Transcript
Speaker: It's not about transferring embryos. It's not even about pregnancy. It's about having a healthy baby coming home. If IVF is so expensive, why would a fertility clinic recommend transferring just one embryo instead of two?
Speaker: It's a question many intended parents ask. After all, you are investing so much time and money and emotion into building your family. Wouldn't transferring two embryos increase your chances of success?
Speaker: Dr. Julian Escobar is a reproductive endocrinologist who has also experienced family building through egg donation and surrogacy himself. The hardest part of my life was when my kids were in the NICU.
Speaker: Hardest part of my life. Today, we're talking about one of the many important decisions intended parents make during this process and why fertility doctors often recommend transferring one embryo even when transferring two feels like the obvious choice.
Speaker: Enjoy.
Speaker: Okay, Dr. Escobar, you are a reproductive endocrinologist at Conceived Fertility, but one thing that some listeners may not realize is that family building through egg donation and surrogacy is actually personal for you as well. Would you mind sharing yeah a little bit about your own journey to becoming a parent?
Speaker: No, of course. um So, yeah, maybe I chose the field because i knew I was going to need help or maybe or. Maybe i I decided to become a parent because it i it was part of what I discussed every day. But yeah, so I mean it's i think it was, um unless you go through it, it's hard to know how personal it is, you know, um the entire process. And whether it is... discussing something so personal about building your family. I mean, most couples probably don't even talk about it too much, right? and But if you talk to a doctor, you're forced to talk to yourself about it, to your partner, to the doctor, then you have to go through an evaluation. um And then you depend on people to just do one of the most important things in your life that
Speaker: that society thinks is basic, you know, but it's not as we all know. And then on top of that, you have to resort to third parties like egg donation and surrogacy.
Speaker: how How do you incorporate that into your life? And even if you are OK with it you're going to have to face your family and friends in society. And how does that it interplay, you know, and yeah What type of donor do you pick? I mean, unless you have to go through it, it's hard to put it in your head. you know, are you picking someone that is just giving you eggs? Are you picking someone because they have your temperament and your philosophies and maybe your dedication in life? Or is it just someone who...
Speaker: looks a certain way. And I guess if you're a woman, someone who looks like you, or if you're a single guy or a gay couple, are you picking woman that you think is beautiful? Are you picking someone who seems maternal? Are you picking the woman that you may bring to introduce your mom if you were straight? I mean, it's just a lot of things that go into it. Sure.
Speaker: And it's different for everyone, you know? And um and so, but it's just a lot of parts of the process. and and And I think what I like to tell patients is the journey and it's step by step, regardless of what journey the fertility world you you take.
Speaker: And I think overly planning and a lot of us are very type A and overly ah putting deadlines, it it just makes it more frustrating. And the problem is that the the field seems so high tech and so in control that it, especially if you're type it makes you believe that you have control in all these little aspects of what when you want to become a parent or what are you going to do or what date or what gender or like i've eliminated yeah bad things that can happen in pregnancy so of course nothing can happen in my pregnancy you know and those are not all necessarily true and surprises are gonna come and so i think regardless of how well educated how much resources you have how much you plan um it's still evident that the miracle of life has to happen you know and um so So, I think going through it was just a very, it's almost as if I knew nothing about it and when I was going through it because the entire experience was just not very medical in my head, you know, um very personal. And I realized for most patients, it's probably like that. I think as doctors, we overly spend time explaining all the medical aspects. And I do think
Speaker: that ah in retrospect, probably like what people care about the most, it's not that technicality of things, you know? Sure, sure. So I do think he's maybe a better doctor, you know? so And so for full disclosure, I have a male partner. So obviously i always knew I was going to need help, you know? ah and um And so I needed i was going need IVF and an egg donor and a gestational carrier. And still there's many different ways of of doing this. And do you combat this against, do I adopt? You know, why do i you know there's there's ah always options. Lots of decisions. A lot of decisions, yeah. So um that's a little bit about me. Yeah. So you knew you were going to need to participate, you know, or have go through some type of process, whether it be this or alternative to build your family. And then obviously being a reproductive endocrinologist, I mean, you knew all of the medical jargon and and yet still you said it felt so personal. What was that experience like when
Speaker: even with everything that you knew. and then I know you said it's made you a better doctor. How how has that changed maybe how you started versus now? How you you know how has that shaped how you counsel your patients? So um I think part of my personal journey was i was not just doing things about myself. you know I have a partner and that is non-medical. And you build a family together.
Speaker: And so I could not come across as I'm going to call in the shots. I'm going to, uh, present biased information. um I'm going to be the one dominating conversations with, um, the physicians or the providers or whatever, you know? And so,
Speaker: um And so even that by itself was was was just just hard, you know, because you have to become a patient, right? and and and And so, no, and sometimes knowing too much is not good because they're overly focusing on everything bad that could happen. Sure, sure. opposed to just enjoying the journey and thinking and everything is perfect, you know? Ignorance is bliss sometimes, yeah. Ignorance is bliss.
