Latest / The Lila Rose Show / E106: This Fertility Doctor Believes IVF is Not The Answer

Transcript

E106: This Fertility Doctor Believes IVF is Not The Answer · The Lila Rose Show

0:00
Just because we can do something doesn't mean that we should.
0:03
And I think what's so hard is that again, we look at people's
0:05
intentions that they want life. And so that's a very
0:08
understandable and also very common refrain is that I I just
0:12
want to have a baby, only 7% of all embryos lead to a live
0:17
birth. What that means is that the
0:19
remaining 93% are either destroyed or they're frozen
0:22
somewhere for who knows how long.
0:24
And that's when we start feeling and sensing that this is not a
0:27
path that we should go down. There's estimated over 1,000,000
0:30
embryos still in storage in the United.
0:33
States 1,000,000. Over a million, yeah.
0:40
Hey everybody. Welcome back to the Lila Rose
0:42
Podcast. Today we're going to have a
0:44
great guest back in studio that we had on the show last year,
0:47
Doctor Lauren Rubal. Dr. Lauren Rubal is an
0:50
obstetrician gynecologist with years of experience, but she's
0:53
got a fascinating personal story.
0:55
And last year we talked about her journey from going from
0:57
being an IVF doctor to a holistic fertility care
1:01
physician. So Doctor Rubal is going to
1:03
breakdown how IVF actually works.
1:05
There's a lot of information that I think is missed in some
1:07
of these media stories and in the common conversation about
1:09
it. And she's going to break down
1:11
the risks, the harms, not just to the child, to these embryos,
1:14
but also to the parents. These are the things that
1:17
anybody, anybody, who is considering IVF should know
1:21
before they go through the process of it.
1:23
And this is something that if you have friends or family that
1:26
is considering IVF or has practiced IVF, has done IVF,
1:30
they deserve to know this information too.
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free chicken doctor Lauren Rubal.
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Thanks for coming back on the podcast.
2:39
Yes, thank you for having me, Lyle.
2:40
I'm so happy to be here. So we're we're friends off
2:42
camera. So I'm calling you Doctor Lauren
2:44
Rubal. So people know your title but
2:46
you're you're awesome everyone. It's been so fun getting to know
2:49
you since moving out here. Same same.
2:51
So and I know people that go to you as a doctor and we're going
2:55
to get into your work as a doctor in another episode.
2:58
But this is all about IVF. Yes, because that has been very
3:02
much a controversial news item recently, and I think there's a
3:05
ton of misinformation swirling about it and confusion about it,
3:09
yes. So I'm excited for you to set
3:12
the record straight for people. Yes, I'm excited to talk about
3:15
it. And I think that we have to
3:17
always preface this by remembering the great pain and
3:21
suffering that these couples who have infertility are enduring.
3:25
And I think that part of the controversy quite honestly, that
3:29
occurs with IVF is just because it can feel very personal,
3:33
right? And and people are already so
3:36
very understandably emotional and sad and sorrowing about
3:42
their diagnosis. But I think at the same time we
3:45
have to be able to look at objective truth to be able to
3:50
create up and forge a path forward.
3:53
So give folks your background and your background with IVF 2
3:56
as a doctor. Yes, absolutely.
3:58
So I am an OBGYN, so that means I did four years of residency
4:02
after medical school, and then after that I did a three-year
4:05
fellowship, which means further training in reproductive
4:09
endocrinology and infertility. And so that's a very fancy way
4:14
of saying that I help women who have hormone imbalances.
4:18
Hormones are simply messengers that allow the brain to talk to
4:22
the other organs and for them to talk back.
4:25
And so I look at those hormones, especially in relation to
4:29
reproduction #1 and #2. I help couples who are dealing
4:34
with that process of difficulty conceiving or who have had
4:38
multiple miscarriages, things like that.
4:40
And so in that I practiced as a full scope REI for about 7 years
4:48
doing it all. So I did perform in vitro
4:51
fertilization or IVF within that within that job.
4:56
And we did an episode last year. You're one of the OG folks on
5:00
the podcast. Awesome.
5:01
You did an awesome job explaining some of your
5:04
background. You have an amazing personal
5:05
story but you talked about how you used to work and do a
5:09
multiple, you know, multiple things, but one of them was IVF.
5:13
And then your process of deciding, no, I'm not going to
5:16
continue to do IVF just for folks who haven't heard that
5:19
yet. Give us the the high level of
5:21
that process for you, why you decided to ultimately leave that
5:25
approach to fertility, infertility care, doing IVF and
5:29
now you're on a obviously a a new track.
5:32
Yes. And I think this ties into
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really again the issues that IVF engenders, OK.
5:40
And so I would say that the what is IVF is kind of the first
5:44
question. And So what that entails is that
5:47
physicians give a woman multiple injections of fertility
5:51
medications on a daily basis for process of about two weeks or
5:55
more depending on the type of what we call protocol that
5:58
they're on. And that those medications allow
6:03
multiple eggs to mature within the ovaries.
6:06
And instead of those eggs getting released and ovulated,
6:10
they instead are removed. And so that is a minor procedure
6:15
where there is an ultrasound guided needle placed through the
6:20
vagina into each of those follicles and to suction out
6:24
each of those eggs. And that's done in every
6:26
follicle that is present in both ovaries.
6:29
Typically those eggs are then taken by an embryologist who
6:35
then handles them, determines which are what we call mature,
6:39
and then those eggs are combined with sperm many times in a
6:43
process that's called ICSI, which is simply when the
6:47
embryologist will select a sperm that they deem is looks normal
6:53
by its shape and also is moving in a normal fashion, meaning
6:56
forward. And they'll physically place
6:59
that sperm and inject it into the egg to try to help with
7:02
fertilization. And so that's done.
7:06
And then the next day they'll put each of those in a Petri
7:09
dish and the next day about 80% of them will have fertilized.
7:15
And so this is the ultimate issue.
7:21
I want to pause to acknowledge that in 80%, in eight of the
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those 10 dishes, for example, there is now a fertilized egg
7:34
which is an embryo which is a genetically unique,
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substantially whole human being with its own set or his or own
7:44
her own set of chromosomes. That will then encode for every
7:50
cell and that will then over the process of the next few days,
7:54
divide from 1 cell into hundreds.
