 So radical, fundamental principles of freedom, rational self-interest, and individual rights. This is the Iran Brook show. All right, everybody. Welcome to Iran Brook show on this Thursday, last day of February, leap year. I'm excited. We're going to talk to a real expert on the show today. And we're going to talk to Eric, Dr. Eric Foreman. Dr. Foreman is the laboratory, the medical laboratory director, Columbia University Fertility Center. He oversees the medical practice as well as IVF and biology and andrology, andrology laboratories. I won't read the whole bio. It's a long bio. It's in the description. But Eric, thank you. Really appreciate you really appreciate you coming today. Thanks. Thanks for having me look forward to talking to you and your audience about IVF and the implications of what's going on in Alabama. And elsewhere. Yeah, I mean, I think I really do think that what the rate is doing the approach to abortion, how they've treated women. Who's, you know, his health is, is, is risked by pregnancy in places like Texas. And now this, this new ruling in Alabama, a state that pretty much denies abortion, other than in extreme medical conditions from pretty much pretty much all cases. I think this is a massive attack on rights. And so, but I thought we'd, we'd kind of dig into the IVF question, because I think it's a really good concrete. And it's such a good concrete that even Republicans are kind of shaken up by it. And they're kind of saying, oh, no, no, no, we didn't mean to do this. And they're trying to fix it. And in Alabama, that it looks like they're passing a lot to try to fix what they've done. But the implications are going to be, I don't think this is the end of it, right, even if they do pass a law because the real implications. But when we start with really the positives here, because one of the things that I think is interesting about all of this is IVF is really exciting and kind of cool. And the whole field of fertility medicine is a lot of innovation. And so I just want us to maybe if you could describe what it is in more detail than maybe we typically get. And I'd be happy to do that. I also have been fascinated by this field for more than 20 years and why I decided to devote my life to it and help people preserve their fertility and achieve, you know, having children. If they wouldn't have been able to otherwise and also have healthy children, which I'll, I'll talk about can be affected by this ruling so IVF is actually not, you know, not an old technology. The first IVF baby Louise Brown was born in 1978, just a few months younger than me in the UK. And there's been, as you said, a lot of innovation over the last few decades, but really the last 10 to 15 years we've seen major improvements in the efficiency and safety of this process. Basically, IVF involves getting getting eggs and fertilizing them outside the body in vitro means in glass, not really in glass we use plastic dishes but basically rather than in utero or in vivo. So in vivo, a woman naturally, first of all women are born with all their eggs, although that's been challenged but basically we think women are born with all their eggs there in these things called follicles. They gradually use them up as they get older and women who ovulate release one egg each month. And if they get pregnant naturally sperm has to travel through the reproductive tract find that egg. Hopefully it's a good egg, good sperm travel into the uterus implant and make a baby. But that that doesn't happen for a lot of couples who are even healthy and trying sometimes for years there could be damage or blockage of the fallopian tubes there could be low sperm numbers. As women get older this this finite number of eggs they're born with the quality, the genetic status of those x changes so that it gets much more difficult to achieve a healthy pregnancy. As women reach late 30s and early 40s and by mid 40s, it gets virtually close to impossible and that's something that is not that that well known out there but it really changes a lot. So we can overcome this by using hormones to stimulate multiple follicles to grow rather than one. We can retrieve the eggs so that we have them in the lab, we can get sperm, either from a partner or donor, we can combine eggs and sperm together to make embryos. And that's a question are those people or are those just taking eggs which are type of cells sperm which are type of cells and come together and make a new cell and embryo or zygote that then divides in the lab. And this had this is where the changes have happened we've gotten much better at culturing embryos freezing and fine embryos genetically testing embryos. So that most of the time now we actually put, I mean I think when people here in your audience hear about IVF you think about triplets and octomarm. Now most of the time we're putting one embryo at a time and we know that that embryo is actually genetically normal for chromosomes we can't test every single gene. This isn't like designer babies or anything, but pre implantation genetic testing for aneuploid is what's called PGTA. Basically we can take a biopsy of a few cells from a ball of cells called a blastocyst determine if it has the correct number of chromosomes. And then in a subsequent month or it could be years later saw this normal embryo and place it in a woman's uterus. So that's basically IVF as we currently practice it, which is still far from perfect and sometimes we're not able to produce any viable embryos. A significant proportion of even the embryos that look normal and test normal don't implant and don't develop into babies. So it's gotten a lot better it's gotten a lot safer. We're seeing a lot fewer high risk multiple pregnancies. We've changed the way we stimulate and and do the process so that women can recover and not put their own health at risk. So it's gotten a lot better. I'm happy to clarify any aspect of that, but that's that's the basics of IVF in a nutshell. So, you know, when you when you implant the embryo in the woman, how many times in a sense of the cells multiply that is how big is this? I got what is it? What does it look like? What is what is what is kind of characteristics? So so initially again, when sperm and egg come together and make a single cell the day after the egg retrieval is the procedure where we retrieve or harvest the eggs. It's one cell, but we can tell that it's fertilized because there are these pro nuclei from the male and female contribution. Then it divides and divides three days after the egg retrieval that used to be a common time to place embryos back. They may have six or seven or eight individual cells. So that that is an embryo