 of this amazing group and I'm just going to introduce Tane Danger, who will do everything from here on out. Tane, yeah! Oh my gosh! I am so excited! This is, first of all, I just have to say how incredibly pleased I am on two levels. One, it is sincerely, as a Gustavus alumna, it is such an honor for me to be a part of the Nobel conference. Two, and almost as much, I'm so impressed that people actually sat towards the front. Like, it's Minnesota. Normally everyone would be like ten rows behind, so you all are heroes already. You win. I love it. So, thank you all so much for being here. My name is Tane Danger. I am the co-founder of the Theatre of Public Policy. I'd like to start shows just by asking, by a round of applause. Please applaud if you have not seen the Theatre of Public Policy before. That is the most applause we get in a show. So, we, what do we do? We have some very smart people that we have on stage and we ask them some big questions. We ask them about practical things from policy or science or ethics and then we have this team of amazing improvisers who take everything that those folks have said and they bring it to life on stage through entirely unscripted improv comedy theater. It's all made up off the top of their head. This seems like a very appropriate moment to welcome to the stage the cast of the Theatre of Public Policy plays a round of applause. Fred and Boat, Fred Chang, Heather Meyer, Shannon Custer, Dr. Jim Robinson, and Dennis Curley's on the piano back there. Oh, very exciting. So, have folks, have a lot of you been here for parts of today or earlier today? Are you all? Oh, yay, yay, yay. No, it's okay. I appreciate all of you who just came for this. Good choice. So, I shouldn't say that. I mean, you should have come for everything next year, but good choice. So, we're extremely excited because we've talked about a lot of very big issues and a lot of heady things. Tonight, we have an opportunity to take some of those challenging questions of science and ethics and put them into a context of, well, how is this intersecting with folks' lives, particularly right here in Minnesota? What are some of the policy implications of what's happening, how the science is progressing, and the ethical questions that we've heard today? So, we have two amazing guests who are going to help us do that. Please, help me and welcome to the stage Dr. Colleen Casey. She's a reproductive... I can't say it. Thank you. Thank you. Do you want to say it one more time? Endocrinology. Thank you, Shannon. And fertility specialist at the Center for Reproductive Medicine. Big round of applause, Colleen Casey. And Dr. Deborah De Bruyne is an Associate Professor at the Center for Bioethics at the University of Minnesota. Big round of applause, Deborah De Bruyne. Very exciting. Thank you both for being here. I'm so excited to... And you've both been listening all day, so you have all of the knowledge and things that we've talked about. So, I wanted to start with sort of a broad question. I mean, maybe we'll start, Casey, with this question. You've heard... We've been talking kind of at a high level all day about a lot of these things. You work in a clinic. You have people coming to you. Do you... Is a conference like this terrible because people are going to come to you and they're going to be like, oh, wow, I went to this conference and they were talking about this thing that I can inject and then I'll get strong like a bowl and I want one of those? Or I'm just curious, like, what do people actually come to you and say or ask about when they are looking at having a child? Good question. I think the media has a lot to play with that kind of situation and that's why this conference is so good because it's real. It's not what the media portrays what we're actually doing. Patients will come and ask me a bunch of things and we'll just have a conversation about whether it's valid or not or whether that's real science or not. But they just really come with questions and they're prepared and that's what we do. We sit down and have a conversation. We don't have exam rooms at their first visit. They come back into my office. We talk about what's on their mind. We talk about where they've been, where they want to go and what their options are and that's what we do. So, we were talking and prepping a little bit before the show and it's very interesting, again, and we heard a little of this earlier today, but what is real right now, I guess you could say in some ways, in terms of the practices or things that are happening right now. And one of the things we were talking about even just right before we got on stage was this pre-implementation screening, right? And I'm wondering if maybe you could just say a few words about what that is and then we can kind of dig into what all that means. Sure. So, pre-implementation genetic diagnosis is, you could describe it better than I can, but the basic idea is it's a process by which docs do genetic testing of embryos before they're implanted in a woman's uterus to select usually against certain disease characteristics. So, you want to test to make sure that an embryo doesn't carry a particular genetic disease before you implant that embryo in a woman's uterus and have her so that she carries a healthy baby to term. That's the basic idea. And so, this is something that happens at your clinic to some degree? Yes, all the time. We do both the genetic diagnosis and Huntington's disease was brought up a lot today, so was sickle cell and those are specific diseases that we can test for. Other things that we can do is we can look at the chromosomal arrangement because we know most embryos that are chromosomally abnormal do not make it past implantation or early first trimester. And so, when we're talking about this though at this point, this is all, is this all in terms of IVF in terms of in vitro fertilization when this is happening? We're not doing anything right now where we're going into someone who got pregnant and trying to find this, right? Not at this point. Exactly. So, what we do is the woman has to go through stimulation. She gets her eggs retrieved, combined with his sperm in the lab. We grow the embryos for five days. We biopsy, five to eight of the cells that ultimately become the placenta. It's called the trophactoderm. I freeze the embryo. I love how you just threw that. It's called the trophactoderm. You all know. Well, they know what somatic and germline is. I mean, this is a smart crew, right? We talked about that all day, but yeah, the trophactoderm is part of the placenta. So, we're not actually biopsy in the embryo. We're doing an early chorionic villa sampling. If you think of it that way, maybe a lot of you are probably more familiar with what that is, but we take those cells, send them to a lab while the embryos stay at our facility, and we wait for the results, and then we are notified of which embryos are normal and which ones are affected. And so, again, putting some real terms on a lot of the hypotheticals that we've heard today, what is that conversation? Do you go back and you say, well, we have all five of these, and you, you know, mom and dad or mom and mom or whoever can pick whichever ones you want, or you will do a blind test if you want? I actually, I'm curious what that process is like. Yes. So, the standard of medicine would be to pick the highest quality embryos that are unaffected first. Now, there are some non-fatal diseases like BRCA2, there are some other bunch of non-fatal diseases that may or may not affect the child in the long run. We know Huntington's will 100%, we know CF will 100%, SMA will 100%, but there are lots of diseases where people just want to know, and they're still going to use the embryos, but they'd preferably transfer embryos first that are not affected. And I mean, this is such a fascinating piece, because again, as we heard earlier today and we've already talked about now, a lot of the things that we see in the media and whatnot aren't, we aren't there yet with some of those, but already you can imagine some of the questions around some of these things, because even making these choices at this level, even at this early level, where maybe it's something as universal as Huntington's disease, everybody's like, yeah, I want to not pass that along if I can, we're already starting to make those decisions then. So I'm curious, when you're looking at this from an ethicist perspective, I mean, is that question inherently different than the questions that might come down the line of, well, I want to start choosing for that they will have, again, I know we said earlier today, it's not a higher IQ, but less propensity for heart disease, or I want to make a choice that they'll have more chance of maybe, you know, having a, not having asthma or some of these sort of gray areas that we talked about. Is that a different ethical question than what we're doing right now? Well, let me talk about a case that actually happened at the university that I think raised some of these kind of interesting issues. So this is a real case, and it's all in the public domain. So I'm going to use the name of the