intended parents or whatever it may be and kind of say, well, hey, let's let's take a look at that embryo quality. What what were kind of maybe some of the the factors that you're not seeing you know on on paper? um Is this technology something that would maybe change some of those kind of standard protocols across clinics?
00:22:50
Speaker
Yeah, it's an interesting question. um You know, I guess if you had that data, like the images of those embryos or or the, or the data output from the machine that says that actually all those embryos were like not really destined to survive anyways, like maybe it would, right? Cause it's, it is. difficult at you and that's just one variable. I mean, you have a surrogate that fails two or three times.
00:23:17
Speaker
Maybe it's the embryo. Maybe it's the surrogate. Maybe it's the doctor doing the transfer. Maybe it's the embryologist that loaded the embryo. Maybe it's the embryologist that thawed the embryo. Maybe it's the embryologist that froze the embryo. It's so difficult. There are so many variables here yeah like all have to be perfect for us to have a success. And if even one is off, then that's a failure. And I think, you know, what we, what we're doing by, by kind of disqualifying a surrogate based on just three failed transfers alone is we're making the assumption that it's something wrong with the surrogate where we, you know, that's an assumption at the end of the day. yeah um And yeah, certainly I can imagine a day where if we had some better tools to evaluate not just the embryo but maybe other
00:24:05
Speaker
factors like other independent variables um that might help us better determine who are good surrogates or who are, you know, you better or worse surrogates. Yeah, no, I love that.
00:24:17
Speaker
i you know, a lot of times you're a in this industry, you have people kind of looking for like that magic bullet type of situation when it comes to this type of technology. Obviously, this is incredibly exciting. But where should maybe patients still ask questions or be more reserved as it's developing?
00:24:38
Speaker
I mean, like i mean, everywhere, I guess. Right. like Sure. At the end of the day, I always tell patients that you're you are your best advocate, like your your best medical advocate. You should always advocate for yourself no matter what. And that's true, of whether it's fertility or you go to the yeah ER, like anytime someone's going to present something to you as a treatment option.
00:25:00
Speaker
you know, i like it it falls under your responsibility to make sure that you ask the right questions. And I think this is definitely one of those things. Obviously you wanna trust your doctor. And I think, you know, picking a a good clinic and a good doctor that has experience is good.
00:25:14
Speaker
um You know, it's it's AI is like a, well, it's kind of like a buzzword, but it's a a new field and everyone's putting AI in everything. And I think even when I look at some softwares, even though they say AI, they're not really AI. they're just more like learning based modules or so you got to be a little bit careful about that. But yeah, i would say like, I'm still cautious myself. Like I don't just adopt the technology just because it was sold to me by a vendor and because there was one paper on it. there's Lots of things with one paper and turns out later they're totally wrong. Sure. So yeah, i mean, I think you have to be cautious and the clinic needs to be a little bit cautious when you're adopting new technologies like this.
00:25:58
Speaker
Because there is so much information available to patients, and especially with new technologies, breakthroughs, things like that, how do you help patients kind of balance hope with realistic expectations?
00:26:14
Speaker
okay Well, that's a hard one. Yeah. ah ah You know, it's funny. Like, as much as I love the, you know, Google and ChatGPT and all that stuff, it's really...
00:26:27
Speaker
really bad too um
00:26:34
Speaker
I think that it goes back to sort of like the transparency and the setting expectations that can really help kind of ground people, so that they're not getting lost in these holes, you know, these like internet holes of whatever it is. Um,
00:26:55
Speaker
So like I, for me, like as many touch points as I can have with the patient, I try. so like, I like to do my own scans in the morning. That gives me an opportunity to, to talk to them for just even two or three minutes and give them a quick update. Um, we try to call them in the afternoon and if I can get a, you know, a couple calls into some patients to tell them their progress, I think that helps. Um,
00:27:17
Speaker
you know as many touch points as we can get with them i think that that can be helpful and it allows you the opportunity to to just really like kind of hone in on the expectations so if you're someone that is 43 or 44 and you're using your own eggs um you know you could read a story about someone that posted that they were 45 and they got pregnant on their own. Yeah. But that's like one story out of maybe a thousand or out of a hundred. Right. And then 99 other women that unfortunately didn't get pregnant, they're not out on the internet writing out about it. No one likes to write about failures. um
00:27:53
Speaker
So I think, you know, just like really being transparent and setting expectations is super important. And I think that, you know, that helps people overall. Yeah, for sure. I mean, i go off on just my soapbox about Dr. Google and how much I am, you know, like, please proceed with caution or just don't proceed at all with Dr. Google. um But definitely it's it is so important to have those touch points so that there you can have that pitch that opportunity to have patient education behind that.