Speaker: ah So I think is that, and you know, so I'll give you an example. So, so we, yeah we did IVF like 13 years ago and had an egg donor and split the eggs and between the two of us. And, um and then we, um,
Speaker: But back then you could put two embryos. Like if you had two embryos, you would put two. No one put one. And so yeah um and so obviously with the cost of surrogacy and just involving a third party and all the legal stuff and everything, you're like, oh, my God, it's just it'd be so nice to get it done right away. you know, and so you put two, but still you you don't know you're going to get pregnant with both. And that was a time when we couldn't get married. And so. um And so you're here trying to form a family and the government doesn't really um support you as a ah as a unit. And so, which he didn't really matter to us, but once you have kids, all these things matter. Then all of a sudden having a will, having ah a life insurance, having a, what's going to happen to my kids, right? And so, and then yeah law laws start changing and Now, you not only that your family doesn't only depend on um the medical part, but the legal part. And it's just like an intrusion into your life, you know. And so um so I think that all these aspects of family building just became more apparent. and I realized that this is really what people think about. So for me, it's more about building the family with my patients, kind of backtracking. Don't tell me what you want to do. Tell me what's the family you imagine. And it's... Like, I had a patient, like whenever I have like, I don't know, 10 years of infertility, they feel very guilty telling you they want more than one child. But like, no, just tell me what, you you know, like, what is your dream? Even if he sounds obscene at this point, you know, but what did you envision and genders or order things? And so, um,
Speaker: And so I think I like to start like that. And that it's it's it's often the husband and the wife or the partners may be at different spots. Someone may be more educated and interested and the other one needs to play catch up. And so I think these are all the all the aspects that come into it. um and um And I just think... My story, it's it's not something that I necessarily bring to the table because it's not about me. But if there's something about my story that can help a patient make the transition, you know, where they're stuck, then I bring it up. You know, whether it's needing help, going, needing IVF or shoot choosing a donor, trying to need a donor. How does it feel to have a donor conceived child? There's all these things you have in your head when you don't know. But now that I've gone through it, can reassure patients of things that now are very simple, the things I never knew.
Speaker: um And same thing with surrogacy, you know? So, um like, what what are the important things that I that i looked for and what type of relationship did I have with my surrogate? And so um so I think it's it's just helpful. and And sometimes it's just sharing your story, your but but your view or part of your experience. And it doesn't mean that that was the correct way of doing it. And I would have do it different we have done it differently. And so so first time we transferred two embryos, thought that we would get maybe one, put a boy in a girl so that we could determine and antenatally if we got pregnant with one, whose was the biological child. And then we got pregnant with both. And so...
Speaker: And they had boy-girl twins, Pablo and Valentino. And um they then we went to have a third child. And at that time, we wanted to make it a secret for the family and the friends. We were not going to tell anyone. And um it it's when I turned 40 and we kind of had big family gathering Mexico. And I never cried. And cried telling my entire family, we're all pregnant again.
Speaker: um And it was just, I feel so blessed. And we come back and did the first sonogram on the surrogate and there was no baby. There was no baby, there was placenta, no baby, and and and and an embryonic pregnancy. So you could plan it all. You could have this surgery. She had four embryos transferred before, all delivered. This was the fifth one.
Speaker: Again, five out of five transfers, she gets pregnant. The embryo, the baby did not form. She was still pregnant. Her HCG levels rose appropriately. She fell pregnant. And so then you go, it's a double whammy. Not only have a loss, but now you're the doctor.
Speaker: managing this. Your nurse is freaking out doing the sonogram. Your partner has no idea what's going on. They're just a special care. You're the patient, but now you've got that. So regardless how you cut it, it just doesn't make it easier being in the fertility world or not. You know, like it's um it's it's a very personal journey, you know, and and and I also. Well, and.
Speaker: And what I'm hearing from you is that I think something so beautiful about this is particularly with where you sit as a doctor is you are looking at the whole of this journey. You aren't just looking at, you know, okay, there's a sperm and an egg. Let's make an embryo. Let's do a transfer. I mean, I'm hearing you, you're, you're thinking about what are your dreams as a family? Let's look at the legalities of things. Let's talk about, you know, what it is to find a surrogate or what it is to find an egg donor or, you know, what, what have you. So, I mean, again, i think that's so beautiful and what a wonderful indicator of, again, like you said, like you had that, you have that personal experience to work from, I know you've kind of already brought it up, and I'm so excited to get into this because for many years, it wasn't uncommon that you were to do multiple embryos during IVF. And you know we all know of the big headlines and you know things like that. and But many patients, I think, still assume that transferring more embryos means a better chance of success. What has changed in the fertility medicine that led to that shift towards a single embryo? I know you already said you would have done things differently now if you were doing this process now.
Speaker: Yes. yeah Well, again, like we said before, ignorance in blis is bliss and medicine is physicians. You know, we, we, it it evolves. You know, we were ignorant before and this was many years ago. and um so,
Speaker: IVF really improved ah in the past 14 to 10 years. Okay. um And so, so it became much more efficient and it was like this kind of mixture of things where you come, we steam you, we cannot steam you too much because you'll hyper-steam and your lining won't look good because we're doing fresh embryo transfers. And then of course, then you're trying to get a lot of eggs, but you can't and sorting it out. And then
Speaker: we realized that really what got you pregnant was the quality of the embryo. And so, and the biggest thing is the genetics the genetics of that embryo. And so then the ability to split the process, ah get a lot of eggs,
Speaker: Maximize the egg retrieval process, get a lot of eggs, good eggs, make good embryos, test those embryos. And then being able to then just focus on the lining and the uterus and transferring a good embryo that was better than the jumble that we had before. And.
Speaker: And so as pregnancy rates ah increased, people didn't change the behavior of how many embryos we were transferring. And very quickly, the studies that showed that transferring two embryos increased the chance of fetal death by like 400% and complications of pregnancy in 600%. So that's when the ASRM in 2017 past the guidance to just do single embryo transfers in certain circumstances. But it went from like a suggestion to a guidance to this is what you should be doing, blah blah, increasing. And then two years later, it even passed for gestational carriers, where it was very specific. Even for gestational carriers, you should just transfer one embryo. And then it takes time for people to change how they practice. Doctors are stubborn. Patients just think that it's better.