family, but I'm not breaching privacy when I do that. It's a family called the Nash family, and they had a daughter, they have a daughter whose name is Molly. She was born with a genetic disorder called fanconey anemia, and one of the repercussions of that, one of the issues that developed for Molly because of her fanconey anemia is that she developed leukemia. So they needed to find basically a bone marrow donor for Molly, and no one in the family tested as being an appropriate match for her. And they then explored the possibility of having a child so that the sibling could be a match for Molly. And so what this family did, and again this, Wow. I mean, there's like, you imagine already, like, you know, being told, oh, you were adopted, but being told, like, we had you for Molly. That's like, I mean, it's I even hesitated, like, sort of make light of that. That's a very serious thing in some ways. The literature calls the children who were created to become donors, saviour siblings, right? That's that's heavy. So in this case, what happened was Mrs. Nash went through the process that Dr. Casey just described, where she had, you know, through the standard IVF process created embryos, and they did two rounds of testing with the pre implantation genetic diagnosis. First, they tested to make sure that they were only going to select for embryos that did not have Phanconianemia. And then the second round of tests, they tested for an HLA match, an immune match, some of which embryos would grow into a child that could become a donor for Molly. They selected for those traits, implanted those embryos, ultimately had a successful pregnancy. So a son was born who they named Adam. And they Wow, way to lay on like metaphor. And on purpose, they named for exactly that reason. And the and the and they used umbilical cord blood for the transplant. And it worked. And Molly is healthy. So there are all kinds of ethical issues there about what kinds of traits is it okay to test for. In this case, they they tested to make sure that Adam was not affected by Phanconianemia. So they that test was clearly in Adam's best interest. But the test that they did to see if he would be an immune match and HLA match for his sister was arguably in Molly's best interest, right? And so what are the standards that we would use, right? What choices is it okay to make? Those are really interesting and I think important ethical questions, right? Um, and I say, you know, that's a real case. So I just think those are really super interesting questions. I, I, I'm really interested in digging more into this. I want to give you a chance, Dr. Casey. And I'm guessing you don't have folks coming in on a regular basis saying like, uh, I, you know, I've got this, I've been drinking hard. And so I need a kidney or something. Like, can you help me have a kid? Like, or as, as like, but I mean, I'm guessing you don't have a lot of, this is sort of this made national news, international news, because it's a unique thing. Yeah, it's interesting. And I think that's why it did. I mean, if you think about, we've looked at all our PGD cases since we started doing it, on average, people get four embryos that they can biopsy. Fanconi is anemia. Two of them by stats are going to be affected. And then with HLA, another one's going to be gone. So maybe they'll have one appropriate embryo to transfer. Now this family, what I don't know about this story, did the family just do this for the first child? And then they were planning to have a bigger family. Were they planning to transfer embryos that were not affected, but they didn't care about HLA. I mean, those are the things that the media doesn't necessarily touch on. I mean, these families are trying to do the best that they can for their family. And I don't necessarily think that, you know, I'd have a long conversation with this patient. They definitely would see people that, you know, the psychologists, they would go through all of those kind of hoops, just to see if this is really in everyone's best interest. Because number one, it's the child's best interest that should override everything. And even there, though, it's this really sticky thing, because you're, it was, what was the daughter's name? Molly. Molly. It's, you know, if you can have a kid that could help save Molly's life, I can understand why that's tricky or why you then start trying to maybe select for some of those things. And then I hate slippery slope arguments, but it seems like that's the, that's the territory we're in in a lot of cases where it's like, okay, so then do you just sort of like get siblings that are the same blood type if you can? Because that'll be convenient. Or whatnot. I mean, there's a lot of these things. And so I kind of want to go back to the original question. I'm curious when you are having some of these conversations with folks, is it, is it this ethical kind of framework that you put around it? Or is it more of a, you know, where are you and where are your family? How, how much do you see your job as guiding some of these folks and just sort of helping them think through, talk through what they want or need? We guide them, but we're not the be all end all. You know, if something comes up, a lot of things have come up where, you know, the spouses have died or, you know, something else has happened in the midst of their treatment. Somebody gets diagnosed with cancer. We, we get together as a group and talk about things. And then we bring in the mental health professionals. And we bring in legal if we need to bring them in. So it, it's a combined effort. It's not, oh, okay. Well, if that's what you want, sure. Here, sign right here. It's, we always take time. And that's, that's why I chose the practice I chose because we're, we are ethical. And if I needed to give you a call, I'm going to give you a call. See what you think. I mean, one of the really interesting things that we've been talking about throughout the conference is this question of standards. And I know, again, we were talking a little before the show. So your clinic has sort of guidelines for both that are prescribed. But then also just within the clinic, there are things you all have agreed on, like, this is what we will do and this is what we won't do. Is that usually like a situation like this, we'd bring to the board and we'd talk about it. And then we decide who are the other players that need to get involved to make sure that everything is going the way it should. We do, we just bring people in and we figure it out. But these cases don't happen very often, but they happen a few times a year. And we just, you know, there's, there's no, there's no rules. There's no guidelines that you have to follow. So we just need to make sure we're doing what's best for everybody involved. So if I can, it's important to understand that there is ethics guidance. You have professional organizations that issue ethics guidance, but it's guidance. It doesn't have the force of regulation or law. It's not policy. And so there, there, one of the interesting questions that's been being raised all day is what sort of oversight should there be for this kind of either research or practice of medicine or whatever. In this case, it's for, for this clinical practice, right? And what you're saying is you have this, you know, very intensely reflective and thoughtful and collaborative process at your clinic to help you address ethical issues. But, but given the way things are currently structured, that's going to be a clinic to clinic kind of concern. Different clinics may handle things in different ways, right? You could have like the, you know, upstairs IVF clinic that, uh, oh yeah, we're a mechanic shop during the day. But come on back and we'll do a different kind of plumbing and then we'll, but because there's no sort of set heart. And so I, the question that I, I, there was a whole poll earlier about who should potentially be the governing body over thinking through and making rules about these, from both of your perspectives, though, and we haven't talked about this, do you think that we're at a point where there should be a governing board? Are we there yet? Or are all of the questions and the issues still so fresh that you're like, no, this is maybe better that we're figuring this out case by case. And if we put it into a big overarching structure, we'll like squash out things. Or maybe we are at a point where like actually before the baby, you know, gets thrown out with the bath water, we need to do that or whatever it is. That's tough. I mean, we have a little bit of governing. We have to basically the FDA CDC requires that we report every single cycle we do each year. And every year they're getting more savvy at actually representing what, what clinics are doing. When it comes to this case by case issue, I don't, you can't, you can't, legislation can't decide everything because it's just going to get muddled in the system. And then patients are going to have to wait eight years before they can or cannot do IVF. And now she's 42 and she's not likely to get pregnant. So I think the problem with governing that is it's going to take