and it's just an individual cells. Those cells again, you can't tell whether it's going to become a heart or brain or it's still, as we say, like pluripotent. It could become anything over the next to big to big advance over the last, say 20 years as we've gotten better at what's called extended culture to grow embryos to the blastocyst stage. And many of them stopped growing. They're just not good enough quality. They're not normal, but by five or six days after we've taken the eggs out, some will become what's called a blastocyst, which is a ball of cells less than a millimeter in diameter. Roughly 100 to 200 little smaller cells so that the egg is actually the biggest cell in the human body. The sperm is the smallest cell, just basically DNA with very little cytoplasm. They come together make this now zygote and then that divides into smaller and smaller cells that by five or six days is this ball of cells with a part that we can tell could become the fetus, the baby, the outer part that becomes a placenta. That's what we biopsy. So this embryo is, you know, visible under low magnification. It's not so tiny, but not so obvious to the naked eye. It's loaded in a soft catheter placed through the cervix into the uterus with ultrasound guidance. It's common to call it implanted or transplant. We use the term transferred or replaced because we actually don't embed it. We just placed it in the uterus as gently as possible. And nine or 10 days later in blood work, we can tell if there is HCG, which is the pregnancy hormone and we follow that and see if a pregnancy ensues. So that's, that's how it works. That's really cool. Amazing. Yeah. So, but one thing that strikes me is we're talking about something that you can barely see with the naked eye. You're talking about 100 cells maybe or earlier six or seven individual cells. Right. So, so what is it? What does it even mean to call this a baby or human being? And as, as the anti-emotionists are calling it, it seems so removed from kind of a just, just a perceptual experience. Never mind our understanding. Yeah. I mean, and the vast much, I mean, I'd say like the majority, depending on age of embryos that are made do not have the ability to even in the ideal environment, which they're not in the lab don't have the ability to implant. I mean, we struggle with patients who've done multiple cycles of IVF have transferred multiple embryos. And so it's far from a guarantee even, even if placed in the right environment, but outside that environment, you know, they're, again, individual cells dividing with potential. But does not look like this is again, not to justify in any way, but, you know, in the abortion debate, you see, you know, a fetus, a certain number of weeks. And there are features that you could imagine look like could become a baby. And if left alone, that pregnancy would likely progress. So it is an active step, which again is often, you know, necessary to end an unhealthy pregnancy or save, you know, improve a woman's health or she just, again, it's not the right time for her to have a child. That's her right, but that is an active step, whether it's medicated or a procedure. Here we actually we have to actively place this embryo into the uterus and hope that it finds a place to implant and continues to develop left on its own. It would just, you know, die out after a week or two at most. So that's the other thing that again is kind of confusing to me that we're not, you know, when we discard these embryos where, you know, they're in their environment where they were made and they can't continue without being in the right place actively from someone who wants that embryo there and wants it to be a baby. So, so maybe talk us through the Alabama court decision and kind of what and then what it implies 5vf what I mean it seemed almost like people were surprised. And the court was surprised and others surprised that the implication of the ruling was that now if you have clinics were shutting down or stopping the procedure. Yeah, so I'm not I'm not a lawyer or an expert in like these political matters, but I will say like I was surprised and, you know, in our field we've been reassured or told ourselves that they would not go after IVF because this is the most pro life thing we're doing, make babies people who want babies, desperately more than anything, or giving them an opportunity and my wife has been telling me for years like this is, this is as you've been saying like IVF contraception, it, it's not that far fetched and you she was right. Even though I don't think, and I hope this isn't going to impact the practice of IVF in New York where I practice or most states, or even hopefully Alabama. It does show, you know, a view that is very different than, than our view of assisted reproduction. And if this view became more prevalent, you know, would limit the ability of us to help people who really want to have children have those children. And so my understanding of it is that there was a situation and I don't know all the details where somebody took, we have these frozen embryos as I mentioned it's become pretty standard to actually freeze all the embryos from the cycle used to be, we weren't as good at culturing and freezing the way IVF used to be practiced, I think again was not as safe and ideal but multiple embryos would be put back a few days after the egg retrieval and their early stage success rates were lower sometimes triplets quadruplets would happen, which would be very risky for that those future children they could be lost the mom so we've gotten much better it's safer to let the woman recover or hormones go back to normal and select embryos to follow one at a time so this clinic apparently has these tanks with liquid nitrogen, where these embryos are submerged. And that's also amazing that they can stay, you know, basically unchanged for years and take them out place them in the right culture media environment and they'll wake up and start dividing again, looking basically the same as they did months or years before. But how long, how long is that being a process of this idea of freezing embryos and being successful at freezing. Pretty I mean pretty early on in IVF even even since the early 1980s I think the first baby from frozen embryo might have been from Australia and the ninth early 80s. But really that they still was not a perfect process and we would lose 20% or so of embryos in that process or there was still an incentive to put them back fresh. About 15 years ago, a technique called vitrification which is an ultra rapid method of freezing them before ice crystals conform was developed, and we see much higher survival after warming or