7:57
So I just want to stop there for a minute, just to have us
8:02
remember that fact. And so anyway, those embryos are
8:06
then watched over a period of days, and they have one of three
8:09
fates. At that point.
8:11
They will either get transferred back immediately, three to five
8:16
days later, typically into the woman's uterus using a catheter,
8:23
And then the woman will find out if she has a positive pregnancy
8:28
test a couple of weeks after that.
8:30
Roughly, That's fate one. The second possibility is that
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they will be biopsied, they will have some of their cells
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removed, and typically those cells will undergo what we call
8:40
chromosome screening. So they'll be sent off to a lab
8:44
and the chromosomes will be screened to see if they're
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deemed chromosomally euploid or containing the correct copy
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number of chromosomes. That's the second possibility.
8:55
The third possibility is they'll be flash frozen and placed in
8:58
liquid nitrogen canisters to be stored there potentially
9:02
indefinitely. And so that in a nutshell is the
9:05
process of IVF and. The process that so going
9:10
through each of those different processes and I I mean it's I
9:15
thank you for explaining it so clearly because I think we talk
9:17
about this and people have different understandings of what
9:19
I mean And it's just very helpful to know exactly that
9:23
each step of that process. So for those those three
9:26
additional processes of you know after the fertilization takes
9:30
place, you have this tiny little embryo, let's start with maybe
9:34
the second one you mentioned some are biopsied for then
9:36
chromosomal screening that also would include gender selection
9:41
as well. And what else?
9:42
What else? How far?
9:43
How much chromosomal screening can you do with a, you know,
9:48
just a couple cells of a tiny little biopsied embryo?
9:52
And how is it typically used? Well, Lila, it's you know, used
9:57
with our current technology. But I think that an important
10:01
part when we develop any new technology is to not look only
10:06
at what can currently done be done, but what is a possibility
10:10
in the future. So the current landscape
10:13
actually, to be honest with you, chromosome screening of embryos
10:17
is has been going on for more than a decade.
10:21
OK. And So what was the premise is
10:26
that, oh, if we can have an embryo that is deemed
10:30
chromosomally normal because we know that the majority of
10:33
miscarriages that occur in the first trimester are due to what
10:37
we call random errors within the embryo, him or herself.
10:40
And so because of that, that embryo cannot continue to grow
10:43
and divide in terms of their cells and then a miscarriage
10:46
occurs. OK.
10:47
And so with that being said, if we can, if the the thought was
10:51
that, oh, well, if we can just place back those chromosomally
10:55
normal embryos will improve chance of pregnancy or will
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decrease the risk of miscarriage.
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And so again, with the current technology that is what happens
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the majority of the time is that they're being used for what we
11:08
call preamplitation genetic testing for anuploidy, which is
11:13
abnormal chromosomes. The more the lesser used is for
11:17
specific genetic issues that they are looking very precisely
11:22
at that gene. But for the majority of them,
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again this has been going on for a while and this the current
11:29
iteration of it is actually not the original.
11:35
In fact the original which is called fish or fluorescent
11:40
inside you hybridization, lots and lots of acronyms.
11:43
But what that entails is was or what was found instead of giving
11:49
you a process of what that means because it is very complex.
11:52
Was that in fact when they it was quickly adopted because in
11:56
the premise seemed to be very promising, they did a randomized
12:01
controlled trial which is a very well respected study design of
12:04
of scientific research. And they found in fact that the
12:10
premise was not correct at least 4 fish for that original type of
12:16
chromosome screening. And in fact the women who had
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undergone, well, I should say the embryos who had undergone
12:27
that fish screening, those couples, that woman actually had
12:34
no improvement in pregnancy rates.
12:37
And what was found is that the the couples who did chose or
12:41
were screened or randomized rather to not have fish done,
12:46
had better pregnancy rates. So just to break this down, this
12:50
is so interesting, you're saying that originally this whole idea
12:53
of the testing of the embryos genetics to see whether it
12:57
should be actually implanted or just destroyed probably because
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it wasn't fit, they thought well it would be a miscarriage.
13:03
It actually hasn't led to better, lower miscarriage rates
13:07
among IVF patients. So the original iteration
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certainly didn't, and there are now different ways of checking
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the chromosomes. But I will tell you, there was
13:16
another recent study that seemed to suggest exactly what you're
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saying. This is not the Holy Grail.
13:23
In fact, there was an interesting article that was
13:26
published by An REI who said that PGT or preamplitation
13:30
genetic testing is a castle built on sand.
13:33
So what, why is that? Is that because they're getting
13:35
the tests wrong? I mean what what is going on
13:37
there that they have such poor success rate?
13:41
So there are multiple factors, OK.
13:43
The first factor is just like, again, any technology where
13:47
there's always a chance for error.
13:48
Fine, that we think is relatively low, but I think a
13:52
lot of it is related to the embryo, him or herself.
13:56
Why? Because in this stage of the
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embryo's life, it's very dynamic.
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There's a lot, clearly a lot of things happening and we like it.
14:05
I like it almost like a soccer ball.
14:08
And So what that means is there might be small areas of abnormal
14:12
chromosomes, of cells that contain abnormal chromosomes,
14:14
but the overall embryo, him or herself will self correct, will
14:20
actually be able to be euploid. And if you biopsy that, let's
14:27
say a white area that was the abnormal chromosomes, you might
14:32
think that the whole embryo, that's representative of the
14:35
whole embryo when that's not the case when it's what we call a
14:37
mosaic. And so that's one other
14:39
possibility. And in fact they're interesting
14:42
small series, but that are starting to get published in
14:46
that patients who were told that they had chromosomely screened
14:49
abnormal embryos, they still had them transferred back and they
14:52
had you ployed live births from this.
14:56
So it just shows the technology, you know, us kind of being God,
15:00
playing God here of saying let's create the life, let's test the
15:03
life at this very early stage to see if he or she is fit to even
15:07
allowed to continue to live. And then we're getting it wrong,
15:10
it sounds like and we have gotten it wrong.