so long to get there that the patients are, it's a wash for them. I think it's, it's really interesting and important to think about what oversight ought to look like. And it, it doesn't necessarily need to be legislation per se, right? But it could be something more in terms of uniform standards. So that it's not so clinic dependent what the process looks like. But I think it's, it's, I just think it's from an ethics point of view and a health policy point of view, it's an interesting and important question. How would you develop that? And what's the best way to make sure that you're not unduly interfering with the decisions that rightly should be between families and their clinicians? But on the other hand, trying to make sure that practices that really are unethical aren't allowed, right? So what's the right balance to strike and who do you bring to the table to make sure that you strike that balance? Those are been questions we've been grappling with all day, right? So follow up question. How do you strike that balance and who should you bring to the table? I would be rich if I knew the answer to that question. One way that this may be de facto, again, isn't entirely being regulated, but gets sorted out to some degree is who is willing to pay for what, right? And so in Minnesota, if I'm correct, some insurance will pay for IVF and some of these, like pre-screening and whatnot, but it's not universal. No, it's not the norm. We've agreed with a couple, and it's not usually the insurance company that decides that it's the employers that are deciding benefits for patients, for patients for employees now. So for instance, Wells Fargo and Medtronic both have really good agreements with IVF where they'll cover 15 to $25,000 worth of care, 100% for the patient provided that they transfer a single embryo. That way they reduce the cost of... A single embryo versus doing two. Two. To reduce the risk of twins. And what's the logic, the theory behind that? Yeah, the big thing is that these women more often than not end up on bed rest for anywhere from two weeks to two months. They're out of the workforce. They're not able to take care of their family, not able to take care of themselves. Other things are just babies being born too early and not being able to breathe on their own or eat on their own. So they're in the ICU for several weeks in some circumstances. And again, Minnesota, is there are some states where it's more universal? Yeah, so there are, I think now about 15 states that have rules, laws, about insurance coverage for reproductive care, reproductive technology. But those laws, it's really a mixed bag. So in some states, the expectation is that insurers will offer up policies that provide coverage for assisted reproductive technologies. But employers can choose whether or not to offer them. In some states, there's a mandate that employers offer insurance to cover this kind of reproductive care. But that in and of itself is kind of a mixed bag, partly because usually there are exceptions for small businesses or for religiously affiliated businesses. In some cases, the mandate is coverage for diagnostic procedures, but not for treatment procedures. In some cases, the mandate is spelled out in terms of providing care for couples who are married, assuming that the embryo, that the egg is fertilized with his sperm. And so there's a pretty clear implication that it's a mandate for coverage only for heterosexual married couples and not for anybody else, which really raises big questions about unmarried couples. It raises big questions about the LGBT community. Well, and that was actually going to be a piece I was interested in, because I was thinking about it. Is there a difference or do any insurance things or companies draw a difference between, oh, well, you want IVF maybe for, I don't even want to try and put in shallow terms, but you want to just wait or something versus maybe you are about to go through chemotherapy or some sort of treatment that will make you infertile or something. Maybe there's a difference between, an insurance company might say, there's a difference between you choosing to wait to have children and wanting to freeze your eggs for that reason. And you having some medical thing where it's like, if you don't save your eggs or do the in vitro now, you won't ever be able to. Right. So they don't make that distinction. It's pretty black and white in Minnesota. So if you have coverage, you have coverage. If you don't, you don't, no matter if it's because you have breast cancer, you need to start chemo next month, or if it's you want to freeze your eggs till later. So it's just dependent on what your plan is. And if you're married in Minnesota, whether you're heterosexual or homosexual, it doesn't matter. You get coverage for whatever you have coverage for. They'll treat couples, they don't, the insurance companies in my experience has not discriminated between that. And does that, I want to get to some of these questions, but does that include surrogacy and some of those kinds of things as well then? Does that start to get lumped in with this? Surrogacy is usually not covered by insurance. There are some rare instances where some of it will be covered. Same with donor egg. Donor sperm is usually covered if they have coverage for inseminations. So donor egg, by definition, you have to do IVF. With donor sperm, you can do inseminations. So it's a little bit simpler when you're using donor sperm in theory if you need to do treatment than it is donor egg. In Minnesota, what have we seen maybe the legislature or governing bodies of any type? Actually, have they started to grapple with any of these questions to think about this one way or the other? Have they done anything? So in the last legislative session, there were two bills that addressed surrogacy. One tried to implement what is kind of considered best practices around managing surrogacy cases. It wasn't carried to term. Exactly. That's right, it was not. The other one was a provision that got folded into the omnibus tax bill. Because that's where I put my reproductive technology type legislation is into an omnibus tax bill. Exactly. In Minnesota, we have a tax credit that provides $2,000 to people who experience a stillbirth, a stillborn child. That money is supposed to go toward burial expenses. The provision that was written into the omnibus tax bill would have outlawed using that tax credit in cases of stillbirth that were associated with surrogacy. Ultimately, yeah. Ultimately. I feel like it's very stark. You would get this money if you had a stillbirth, but if you went through a surrogate, then you would not get it. Not because the state legislature was considering drawing a distinction that that was different somehow. Yes. What was the logic behind that? I think they really just wanted to discourage surrogacy. Often what we do in policy is we decide that we're not going to allow taxpayer dollars to be used for things that are controversial or that we think at least some segment of the population would view as being ethically inappropriate. I think it was a place where the legislature wanted to draw a line in the sand and say you can use a surrogate, but we're not going to allow you to use tax dollars for the repercussions of your use of a surrogate. I hesitate. I have not looked around the audience too hard. We're at a Lutheran school, so let's beat up on the Catholic Church a little. This was a piece of the Archdiocese in the Twin Cities. This was a legislative goal of theirs to some degree to discourage surrogacy. I mean, that brings us to this whole other question of there's a legislative potential regulation around some of this. There's maybe an insurance piece, but then there is a moral religious sort of understanding of some of this. I'm curious about where you see some of that intersection and how that informs this for better or worse because you can imagine, as we heard earlier today, maybe there are good intentions there, but does it play out? Does it have the effects? Does it have the intended consequences? I mean, the concern is, is it's private money, and if they can hire the right people, they can make a harder argument than others that may not have a lobbyist. The other thing to consider, too, is there's movies about, well, Breeders was a movie about gestational carriers, and they interviewed a bunch of different gestational carriers, and what they said and what they regretted wasn't good medicine. Just to combine terms, gestational carriers, sir, get same thing. Yeah, same thing. So, you know, one woman said she didn't have legal counsel. Well, we require legal counsel. We require everybody meets with the psychologist. We require that everybody screened. We follow FDA guidelines, and both scenarios that they review this great movie were wrong. I mean, that's just not how it's done when it's done right. I think, again, that two things. One is, one of the issues is that there's not a law in Minnesota that governs surrogacy, and so the when it's done right, it really matters there, right? Because, again, that could be something that varies from clinic to clinic, and so