00:28:22
Speaker
One of the things that is so great is, you know, I know you serve on the board of Families Out Loud with Katie. It's just, you know, supporting the LGBTQ community. From your perspective, how does fertility care need to just continue to evolve to better support LGBTQ intended parents?
00:28:45
Speaker
Yeah. Yeah. I mean, for first of all, like I think we should acknowledge that it's come a long way in the last 15 years. Right. It's really come a long way. um And even the the founders of Families Out Loud who had to go through surrogacy themselves um even five years ago, I think is when they went through it or or around that time frame.
00:29:10
Speaker
Had a really tough time even back then. um and things are getting better and better, which is, which is good, but you know, Phil, I think they will continue to get even better.
00:29:22
Speaker
The good part is that we have a lot more tools available to us today that maybe weren't available 10 or 15 years ago. and,
00:29:35
Speaker
and Things like the ability to find a donor or find a surrogate or find a reputable agency. I think you're just having an easier time today to find that than you were if you were looking for a surrogate 15 years ago. You probably had like a pretty challenging time. Yeah. I think that there's a lot more education out there now.
00:29:55
Speaker
and groups where you can join and have these like, you know, interesting live interaction sessions with other intended parents that are looking towards surrogacy and a lot of kind of open discussion, which is great. Yeah. um We're definitely seeing a lot more even just in terms of education on websites, like clinic websites are going to have, you know, have whole sections dedicated just towards LGBTQ or surrogacy. or third party and i think that's great i think that gives you a lot of insight as to whether that clinic is going to be a good clinic for you. They have something on their website about it.
00:30:38
Speaker
um And I think we are much more open to doing click cooler things today. like we you know i get a lot of patients who might want to do reciprocal IVF cycles where you've got two women and they're going to use their own eggs, but their embryos that they're creating, they're swapping, right? So one person carries the embryo of her partner. And that, you know, that wasn't something that I ever saw in fellowship.
00:31:07
Speaker
It's just, I don't know. It just, I never saw that. Sure. But we we see it a lot today and we're proud to offer it. And I think it's a really great way for, you know, two partners to both be involved some in some way or another,
00:31:24
Speaker
and sort of like building that family together and that's to me that's that's like one of the coolest things you can do. Yeah. yeah When you are talking about the future of fertility, the advancements, all of the different things from your perspective, what is most exciting right now and what
Innovations in Embryo Growth and Genetic Testing
00:31:48
Speaker
might be getting a little more attention than it should? I am, um,
00:31:54
Speaker
really excited about some of the new equipment that we use in the laboratory today. well you're a tinkerer. This feels right. like I'm a geek kind of when it comes to tech and equipment and engineering. um We typically will grow embryos in incubator neonatal ICU and you have the babies grow, you know, not growing, you have the babies that maybe are premature and they're sitting in this incubator and it's warm and cozy, right? So we the same thing, but in a much smaller form factor. And so those little incubators are controlling things like your pH and your temperature and your oxygen and carbon dioxide in a tiny little chamber so that this embryo can grow. um
00:32:44
Speaker
Traditionally, we would take the embryo out of the incubator every couple of days to check on it. And the problem is that that exposes the embryo to the air and the ambient air quality and the ambient air temperature. And you're kind of taking the embryo in out all the time.
00:33:00
Speaker
There is some really cool technology that's come out in the last decade, but really has made huge strides in the last couple of years called time lapse incubation. okay And it's very cool. It's where you have in the actual. incubator a camera that takes pictures like every fifteen minutes of the embryo across five or six or seven days.
00:33:24
Speaker
And an embryo, you should think of it as like a sphere, right? It's like a basketball. right not only does it just take a picture, but it takes a picture at different focal lengths so we can see the top of the embryo the upper pole the middle the lower pole the bottom of the embryo all those pictures um every 15 minutes across seven days, right? So we get this like tremendous amount of data.
00:33:50
Speaker
We are able to watch the embryo grow across the five to seven days. yeah We don't have to take the embryo out of the incubator, right? We sort of like set it and forget it. So we're not manipulating the embryo. We're not changing the temperatures, taking it out, putting it back in. And I think we're finding like just that alone we're getting better outcomes.