thawing something like 98 99% of the embryos survive and look just, you know, just as good as they did when we froze them. But sometimes one just doesn't come through and that's when something we could talk about why, why we make more embryos when we can if we really want this to work. But in this particular case it seems like someone I think maybe unauthorized somehow got access to a tank, took out what we call a cane, maybe got burned by the liquid nitrogen dropped it and those embryos. Again, we're not, you know, in the right temperature and basically we're no longer viable, which is a tragedy. This is terrible. There were other situations that got a lot of attention the media a few years ago where there were there was a tank failure in a clinic and embryos were lost and this is, you know, I'm a lab director. And this some keeps me up at night that we have these tanks dozens of tanks with eggs and sperm and embryos and, and, you know, we take this seriously because it's, you know, it is a couple or individuals, you know, hope for future possibility of pregnancy and parenthood. And that's, you know, tragedy is the, you know, people who donated the egg and the sperm, the tragedy that they plans are now thwarted that they, you know, they won't be able to follow through. Right. So, so, so that, you know, that is a sad situation. But then, again, my understanding is that then some of the couples suit or are claiming, you know, wrongful death of like a, like a child basically. Okay. So, from, you know, this accident or accident or intentional, I'm not sure, but basically the judge rule that those embryos, you know, our children and that a clinic or a doctor could be held, you know, accountable for the death of a child or children in this process, which, again, we would be viewed as a loss of, you know, valuable, you know, property that, you know, could potentially be used to hopefully achieve a couple of dreams but not actual children. Yeah. So that, that concern, because in the process, as I mentioned, as we're growing, culturing embryos, some of them stopped developing. So, does that mean we made embryos and we, you know, cause them to die or killed could, you know, could we be held liable? Embriologists move around the lab carrying dishes and moving embryos from the baby's, from the baby's, from the baby's, from the baby's, from the baby's, from the baby's, from the baby's, from the baby's, it's very, very painful. That's, that's a sad problem. you know, cause them to die or could we be held liable? Embryologists move around the lab carrying dishes and moving embryos from one media to another. I mean, they're amazing and almost never make a mistake, but we're humans and things happen. So if something happened, you know, are they at risk of, you know, again, death of a child? So the clinics in Alabama told us was clarified, they basically stopped practicing IVF, which was really sad for, again, those couples that really want and need this technology to have their children. So that, again, if, you know, if each embryo is viewed the same as a child, I mean, that would have dramatic implications on our ability to practice IVF and advance this technology and help people in many ways. Yeah, I mean, this is, I'm looking here at the story in the Washington Post. It's got a citation from a state representative, Ernie Yarbrough, who's a Republican. And, you know, he has this to say, it is not possible to do IVF in a pro-life way that treats embryos as children, which they are. He then goes on to call the destruction of embryos part of IVF a silent holocaust going on in our state. That is one view. Again, another view is that, you know, without IVF couples who want to have children would not be able to. There's some couples that, again, if a woman's fallopian tubes have been damaged, she's had ectopic pregnancies, men who have very low sperm counts, sometimes there's blockages or certain situations where there's just essentially no possibility of having children. And then there's also situations where couples would be at risk of having very sick children, even children dying. And again, I think this view, this was an estate center, would view that as preferable. So I mentioned briefly pre-implantation genetic testing. We do IVF even for people without infertility. We have patients who have a child who has some rare genetic disease and dies, and they don't want to risk that happening again or terminating a pregnancy. So actually preventing abortion by making embryos and we work with genetics laboratories to develop probes to be able to target when we get this DNA from these few cells we biopsy, we amplify that DNA and can determine whether the embryo inherited a mutation and is a carrier like its parents or two copies and would have this disease. And then we saw an embryo that wouldn't have the disease. But again, if you view each embryo as a person or baby, they could argue that even those embryos that would be destined to have lethal genetic condition should be given a chance. It's not clear how that would happen. Could you keep these embryos frozen in perpetuity and then who was responsible for that? Because there's cost to storing them in space is it the couple who people pay storage fees but then when their family is complete, they've achieved their goals, they no longer keep them stored. Some people donate them to other couples and that's their choice. But most people view this technology again as a way to help people have as many hopefully healthy children as they want, hopefully one at a time. And when that's complete, you can discard your embryos and move on with your actual children. And so a ruling like this would suggest that those embryos would have to be kept perpetuity, not just the ones that were not used because some couples might decide ultimately not to have children and the embryos are there and they're never going to be used. I mean also couples could divorce and there's been cases where one person wants to use the embryos and the other doesn't and most clinics like we would not thought and transfer such an embryo we don't think we should make someone a parent that doesn't consent to that. But again, if you view it as a child already then either party could theoretically have a right to it and make a child make someone a parent who doesn't consent doesn't want to have a child with that person anymore. Could be someone abusive, you know. Again, I mean it's there's all kinds of reasons why and so that's another scary, you know, potential implication. It's not clear like what would happen to these extra embryos who would be responsible and that's part of why it could shut things down and alternative