that question of oversight that we keep raising comes up. The other thing that the other issue that gets raised for me about the role of religion in all of this is, you know, thinking about what role religion might play for a particular family or couple trying to decide what sorts of reproductive choices to make for themselves versus what role religion plays at the public policy level, right, where you have particular faiths wanting to have policies created to sort of implement their vision of what is ethical and what is not ethical, and, you know, whether that's legitimate or not. So I should say in the second half of the show, we open up for all of you to ask questions to these folks, but the last piece I wanted to ask you is, again, and not everybody was here for the whole day, but I am curious, you were here for most of the day, is there anything in particular you heard that is still rattling around inside your head that you're still thinking about or raised a big question for you that you're reflecting on or thinking about? Sure. I mean, what I took away from the CRISPR-Cas9 lecture was, you know, here we can potentially go in with embryos and cut out that enzyme and make it right, make it a non-affected embryo. And CRISPR, just for folks, is this technology where you can, as you were saying, instead of, you know, saying yes, no to a thing, you can potentially edit it. You can edit it. You can cut the gene out and make it not be affected. And what's interesting is what we're limited by with PGS, or PGD, when we screen embryos for Huntington's disease or CF or whatever it is we're doing, we don't transfer the embryos that are affected. With CRISPR-Cas9, if it works, and you know, the technology is interesting to me, and I agree we're not ready for it yet, but if you can change, if you can fix the embryo, you don't discard that embryo. So now couples have many more opportunities to do embryo transfer for normal embryos or chromosomally normal non-affected embryos. Wow, that's very interesting. So one thing that I think is a big issue for me are the social justice issues. So we've talked some about insurance coverage and, you know, concerns about financial access or lack of access to reproductive care. There are other concerns about access or lack of access besides the financial ones, things like trust or cultural sensitivity or just geographic disparities. In Minnesota, most of clinics like yours are in the metro area, right? So if you're from greater Minnesota, you have much less access. Some states have no clinics like yours. And so in addition to paying for the care, you have to pay for the travel and the lodging and take time off work, and it can be very, very difficult to access this kind of care. And that's a social justice issue, right? What are we going to do about that? I think that in addition to that, I teach public health ethics, and so one of the things I always think about is sort of what comes before this use of technology. What can we do to think about preventing the need for this technology in the first place? So think about things like delayed access or lack of access to treatment for sexually transmitted diseases, for example, that could compromise fertility. There are real disparities in terms of STD rates in Minnesota, I think that's not uncommon across the nation. There are disparities in terms of access to care. Other things like exposure to industrial chemicals at your workplace, for example, can compromise your fertility. And so there are kind of interesting environmental health or environmental justice issues there as well. Well, on that important note, we're going to pause here and leave the rest for you all to ask questions in the second half. But right now, can you all please help me in doing a tremendous round of applause for our two great guests? And we're going to get off. We'll go that way. We'll get off stage. We talked for a long time. That was good though. So I'm going to turn the stage over to the cast of the Theater of Public Policy. So as I said at the top, what they do is they take everything that we've talked about and they bring it to life. And this is all unscripted. This is all made up on the spot. This is off the top of their heads just based on what we heard and some of the things they gathered earlier today. So please be generous and make a big round of applause for the Theater of Public Policy. All right, everybody. Don't worry. This is going to be a quick ethics board meeting. We only have a few cases that we need to get through. Everybody's here. Psychology, legal. All right. Ready? Go to the first one. All right. We have a situation where a little boy would like a playmate, but he would like it to look like him. Oh, it's the mirror image playmate stuff. Yeah. How do we feel about this? The precedent is if they both like to play hockey, it's fine. But if one wants to do checkers and the other wants to do golf, we don't do it. Okay. I think it sounds adorable. As a twin, are you offended by this? No. But I also think that we should probably get a third because that way they can both gang up on one of them. All right. We'll recommend two. Oh, yeah. I want to say what he said. Yeah. I mean, I think that works better just in my experience. Okay. All right. Case closed. Second case. This one, it's by an animal lover and they want to have some sort of Fox human hybrid child. Yes. Yeah, absolutely. Yeah. Yeah. Yeah. The cute fuzzy animal, small child thing. Imagine the Halloween costume. Whoa, whoa, whoa, whoa. Wait, wait, wait. Do they live near a chicken farm? That is a good point. Good point. Pull three. I'll find out. We'll table this until next time. Okay. Okay. It's still really cool though. Okay. Just keep going. And cute. It will be cute. It will be adorable. The third one is the one that you were telling me about at lunch, right? Yeah. This one's a little tricky. All right. So everyone's familiar with Benjamin Franklin, correct? Who isn't? Okay. Well, someone has managed to get some of his DNA. I don't know how. They want to create a child that has all the characters of Benjamin Franklin. And we know IQ doesn't transfer, but they don't know that. Um, hilarious witticisms do transfer. That's true. Yes. Yes. And that big hat. Yeah. All right. So poor Richard's almanac and the big hat. Yep. All right. That's finished. Uh, where's that? I brought my stamp. Oh, yeah. Approved. Approved. Thank you so much for going out on this first date with me. I appreciate it. I hope you don't mind, but I brought a psychologist with me. Oh, well, in the event, hi, I'm her genetic counselor. Yeah. In the event that you become my gestational carrier and I don't know why I'm holding hands with my folks. No, that's fine. It wasn't. It's totally important. Yeah. I mean, I thought that maybe we could just get some of the basic questions out of the way so that then we can just relax and enjoy each other. Oh, thank you so much. Well, Stefan is here. He has mapped my entire genetic genome. In fact, we're so good at reading it, but we can't write it. But he has all the answers. Okay. Well, you know, Dr. Phillips is here to see if you are mentally sound. Oh, well, it's not for me to answer. I would like to ask you about that thinning of your hair. How long has that been going on? Oh, thank you for asking that. Yeah. Since I was 40. Okay. Ooh. I'm glad I brought something to write with. Yeah, good. And so I noticed that when I was looking at your profile on OKCupid that you like cats. Yeah. How many cats do you have? That's for Stefan to answer. She has two. She has two. In my genetic genome. Yeah. She only has one right now, but her genes say she will probably get another one in a couple years. It sounded like she said she was part cat. I don't know how I feel about that. I have a big question. Okay. You alluded to the fact that you might be over 40. I'm worried about your fertility beyond in your aging years. Could you answer that? Well, Charlie Chaplin had babies till he was like 78 or something. Oh, are you funny? Hey, everybody. Are you paying too much for IVF? Oh, meeting all these counsellors, psychologists can't remember those names. We'll come down to Denny's IVF clinic. I'm over on third and grand above the cell phone store. Why? You don't have to take it from me. Listen to one of these great testimonials of a happy customer. I was an uninsured sperm donor donor donor and now I have 18 kids. I had a great time. He gave me an IOU for the IUD. He removed and then I got IVF. When you were listening to your traits that you wanted, did the ethicist laugh? Well, no one's laughing here. All even throwing a few traits for free. That's my Denny's promise. And if you don't like that kid, I'll raise him. I got a whole bunch of kids in the back of the shop. They help me clean up at night. So tell your friends, come down to Denny's IVF. Ask for Denny. That's me. I'm the only one here. Pulling the savior sibling thing again. You know, I don't want to share with... Sorry. You know, you've already shared. Yeah. Jim, you, I mean, we can't help it. He is the savior. He's the reason you're still here. Oh, but he says that every time he wants