Speaker: And then I think it took a while. and I just saw from the president of SART that out of 100,000 babies born via IVF, this was the first time where 97% were singletons. When I was in residency, we used to see triplets and quads all the time. When I was in fellowship and I finished fellowship, twins was the common. And yes, I was like, yeah, people bleed in pregnancy all the time. Well, why? Because they were twins. You know, nowadays that we do singletons, they don't bleed all the time. you know so you just know what you know at the time right and so so it's been a dramatic change and now even insurance is coming into play we're like yes insurance coverage for ivf has tremendously improved but they're going to now monitor that you don't get people pregnant with twins why because that means they're going to be more complicated pregnancies they're going to deliver early and even though an ivf cycle is expensive it's nothing compared to a stay in the neonatal icu which can be 200, a thousand, a million dollars, you know? And so just all in all, the right thing to do is to not just put eggs and sperm together and not just transfer embryos is to make a good one quality embryo. Humans are supposed to get pregnant with one baby. And it's not about making embryos. It's about making good quality embryos and it's not about transferring embryos. It's not even about pregnancy. It's about having a healthy baby coming home, you know? And so I just think the vision has changed and now it's mutated, i think, from bringing a healthy baby home to
Speaker: building your family, like planning your entire family. So I i think it's so boring. Like I would never wanna sit down and and just push IVF on people and just be an egg sucker and just kind of like like a one trick pony. no you know, you need to, um ah these are just tools and you just need to help the patient see them as tools. And so if you kind of allow yourself to see that when you have a nail, you need a hammer and that's the tool, then all these other emotions and feelings and and and and preconceptions about fertility care, IVF, embryos, surrogacy, egg donations, prem donation, become more manageable. You know what I mean? And the reality is that
Speaker: I say to people, like for medical, let's say for me, for medical school, trying to get into medical school was it's obviously be it was a dream I always had. Right. And so I was obsessed by it. Right. And then you're taking your MCATs and then you're applying. It was the center of my world. But once I was in medical school, I never, ever, ever thought about it again. Same thing. When you're trying to build a family, anything, you're very sensitive and obsessed about the process. But once you cross that line and either you realize you needed IVF or you need an egg donor or you need a surrogate, and now you are pregnant or now you have your child, those big emotions about these things don't really, like they are fading the past. That anxiety that used to have, those panic attacks are not real anymore, you know? I'm dying at your reference to being called an egg sucker. This is just absolutely killing me. Awful. I mean, I think that's that that's that that that's not what I do. You know what i mean? It's just not. i mean, of course, it's part of what I do. Of course, doing a speculum exam and a sonogram is what do, but they're just tools, you know, the end. Right, right.
Speaker: My gift, what I bring to the table is trying to individualize every single person or couple in front of me, understanding who they are as people, what their journey has been, what their preconceptions are, where they want to get to, and bring them as many options in an unbiased way so that they can make the right decision.
Speaker: Oh, for them love that. Yeah. And okay, so i think I think a lot of intended parents, you know, the idea of, and you've kind of already said it with your own personal experience, the idea of twins feels like this winning scenario for so many different reasons. um And you also, you know, again, you became a parent with twins through egg donation and surrogacy.
Speaker: How do you navigate those individualized conversations today, knowing both obviously your personal experience and then what fertility medicine has learned over the years?
Speaker: Well, I just think it's the wrong thing to do, right? It's the wrong to transfer two embryos nowadays. It's wrong to intentionally get the average person pregnant with twins. But I feel very guilty when I have my twins plastered all over my practice. And I would never say i would want to have my kids any other way. They're perfect. My experience, my journey has been perfect the way it has been, okay? But even my kids, from someone who had...
Speaker: three babies of her own at term vaginally. Then she cared for a woman with heart disease, twins, and delivered them early. And then she carried my twins and delivered early. My kids stayed two and three weeks in the neonatal ICU. And I can tell you, I moved 17, 20 times in my life. I had to learn a different language. i gone through a lot of hard things in my life, medical school, all the things that people go through.
Speaker: yeah The hardest part of my life was when my kids were in the NICU. Hardest part of my life. It's... You've... struggle so much to reach that dream become a parent especially through surrogacy someone's taking care of your kids and finally you imagine the day when they're born and you the least thing you imagine when your kids are born is that you're going to get to hug those kids and have those kids and then that the doctors and the nurses take them away and then you are supposed to be the provider right you take time off you give it your all
Speaker: And yet you're completely incompetent because you have no idea how to take care for these little fragile babies and you rely on all these other people. It's a very vulnerable time. And so I just don't think it's the right. I just don't think it's worth it ah for for many, many reasons.
Speaker: I'm not saying that there may be a place for double embryo transfer, right? I mean, there are situations where people have really poor embryos, have transferred many embryos. You know, like when when you're not trying to have... to Also, there may be a chance where you have an early uterine cancer that gets cured and they're telling you after this delivery, you're going to get a hysterectomy. And then you, asset with a group of doctors, decide that perhaps...
Speaker: transferring two embryos and trying to carry for twins and then getting your hysterectomy may be better than a patient transferring one embryo and waiting a couple years to have another baby and then doing that. Like there may be situations. I had a patient that had six laparotomies once cut from here to here for these very crazy adrenal tumors. And there were only six cases in the world of patients like her. oh She was in her mid twenties. She had had her belly filleted open twice. it Sorry, six times.