15:12
And the the the whole point in the the positive, you could say
15:15
the good intention is, well, they want to avoid the baby
15:18
being miscarried, but what what happens to the babies or to
15:21
these tiny embryos that are seen as deficient chromosomally?
15:27
So that's the thing I would say that the if there is, what's the
15:31
standard practice. Standard practice is not to
15:34
transfer a chromosomally abnormal screened embryo.
15:38
So what do they do with the baby then?
15:39
So then typically what would happen is that that embryo is
15:43
destroyed, so with sometimes they would opt to just continue
15:48
that embryo being frozen. So those are the two
15:52
possibilities. At that point, again in a
15:53
minority of cases, there will be doctors who would be open to
15:58
transferring that embryo still, which is again where that series
16:01
was derived from. So then the third case.
16:04
So it sounds like eugenics to me.
16:06
I mean, what is eugenics? It's creating a better, a
16:08
cleaner genetic line that is more accepted by whatever social
16:12
group is doing the work of it and wanting to be in power.
16:15
And they're trying to basically weed out the undesirables.
16:21
I think that when we look at it objectively that this starts,
16:28
yes, I think that that is the conclusion that can be drawn
16:31
from it and that's why we have to be a society and a culture
16:37
that again is able to look at that objectivist, that objective
16:41
truth. And I think what's so hard is
16:43
that again, we look at people's intentions and we know that for
16:46
the vast majority, everyone's intentions are pure, that they
16:50
that they want life. And so that's a very
16:53
understandable and also very common refrain is that I, I, I,
16:58
I just want to have a baby. I want to create life.
17:01
But I think we also need to remember from the perspective of
17:05
the embryos that they have a very low chance of life.
17:10
And So what that means is there was an interesting study that
17:12
came out of the UK that on average about 10 to 15 embryos
17:16
are created per cycle. And out of those, only 7% of all
17:22
embryos lead to a live birth. So what does that mean?
17:26
What that means is that the remaining 93% are either
17:30
destroyed or they're frozen somewhere for who knows how
17:34
long. And that is a staggering
17:38
statistic. So you bring up to 15 lives into
17:42
the world on average a cycle and then maybe one of them will make
17:46
it intentionally. Is the design of the of the
17:50
system is that you bring those lives and you want to just you
17:52
need one. You want one live birth and in
17:55
the process the rest could be either destroyed or frozen.
17:58
And so that's the point of the of looking at this and saying
18:02
that exactly there may be 10 embryos here.
18:05
So which life are you going to choose?
18:09
And that's when we start getting into that, Yes.
18:13
Where? Where you start feeling and
18:14
sensing that this is not something that we want, this is
18:18
not a path that we should go down.
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using the code Lila at checkout. There was a famous YouTube.
19:37
There is a famous YouTube same sex couple on YouTube and his
19:42
name is Shane Dawson. He has this very checkered past
19:45
of saying very sexual exploitative things about
19:47
children and making jokes about sexually exploiting children.
19:50
So it's very concerning that he came out recently in the last
19:53
year saying he was going to go through surrogacy process, IVF
19:57
process and have a child basically purchase, purchase a
20:01
child with his partner and he made it very public and a lot of
20:05
his fans unfortunately there's there's some die hard adoring
20:08
fans, he can do no wrong. We're so excited for him.
20:11
Again, he's made jokes about molesting children before and
20:14
he's molested underage girls even before on camera and and
20:18
made jokes in about sexual molestation of them.
20:21
So it's very concerning. Long story short, there was a
20:23
video out that he said they had, I think, 10 or a dozen embryos
20:27
and they were kind of picking boys or girls.
20:31
So it wasn't even a genetic test about your, you know,
20:35
chromosomal issues. It was do we want a boy or a
20:38
girl? And I think they ended up with
20:40
two boys, if I remember correctly, or maybe it was a boy
20:42
and a girl. And they actually have completed
20:44
the process. These, these infants are with
20:46
this man now. We don't know.
20:48
Their fate is that? How?
20:51
How common is that? Where it's not just chromosomal
20:54
testing for as they see deficiencies, but it's also, I
20:59
want specifically a boy or a girl embryo.
21:01
And so I'm going to leave the boys on ice, 'cause I want the
21:03
girls, or leave the girls on ice, 'cause I want the boys.
21:06
I mean, I certainly was participating in that.
21:11
So it's not uncommon. It's called family completion
21:15
through sex selection. And so these women, who many
21:17
times do not have difficulty conceiving, undergo this
21:22
process. Yes.
21:23
And so once they get the results back 46 XX or 46 XY, they will
21:28
either freeze them or they will destroy the ones that are not
21:32
the this, the desired sex. And I think that that brings up
21:38
complete. Another point is that again
21:41
there the regulation behind this.
21:43
And I know that was what was so troubling about that particular
21:46
case that you bring up is there really is not a lot of
21:51
regulation and screening such as there is an adoption for
21:55
example, right. And so these babies are are
22:02
being placed potentially in these situations that they
22:06
shouldn't be absolutely right. There was a viral story.
22:10
I'm going to pull it up. This just happened.
22:13
I think this just started making the rounds.
22:15
It was. It was reported on in the last
22:17
few days. There was a Chicago area vet and
22:20
well known national dog show judge.
22:23
Name's Adam King, 36, nine years old and he had he and his same
22:29
sex partner again. We're going through the process
22:31
of surrogacy. They were.
22:32
I don't know if the baby has been born yet or is near birth,
22:36
but he has been arrested because he was distributing child sexual
22:40
assault materials and he was in chat rooms talking about how he
22:43
was going to be taking home a baby soon and he would plan to
22:48
rape his newborn. So, you know, it's thank God
22:51
that this man has been arrested And this newborn or this preborn
22:56
baby, we don't know this. The fate of this child is not
23:00
going to be handed over to this man.