to play. It's only because he peaked so soon. The most important thing he's ever done. He's already done it. True. All right. Thank you so much. You're welcome. Thank you for saving my life. Yeah. Play tic-tac-toe. Yeah, please. All right. Mom, I... You walked away. I'm sorry here. When your brother gets down off of that, there we go. So they chose you. Yeah. Yeah. I have an 18% chance of having an outer belly button, and so they're not going to use me. Oh, they chose me. You're so lucky. I'm a chromosomally normal embryo. I'm, like I said, I'm pretty normal, but for that 18% outer belly button thing. What are you going to do? Which they could change. I've been edited. I'm perfect. I can't help it. You don't even have to hold your hands up like this. No. You're so lucky. I can move things with my mind if it is called a mind. I don't know. Wow. That's incredible. I know. I feel incredible. Yeah. I don't know. I guess I'm just going to live here in this dish. That's okay, you know, because you're giving your life to science. Yeah, but I'm not going to become a person. Oh, you know, that's so overrated. Honey, I can't find the crisper. Oh, I, uh, I can't find it. I got genomes to cut. Yeah. Listen, I, uh, I got confused in the kitchen and I, uh, used it on the lettuce because the lettuce. Yeah, because it was a little flat and, uh, and I used the crisper to just kind of like spruce it up. Hold up. Hold up. This is an ethics violation. The crisper is to be used in very particular circumstances. You can't just go editing all the vegetables. Listen, honey, I don't want you to bring up the ethical thing again. I'm sorry. We talked about this. I'm sorry. I told you when I brought that crisper home, it was for me to keep in the garage to edit genomes that had very specific issues. You know, Dave's wife lets him use the crisper for whatever he wants. You know what? Just because you're my wife doesn't mean you can use my crisper. You can get your own crisper. Mom, dad, there's a head of lettuce running around the garage. Kathleen, this is a tough conversation. Oh, I like those. Yeah. And as your employer, I've been looking over the insurance policy that I've been making possible for you as my employee. And I see that you want to have the in vitro fertilization. I can't really allow that because nobody else knows how to fix the copy machine. Okay, come on. If you're gone for more than two weeks, we are just down the drain. It's coming to that. It is. I can teach people how to put the toner in. It's usually just toner. Yeah. But if you notice, none of us can do it. It's you, Kathleen. No, it's not me. I think you just don't want to learn it. I mean, can I just have like a masterclass or something? I just really want to go through with this. And I don't want that stupid copier to be the thing that keeps me from it. I can understand that. But gosh, I'm the employer. That's my argument for everything. It only works at work. Oh, wow. There's so many choices. It's like a subway. Yeah. Wow. I mean, here we have, I mean, we could go straight traditional, where I carry it, I give birth, all the thing. But then this whole gestational carrier section is exciting. Oh, yeah. So I mean, even what you put in it is a whole thing to choose to. So like, you select your shape. So if we select traditional me or somebody else, then we have to pick the shape of that bowl. And then you have to pick the ingredients, I guess. Gosh. I mean, kids is complicated. Right? It's just to think you could just, I thought you just got a salad, but now you got a sorts of salads. You know, I think you're going to go want to go with the deluxe model. Yeah, it's got that undercoding that's going to be something you're going to need. I feel like the undercoding is always something they sell you, but then they tell you you don't really use it. I was born with undercoding. Oh, you were? You were? Look how I turned out. I mean, you work here. Hi, state legislator. I'm glad to be working in the same chamber as you. I should have learned your name, but I'm just calling you by what you do. It seems like we have to legislate around some gray areas. And I'm really afraid because I don't know how to do that. Well, you know you're in luck because I only see things in black and white. Thank goodness. Yes. Yes. Well, can you reach across the aisle? Excuse me. I just wanted to let you know that in 2017, no one believes in science, so you guys are covered. Oh, what a relief. It makes it much, much easier. I bet I'm just going to use my personal feelings. That's what I've been doing for years. Are you serious? Absolutely. That's easy. And then if anyone questions that I accuse them of being racist. Oh, well, there you go. I brought my my ink pad. Denied. That was so easy. Yeah. I just put my ink pad in my pocket. Doctor, doctor, my daughter was just in here talking to you. And I sent her right back out. Well, I'm worried that maybe she might pass on some stuff that I don't want her to pass on to my grandkids. What do you mean? Well, it's not like genetic problems that like I have, but it's like she doesn't clean up her room. And I don't want my I don't want to have to harp on my grandkids because grandkids is the whole reason you have kids anyway, right? So could you like make sure her little ones don't have the messiness gene? So a quick question. Cool. It's going to answer a lot of others. Excellent. Do you know what genetics is? You bet I do. It's the whole science. Mom, we almost done. I guess I have to just wait in the car. Oh, yeah. Yeah. Also like the whininess thing. I know she's 36, but I don't want. Thank you, both of you for joining me in our community around athlete's foot. I've Yeah, you know, I was going to use some Tenactin, but I realized that would separate me from you and we would not have the same athlete's foot culture. There's a cure? Well, there's a treatment, but I don't think we should use it. It'll come back. I mean, I even wear rubber sandals at the gym and still, I mean, it's all the way up to my knee practical. Oh, you are so lucky. I am lucky. Why are we standing so close? Don't you want to be part of us? Oh, I want to get rid of this acne foot. I can't go to the beach. We thought you were our friend. Yeah, I am your friend. It's just, I don't even know you. We do other things. I don't understand. It's not just about this. Oh, yeah, but you can walk outside and you can put your feet up on the porch and people won't be grossed out. They'll actually eat around you. You're not going to wear my tube socks anymore? No. These are the things you're going to miss if I leave. Putting your feet by people who are eating, sharing tube socks with other grown men? There's nothing more to life. No. Not that I've found. I want to live a little. Oh, I want to go out there. I want to get on the dating scene. Oh, good luck with that. Maybe I want to be a foot model. Did you ever think about that? And not just for the before picture. I want to be an after. Oh, come on. You are. You are kidding yourself. You know what? You are. What? You're footest. Footest? Yes. You're totally footest. I'd go so far to say you're even angkless. I know. Enjoy your privilege. Yeah. I just guess we weren't as good of friends as I thought. Don't say that. Don't say that. It's a bell I can't unring. Don't say that. I mean, you still have that earwax problem? I told you that in confidence. So does Fred. All right. So good. All right. Please. How many welcome back to the stage? Our two amazing guests. Where did they go? Dr. Casey. Oh, they're right behind me. Hi, welcome back up. Yay. Have a seat, cute heather. You all have moved farther away from me, since the improv happened. It's fine. So this is the part of the show where we open it up for you all to ask questions of our guests. But we like to give you a chance to rehearse a little bit. So if you want to turn to the person next to you, ask them a question that you actually would like to ask of one of our two brilliant guests. You'll have a chance to practice and make a new friend. All right. Ready, set, go. The Jeopardy background. He's playing Jeopardy. Oh, I have to go and actually get their question. I forgot. Oh, you have a question already. I didn't even say. Normally I would say, oh, if you have a question, raise your hand and I will come towards you. But look at that. You all are on top of this right from the get go. Yes. So you have four embryos and one is good. How do you destroy the other three? What actually do you do? She said it just throw it down the drain. Yes, good question. So the patients will sign a consent form ahead of time on what they want to do with the embryos. What the consent says is that we will destroy them in an ethical manner. We don't actually destroy, we don't just, I mean, we deactivate the embryos. So the embryologists in the lab have a special technique where they will deactivate the embryos. But we have to get permission as the physician talking to the patient that they don't want the embryos anymore. I don't know if we got an exact answer. Yeah, how does it actually, how does it work? Or what does it look like? What does it look like? Yeah, what