Speaker: Her actual OBGYN asked me to get her pregnant with twins. because how many times can you do a s surgery on this lady you know so there may be situations but that's kind of talking about winning the lottery those are exceptions you know the reality is most of us had just have to work same thing the reality is that you want to bring a baby home not just get that positive pregnancy test This episode of Create a Happy Family is brought to you by Gather Records.
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Speaker: Do you feel like sometimes safer is sometimes misunderstood as quote unquote less successful?
Speaker: Yeah, because, you know, i mean, even it it was so nice when we were transferred to embryos because the pregnancy rates, the positive pregnancy rate, the ability to tell a patient you are pregnant.
Speaker: was so common. You know what I mean? Like it's, it's, it's, I was 80, 85% of the time. But now when you transfer one, it's like two thirds, you know, and you feel like such a failure. But the the reality is that people are having healthier pregnancies. They're delivering those babies. And, and it doesn't take much. I mean, the day that you transfer two embryos,
Speaker: and you know it's the wrong thing to do, and your patient loses her babies at 22 weeks, even if you told even if you gave the patient the autonomy, the the right of choosing, if you educated them, and still you went ahead, that happens. It just doesn't feel good. You know what I mean? it's um so but the way i like to work is i don't work very paternalistically i like to i think you you have to educate the people with the reasons why i think most people understand if you make an effort and you involve them in the decision making and there are situations where you just have to involve maternal fetal medicine doctors or their ob-gyn or other specialists to come together you know in a decision that is best but again It's not about the technology you're using. It's about looking at the big picture. You have to look at the big picture.
Speaker: I was going to say, or I was going to ask, how how do physicians evaluate when an exception should be made? i know you've already kind of given us some outlier examples, but what are some of those things that you're looking at when you do have someone that is wanting to do a double embryo transfer?
Speaker: I mean, I think i there are going to be very few people. I think nowadays are going to be patients who probably froze eggs, froze embryos long time ago and maybe froze two embryos in one straw. And so there is thick and so there's the, they're theyre they're okay, if I th throw out that straw and refreeze one embryo, I'm going to lower the chance of pregnancy or like, you know, from that one embryo and the history, right? Like I,
Speaker: Like, i again, I mentioned before, IVF wasn't that great back then. So, like, I have a lady, it's a great story. she She's a police officer. She was 26. We did IVF.
Speaker: Got seven embryos, no PGT attested, people didn't do that back then. Transferred two embryos, she got a boy. Transferred two embryos, she got another boy. Then later on, transferred two embryos, she got a boy. and they had one left and the husband was, we need to give that embryo away. you know He was like, there's no way. you know And they gave it up for adoption, well, kind of embryo adoption. and um and And another couple got the embryo and I transfer her.
Speaker: And um it was a not good looking embryo at all. Okay. And she delivered the most beautiful girl. But the point is, every single time we transferred two embryos, she got pregnant with one baby. She had delivered one baby, you know. So I do think sometimes embryos come from like they're all embryos or they come from other places in the world where IVF may not be up to par. And then they're just not good embryos. And so, um and then, and so it also depends on, on what do we think of the uterus. Like there are women who are born with a unicorn uterus. Those, um those uteri can only,
Speaker: can barely get to 28 weeks with one embryo. So you're not going to put two embryos under someone like that. you know There are some patients that have already transferred one, two, three embryos and they're not getting pregnant. And then and then the question is, do I transfer two or do I really look further? do I throw out the other embryos and do PGTA? Do I do an ERA analysis? Do I do a hysteroscopy? Do I make sure they don't have hydrosol pinges? Do I do a receptiva test? um Do I see if the patient has endometritis? There's many other things that you can do um to really see where the issue may lie. But if you really think the problem is the embryo and the quality of the embryo, and you've tried too many times you get to a point where
Speaker: perhaps consider transferring to is a reasonable option, then you can have to address that. But you kind of cannot address it in a vacuum because you cannot just transfer. I said, well, it's not my problem anymore. How are you going to manage that pregnancy afterwards? And so I think that's where you need to involve maternal fetal medicine and the obstetricians and other people.
Speaker: Yeah. So, I mean, it really is a just full evaluation looking at it just the whole picture, like you said, and then, but it sounds like there's, before you even would say yes to an outlier case, you would rather do a whole lot more testing and investigation. I would. And frank and frankly, you we practice very individualized medicine in the U.S. because people are paying for it, right? And we that's how we run life. it's It's what I want. It's not the community. The government is not going to tell me. But the reality is that...
Speaker: um it It does matter how things are done. So if I'm telling you that 97% of the deliveries after IVF were singletons, and then you find this awesome doctor somewhere, let's say California, right? And they're, yeah, they'll transfer two embryos. You have to ask yourself if that doctor is practicing as an outlier or in Tijuana or whatever, you know, you need to ask yourself, is that really, am I just getting what I want or am I really getting the care that I need, you know? And you need to ask yourself that question, right? Like if you go to three plastic surgeons to fix your nose and they tell you, if you do that, the tip of your nose is going to fall off. And then you go to Tijuana and then that doctor does it.
Speaker: I mean, you'll find someone who's going to do it, but that doesn't mean it's the right thing. you know But in the end, yeah um you need to ask yourself, who do I value more? The person who just says yes to to everything I want or the person who's really giving me advice? you know The person who's going to be transparent and clear and honest. and yeah There are patients who come in and say, I want to do IVF.