23:04
But like you said, is there really no regulation around any
23:09
kind of parental screening for those that have the means to go
23:12
and basically pay a surrogate, pay for eggs, use their sperm,
23:16
whatever it is and hopefully bring in their view, bring home
23:19
a live baby? Not that I'm aware of and it
23:22
really the the screening that's done is more so for the woman
23:26
whose uterus they're going to use so for the surrogate and so
23:29
that to. Make sure she's good enough,
23:31
basically, and healthy enough. To make there's a medical
23:33
component, but there is also other types of screening legal
23:37
of course, proceedings that go on before the contract, while
23:42
they're devising the contract, right.
23:43
And so that is not, you know, again, we think about the
23:48
medical risks these women are enduring.
23:51
For a lot of these surrogates that I talked to, they have this
23:55
desire to help others build their families.
23:58
Absolutely. There may be, you know there's a
24:01
financial motivation surrogacy cycles are you know they cost
24:07
over $100,000 typically that the surrogate.
24:10
Can make a big chunk of that money.
24:13
Actually, I'm not sure what the breakdown is for how much the
24:15
surrogate receives. I think it's in the 10s of
24:17
thousands. OK, so that.
24:19
So there's a discrepancy there with how much those cycles cost
24:23
for the intended parents, which is what the term is.
24:27
And then they're also faced with nurturing and caring for this
24:31
baby. And especially there have been
24:33
court cases where where if there is, for example, something, a
24:41
screening test that shows that there might be an abnormality in
24:43
the baby, they then are against their will, sometimes being
24:50
forced to undergo abortions later on.
24:52
And this? Is a screening test that
24:53
happened after the screening test that they do initially
24:56
'cause you mentioned when it's when the embryo's so tiny,
24:58
you're talking hundreds of cells.
24:59
You're not talking about billions of cells.
25:01
Later on, you're talking about very small embryo.
25:04
If they're biopsying a part of it, they might get a false
25:07
positive or a false negative in terms of chromosomal issues.
25:10
Once that baby's implanted, the surrogate is, you know, just
25:12
stating this beautiful little life.
25:15
And then they do other screenings to test again.
25:19
And if the intended parents, the purchasing parents, don't like
25:23
the results of that screen, they can ask for an abortion.
25:26
Yes. It's, I mean it's I think about
25:31
the case we just talked about. I think about another case, a
25:34
woman, I think her name is Brittany Pearson in California
25:37
and she was a surrogate mother and again, felt
25:40
well-intentioned, like she was trying to help people, you know,
25:42
also bringing some extra income for her family.
25:45
And again, two men. I mean, many of these stories
25:47
involve these couples, these two men in the situation again,
25:52
working, paying her to do this, for them to have their first
25:55
child, they can't have it naturally, of course.
25:57
They need to use a woman's body for this.
25:59
And she ends up getting breast cancer, a diagnosis during her
26:02
pregnancy and wants to pursue treatment but doesn't want to
26:06
harm the child and so is willing to do an early delivery, delay
26:10
her treatment enough to do early delivery to give the baby a
26:14
chance. And the men wanted to abort.
26:18
They didn't want to give the baby a chance at life because
26:21
they didn't want to deal with the NICU baby and they told her
26:26
that she needed to abort. She said, well, I'm willing to
26:28
even take care of this child. But they didn't want a child out
26:31
in the world, they said with their DNA or one of their DNA,
26:34
right. Obviously it's just one of them.
26:36
And they insisted on an abortion and that baby ended up being
26:42
killed. It was she.
26:43
He was delivered to preterm and he was denied medical care when
26:47
he was delivered and he died. They just let him die in the
26:50
hospital room. And you know, I think about that
26:53
and I think how can that not be seen as infanticide?
26:55
My, you know, just looking at that case on its face, it's
26:59
obviously horrific either whether it's infanticide or
27:01
abortion, but that that was perfectly legal right in the
27:05
state of California. And and I think the other point
27:09
to that case is the point that so many different couples have
27:14
to face that they haven't thought about.
27:17
But at the end of the day, these couples know that those are
27:20
their children, what you just mentioned.
27:23
And that's what makes again, sometimes the suffering pursues
27:28
you even you don't realize you're trying to again create
27:31
this life, create life, have this baby and then you're end up
27:35
with a surplus of embryos. You've completed your family and
27:39
now you have 10 embryos left frozen and they are your
27:43
children. And so you don't know what to
27:47
do. And I this is a very real
27:49
situation that you that you had the nail on the head of and and
27:53
alluded to is that they don't want to have them adopted
27:58
because they are their children. They don't want to destroy them
28:01
because they are their children. And So what they're they're in
28:04
this quandary. And so as a as an aside, I think
28:08
that we see that that that's a very common scenario because
28:11
there's estimated over 1,000,000 embryos still in storage in the
28:15
United States one. Million.
28:17
Over a million, yeah. It's thought so.
28:20
There are very, this is again not an uncommon issue and that's
28:24
just one of the issues that these embryos may face, right.
28:28
And so when we think about other reasons, again, when I think
28:31
about what are the issues that brought me away from what I was
28:35
doing and into a completely new practice, I always say that my
28:40
greatest career achievement was leaving that world and pursuing
28:45
A restorative reproductive medicine and integrative
28:48
gynecology practice. But it's because of the
28:51
objective truth that embryos are human beings at their earliest
28:55
stages. Again, we know that they'll grow
28:58
in a dish on their own. As long as they're provided the
29:00
proper nutrients in media and temperature, that's really all
29:04
they need. They.
29:07
So they're they're humans. They're also subjected to so
29:10
much, right? They're subjected to potential
29:12
lab error. And so that could be the
29:15
embryologist. Maybe there's a lot of touching
29:19
that goes on and manipulation just by checking the embryos
29:22
themselves or by the processes. Like I mentioned, when when
29:25
they're undergoing ICSI or they're undergoing biopsy,
29:28
they're undergoing freezing or thawing.
29:30
So there can be damage to the embryo that is derived from
29:34
that. They can have issues with,
29:37
again, the surroundings. And so if the incubator
29:39
temperature is wrong or if the media is contaminated, that can
29:42
damage embryos, right? They can undergo issues where
29:47
there's those false positives in the chromosome screening and
29:51
then be erroneously called abnormal and then destroyed.