which I've heard like Ben Shapiro talking on this topic makes sounds simple but you know basically said you should only fertilize as many embryos as you would want to put back but that you know would actually be disastrous for this field. I mean I don't know if you want to talk about what would be disastrous. So first of all again even with the best technology and the best lab like more than half of the IVF cycles even fertilizing all the eggs and making the embryos and transferring them and genetically testing we still struggle and there's a lot of people who have to do this multiple times and it's hard to predict. Some people do really well and their embryos develop beautifully and there's more than they need and there's for reasons we can't predict there's quality issues and you don't know that up front so the only way to practice this way would be to you know fertilize a limited number which could be one. I mean if it was one at a time again it's if you can, we've gotten better at freezing eggs so theoretically you could fertilize one egg make an embryo, transfer to a woman or it might not develop and if she doesn't get pregnant so another egg fertilize it make another embryo or make more and that would be so inefficient that again people would be incentivized to put multiple embryos back and so we'd go back to higher risk twin triplet pregnancies also this resource we already struggle in certain areas to have enough doctors and embryologists to perform these services so with each treatment to achieve a baby involve that many more steps I mean there's things that may be automated in the future but it would either again involve so much more work that we just couldn't accommodate you know the demand and I mean it would become a lot more expensive there'd be fewer babies and that doesn't again and then in that view genetic testing of embryos probably would not be an option so you know again there would be more babies being born with genetic diseases or terminated you know if it was in a state where that was legal but when these things go together but What's the point in doing genetic testing because you're not allowed to according to this ruling you wouldn't be allowed to discard the ones that had a negative genetic outcome because they're still babies theoretically Correct, again according to that interpretation So, yeah, good No, I think it again that would be a very like anti-life approach there would be fewer babies right now roughly 100,000 babies a year are born through IVF approximately 2% of in the US many more worldwide there's been estimates of 8 or more million babies born through IVF worldwide 2% of babies born in the US are through IVF and I think that's part of why this you know again has maybe you know gotten this kind of attention I think everyone knows someone who had children through IVF or and that those children are normal and healthy and again would not exist without this technology So you know you told me before the show that Betcha Piro had commented on this I had heard that so tell us a little bit about what Betcha Piro said and his attitude and you know where do you think that attitude actually comes from? Yeah, I mean basically again I listen to a segment he basically said that you know life begins at conception or fertilization that location doesn't matter that sort of pro-choice or pro-reproductive rights view is it's all about location and to him it's it's a life wherever the location it's a life if it's sitting in a dish or frozen in a tank or in a woman's uterus or again born is an actual life and that's so destruction of any life is wrong and that he's not against IVF but he thinks it could be done more responsibly like I said by only making as many embryos as you would use which again I think it sounds to some like that that sounds good maybe okay but again the outcome of that would be fewer successful treatments the inability to provide this service to as many people has really benefited in time matters so if you a wait list of a year or two I mean that could be the difference of having a successful treatment or not so even months matter so if it takes that long to thaw out these eggs and make embryos and find out if it worked again some couples who would have had success and would have had a healthy child will not be able to and if they try you know later when it's their turn again they'll be older and they just won't the way it's currently practiced there's just not the resources to do it to do IVF that way and produce as many successes as we are able to now he didn't really comment on genetic testing but again I think his view would be that that is like eugenics and should not be done and where the view is coming from again it's it's more of a Christian or even Catholic I think type of view so the pope has ruled against IVF you know from the beginning of IVF that I mean they're consistent on that that they view it as a life and that have never approved of it Ben Shapiro's Orthodox Jewish Jewish faith is very pro-children it's very important to have children have you know many children and so Ben most rabbis are very supportive of IVF Israel has very high utilization and supports using IVF to have even two children and even again termination can be abortion can be permitted in certain situations so I mean you know from my memory there was never any I mean Israel never had an issue like the US does around abortion and the religious in Israel never made it a big deal and as you said IVF is very very popular common almost every Israeli there are lots of clinics in Israel and there are lots of specialists in Israel who do this the life of the mother is always like even like psychological impact you know of having an unhealthy child it's you know the mother's life is the most important in my understanding of the religion and abortion can be approved you know if that would be in jeopardy but also at a very early stage like the first I think 35 days or something it's not even considered like truly a life even in that like location of being in the uterus and growing so there's really like not even any I think like need for a rabbi's approval that early in my understanding but I'm not an expert on that so the good news is that it looks like Alabama is passing a law that the legislature is passing a law that says that you won't be able to hold doctors and lab officials or clinicians responsible legally for the death or damage to an embryo but it seems to contradict the Supreme Court's claim that embryos are human beings if embryos are human beings then how can you not hold them responsible right I mean it seems like there's a contradiction there so it's going to be interesting to