00:34:11
Speaker
So to me, that's like really cool technology that's out there. And we can even talk about really cool we can even export a video of this embryo growing over five days and give it to the patient, right? Like after we've transferred the embryo and they're pregnant, yeah it used to be that you would give people like a printed picture. oh Yeah, everyone just has their one little thing. yeah Now we can give you like a video of this embryo that has been growing in our incubator for five days. And it's like, it's mind blowing. It's really cool stuff.
00:34:42
Speaker
That is so cool. Obviously, when i shouldn't say obviously, but part of, you know, just creating embryos is, you know, some of that genetic testing and, you know, just all of that. Just does this technology have anything to do with kind of taking away the natural issues that can come up if you're going you know, try and, hey, let's check for certain, you know, genetic markers or things like that?
00:35:07
Speaker
So the answer is right now, probably not, but in the future, definitely. Right. So I think what we are going to learn is that i analyzing the footage over five days or six days or seven days and analyzing the hundreds of images that we're getting, we are going to learn a lot about the morphokinetic how the cells are goodiding are they equally divided Are they off to one pole? Is it skewed? Are there, you know, a lot of particles, right, as they're dividing? um
00:35:41
Speaker
And we are going to probably learn over the next five to 10 years that that somehow correlates to whether an embryo has Down syndrome or whether an embryo has um a high risk for miscarriage or or a high risk for pregnancy. or We're going to learn this stuff. Right now, we have all the data and we don't really know what to do with it.
00:36:02
Speaker
Now, it's like when the genome was first sequenced, we knew the genome, but we didn't know what it meant. Right. So that's where we're at. We know what it kind of looks like, but we don't yet know how to interpret the 3000 images that are taken.
00:36:18
Speaker
And I think that's where to like to bring AI back. Right. That's where yeah some really like good computing power can look through thousands of images and have a much better idea of what that means and how well it will correlate to an outcome. And we will see that like, for sure.
00:36:35
Speaker
i am ah a huge believer that there will be a day where no one is doing DNA biopsies anymore, because it's just not necessary. And that this data we're getting from these time lapse imaging incubators is going to be as good as the DNA data that we're getting.
00:36:51
Speaker
Wow. That is so cool. Yeah. it It all sounds so exciting. And you've kind of already said it earlier, you know, you still always
Ensuring Safe Adoption of New Technologies
00:37:01
Speaker
proceed with caution. Is there anything about this, you know, just all of these like advancements that are taking place where you're like, i don't know, nervous or kind of like, hey, let's not go down that road. Yeah, I mean, you know, I mentioned this thing called a non-inferiority study before. and And that's really critical when we bring on technologies. And what that means it's just like a fancy word for saying that someone has studied this new technology, new method, new protocol, whatever it is, right? New media. There's lots of things. And they've compared it to the current standard.
00:37:36
Speaker
And they have proved with you know without a doubt, with some really good statistics, that this new technology, we'll call it, is at least as good as the standard of care. right um And I think as long as we have data like that, that I'm not as concerned moving forward. But it's really important that all of these companies and vendors make sure that they do the proper studies. and that the physicians and the clinics do the right due diligence before adopting
00:38:10
Speaker
dead study. yeah Um, this is probably true of any medicine too, right? Like when a new heart, like a new heart medicine comes out, our new blood pressure medicine comes out, or cholesterol medicine comes out, we don't just take it, right? We like, we study first, we do RCTs, we do a phase one trial, a phase two trial, a phase three trial, it gets FDA approved. And you know, the same is true, um, in IVF.
00:38:34
Speaker
I think sometimes we all get so excited. And so we want to adapt something really early. on but you know on the other hand like we use you know we have to be cautious and careful. And I think we you know we certainly try to do that here at our office.
00:38:47
Speaker
Yeah, for sure. kind of continuing along, you know like you said, you you're excited about all those things, but you obviously, you look at the patient as a whole or the you know scenario as a whole, particularly with third-party reproduction, surrogacy, egg donation, where it involves multiple people placing so much trust in the process for you. Like what responsibility does that place on the physician physicians to ensure that everyone is feeling informed and knows that protocol and kind of maybe just going back to kind of just that patient education aspect of things?