29:55
And so can you see that there's just so many areas that are not
30:01
the best for our patients that are not the best for these
30:04
couples. And I'll tell you, I remember
30:08
sitting in front of so many couples who had one embryo, we
30:13
did PGT and that embryo was deemed chromosomally normal.
30:19
And I and to say to them that that was the case, it's it's
30:27
incredibly, it's heartbreaking and I still think about it to
30:31
this day. All those situations, especially
30:35
with the knowledge that I thank God, have now felt like I just
30:40
was in so much cognitive dissonance before and it was
30:44
focused on, on wanting to help people.
30:47
But again, we have to focus on objective truth, so.
30:51
You would be sitting down with these patients and you would
30:53
have to share with them the test came back and there's a
30:56
chromosomal deficiency or or problem, abnormality,
30:59
abnormality and what would be the typical response in those
31:02
situations? Oh, it's utter.
31:05
Utter. Again, it's heartbreak for all
31:08
of us in that room. I felt the same way.
31:12
And again, what would they typically?
31:15
Decide. But what?
31:17
What? What was the decision that you
31:18
make with that information? Typically the decision would be
31:22
that we weren't going to transfer back the embryo.
31:26
And like you said earlier, in many cases this baby could be
31:30
healthy. But even if they're not healthy,
31:32
you know you don't destroy baby because they're not perfect.
31:34
I mean it goes on and on and on and the the reality is though
31:39
this is like the real world of what is happening with again
31:42
couples that want life. We we love, life is good.
31:47
But this process that we've invited in or that we're
31:51
practicing at large like you're saying, is rife with so many
31:54
risks to these babies and so many are not making it.
31:59
You mentioned the million frozen embryos or million plus frozen
32:02
embryos. Is there any regulation that you
32:06
know of? Or what is the common practice
32:09
when an embryo is just indefinitely frozen, I mean.
32:13
Well, so there's a storage fee and so that embryo will can
32:18
remain frozen indefinitely. We think it can again medically
32:23
meaning as you've probably seen in the news, there are stories
32:26
where there are 30 year old embryos that are then
32:29
transferred back and are live, live, born and and so even.
32:35
Sometimes can created an 18 or 19, you know 1990 or something
32:40
and then all of a sudden you're you're born in 2023.
32:46
Yeah, it's actually, you know, so that can happen, right.
32:50
But in order for those embryos to continue to be technically,
32:57
they, they are requiring a storage fee annually from the
33:01
parents. And so I think I mentioned this
33:03
even the last time that sometimes people move or they
33:08
they're they're lost to follow up is what it's called.
33:11
And so it puts again, first of all the embryos in this
33:17
situation, second of all the the fertility clinics then have to
33:21
decide what do we do with these embryos.
33:24
And typically they'll just remain frozen.
33:26
But I think legally, because they they do sign, they could,
33:31
they could destroy them at that point if they've made a good
33:34
faith attempts to reach out and it's not being responded to or
33:39
their storage fees aren't being paid.
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That's everylife.com. When you were working at the IVF
34:30
clinic and you're dealing everyday with making life or
34:34
death decisions for hundreds and maybe even thousands of these
34:37
embryos, Did the other people working with you have were, were
34:41
there any kind of moral moments that they experienced where they
34:44
had a moral qualm with the kind of power they were wielding and
34:47
the decisions that they were making?
34:51
I think that in the sense of grieving with the patients in
34:55
when when someone wasn't pregnant, when we had those
35:00
situations where we're sitting together and there are no
35:03
embryos to transfer, for example.
35:06
Like of course there is real, real grief and love for our
35:10
patients. Like absolutely, without a
35:12
doubt. But in the sense of again, being
35:17
the ones who are guiding these people, who are coming to us as
35:25
experts and guiding them to give them the best, safest moral way
35:37
to deal with their fertility. I don't.
35:42
I I know for I can speak for myself.
35:44
I don't feel like I was able to do that.
35:50
And I think it was because of, again, for me, it was very much
35:54
like a spiritual blindness of what life is when it starts.
36:00
A lot of cognitive dissonance here, that I could be the
36:03
purported expert in fertility and Women's Health and embryo
36:07
and embryos and all of these things that I'm dealing with and
36:10
still be able to just accept that, oh, life begins at
36:13
implantation. OK, no, it doesn't.
36:16
I could literally see those embryos growing from day-to-day
36:20
in those dishes, again, from 1 cell to hundreds.
36:24
When it what happens normally, What happens normally is that
36:28
the egg and the sperm meet in the tube, in the fallopian tube
36:31
and then that embryo is then created in the outer part of the
36:34
tube, starts dividing really rapidly.
36:37
By the time that embryo gets into the uterine cavity, it's a
36:41
process. It's actually five days later.
36:43
And that embryo, again as I said to you, is about it's hundreds
36:46
of cells at that point. And so that's when we typically
36:50
transfer those embryos back is on day 5.
36:53
And so if it's a fresh transfer and so to know that, but not to
37:00
realize that that embryo is living, to know that the
37:06
chromosomes in that embryo are unique and and separate and will
37:12
create and will create a live born human being.
37:15
If, if given the chance to continue to do what they're
37:19
doing already in that dish and to not have that be at the
37:24
forefront of how we're counseling patients, I think is
37:29
again one of the reasons I believe that we need to have
37:33
alternatives and that there are better alternatives and that the
37:38
practice of IVF, again, as I, as I say all the time, just because
37:43
we can do something doesn't mean that we should.
37:45
And I know I I have to say two points.
37:49
I feel for people with infertility with all my heart.
37:52
This is why I'm doing this. I truly love what I do.
37:56
I love walking alongside of people in the best of times and
38:00
in the worst of times. We cannot lose sight of the
38:04
embryos. So we cannot be so focused that
38:09
we forget about all of these human beings that are, that are
38:16
the most vulnerable, the most vulnerable, and that are not
38:20
being treated the way that they should be, which is with the
38:24
utmost of care because they are the most vulnerable.
38:27
And then secondly, I really want to also emphasize because I
38:30
think this is another point of confusion for people.
38:32
Any child who is created, any child who is born, who, who was
38:40
conceived through IVF is a beautiful blessing, of course.