Speaker: I'm like, just because you want to do IVF and you can pay for IVF and you're willing to do IVF, it doesn't mean that, like, when you talk about it, like, why? You know, like, it's, and so, of course, many people will be like, yeah, I'll take your money, you know, or like, if a patient says, I want surgery. No, I think it's your responsibility as a doctor. I had a patient said, I'm coming back, to I hadn't seen her in a year, and said, I want IVF.
Speaker: Now, I agree with her 100%. She needs ivf But I still felt it was my responsibility to go through the process with all her options and explain to her, even though she wasn't asking me why she was making the right decisions. I think i think that's that's where my value is. You know what I mean? is to just or Or their patients were very well-educated, chat GPT, Google, the hell out of everything. and they Sure. They had very clear mind.
Speaker: I just know that I can bring to the table sometimes stuff that they had never thought about, you know? And I think it either helps them say, yes, what I had thought about is exactly what I want to do, or I'd never thought about that, you know? And so, um and so I think that's, that's, that's it. So I think, yeah, you can get cookie cutter medicine. You can just chat GPT things, or you can find a provider who's going to, um,
Speaker: look at the bigger picture. And I think there's providers that look at a bigger picture that are going to focus more one thing than others. I'm sure there's people out there that will love to talk about diet and all day long and supplements. And there's other people are going to like to talk more about other things, you know? So ah like, we are going to be more like holistic and it just depends, you know, but I do think it's such a personal journey and it's, it's not a,
Speaker: necessarily an emergency, and that I think finding the right person to click with, it's important because especially when things don't go right, which happens all the time, like I just told you, I transferred euploid embryo on the perfect surrogate, everything had worked before, and the baby didn't develop.
Speaker: I think when you find yourself in an uncomfortable situation like that, you would you will wish you're with someone who sees you as a person and you have a good relationship with. These can be very long journeys and you just want, I think having the right bond and the right discussions with your doctor is is important, you know.
Speaker: Yeah. Well, I mean, it kind of goes back to you this idea of it's so, it's easy and it's fun to celebrate and talk about the success rates. And, you know, when it was twins, everybody had these success rates that were, you know, blown out of the water and just all of those things. But really the value in the team that you are building that Is that person, what, how is that person, your doctor, your agency, your attorney, you know, whomever, how are that, how is that person going to support you when things aren't going right?
Speaker: And will that person be transparent and honest with you and maybe tell you the thing that you don't want to hear, but is going to tell you the thing that you need to hear?
Speaker: to know Exactly. any That's what I'm saying. like Anyone can just follow and do, blah, blah, blah. Say, okay, I can cut 10 minutes of my day by just saying yes to her and not talking about it. you know So I think it's it's a group, especially the more you go into third-party reproduction. you know Anyone can set up an agency and call themselves an agency. You and I know it's not the same. you know i Absolutely. Absolutely. it's so true.
Speaker: I mean, I have people say, oh, no, I'm like, like, they're doing surrogacy. And he's like, oh, no, no, no, I have my brother-in-law is an attorney. I'm like, your brother-in-law knows nothing about surrogacy law in Texas or in Idaho or whatever. A real estate attorney does not equate to a sister reproductive technology attorney. Please do not do this.
Speaker: It's like when my mom comes talking to me about her, you know, big toe arthritis. Why do I know about that? You know, like, I'm not. right It's just completely different. And so i just think that you you want...
Speaker: you want the right people and the right people is not paying more money it's just finding the right team and and and and and when you do third party these things are very important i mean you want a donor that has been properly counseled an agent that has a lot of choice um that is going to coordinate things very well between the donor and her thinking that she's the best thing since life spread and she's 22 years old With the intended parents and the cost and the emotions with all of this, plus all the resources of the the clinic. and And everything needs to fall into place. You know, and a lot of people just think that it's just pushing. And it's biology in the end. And yes, sometimes we do cut cut corners.
Speaker: Yeah, if you call me and you tell me you just got diagnosed with cancer, breast cancer, you're going to start chemotherapy in two weeks, guess what? We're going to start IVF now. You know, it may not be the perfect time of your cycle. Like sometimes you just have to work with what you have, right? Right, right. There's always those extended those outliers and and and circumstances and things like that.
Speaker: i I want to go back to something that you said that I feel like is just so important is you, I think you do have... Intended parents in particular with third party that come to the table with, I mean, it is, it's a emotional process. It's an expensive process.
Speaker: How do you help intended parents balance this desire to, you know, quote unquote, maximize their chances with what's in the best interest of having a successful pregnancy with you know their surrogate and then having a healthy baby and having that positive outcome?
Speaker: Well, I mean, it's um people come from all backgrounds and all different expectations. And sadly, when you pay for something, Some people get fooled and give them a sense of ownership. Just because you're paying a donor or an agency, it doesn't mean you own them. Just because you're paying my clinic, it doesn't mean that you own my staff when you get to be rude. Just because you're paying a justational carrier, she's...
Speaker: not your slave. She's not any less of an independent, smart, educated woman that can make her own choices. And so I think if people already come into the game with those expectations or they get fooled or because you think, oh, I'm going to do IVF and I can pay for IVF and therefore I'm going to have a baby. No, talk to all the people who do IVF and how much failure there is. You know, like you don't share debt they're like you make things more likely to happen. You're shorting the time to attaining what you need.