does deactivation mean? I don't imagine there's a switch. Yeah, is it a chemical process? Or is it? I believe that it is. I'm not an embryologist. I've never actually seen it. But I believe that's how they do it. Okay. Other questions? Oh, wow. Oh, that side is winning. But I'll come back over there. Okay, wait. Was there one that was closer here? Yeah, right here. I'm just curious when, have legislators who are talking about these issues and trying to legislate about these issues, have they ever come to you first to get a little background info maybe? Maybe? Wow, what a leading question. People from faculty from my center have been involved in some of the debates at the legislature or other issues with the state government on a number of issues. I don't know that we've been consulted about any of the issues I'm talking about today. But for example, when the state developed Minnesota Care, the Minnesota Care program, my center was consulted about that. We've been consulted about genetic privacy issues. We've been consulted about public health emergency planning. So sometimes, actually, the state does come to us. Yeah. No? Do you have legislators ever come to your clinic or anything like that? No, but some of the physicians have testified in the past. Okay. So if a bill is being threatened to go through or whatnot, we've had physicians actually go and testify. Okay. Hand here? Yeah. So I'm a high school student and in high school, there's often a lot of stigma around reproduction in general, but especially like in vitro fertilization and surrogate mothers. So how do you suggest that we, as high school students, can educate our peers and reduce some of that stigma? Do you have a specific like, is it because you go to religious school or people don't understand the process? What specifically is the issue? I think that it's a mixture of both of those problems. I go to a public school, but there are, I think that people have some misconceptions about what exactly happens and then there's also religious factors that come into it. Sure. So as someone, and I can't remember who was talking about that many women in this room today are not, or many people in this room are not going to have trouble getting pregnant. And that's true for 92% of people in college ready to eventually start the family or whatnot. So it's a small population that has infertility, but it's also even a smaller population that actually moves and goes forward with IVF. A lot of people don't know much about it. If there's a religious factor, we deal with it, meaning that if patients don't want to freeze embryos, we won't freeze embryos, we will only fertilize the number of eggs that would end up as embryos to transfer, meaning to fertilized, to grow. Maybe we freeze the rest of the eggs, maybe not. I guess the stigma for IVF, I mean, the other thing that was mentioned today is you try so hard in high school and college to not get pregnant. And then all of a sudden people come to me all the time saying, gosh, if I would have known this, I wouldn't have worried about it for all this years. But there's some truth to that because so much of where you're at right now, people are not wanting pregnancy. So I think it is hard for high school students to really get IVF and understand it. The science is cool. It's great for many, many people. It should be the standard of care. It gives you the highest success rate. Gets you to pregnancy faster. I just... Do you ever... I'm just a build on this. I'm curious if you ever hear from folks that they worry, oh, if I have a kid through in vitro, they'll be known as like a test tube baby or whatever it is. The stigma question, is that a concern would be parents ever come to you with? Interesting. When I went to a meeting in Chicago in June and Elizabeth Carr, who was the first IVF baby, was there and Louise Brown, the first U.S. baby, was there and they presented it. It was kind of like this kind of setting. And somebody asked, what was the weirdest question you ever got? One person asked them, how did you get out of the test tube? Another person asked Elizabeth if she had a belly button or not. So there's just a lot of misconceptions. And I think, I mean, it is hard to understand. I mean, a lot of people don't have to deal with it and it doesn't affect that big of a population. So I think, you know, I think just being open-minded and not, you know, the religious thing, it's hard to get around that, but there are ways to get around that for people that need, that want to have a family. And one other piece, and I'd be interested, both of you, Dr. DeBruin, as well. I guess even if, you know, the science is cool and whatnot and we know, obviously, kids who are born through in vitro, they obviously had very little say in that. But I still think a lot of times, you know, infertility is something that a lot of couples don't want to talk about. And so, I mean, a lot of people, you wouldn't know, oh, their child might have been born through in vitro fertilization, which maybe adds to that stigma. So I'm wondering is there an element to that that we should be more out and proud folks who use these methods? I think that there is a lot of, very unfortunately, a lot of stigma around infertility. And stigma is a huge issue that, you know, really can impede people's ability to access appropriate therapy. It can cause a lot of misunderstanding. It causes a lot of shame. It's not just in this area, there are lots of health issues where there's a lot of stigma, but I think you're right. I mean, I think there's just a ton of stigma around infertility in general. Well, part of it too is how do you tell your employer that you want to start having a family? You know, that's time off. They know you're going to be a maternity leave. Nobody else can change the toner, right? So it's things like that. And I think that's a big barrier. I was talking earlier today, saying that some women will take the whole day off of work for a 20-minute appointment because they really just don't want their employer to know what they're doing. And that's sad. Yeah. Okay, I have a question over here. Yeah. We're led to believe that infertility is on the rise. Is that something that you would agree with or disagree with? And in those same articles are things about, okay, the plastic in our food has gotten into our food and that's increasing infertility. Or whatever topic may come up, do you think we as a society are looking to address some of those underlying issues that might even help prevent infertility? I think there's more awareness than there used to be. The numbers really don't speak to infertility being higher than it used to be. What is different is the age at which people start building families. And the age of the woman, unfortunately, is the biggest player there. So women that wait longer, it's a longer time to pregnancy. They're starting to see some correlation to males and infertility as they get older as well. It's not as pronounced with women as is for men. I mean, sorry, the other way around. It's not as pronounced for men as it is for women. But I think that's the biggest barrier for women is that they're waiting a long time. I think in terms of questions about the public health interventions that you might use to prevent infertility, I think in general in this culture, we're not as good at supporting public health intervention as we are at supporting cool technologies in clinics. We have a technological imperative in this culture. And we have a tendency to neglect public health concerns. And so I think it is really important for us to think about moving back and thinking about prevention to some extent as well. It'll be interesting because there's this news out now about how we have the highest rates of sexually transmitted diseases now that we've had ever. There's been just a huge resurgence in terms of the rates of sexually transmitted diseases, which I'm guessing will end up potentially affecting fertility sort of downstream, yes? Yes, yeah. And that STDs for women like Chlamydia in particular can cause tubal damage to the point where IVF is going to be the only option for her. And you keep bringing up access to healthcare and I really see that. I see patients from New Olm or from, you know, Landsboro or way up north, you know, that they've been trying for 10 years. They just don't have access. And if they would have come to us 10 years ago, it would have been a whole different story and it's really sad. I got a question over here and then a couple over there. It sounds like in terms of both our understanding of the ethics and the technology itself, we're sort of in the infancy period of this or sort of the pioneer period. When we talk about the things that have been talked about today, CRISPR and direct gene editing and things, can you guys talk about the future of how those are things like gene rich, the idea of being the gene rich and the gene poor and if we can really trust the free market or the private sector when the issues are about the future of our species, both in biological and in cultural terms? We have 30 seconds for that. Well, I can say something quick to that. The analogy of