00:39:28
Speaker
You know, like i I always tell my intended parents that it's my job to be your advocate, right? Like that's my job. And Everyone that you're going to interact with, like they're all going have their own agendas.
00:39:44
Speaker
you know Maybe the egg bank is going to want to sell eggs and the surrogacy agency is going to want to sign the contract and the lawyer is going to want get the lawyer fee. like they're all goingnna Everyone's going to have their own agendas. And we certainly have our own agenda too. I mean, I'd like to think our agenda is to get pregnant. right um But ultimately, like I tell people that, like, what I really try to do is advocate for you as the patient. And if I think that somewhere down the line, you know, it's not a good match or something's not a good fit, then I'll be completely like clear and honest about it And it's better to know what
00:40:23
Speaker
you know later yeah um A lot of that comes down to our processes and our screenings that we do and reviewing the the medical records and making sure that the psychology evaluations are right. Like, that you know, we have a pretty good outline of the things that need to happen before we match either with, a you know, egg donors or with surrogates. because at the end of the day we you know we also want that match to last forever um
00:40:56
Speaker
And like the only thing I can offer is my experience and my expertise and just really like letting the patients know that like we're on their side, like we are really on your side. And and the truth is like everyone here is on the patient side. But at least from the medical perspective, like, you know, we try to give them as much decent, good, quality, competent medical advice as we can.
00:41:21
Speaker
Well, and again, it just goes back to that value of being transparent. And I'm not going to give you necessarily the news that you want to hear, but I'm going to give you the the honest you know truth in all of this. And and it goes to you know working with industry professionals that that share that, working with you know the agencies that don't look at everybody as a number or, you know, the attorneys that are, you know, in it, not for the lawyer fee, but for, you know, that, Hey, guess what? Parentage time, you know, just that kind of thing. Yeah. And, uh, you know, like, just like most clinics that we, we have the partners that we like to work with and the ones that we don't like to work with. And I would say on a podcast with you, so, um, but yeah, there, you know, there are,
00:42:10
Speaker
there are people that we don't like to work with. And I'm not shy about letting my intended parents know that maybe you should look somewhere else. Yeah. Well, and again, that goes back to just the importance of that patient education and having those trusted, you know, just that trusted team of, you know, yeah. Hey, I realized that maybe you saw that, that one Google review or you typed it into chat GPT, but you know, let's, let's do, let's, let's follow up with that. Yeah.
00:42:36
Speaker
And I think, you know, organizations like Families Out Loud are great because yeah they have their own reputation. and you know that if you're going to go with one of their partners, like you know, that are on their whatever list they have, you know, you're probably going to find someone reputable as opposed to just doing like a random Google search.
00:42:56
Speaker
Yeah, for sure. Yeah. When you think about success in these journeys, what to you like what does that look like beyond you know just that positive pregnancy test?
00:43:10
Speaker
um it's yeah It's probably different for different people and different journeys. It's like you have some patients who positive or negative pregnancy, like it's really important for them to know that they did everything they could have possibly done, right? Like they don't want to wake up one day in five years regretting not done something. And I think that, you know, even if you have a negative outcome and not everyone that comes through our program is successful in terms of having a live birth. Like that's just, that's human biology, by the way, like that is just the way it is. There's no program that's one hundred percent. But I think what, what makes us really different is that
00:43:54
Speaker
we try to help the patients understand that even if they didn't have a successful outcome, like we really did everything possible. and there's a lot to be said for that. You know, there's like really a lot to be said for that. And um sometimes like knowing that you did everything possible to use, your eggs like and it didn't work that that might give the person kind of like the I guess like the reassurance that, yes, i think I'm ready to move to donor egg and that's okay. And that's not a bad thing. um So yeah, I think making sure that, you know, people understand that they did everything they could, um you know, within reason is is really important. um
00:44:42
Speaker
Obviously we love the success stories and we love the, you know, the babies and the baby pictures and all that stuff too. Oh yeah. It's, it's the best for sure. yeah It is the best. I mean, when we call patients with their pregnancy test, it's it's usually like me and all of my coordinators in my office and we call them on speakerphone and we we yell at them. We're like, you're pregnant and yeah and crying. you know We like to do that.
00:45:08
Speaker
Oh, I love it. I love it. The baby pictures are just, yes, no, it's it's the best. I love it. My favorite has been, I get like the Christmas cards and I'm like, oh my gosh, they're so huge. And just like seeing all of that. No, for sure. We like we keep a cork board with, um you know, all the cards that we get from people. And it's it's a really nice reminder when you when you walk in every morning of like, lines.