see how this plays out and how it's interpreted yeah I mean I think hopefully we'll allow clinics to feel comfortable that their day to day processes are not being viewed as potentially murder so I hope that they'll be able to reopen and offer this technology but if it's still like being held legally that the embryos are children that still again puts doctors andologists in a difficult position that this can change or again what do we do with excess embryos is it acceptable to test and select against embryos that would have diseases it's not so clear what the implications would be what do you describe a little bit about what makes the field is heading like I mean this must be a super exciting field the whole area of genetic testing is ramping dramatically and I'm sure the technology that you guys can you project into the future and kind of where this is going and IVF and other potential fertility treatments yeah that's a great question so I mean first I think there's still a long way to go like I said earlier we still unfortunately don't succeed and we have other options that at a certain point when we're in the 40s age group it gets very difficult to find eggs that even with producing multiple of them but we have technologies like donor eggs or women donate their eggs at a younger age and that's complicated there's carriers like women carry pregnancies for women who may be at risk medically or has her uterus removed surgically so there's different ways that we can help people achieve their goal of having children but genetic testing which we've talked about a little bit and I think is really underused that we have little babies born with rare genetic diseases that we have the ability to test and determine that couples would be at risk and so I mean it's gotten more and more used with testing people before they decide to have children and see if they're at risk of having a child rather than waiting until they're pregnant or until they have a sick child so applying pre-implantation genetic testing for these is definitely there's room to improve there I mean it's interesting I've only been out of training for a little bit more than 10 years but there's certain conditions that are also ethically controversial like adult onset conditions BRCA one or two is a breast cancer gene so we have patients that are healthy and successful but they're at much higher risk of developing breast or ovarian cancer they have to go through lots of screening and anxiety and risk reducing surgery so that's a again interesting ethical conversation should they do IVF to make embryos even though one that has BRCA could be healthy but could be a healthy child but would have this risk and not everyone does and again they have the right where it's legal and permitted and I think it's an interesting conversation but 10 years ago I would say to these patients we don't know in 20, 30 years when your daughter is ready to have children we may have gene therapies that can fix that gene so maybe you don't have to do this on the other hand now I say if you don't use this technology it might be illegal for your daughter to use this technology so if you want to get this gene out of your family it may be better to do this now while you still can so and that's just in 10 years and I used to kind of say it jokingly but now seriously and in states where abortion is not legal I know you discussed the case in Texas you know getting pregnant even if you don't have infertility getting pregnant even for a fertile couple in their early 40s again we know people have been delaying when they start their families as it's a trend globally so we see couples that are having children at a more advanced age still young and healthy but baby 2 is considered for reproductive standpoint in advanced age and so if you're 41 infertile in Texas and you get pregnant and there's maybe a 2% risk that there could be a chromosome abnormality and if that happens you have to carry that baby and maybe you've had two prior C-sections you have to have a third C-section and that's risky for another child that's even more risky or go out of state and you know will that be that's not feasible for everybody so using IVF to select an embryo that wouldn't be at risk of one of those age related changes and that's a trend we're seeing more of in terms of like almost science fiction again I don't know that this is going to be in an hour time or it's going to be legal but there are people have written about making new eggs or making embryos so we don't select for really traits I mean people have looked at that but I'm just talking about the basics like correct number of chromosomes not having a disease that will make a baby die but theoretically in the future and whether this is a good or not something that's interesting could we take skin cells and turn them into eggs and make lots of embryos and test them and would we have you know the bioinformatic ability to know which is the healthiest or smartest or whatever and we're a long way from that and questionable whether it will be permitted but that's something that's been discussed but the idea of making germ cells like there are individuals who don't have eggs or who don't have sperm could we take other types of cells and you know make sperm so that someone could have a child that's genetically linked to them that's an area of you know of active research so there's I mean a lot of interesting areas this field could go but even I'd say just like the basics of what we're doing now like there's still a lot of babies born with rare genetic diseases and couples who are struggling to have a child even with the best technology and the best labs in the United States and so I worry about anything that restricts that and makes it more difficult for us to practice and again you know I view like our role to help help a woman or couple have as many children as they want to get one at a time safely and when they're you know and again like I said sometimes sometimes in the process there's more embryos made they do really well and they make five embryos and the first two make two healthy children and that's a success they have two healthy children their family is complete and they didn't need those other embryos and again there's other couples that have to go through three or four rounds of this just to get one embryo to take and again we just we're not great at predicting who that's going to be other than age and number of eggs so again if you care about life and reproductive you know rights ability to have healthy children you know you should be concerned about giving rights to pre-implantation embryos you know in the lab and not again not actually children