building the race car when it's already going, that's what it feels like sometimes. And that was perfect. But I also think it's, you don't want to blaze the trail, but you want to be ahead of being the norm. So that's kind of always been the philosophy of our clinic. Don't be the first one to use CRISPR on your patients. You know, it's just wait to let it shake out because it does shake out. They mentioned several things that never went anywhere. You know, if a marrow is supposed to cause a bunch of birth defects and that was just not the case, and that was presented at a plenary at one of our national meetings and it was a horrible study. So there's a lot of things that happen that we're like, okay, take a breath, wait six months or whatever it is and then do it. I think that the, Jacob Korn said today, what we should be doing is thinking about what we should do before we think about what can we do or what should we try to do. And from an ethics perspective, that makes a ton of sense to me. It is really hard when you're building the race car as it's going. And one of the real challenges always with bioethics is that what we tend to do very frustratingly enough tends to be reactive rather than proactive. And this is why I keep raising this issue about oversight. You know, now is the time to have the conversation. So this is partly why this discussion is so fantastic and so amazingly well timed, I'll say to the organizers, because it's now is really the time for us to be thinking as a society, how do we want to manage these issues and what do we find to be appropriate and what do we find to be inappropriate. Okay, I have time for maybe one or two more questions depending on how, if they're as easy as that one. Did you have one here? I'm curious about this freezing process. How, where do you keep them? How long can you keep them? And then is there a freezer burn? What do you do with them? How do you get, really, how do you dispose of them? Yes, so there, the freezer burn was the slow freeze technique which we did up until about five years ago and our recovery rate for embryos, meaning surviving the freeze thought process was about 50%. About seven years ago, we started vitrification which is like a flash freeze. So it's basically, I compare it to, well, I have young kids, but when Anna gets frozen at the end of frozen, she was vitrified. And notice how well she came back when they found her out. That's vitrification. So now our freeze thought success rates are about 95%. Wow. And you can keep them as long as you want. We've done transfers two days after, we've done transfers 10 years after, and they tend to survive either way. Wow, that's great. Okay, I have one last question here. I'm wondering if you can speak to how you deal within a clinic and also between clinics about how physicians make decisions about who they treat in terms of access, whether that's about marital status, income level, all of those things. Do physicians have a right to say no? And if so, is that made public? We do have the right to say no as long as we provide an alternative. That doesn't mean patients aren't going to get litigious about it because it could happen. A good resource for us is our psychologist because our psychologist works with every clinic and she can tell us who's going to have what opinion on things. But also, I mean, I'm friends with a couple of the other clinics, docs at that clinic, I can call them up and say, hey, what do you think about this? We're not comfortable with this. The best example, well, I can't really give, but if there's a medical reason why we shouldn't be doing a retrieval in the office, we'll send people to Mayo and we'll call them up and say, hey, what do you think about this patient? Are you willing to do them because you have the resources if things don't go well? And I'm curious from a bioethic center perspective, is that knowledge captured then in some way somehow? Or are there people, I mean, are you or other folks trying to say like, okay, this is all happening and yes, the race car is being built as we're driving it, but somebody's also writing down the plans of how we did some of that or what decisions we're making? I think, again, that really depends upon the way the system is built. So right now, as we've been saying, it's a very clinic dependent system. And so that sort of thing, presumably, if things are going well, is being captured at the level of your clinic, but wouldn't necessarily become general knowledge or be captured in a general sort of way. That's another thing that oversight can do, is it can allow us to share experiences or gather data that we can then use to improve practice. All right, can we do one more amazing round of applause for our two amazing guests? Yes, we're going to get off the table. Yay, yay, okay, whoa, whoa. Stick a daddle one last time. So one more time, we're going to turn the stage over to the cast of the Theater of Public Policy, just like before, I swear this was all made up. So please, a round of applause for the Theater of Public Policy. All for coming. I was the first TestTube baby and I'm prepared to answer any questions that you may have. Hopefully this will clear up some misconceptions, yes. How do you go through life with that cork on top of your head? The cork I inherited from my father. He had one, his grandfather had one. It's just kind of now something I continue on. I hope to pass it on to my son as well. Do you think it's weird that they named you Beaker? At the time, no. When I first learned about it, I didn't understand the reference, but since taking science class, I find it very funny. Why haven't you broken yet? Why have I not broken? Shattered. Shattered. Are you tempered class? I get asked that question every single day. Sorry. I'm not made of glass. I'm a human just like you. Except I got the cork. Just a byproduct. You don't believe me? No? See? Flesh like, huh? Flesh like. Awesome. You said it. That concludes questions. I'm going to go now. So, I know you all have some misconceptions about conception. Thank you, no one for laughing at that. I didn't go through 28 years of medical school to not have funny jokes. It was funny that we're nervous. We're very nervous. We're very nervous. I can tell you're nervous. It's just that Fred and I aren't quite sure which one of us is going to be the surrogate. Yeah. Oh. Yeah. Yeah. So if you could just maybe clarify. Oh, it's going to be Fred. I told you I was more maternal. Hey, it's only because when I sent home the homework, Fred's the only one that watched all of Frozen. I told you the Ziploc bag would keep it frozen. Oh my gosh. Yeah, that's our baby. Oh my gosh. I feel, I don't know what I feel. I feel a little stressed out. This seems bad. That baby's been sitting next to a canister of light sour cream. The technology has improved. It's perfectly well preserved. You think? Yes, absolutely. Hey, let's go, let's go implant. Honey, come on. We talked about this. Okay, I'm bringing the sour cream. All right. The question isn't just for me. Should we have a baby? Because, you know, after the psychologists and the geneticists said that we could actually go ahead and get married. But, it's more like- Wait, wait, we're getting married? That's what the, my psychologist said that I was mature enough, finally. Okay, we'll get back to that. What were you going to say? Not just should we have a baby, but how should we have a baby? I think the question is more should we have a baby, not could we have a baby? Just because we could have a baby doesn't mean we should. Then we'll worry about how? Well, I would have a baby if it were possible, but I can't because of, you know, the anatomy and stuff. Well, no one can have a baby just on their own, and then if you did, we would get into cloning, which is not really at all what this conference covered. You're right, but I think what you're talking about is you're talking about a dystopian science fiction future. And I was just saying, gosh, I'd like to have a little one. Oh, well, when you get into the idea of you just want a little one, think about why do you want that little one? Is it just a narcissistic mirror of yourself? Or do you want to have a family? Fast forward four more hours. Let's just have sex. Somebody stop this race car. It only has two wheels. No, I got it. I got it. Somebody help. You need a new spark plug. Come on. Hold on. I got a wheel. You're going too fast. I'll get you. Hold on. You're sure hot. No, I'm going to stop. I can't keep going around like this. You can't stop. Here's your decal. No. I don't need a decal. I know. I need a proper engine. I need some brakes for one thing. I just put in a bunch more oil to ride to be much smoother. Here's your beer cozy. This is NASCAR, right? That helps. You've been kind of dizzy now. Yeah. Feel free to cut the scene any time you want. Yeah. OK, here's the thing. Oh, no, I know. I know you've been at this conference with your big science situations there. Don't bring it up at Thanksgiving or you're going to ruin everything. Look, everybody keeps asking when. And I say, oh, I don't know. It's not in our hands. Yeah, that's not good. Just