Speaker: But the miracle of life has to happen. And frankly, um if you're going go into something as complicated or surrogacy, like I don't want to be here preaching, but i mean, and cultures are different, right? there There's cultures where they don't have to have contact with the gestational carrier, there are cultures where people ship off their kids for a year or two or five years with their parents, their grandparents, and then they get the kids back. We all have different cultures, right? There's cultures where you have multiple generations living in one household. And then there's cultures like here in the US s where we're kind of separate, you know what I mean? Like you don't live with your parents and with everyone else, you know? So, but there's a mixture of everything. And so same thing, you know, like I've had people who wanna work with a surrogate and they're lovely patients.
Speaker: And they never show up to any appointment. They don't show up to a transfer. They don't show up to the sonograms to see their baby. i think it's bizarre, you know, because I'm like, she's caring for your child. She's interested. why are you not showing interest? And then there are patients that are like, oh, I want the surrogate to come and live in my house because that way i can watch what she eats. And I'm like, you're not going to do that, you know? so Yeah, nope but No. So I think the moral of the story is that um that's why we involve psychologists and attorneys. And we talk about their relationship. And that's why, regardless of what the agency thinks of the surrogate and the attorney and the doctor, you need to meet that surrogate and her life and her partner and her kids and see, because everything in her life will affect your life. So if you don't care to know how
Speaker: what she has to drive or how her job is like or how many kids she has to drive or how many times a day she has to cook or if she has support from a partner or not. If you don't care, then then then you're just just doing this, blinding yourself. You have to care. If she gets placed on bed rest for your child,
Speaker: she's going to need someone to help her out in that household to feed her children. She won't be able to go to work. So at the end of the day, i do think people need to make an effort to get to know and see if if they all have the right expectations.
Speaker: I happen to... get to know my surrogate very well, all her kids. We just got invited to to one of the kids' wedding 12 years later. Amazing. Yeah, she pumped milk for us for three months. It lasted five months for the twins.
Speaker: um she i mean it's ah we I went to every single appointment with her OB. A lot of husbands don't even know do that. I'm not saying people need to do what I do, but it was our journey. Now you asked me about twins.
Speaker: What sucked was that we had never changed a diaper before. and we struggle so much to be to become parents that you kind of feel like, oh, I'm like my late 30s, early 40s. And so in trying to be protective and trying to say, um you know, we are completely responsible for these babies and we're gonna be there a thousand percent of the time, we never got a nanny and we never had a family to come and help.
Speaker: And so if you do that with twins, when these kids are born, you have to feed them every two and a half hours. And each kid takes you about 45 minutes. And so because they can't even hold their head. So if you do it by yourself, every hour and a half, you're done. You have one hour off and you start all over again, 24 hours a day. Or if you take turns, then you can do the math, you know. And so if you do it at the time, you it at time. you're going to get burnt and And we did that. And the first time we had a full night's sleep was at 13 months, you know? And so was it incredible? Yes. Was I miserable? No. Do I remember anything?
Speaker: Oh, thanks to my yeah iPhone, I do You know, Josh, what do you think of iPhone? remember. But otherwise, absolutely not. but You can think about it all you want, you know. and But I do think the right thing is singletons.
Speaker: um that is That is women. We're made for that, you know. and and were but But that doesn't mean that we cannot welcome twins or we cannot handle those things. But I do think just because he's cute.
Speaker: No, because it's what do you want to post on social media. No, you know, you think the pregnancies want pregnancies easier. no it will not be easier. And postpartum, like for me, I didn't deliver a part of the delivery. But the first two years were extremely hard, you know, and ah and so much. And that's why we had I wanted to have a third baby because I don't think I.
Speaker: i want to say I didn't enjoy, but I didn't savor, savi your I didn't taste different all the milestones. Because you're surviving. I mean, you're surviving. My poor, so I have my first, my kids, I've been a surrogate twice, but my kids, I have a singleton, and then I did have- I didn't know you were a surrogate. I'm glad I'm thinking two things about surrogates. You know, there are two girls. Yeah, you did. Yes. Oh, thank you. Thank you. I agree.
Speaker: But yes. So my kids, my keepers, um I had a singleton and then I had spontaneous twins and my poor twins, they will ask me all the time. Oh, when did this happen? Or when did, you know, what was my first or all of the things? And i look at them and I'm like, you know, i don't remember. Because you were just surviving. yeah that I mean, you really are. And it's in the best way, truly. I mean, I i love my twins. I do. I absolutely love them. Of course. And as a surrogate, actually, my sweet intended parents did do the single embryo transfer and it split and they got identical twin girls. So I've carried twins twice, but um that was not their intention. That's amazing. Yeah.
Speaker: It was amazing. And those girls are amazing. And my twins are amazing. But it is. It's a totally different scenario. It's a totally different pregnancy. um And it is, ah for all of the reasons that you're talking about, it is more than just thinking about, oh, how cute will it be? Or, you know, oh, let's just take advantage of this scenario where we're in a situation where we do get to dictate certain things.
Speaker: I do wonder, though, do you feel like intended parents feel this pressure to, you know, almost, again, kind of, I hate to keep using this word, but or this phrase, but feel this pressure to maximize their chances? Because, I mean, at the end of the day, this process is a huge investment. Right.
Speaker: I think so, but I think it's changing. you know i think it's all about the education. i think I see a lot of patients from Europe. I almost never hear someone wanting twins. And it's just because that is the mentality and what's preceded them, right? I think in the US, there's been a huge change from where it was normal to transfer to to maybe five years ago to three years ago, people started thinking about it. And now, unless you live under a rock and you're gestational carrier, you want to be a surrogate, you realize twins is...