yet see you mentioned you mentioned so is one of the one of the fertility methods I guess that people are using and I've noticed just recently that there seem to be in the press there seem to be people attacking surrogacy the morality of it and challenging the legality of it have you seen that and where's that really coming from? Yeah so so surrogacy law is really very state by state I mean that's almost what we're starting to see with abortion IVF that even in New York where I practice it was not legal to it was one of the few states until just in 2020 just a few years ago it was not legal to compensate a surrogate or carrier where again there are couples there's a women who have congenital heart condition that they get pregnant they have a very high risk of dying or they have a child and they have a hemorrhage and they have to have a hysterectomy they don't have a uterus but they have embryos they want to give those embryos a chance at a life and someone is willing to help them and they get typically compensated in the process sometimes it's a friend or family member but most people don't have someone willing to do that women that are screened we screen their health and psychological history and pregnancy history so they've had uncomplicated low risk but pregnancy is as you've talked about it is risky so it's not something to be taken lightly even a healthy woman who's had a healthy pregnancy is taking risk to carry a pregnancy and deliver but there are women that are willing to do that and so that is how gestational carrier or surrogacy works and then there's typically contracts as reproductive lawyers who will make contracts and different states have different rules on when the baby is born who's on the birth certificate whether adoption has to occur but there's clear contracts that the parents who produced the egg and sperm that made the embryo it's their baby after the baby is born I've also seen attacks on this from both sides you know on the the right you know saying this is sort of renting a womb or again like making you know babies again similar to how again we're making these babies in a lab and that the mother the woman carrying the pregnancy is the mother who carries and delivers and again that person plays an important role but the parents who are going to raise that child are the parents but I've also seen on the left attacks and from the feminist side that it's sort of you know abusing or you know how to articulate it as well as I think that in New York it was both sides there was a religious argument against it there was a feminist argument against it that it's exploiting women basically although again they're doing this from their own free will and choosing to how to use their body so it's kind of interesting that this you know some of the same group that is very pro abortion rights that you have a right to your own body to end the pregnancy felt like it's exploiting for a woman to choose to use her body to help another couple have a child so it's it is an interesting you know controversial area in our field how worried are you about you know politicians both left and right kind of wanting to regulate not just the kind of health care as a business but health care as a science health care as a process you mentioned in 10 years these gene therapies might not be legal I mean how worried are you about the politicization of the science of medicine yeah I mean I'm generally like an optimistic person and I'm busy we have a busy clinic and I'm working hard to try to help patients have babies and work with our team of doctors and amazing lab staff and nurses and so that occupies most of my energy and I just have to believe that like the benefits of this you know are so obvious and I've touched so many people that I hope nothing will be done to restrict it but I am concerned you know that one judge you know could have this rule that a lot of people even like Nikki Haley people have said like oh yes I agree it's a baby and that has huge implications and again I think I'm worried about politicians that don't really understand the intricacies and implications we saw that with abortion rules that there's question of if it's an ectopic pregnancy that you know could put a woman's life at risk and can't continue to term is a doctor allowed to end that pregnancy and worrying about technicalities of a law shouldn't interfere with doctor-patient relationship and I worry that politicians thinking again they know more than they do or sometimes just the words even like the terminology you start reading if you're in these fields and you read the language and the bills it again doesn't make sense and doesn't reflect like medicine the way it's practiced and could be interpreted again to say that you can't save a woman's life you should let her lead to death internally from an ectopic pregnancy like that's scary and again I think eventually hopefully those things will be sorted out but along the way some people will suffer and die or not have children or not have access to amazing treatments that could be available so I am concerned that if you say it's okay to limit what a woman can do with her body that that could be taken to limit any area of medicine that someone views as you know not I mean plastic surgery anything like why someone could some group could say like you shouldn't be allowed to do that you should change the way God made you I don't know it's best left between patients and doctors and experts in these subject areas and we've had amazing progress when it's done that way and so I think everyone is listening that again will hopefully be inspired to even if you're beyond having children or not having children that this is an important topic what is what is life where do rights begin absolutely so we've got a couple of questions let me just say to the audience if you have any questions the super chat is available so feel free to ask questions about IVF about abortion about anything regarding fatality anything you think the doctor former might have something to add so I like cloud has has a question about could you discuss why this used to be a lack of male contraceptive options compared to female contraceptive options yeah that's a good good question I mean some have I think to interfere with ovulation has that development of the birth control pill was an amazing advance in our field I know you spoke about it recently and again the woman is the one that ultimately is like where the pregnancy happened so having control over preventing pregnancy I think is more reliable when a male whose fertile ejaculates there's hundreds of millions of sperm and again a woman would have to be trusting that the partner