say, isn't this the best cranberry sauce you've ever had? Just say that and leave the science stuff in the garage. I'd like to, but I feel like we're not giving them the information they seek. Yeah, they don't want no. Nobody wants that information. It's just like, ah, it's just stressful. I told your mother that I had low motility. And then I. Oh, that's a big word. Yeah, well. Yeah, that's. And then I explained what that meant. Because people can Google that stuff now. Well, she did and she won't look at me anymore. Yep, now it's done. Yeah. She's that's it. My life is so much more peaceful since I told her that. You're burning bridges. That's what's happening. You're burning bridges. Oh, they're here. Oh, OK. Here for Thanksgiving. Wow. Come in for Thanksgiving. You take my hat. Yes, I'll be happy to. Hi, Jacob. How are you? Good to see you. Oh, it's good to see you. Yeah, yeah, nothing's going on. We just have food. Just food. Just food. That's what Thanksgiving is all about. Yeah. Yeah, well, what happened is a Tom turkey and a Hen turkey, they made it and then they made an egg and then it grew into a big turkey. And then we killed it. And then we stuffed it and now we're going to eat it. I know how a turkey works. I know. It's so funny with this. Oh, gosh. I'm here for Thanksgiving too. Well, welcome to Thanksgiving. Come on in. Yeah. I see we're having food. I know what food means. Do we have a low door? So I'm just checking for little footprints or like small baby gates, you know. No, we're just going to have rolls. Oh, well, Thanksgiving's for family and you can't have family with just adults. Yeah, it's just I don't. Yeah. Science. What is she talking about? Gotta just leave it in the back. Oh, I got some baby carrots that I brought. Oh, they're just carrots that have been cut off. Oh, they're baby carrots. Baby carrots are impossible. Yeah. There's our, look at the house. I invited a lot of people. Hey, big boy. You're not corrupt yet. Okay. Okay. Um, it's don't be nervous. No class. Get in here. Okay. Welcome to homeroom. Now here at Jefferson High School, as a teacher, I do love you to relax on the floor. Can we get desks at some point? No. Okay. We're very important. I want to introduce you to our new student. Her name is Geneva. And yes, she's a lot older than you and she is pregnant. We're just working on integrating surrogacy into the high school experience. To remove any nervousness you might have the idea. She's just a regular woman carrying a baby for somebody else. Yep. Totally. I don't want to encourage any of you to get pregnant unnecessarily, but she, because she is an adult woman who made this choice on her own, but just don't be afraid of her. Yeah. I knew the family. We worked it out and it was in vitro. And you're in vitro. It's totally fine. Yeah. It's totally fine. Yes. This is just, you know, a part-time job. So then you're doing on the side, being pregnant. Yeah. I still have time to do my homework. Yeah. I guess I, in about five more months, I might have to take some time off from school. What's exciting is Geneva already has all of her graduate and undergraduate degrees, because she's an adult woman. The one she'd do in high school. You're going to have, are you going to be pregnant over the summer? Yes. If you do the math, I will be pregnant into the main part of the summer. Gross. Frederick. Well, it is. No, it's not. That's how you showed up. What? You were all inside a belly once. And I was born in June, so no. Not me. Yeah. And it wasn't a belly, it was a uterus. We were all born inside uterus. That's why there's an us at the end of this. Well, we weren't born in the uterus. We were, well, the way, I don't want to have to talk about how it happened. You've already started. Okay. Imagine you're a turkey and... Got my back. You all right? I don't know. Okay. I don't know what I'm supposed to do. Well, go get the crisper. Okay. Why do I bury it behind everything? Edit this thing out. Okay. Put it on there. I think this is the salad spinner. I am so sorry. This is killing me. I know. Pain is a natural part of life, though. If you didn't know pain, you wouldn't know happy times. Okay. Good God. All right. All right. Now, when you have the editing material, right? Yeah. Okay. Well, spin it. Wow. That is great. I just saw my bald spot on that thing. Can you take care of this? Something you want to tell us? Well, I just thought we could have a secret conversation. Just us? Just the three of us, privately. Just like, just about infertility. Whoa. Wait. Don't feel weird about it. We can talk about fertility, too, but... Okay. We're talking about fertility, not infertility. Well, either one is okay. It's a whole experience. And fertility, actually, I would say infertility is part of fertility. It's a general term. And inside of it, you have fertility, infertility. So if we... This weird response is why I wanted to talk as a team, guys. I think all words that have a prefix are just kind of... So infertility. You don't like any... You don't like... What about if it was just other infertilities? Yeah. Other infert... Like, sometimes... That's what you want to talk about? Other infertilities? Yeah. I want to talk about, like, sometimes people have a baby as soon as they say I want a baby, and other people have to have a lot more obstacles in their way. And then, like, my mom said she wished she'd been infertile. Oh. Yeah. Oh. That's something to talk about in this... Just deactivate it. Come on. But what do you think I'm doing? We got to get out of here. It's quitting time. Just deactivate all the embryos and we can go home. I just got to make sure you do it in an ethical manner. Is this okay? Yes. But I think you could do it without the tood. Without the tood? Guys, I'm not gonna get off for the day. Just, uh... Yeah, we're finishing up. Don't touch the cop here. Yep. Kathleen! You know what I'm gonna do, of course. You better not. Yeah. After I've deactivated them, I'm gonna freeze them again. What do you mean? What do you think? You've been doing this every day? Yes! Why? Open the freezer. Let it go, let it... See? It just feels like the... It didn't sing that time. Just frozen. It's really cold. You're shivering. Yeah, I know. I just hope they pick me. I just hunkered down. I'm holding it out. I don't want them to take me for a while. I want to ripen like cheese. I hope I get implanted soon because it's just getting too cold. I'm holding out for 15 years. I'm gonna wait. But in 15 years? I'm gonna be older. But I'll be 15 years old and you'll just be a baby. Yeah, but I'll have all the wisdom of being in this freezer. You know what? Who needs to go to the Arctic? I've already been there. I'll be able to come out and explore and already be on top. But think how good it'll be to be born. Yeah. And if I wait, it'll be that much better. Gosh. Every minute that I spend in this freezer is more anticipation for me and my parents. They had to work for me and wait for me. So I'm going to be the best thing they've ever done. You're just going to show up. But I'm going to be a prize. The greatest prize of all. That sucks. There's something I want to tell you and I think it's best to break the ice if I start reading from this article. And we can discuss that first. Okay. There's been a rise in STDs lately that have been affecting fertility. What do you think about that? I think that's too bad. What if this issue was not abstract and someone you knew had one of those STDs? You gave me athlete's foot. I can't believe you. I thought it was harmless. I just, I started scratching it and thought it would go away. Yeah. Great. That's what this is. I will never have a child now. But it doesn't, it has nothing to do with your plumbing. Athlete's foot is completely different. It's more an attraction thing that. It bothers me when you use the term plumbing. I had a teacher once who said I came from a tummy. You came from a tummy. If we're going to talk about this, I think we need to use the words. The ones with the latinate base that make you want to end the conversation had a cocktail party. Well, which ones could you mean? You have two views for matters. Oh, why in your vesticular. Lutinizing hormone. Something will happen if I get close to someone else. I thought we were being mature. I lost it. I lost it. Now your turn. Sing. Your rest over is below. That's death or rest. Painist is nothing to be afraid of. I'm sorry. Seaman, seaman, seaman, seaman. Bad. I forgive you about the foot. Same dirty words. Did you sing seaman? I might have. I could have seen him going like this. Such a dream for us. I want to do a tremendous thank you to everyone involved with the Nobel conference, particularly Barbara Larson Taylor and Lisa Helky, who actually had the crazy kind of a loud applause for our two amazing guests who joined us on stage. If you enjoyed anything that you see, we would love to see you again. We would love to. We do shows all the time in Minneapolis. Maybe this went okay and we'll come again. So did you all have a good time? Brandon Boots. Heather Meyers. Brett Chang. Shannon Custer. Jim Robinson. I'm Tame Danger, but Dennis Curley. That's a piano.