38:46
And I would say that, you know, God can bring good out of
38:51
anything and that child is the good that comes from even when
38:55
we pursue these, these types of treatments for that creation,
39:01
you know. Such an important point, and I
39:04
know it it it makes the conversation all the more
39:06
sensitive. You have people really
39:07
suffering, yes, through infertility.
39:09
And then you have those that were IVF, you know, conceived,
39:13
or they are parents that have children conceived in I, I VFA
39:16
niece or a grandchild. And it's so personal.
39:19
And like you say, these children are the whole point of why IVF
39:22
is fraught. And the problem is not because
39:24
life isn't precious, but because life is precious.
39:27
And that these children who are conceived, every single one of
39:30
them, the ones that made it, the ones that are frozen and the
39:33
ones that have been destroyed, every single one of them are so
39:35
precious. And that's the reason we're
39:38
talking about this. That's the reason this matters.
39:41
I do have a question about the process of, you mentioned the,
39:45
you know, the embryo growing in the in the in the dish and then
39:48
it's transferred after maybe five days when it's a few 100
39:51
cells. At this point, what is the
39:53
longest time the embryo can develop without being
39:56
transferred? At what point does it need
39:59
implantation or can you kind of generate or simulate some sort
40:03
of implantation experience? Obviously I'm getting into.
40:06
The other controversy of the development of the potential
40:10
development of artificial wombs here, what has been done so far
40:13
in the space that you know of? Yes.
40:15
And so typically the embryo by day seven of his or her life we
40:23
really again naturally that embryo is already undergoing
40:27
that process of implantation at that point.
40:29
There's this really it's very interesting.
40:30
There's this window of implantation that exists in the
40:33
uterus. It's just so beautifully timed
40:35
in our bodies. It's such a miracle for any of
40:38
us to be here because there's a like a 24 hour time frame where
40:43
the the it's almost I think of it like this window opens up in
40:46
the uterus and there are these structures called penopodes.
40:49
They, they beckon and there's a crosstalk from the embryo coming
40:53
into the uterine cavity and then and the peanut poke's coming out
40:56
from, you know, at the endometrium and then pulling
40:59
that embryo in and then that window shuts.
41:01
And so that's why when we think about progesterone, which is a
41:04
very important reproductive hormone, the timing of
41:07
progesterone's critically important 'cause it opens and
41:08
shuts that window of implantation anyway, the so.
41:13
So that whole process has to occur at a very precise time.
41:18
When we think about artificial wombs and that burgeoning
41:24
technology, they might be able to simulate that process by the
41:30
administration of these hormones in a very precise manner.
41:34
It's similar to what's done during frozen embryo transfer
41:37
cycles. Simulate that process in a live
41:39
woman or simulate that process in some artificial womb.
41:43
You know, as of I think even 2017 there, there were reports
41:46
that, you know, some scientists have been successful in
41:50
developing a baby sheep in a bio bag, as they call it, you know,
41:53
an artificial womb and bringing the baby to term, the baby sheep
41:57
to term. So I know we haven't heard any
42:00
reports that that's been done successfully on a human, but
42:05
that leads to a whole other question about what?
42:08
What are the more? What's the morality around
42:10
artificial wombs? Well, even artificial rooms, but
42:13
also Lila, there is it it, it's been done already where they're
42:18
developing embryo, like that's what they call them, embryos
42:23
from stem cell derived tissue. So what that means is this is
42:32
not an embryo created from an egg and a sperm.
42:36
They're a manipulating stem cells which are what we call
42:39
totipotent. So they have the potential to
42:42
become any sort of cell in the body and what they're doing is
42:45
that they're creating an embryo specifically from the stem cell
42:50
and they allowed that embryo to grow to like day 7 or even a
42:54
little bit longer and that then opens up a whole, so.
42:59
That embryo would have, if anyone, biological parent, but
43:05
it's not even clear how the bond of like mother, child, father,
43:10
child if the stem cell was from a man or a woman.
43:13
Correct. Or even, again, soul, right.
43:16
You think about all these different it's very it feels
43:22
very otherworldly, almost like it just shouldn't.
43:27
It's it's crazy. And then there's cloning in
43:30
addition. And cloning as well.
43:31
So there's a whole host of different technological, again,
43:36
things coming down the pipeline and this is the end of what
43:43
we're already dipping our toe into now, which is again the
43:47
reason why this isn't just to help the embryos that are
43:54
created and sitting in storage indefinitely.
43:56
Now this is a call for us to examine what are we doing and
44:03
why are we setting ourselves up for something like this down the
44:06
road. It's, it's.
44:09
Very scary. What's the interest in cloning?
44:11
I mean I I've seen it talked about now it's talked, been
44:15
talked about for decades and there have been, you know,
44:18
animals that have been cloned like Dolly the sheep.
44:22
And there have been even among very pro abortion, super pro IVF
44:28
scientists, there's, you know, in the West.
44:30
Anyways, there seems to be some reticence to go whole hog on
44:33
cloning. I've seen alternate, you know, I
44:36
think it was some Chinese scientists and labs talking
44:39
about how they will be experimenting with it.
44:40
So we don't know what's happening in other countries.
44:43
What are the ethical issues? Walk us through what cloning is
44:46
and then what are the ethical issues with cloning.
44:48
Yes. And so again, cloning would be
44:50
to to replicate that person's DNA, to replicate that person
44:56
ultimately would be the ultimate fruition of that, similar to
45:03
Dolly the sheep, OK? But and when you say replicate
45:05
the person, make a genetically identical person, correct?
45:09
And but that is, is that the same as a genetically identical
45:12
twin? So it wouldn't.
45:15
It could be. But here's the issue.
45:18
This is again, the hubris of man.
45:21
Because we are, we think that we can do that.
45:25
There are so many levels by which we develop be it from
45:29
again our chromosomes then form different proteins, there are
45:32
what we call epigenetics. So that is certain factors that
45:35
silence or turn on and off our genes from being expressed.