is compliant she still may want to protect herself there have been options that have looked at to hormonally like suppress sperm production but have not taken on again in the market why that is it's hard to say I think they may have more side effects it may take longer to reverse so women stops taking hormonal contraception typically she'll resume ovulating very quickly but if you suppress sperm production it takes months to make new sperm that's another factor but interesting question I haven't thought about you know in depth it does sound I mean what you said about the woman probably wanting to maintain control given that she is the one who bears the direct consequence of pregnancy makes a lot of sense so that even if you had male contraception out there women would probably want to take it although with married couples you know with a with a trust as high maybe that becomes less of an issue but certainly unmarried women you'd think would want to take contraception no matter what surgical sterilization like vasectomy is quite you know highly utilized in this country having more so now than tubal sterilization which is more invasive so I think it's you know when a married couple has their children it's not uncommon for the guy to say he'll have a vasectomy but for like reversible contraception there's not really options on the male side no no it is interesting I wonder how much of this is related to discrimination against women and a willingness to play around with female hormones and less to play around with male hormones I don't know could be some of that kind of a alright I think this is a last question if you guys have any more questions now's the time guys could you talk could you describe Apollo Zeus wants to know could you describe I don't know what this is andrology so andrology is more like male side of reproduction so the andrology lab deals with things sperm related so we do semen analysis where we assess like the concentration motility shape of sperm process sperm samples for when we don't always do in vitro fertilization there's other fertility treatments like intrauterine insemination where sperm are placed in a woman's uterus so women are single or same sex couples can use or their male partner doesn't have a sperm can get sperm donated by a sperm bank and they don't necessarily need to make use of this IVF technology they can place you know wash thawed sperm in the uterus so andrology is kind of the study of male reproduction but something I did something I also didn't mention another interesting advance in this field is for people who get diagnosed with cancer or some medical condition freezing sperm, freezing eggs freezing embryos so that's another we sometimes have a married couple and women could get diagnosed with cancer and they want to make embryos because she's going to be exposed to chemotherapy that will damage her ovaries where she may have to wait years before she's hopefully cured and can then be pregnant so in this type of scenario again could we make those embryos like if you're only like Ben Shapiro says fertilizing as many as you would use is she like committed to use all of those in the future we want to make as many as we safely can because we just don't know how they're going to do years in the future I'm curious about the genetic screening you mentioned the breast cancer gene which is an obvious one but is there any thought about things like we now know for example that there are genes that make it much more likely to get Alzheimer's Apo E4 I think and genes that relate to other cancers are there any thoughts the screening for those as well in the future or is it even being done today I mean Alzheimer's coming such a big deal yeah so I mean there's anything that we know what the location is what the mutation is we can theoretically test embryos for it but it's mostly going to use and still under use even for conditions where we know like sickle cell there's one fair change and it changes the function of red blood cells and that's clear cut so when there's this whole controversial area in our field called polygenic risk scores can we take other markers and predict if embryos are going to be more likely to develop diabetes or heart disease or Alzheimer's I don't think it's like clear cut enough that again even the BRCA1 gene it's not a guarantee that you'll have breast cancer but it may be a 60% lifetime risk so I think with later onset conditions the oldest person born through IVF is 45 years old it's not really and I'm not aware of it being used yet but again even though it's amazing and gotten safer it's still invasive it's still taking medications going through a procedure it's fairly expensive although I think well worth the cost but there doesn't seem to be a demand to prevent diseases that have onset later although things like Huntington's disease there is and that's another interesting area where there's people who know that their parents had Huntington's and they don't want to know whether they have it but they want to ensure that their children don't have it so we actually do things like that where we will do IVF and test and make sure that an embryo wouldn't develop into someone that would get Huntington's without even telling the patient because they don't want to know or be biased one way or another so it's called non-disclosure PGT interesting and that's only going to get I mean stuff like that there's going to be only more of that as we understand that you don't have to understand the relationship between disease so again anything again that is genetically linked and there's a clear relationship we could potentially test for people often ask about autism but it's just not one gene or well understood so we don't test for autism we can't reduce that risk but if in the future there are some genes or changes variants that are associated with it there's potential to test for anything so yeah I think that in the future testing for more things preventing diseases is definitely an area where this field is going if allowed to Alright so Paul Azuz has a couple more questions I don't know if this is your area but he asked if long term anabolic steroid use if you know where it causes damage to sperm production in males Yes it does so basically when you take testosterone it kind of tricks a male's brain into thinking there's testosterone around and so it doesn't tell the testes to make testosterone and to have sperm produced it's not just testosterone circulating in the blood you can measure blood level and it's high but locally where the sperm are being made it's actually low and so it can actually cause what's called azospermia like no sperm it's usually reversible