00:45:37
Speaker
Yeah. No, a hundred percent. yeah For someone listening right now and navigating, you know, just their own fertility treatment journey, maybe they're feeling overwhelmed or uncertain.
Emotional Support in the Fertility Journey
00:45:51
Speaker
What would you want them to understand about this, just this field where they are and as they move forward?
00:46:00
Speaker
i mean, like the most important thing is for them to understand that they're not alone like you're definitely not alone. If you think you're overwhelmed, everyone else around you is just as overwhelmed. Like there's no one that walks into my office that is like, oh, I'm happy, you know, that I'm here sitting at a fertility clinic and I need to use a donor a surrogate. No one is happy about that. And I think, you know, it's okay to be nervous and anxious and overwhelmed. Like that's just, it's normal and natural. in fact as it's probably unnatural if you're not So, yeah I think, you know, take a deep breath, understand that it's normal. And the other thing that is sometimes helpful is try not to just put everything together at once. Like as if you have to do everything in one day, right? If you have to get out of that mindset and just look at the bigger picture and understand that there are steps and like, you know, you do this in baby steps and it's not going to happen overnight. it's not goingnna happen tomorrow and that's okay Don't get overburdened with the 70,000
00:47:11
Speaker
feel comfortable with it and then move to the next thing finish that then move to the next thing right right if you're two men and you're trying to have a baby maybe the first step is just a semen analysis just just get that done like don't worry about finding a surrogate and egg donor what about like just do your semen analysis make sure that looks good and you know once that's good maybe the next step would be freezing sperm fine do you know do it in like little steps otherwise i think you will get overwhelmed too fast um when you're going through fertility treatment, it's like learning a language, right? We like we speak a different language. and It's a totally language. It's the same thing when I bring a new nurse on or a new coordinator. it takes them three months just to learn like the words that are coming out of my mouth. Absolutely. The alphabet soup that is fertility is crazy. yeah So, you know, you're not going to, just like you don't learn a new language in a day, you're not going to go through your fertility journey in a day. There's lots of things to do. um And, you know, you'll, you'll get there eventually.
00:48:11
Speaker
Yeah. no absolutely. Absolutely. Well, Dr. Olsha, just thank you so much for everything that you do. And you know again, just the partnership that we have through you know Families Out Loud and just all that you do for you know our mutual clients. But I do have one last question for you, and it's a fun one. um For anyone who knows me and you you've seen me this whole time sipping on my um lovely cup of coffee, coffee and I are never far from each other. um i may or may not be a little dependent, um but I always love to ask the question, what has filled your cup today? Literally or figuratively, what has been the thing to fill your cup? Yeah.
00:48:57
Speaker
Let's see Well, i I, like you, have a coffee cup. Yes. What has filled my cup today? um you know... I'll tell you what filled my cup today was, um, I just have like kind of a basic coffee situation with a touch of cream. And then I am currently still riding the high of my eldest who is it's show week this week. They're doing frozen junior. And she was open last night. And the whole like you who big summer blowout thing was just so fun. And it was just so cute. And I just keep thinking about it. I'm like, how are you 14? What's happening? Yeah.
00:49:36
Speaker
All right. um I'll tell you what filled my cup today then. um and In the same vein as fertility. So I have like a chicken coop in my house and I own chickens. I love it. And I just got this like brand new Batsy
00:49:58
Speaker
so i like I finally had an egg and I was very excited. Obviously, you know what I do for a living. Yes. Yeah. I'm now getting eggs from my chickens and it's really cool. And I'm excited. i was like so excited for that.
00:50:13
Speaker
Oh my gosh. Congratulations. You're like, you're and you're a chicken dad, I guess. yeah ah That is amazing. I love that so much. Oh my gosh.
00:50:23
Speaker
Well, again, just thank you so much for everything, for explaining some of this fun nitty gritty and just for all that you do in just supporting your patients. Really, um it just, it all matters so much. and we're just, we're so grateful. And I'm just so grateful that you took the time today to to be here.
00:50:42
Speaker
Thank you so much for having us and for having me. And I hope your listeners got something out of this and, um,
00:50:51
Speaker
hundred percent thank you
00:51:12
Speaker
you