45:39
Then there are cellular factors and you kind of go from micro to
45:42
macro level. All of the very complex
45:46
interactions that exist to make us who we are, which is why
45:49
twins, identical twins who are chromosomally the same, are are
45:55
not, are not in reality and. It is amazing that that truth
46:00
that you can have two genetically identical human
46:03
beings, you know, and they're very different in personality,
46:07
even in some of the things they struggle with physically, right?
46:10
Some of their physical ailments or development can look
46:13
different. That's right.
46:14
Because again, of all the layers on top of simply the genes, even
46:19
the mother's womb during pregnancy, and then of course
46:22
the environmental influences after they're born.
46:25
And so for us to think that we can just very easily, oh, we'll
46:30
just clone a human being, no problem.
46:33
And not to understand that by manipulating these things, we
46:37
might be opening that person up to an increased risk of cancer,
46:40
for example. There might be so many other
46:43
downstream effects that we have no clue about that that are
46:48
present. It's just it's it's not it's not
46:51
good science. Are there health risks to IVF
46:55
conceived babies after birth? We talked about obviously all of
46:59
the lethal risks to them before birth and what they're put
47:02
through, but after birth? I've heard that there are
47:05
studies that indicate that there can be health issues for these.
47:09
Kids, yes, there, there are issues for for both the mothers
47:13
and for the babies. And so for the children born to
47:15
IVF and to ICSI, which is that sperm injection into the egg,
47:21
there seems to be an increased risk of birth defects.
47:25
There's about a third increase over the baseline population
47:29
general risk, which is about two to 4% and so that's one of them.
47:33
A second one seems to be an increase potentially in certain
47:38
cancers so such as leukemia or hepatic tumors, and there's a
47:42
question of an increased risk of autism or other.
47:46
And this is just because the child went through the IVF
47:48
process. Well, we aren't sure exactly
47:51
what it is. We aren't sure if it's because
47:53
for some of those children they otherwise because of the
47:57
fertility factors involved that may have played a role versus
48:02
the technology that was used itself.
48:04
And so that part isn't clear that it's an association not
48:06
necessarily causative but we do see that those that those risk
48:10
increase that's for children and for moms and even in in
48:14
pregnancy specifically mothers have significant increase in
48:19
risk from four time increase risk of still birth.
48:24
Mothers who go through IVF. Yes.
48:27
Four times increase in still birth.
48:29
In still birth of those babies are.
48:31
Women told that when they go to IVF clinics, does that make
48:34
clear to them that that is a risk?
48:37
I think that most doctors would absolutely explain the risks
48:41
both short term and long term. But I also think I know when I
48:45
went with my father who was dealing with cancer, so
48:48
different specialty. I'm a physician, I felt like I
48:50
walked away with 50% of that information in my head.
48:52
It was very, it was just a a plethora of information coming
48:58
at me. And so I didn't hear all of it.
49:00
And so I wouldn't be surprised if that didn't register when
49:02
you're thinking about the numbers of pregnancy and
49:05
whatnot. But yes, four times increased
49:07
risk of still birth. There are issues with placental
49:10
accreta where the placenta gets stuck into the wall of the
49:12
uterus and that can cause life threatening hemorrhage or
49:15
removal of your uterus. There's an increased risk of
49:18
hypertensive disorders which can cause seizures like for example
49:21
preeclampsia or eclampsia or can be deadly diabetes, perinatal
49:31
mortality or morbidity. So they have an increased risk
49:34
of having to be in the ICU. So there are, yes, there are
49:38
real risks that have a relative increase when you undergo IVF.
49:43
I want to get to the politics briefly.
49:45
This has been so helpful and I know folks listening.
49:47
It's very eye opening to understand step by Is there
49:55
anything else that you think people should know about IVF
49:59
that isn't commonly understood? I would say that again the human
50:12
condition is always to hope and so many couples they hear that
50:16
IVF may work and it's internalized as it will work.
50:22
But IVF overall when we look at the data has about a depending
50:28
on how you also analyze the data and what the denominator is,
50:33
it's about a third of the time you have a live birth out of the
50:38
cycles performed. And so again, I think that that
50:42
isn't always clear to people that people for some reason
50:46
think it's 100% right, which again I I understand it's, it's
50:50
normal to feel very hopeful and you're putting so much of your
50:53
time and emotions and the physical part of having to
50:56
undergo all these medications and the cost, the emotional
51:01
toll, the marital toll, but it's there, it's not the panacea that
51:09
it is thought to be. We're going to do a Part 2 to
51:14
talk about the positive solution and recommendations for couples
51:18
that face infertility and just general Women's Health.
51:21
So I'm very excited for that. So folks who are listening that
51:24
episode will be coming out in the near future.
51:27
I do want to address what's happening right now politically.
51:30
I know that you paid. You're paying attention to it.
51:32
Obviously, we all are and just any of your thoughts on it.
51:35
So Alabama Supreme Court recently ruled that the parents
51:40
of children who had been destroyed negligently in an IVF
51:43
clinic in Alabama could bring a wrongful death lawsuit and seek,
51:49
you know, some kind of recompense for what they
51:52
endured, having their children just smashed basically.
51:55
And that was seen largely, you know, in the pro-life community
51:59
as a step forward. I certainly thought, yes, at
52:01
least this child in this IVF clinic has basic legal status
52:05
that their parents can at least sue when the when the child's
52:07
killed. I mean, it seems so baseline,
52:09
right? It wasn't.
52:11
You know, the Alabama Supreme Court had some nice rhetoric
52:13
about the value of human life, but they did not rule that these
52:16
children have equal status to other preborn children in the
52:19
state of Alabama because abortion is largely illegal in
52:23
Alabama. So you can't kill your preterm,
52:26
your preborn baby if you're carrying him or her, but you can
52:31
still destroy your or unfreeze let allowed to die your preborn
52:38
embryo in a IVF clinic. So that's the the crazy thing
52:42
about this is that that could still happen.
52:44
But the IVF clinics didn't like the additional legal risks that
52:48
they may endure because of this new wrongful death lawsuit that
52:51
can be taken, you know, brought against them.
52:53
And so some of them threatened to shut down you outrage.