although if it's long term it may not be but so you have to be really careful not just anabolic steroid use but you know it's not uncommon for some clinicians to prescribe testosterone for guys to boost their energy or their sex drive but if they are potentially interested in reproduction we would recommend against that there are ways to stimulate them to make more of their own testosterone but be careful about giving testosterone and using it for bodybuilding purposes could have implications on reproduction later Regarding last q-t-o-t effect on virility I don't know what it means but maybe Regarding what? Oh, regarding last question q-t-o-t effect on virility I think you already answered that that's t-o-t is testosterone Yeah, yes You have to be careful or free sperm before end Yeah That to me the science of being able to freeze eggs and freeze sperm and freeze embryos is just that is pretty amazing and that it works and they function, they fully functional once you unfreeze them That's really cool Yeah, it's amazing Thanks for having me on and being willing to delve into this topic and I hope you and your audience found it interesting I think everybody found it incredibly interesting I certainly did, thanks for the work that you do and for speaking out about this, I think it's really, really important for all of our medical freedoms that we talk about this and that we stand up against kind of when the little tyrants try to control us so, thank you for meeting in person sometime maybe in New York Alright guys I will see you guys tomorrow bye Eric I'll see you guys tomorrow for an AMA Ask Me Anything session at what is it, 2pm east coast time so those of you who contribute $25 or more a month should have the link and everything for that that is not tomorrow, what am I talking about today's Thursday, it's not Friday tomorrow is a regular news roundup the time might not be regular I might be doing it early people have crammed into my schedule all kinds of stuff in the afternoon something has to give here, this is not good so tomorrow we will have a news roundup, Saturday we will have Ask Me Anything you can also still ask me anything now if you get in a question quickly that is we can talk about anything else that you want you didn't have a lot of questions on this topic but you can ask me anything right now I found this amazing it's great to have, I love experts it's great to have an expert who knows, really knows what he is talking about and somebody who is really experienced in the field who is really dissected and give you both the practical and the moral issues involved so that was tremendous of Eric and I intend in the future of the show is to have more people like this on the show and the incredible Ironman fans, objectivists out there who really world class experts in the things that they do and I think one of the things we need in the show is do more highlighting and bringing them forward Andrew asks what do I think of Ben Shapiro's opinion I think it's barbaric I think it's horrible and I don't think it's really Ben Shapiro's opinion I don't know but Ben Shapiro has proven to me that he is willing to cater to his audience so I think he is even though his Jewish religion might not dictate this his audience is Christian, he knows that he knows you know now you come up with questions Jesus great guys should have come up with questions earlier Eric's gone so what was I saying Ben I think is catering to his audience I don't know what he actually believes he certainly does those of Trump he doesn't like Trump he doesn't like anything about Trump he despises Trump I think Ben Shapiro deep down cares tremendously about character for example the idea of the President of the United States sleeping with porn stars and stuff like that is really offensive to somebody like like Ben Shapiro the many wives he's had at all of this Ben Shapiro is really religious honestly religious to the extent it can be but he can't he knows he knows where his income comes from he knows where his income comes from that's the difference guys I will always tell you the truth I will always tell you what I really think even if I know it pisses a bunch of you off even if I know a bunch of you are going to stop supporting the show I'm going to tell you like it is I'm going to tell it like I see it Jay says why do you prefer Patreon to YBS donations I'm not exactly sure but I know that Angela my assistant prefers it she has to deal with it all I think she just finds it easier to deal with Patreon than PayPal in terms of changing stuff cancelling people people's mentorship when they want to it just seems like Patreon Patreon's whole business model is built around catering to me right to creators, to people who are putting stuff up and to support those creators and to people like you who want to support creators so I think what Angela finds and I'm sure this is true is that just the better set up for it than PayPal which is this is kind of a side business for them these regular payments, subscriptions that's not the core of their business Paulo Azuz says 3D bioprinting and stem cell tech yeah there's a lot of exciting stuff coming down the pipe the question is will they let us do it 3D bioprinting sounds like you're playing God there stem cells what the hell what are you trying to do with these cells make them do something they God didn't design them to do Alejandro can certain genetic diseases be prevented using IVF yes he said that right if so which ones tend to be the most common he mentioned a couple the one he mentioned is breast cancer the gene for breast cancer you can only implant in a woman the embryos that don't that gene is not present Hutchinson disease sickle cell anemia which is just one gene flipped which you should be able to you should be able to screen for but over the next few years you'll be able to do that with many many many many diseases as we discover more of the links between genes and disease so it's going to come there are going to be more options than they have been so far all right thank you guys I appreciate it I hope you enjoyed the show you can use stickers to support the show to show your appreciation as just a reminder the show is made possible through the support of listeners like you so please consider doing a super sticker or whatever it's called here or becoming a monthly contributor on Patreon or on your own book show dot com slash membership which is a paper which is mostly paper all right did I say Hutchinson's Huntington's I meant Huntington's right that's what I meant I think all right as I said I'll see you tomorrow probably morning for a news roundup I'll ask me anything see you soon bye everybody