Speaker: there's no, and and they it's kind of contraindicated. It's not what you're supposed to do. And as a, as an, and also is going to increase your chance of a C-section. My surrogate delivers singletons vaginally and her twins, sorry. And the, and the two twins she delivered by C-section and surrogates know that because then it limits the number of times that they can do this. um And so,
Speaker: So I i think it's slowly changing, you know, where it'll be harder. I just think it's it's happening less, less, less and less. But yeah, I think it's not only... surrogates have become incredibly unattainable in the US financially, just extremely expensive. People from all over the world are coming here for it because it's not accessible there. So there's a shortage of surrogates and that just inflates the cost of everything. and yeah um And so either you find agencies or people who want to be surrogates who definitely shouldn't be. um and or so I think the quality of what comes across is vastly changed. And I think the cost for people where a professional could afford surrogates in the past and now would be very difficult. And so people are looking at options internationally.
Speaker: And, you know, it's all like that. And so, of course, if you but that tells you how innate is our desire to be a parent, that you're willing to go through all these hoops to just become a parent. And so. um um And so so so anyhow, so yeah, so people will save their money and people will go to other countries and people will transfer to embryos and people will probably do things that are not proper, but they don't understand that this is...
Speaker: i a one year commitment, a longer commitment. If your kids are born severely premature, they can die or they're handicapped for life. And one thing is when the embryo just split or when we didn't know any better or when that was the standard of care. But once you start diverging from this standard of care and you're trying to force to do something that is not what is being recommended, if things don't go right, I think people would feel very guilty.
Speaker: Yeah. Yeah. And I mean, I agree with you. There's so many, it it's such a layered process and you're right. It is there's so much to think about and it, it is a, it's heartbreaking to think about the average person who so desperately wants to be a parent, but because of all of the hurdles and barriers, it makes it almost near impossible. And yet,
Speaker: at the end of the day, there is a standard of care for a reason. And you know you in the seat that you sit in, me in the seat that I see to sit in, we all we can do is just say, this is the standard of care and here's why. And it's not because we don't, again, right? It's being transparent. It's being honest. And it's not because we don't want to tell you the thing. Like we so desperately want you to have that baby, but we want you to do it in the way that is best for you and that baby.
Speaker: and the surrogate and the egg donor and all of the people. But you you then have to be able to listen to these people. You have to have the connection with the parents. You have to listen to them and you have to meet them or where they are. You can't just give an answer like that because it's not fair to them. And that's why think the team is so important, and especially when they talk to multiple people and they hear similar things.
Speaker: For years, even when we could transfer two embryos, I would tell someone, Why do you want me to transfer two embryos on your surrogate who lives three hours from the closest reasonable hospital?
Speaker: Why? i'm already telling you that 50% of all twins are born prematurely. Why would he transfer two embryos on someone who doesn't have access to advanced medical care?
Speaker: Like transfer one or get a surrogate from big big metropolitan area. That was back in the day when we used to transfer two. I do think that you have to put it all into context. You know what I mean? Like you have to, um it's not so cookie cutter, but I do think it's become a lot easier. The conversations become a lot easier. I used to spend so much time talking to people before, but people still ask nowadays, you know? And, um and I, I, I,
Speaker: There's autonomy, there's being paternalistic, there's guidelines. I think in the end, sometimes things can get murky and that's why you need to then dissect them out better and talk to other people, you know, and and and and and bring other people to the mix to see if that's the right thing to do or not, you know? And so.
Speaker: yeah. No, for sure. why What's maybe some of the biggest misconceptions that you would want to correct?
Speaker: Regarding what? Regarding just this process in general. If you could just shout from a mountaintop, hey, there's this one thing that I always keep hearing.
Speaker: What would be that one thing that you would just want to correct? Well, there's many, but ah since we're now talking surrogacy, is there something that really... and Annoying is not the right word, but because i hear it all day long, so just my tongue. It your gears.
Speaker: Yes. It's like... Why are you so obsessed on this surrogate part when you have not even tested yourself? Like just because you know you'll need a surrogate you're It's like just because I'm in in in fifth grade and I want to be a doctor, why am I so obsessed about the MCAT or being in medical school? you know like okay You're miles away.
Speaker: So I'm not saying don't learn a little bit about it, you know but you're not even there. You're not even close. Do you have normal sperm? like Do you have any infectious diseases? Do you know how much the process is ah where's Where are the eggs coming from?
Speaker: are you going to have to do one or more than a one IVF cycle? Can you afford that? And the reality is that there's way more intended parents than surrogates, and the surrogates get the pick, and they get taken away right away. And so why would they put attention pay pay attention to someone who hasn't even just started the process that lives their castles in the sky. When someone comes, I have four euploid embryos that are gorgeous in their freezer. Of course, you know, why would a surrogate put herself through meeting you, devaluation, which is not fun for any woman, three, six months of legal papers,
Speaker: when you don't even have it. And so so so I know that the focus is surrogacy. I know that that's what they all are focused on. But you have to start from the beginning, you know? um yeah So I would say that is...
Speaker: It's a process, and it's a process that can go back to back or be done in tandem. And then there is a process also that can take a long time, and it's okay. It's okay if you only have your resources to make your embryos, and you have to wait a year to find the right decisional carrier that you trust, that is good for you, your family, that you can afford, and then do that. You know you don't have to have also immobilization because I don't have 200K, you know, or 150 or whatever it costs, you know. You can just say, first, let me make embryos.
Speaker: Then let me refocus on surrogacy options, you know. Yeah. Yeah. yeah Yeah, you don't have to have it all figured out as soon as you walk into the office. It is sometimes better just to take it. It's overwhelming. It is very overwhelming. Peace by peace. And it's the last step. You cannot transfer an interview without. So people start creating. I have an intended parent now.
Speaker: okay He's been my patient for three years. Finally, we transfer the surrogate, okay? After so many years. He was so mad at me because the surrogate's due date was going to be the 8th of January of 27. And I'm like, dude, you just signed a week ago. There's nothing I can do. but her daughter is going, look this is real. Her daughter is going to be 15 years.
Speaker: in 2029, and she's going to have to go to Guatemala for her daughter's quinceanera. And by then, Dr. Escobar, I have to have my three kids.
Speaker: Oh, my gosh. Stop. No. yes It's like, come on, you know? Of course you're going to drive yourself crazy. no normal human human brain can handle all this information. You have to take it step by step and you have to celebrate all your wins.
Speaker: You pick your donor. Boom. You um did IVF and got embryos. Go celebrate. The hour is moving to the next step. You need to live, enjoy the process. You need to be kind to yourself.
Speaker: For sure. If listeners remember one thing from this conversation, what would you want it to be? I think everything in society surrounds building a family, whether you know it or not. Going to school is to get a good education so you can support your family. That's why we want a good job. That's why we want the guarantees we have. That's why we want a house. That's why we find, i mean, I don't know if humans are supposed to be monogamous, but it kind of works when you have a partner who helps you throughout the process. And so that's why we get married, you know? and
Speaker: All this, what why do we try to look better or wear nicer things or have a better education, whatever? Because it's it's how you flirt with that other person, right? It's all surrounding having a family. How do i pick my pick to build a family? And so I think it's completely great in society. Being a parent is...
Speaker: the most incredible experience in life. If you choose not to, it's fine. If you couldn't, it's you're to have a fabulous life. But whatever you have to um give up or all the efforts are totally worth it. You will never say I wish I hadn't tried. um And if you're lucky enough to be a parent, you get to rediscover the world and you get to reinvent like what your purpose in life is. And all of a sudden, a lot of other things are...
Speaker: have a different meaning. And we were just talking about, even if it's intellectually, the way you think through things and the decisions you make, even this guy who didn't have kids was already on the third kid before the quinceanera in Guatemala. You know, it's just something happened where you...
Speaker: And you hear about the mama bear and I do believe it. I quit my first job ah three months after my kids were born. i would have never had that. You know what? To quit, you know, unless I had the kids, you know, there's just something just changes your perspective in life. We all have different journeys. You don't owe anyone an explanation.
Speaker: even if you're married your partner may have different ideas you know but you you it's it's you will not regret that journey and so you need to be allowed to be in a space where you're um can be honest to yourself and if you're with a partner with your partner and then if you need assistance you need a team and you need to do this for yourself i just had a couple last week that said to me that the only reason that we're doing this was because of their parents, you know? And so it makes it even harder, you know? So I think you just, it's in the world. And you can never judge anyone. I've had patients who've had seven babies and they still feel they need to have another child. So there's no judgment, you know?
Speaker: No. Yeah. It's your journey. It's your family. Yeah. No, I love that. I love that. And it's worth it. It is. It's worth it. 100% worth it. Especially if you have...
Speaker: the team surrounding you, supporting you, being transparent. Well, Whitney, anything that is difficult to attain life, you appreciate more.
Speaker: So obviously cannot just get pregnant like that and I can never get pregnant, but so you just know I just know that um
Speaker: anything that came easy to me in life, yeah, great, but anything I had to fight for has a different value. And I do think even those parents who became parents in their 20s and had to struggle in their 40s to have another child, they're in a different position in life themselves. And just because they had to struggle, it's just a different experience. job Yeah, 100%, 100%. Well, again, thank you so much just for your candor, your expertise, your passion, and just for everything that you do for all of your patients, our shared patients, just you know everything. I really, really just appreciate all of this. I have one last question for you.
Speaker: It's a fun one. Yes. So you've seen me this whole time. um Coffee and I have a um very important relationship with one another. um And so I always love to ask the question, what has filled your cup lately, literally or figuratively? What has filled your cup?
Speaker: You had me a coffee. need my coffee. you know, like we've got ah yeah It's it's just, you know, it's yeah like i i don't know what maybe it's the treat you know maybe it's like you just took five minutes for yourself you know and uh there's something to it you know uh and like like i like kid wanted to make a cake and i don't really do my but i was okay let's go to a grocery store i never go to a grocery store and um and then
Speaker: I was like, I deserve a cold coffee at Starbucks. it was last time I got a Starbucks? Months ago, you know? And it age just felt so special, you know? Yes! And so there's something to say about that. Yeah, I like my, du I feel very trained. And, you you know, and patients do get me um these things all the time. You'll enjoy this.
Speaker: Oh, I love, oh my gosh. Okay, so if you're listening, it says Dr. Escobar at your cervix. That there you is hilarious. That coffee cup. Oh my gosh. That is hilarious. And I have a long like that. It's just very cute. You know, it's just special. Yeah. So it's a treat. Yeah.
Speaker: Yeah, no, I agree. I agree. I love it. I love it so much. Well, again, thank you so much, Dr. Escovar for, like I said, just all of your expertise, your wisdom um and your stories and everything that you are doing and continue to do to just counsel and build all of these amazing families. And I am just so grateful for your time.
Speaker: Thank you, Whitney. It's been awesome.