52:57
You know, you have then pro-life Republican lawmakers and you
53:01
have the governor of the state who is pro, who has said she's
53:04
very pro-life. Then vote on legislation that
53:07
removes any criminal or civil liability from IVF clinics in
53:12
the state, which was just a wild thing to do when you think about
53:15
it. Now if you're a parent, you
53:17
wouldn't be able to even bring a wrongful death lawsuit if the
53:19
IVF clinic is criminally negligent.
53:22
So I'd love your just take on that.
53:24
And and I if you have any thoughts too, just on the fact
53:26
that this happened in pro in a pro-life state, you know there
53:29
was so much outrage and furor over the Alabama Supreme Court
53:34
decision which was so limited in it in what it ruled that you
53:37
have pro-life. People say they're not.
53:39
Not only are preborn babies in IVF clinics not of equal status
53:43
to preborn children in the womb, but you can do whatever you want
53:46
to them, and even the parents of those children don't have legal
53:48
recourse. Yes, I think that it really,
53:51
Lila highlights the question that we all have to stop and ask
53:57
ourselves when when does life begin again?
54:01
And it's a hard reality to realize that those embryos
54:06
should be afforded the same rights as everyone else were
54:09
fighting for. And it's a yeah, like you said
54:13
it, we can't make a distinction between wanted versus unwanted.
54:18
They have unalienable rights. Those embryos do.
54:22
So that's the first point. I think the second point in
54:25
relation to specifically that is that it really was a huge step
54:31
backwards of protection for the couples that are undergoing
54:35
these fertility treatments because again error may happen
54:41
and and if it's clear negligence that caused that like leaving.
54:47
I I don't know all the specifics, but to me the door
54:49
locked and a crazy. Person walked in and smashed.
54:52
Correct. To be able to access an
54:54
Embryology lab seems very. It should be like a bank, right?
55:00
I mean, I would think it's like a bank.
55:01
And the money is behind us. It is.
55:03
Any money behind is. Safe.
55:04
So I I don't understand how that was even possible #1 how they
55:08
could access that without anybody stopping them and and
55:12
not just. Access, but get in there and
55:14
have take the time to destroy, right?
55:16
Some of these children smash them.
55:19
Right. And so all of those things being
55:22
said to me, that is again a huge step backwards for the parents
55:28
if that situation ever occurs again, that they their hands are
55:32
now tied, their hands are now tied that there, that there is
55:36
no protection for them. So I do.
55:38
I I I think people are very emotional about this.
55:42
Again, understandably, but we cannot let our intentions, our
55:50
feelings about this, override objective truth.
55:57
So what do you think should happen?
55:59
I I've been asked this a lot on interviews recently about IVF
56:02
like, well, do you want to, you know, ban IVF, stop IVF.
56:05
And I say, well, with all the facts that are present here
56:10
about the fact that these are human lives, they have human
56:12
rights. And you can't really ethically
56:14
treat an embryo in an IVF clinic.
56:18
Like, how do you ethically treat an embryo in an IVF clinic?
56:21
And some people have said to me, well, what you can do is you can
56:23
just create 1 embryo and then make sure you implant that
56:28
embryo and just do one at a time.
56:30
And that would be the ethical way.
56:32
And that's what I would do basically.
56:33
Or that's what I did do or whatever it is.
56:36
Is that even going to address the infertility challenges of
56:40
the couple? If IVF is done and and and this
56:42
is separate from the procreation unit of stuff about, well, the
56:45
child deserves to be conceived in the love of their parents.
56:48
I think that's a very important moral principle.
56:50
But let's just say theoretically you do IVF where you just create
56:53
1 embryo and you implant 1 embryo and you just go out until
56:57
you get a success story. What's your take on that?
57:00
Well, I think they're they're, first of all, what is the reason
57:03
that that couple is struggling with fertility And has every
57:09
attempt been made to optimize those issues.
57:11
So again, that's the principle of restorative reproductive
57:14
medicine, is to really dig deep at the root causes and make sure
57:18
that those are corrected. You know, unexplained
57:21
infertility represents anywhere from 20 to 30% of all couples.
57:26
That means that they say, OK, ovulating at least the tubes
57:30
open, sperm look fine. But within that there are
57:34
actually a myriad of causes, for example, endometriosis or
57:38
hormone imbalances that could still be addressed.
57:41
And so I think the first piece of that is let's make sure we're
57:45
starting at the beginning and helping these women become as
57:50
healthy as possible just for their general health, for the
57:52
health of their pregnancy, for the health of their, their baby.
57:55
And so let's take it back to its beginnings.
57:58
That's number one. Number two, from a standpoint of
58:03
what to do next, where do we go from here?
58:06
I would say that there are still potential issues with natural
58:10
cycles. There's still the issue of human
58:12
error. There's I think still for many
58:16
people that chance every month is not going to be certainly
58:22
above 50%. Like it isn't even when you use
58:25
multiple embryos. And so it will require many
58:28
cycles and a lot of money potentially.
58:31
So I don't know if practically will ever be the predominant way
58:36
of approaching it. I will say from a, from a, you
58:44
know from AI don't know if legal, I don't think that's the
58:47
right word. But from the standpoint of
58:50
moving everything in the right direction, I think that that's a
58:53
much better approach that at least tries to respect that
58:57
embryos life. And so if we can kind of get
59:02
ourselves to that as opposed to where we are currently, that is
59:06
a step in the right direction in my estimation.
59:08
And what's your message? So you you used to do IVF, You
59:11
left IVF. We're going to get in, in a
59:12
future episode, into your care, your practice now, and all the
59:15
amazing things you're doing. What's your message to people
59:17
who may be listening on the other side of the coin, not the
59:20
parents who are struggling with infertility, but, you know,
59:23
people in healthcare who believe they're doing maybe a good work,
59:28
they're trying to help families. You were in that.
59:31
You were in those shoes? Yes, absolutely.
59:34
Again, we are. All that's why we went into
59:36
medicine was to help and that's why the parent for everyone
59:40
involved. I have to say, I understand we
59:44
all have those good intentions, we all want to help you, but at
59:50
at what price? #1 and #2 I think when we when
59:53
we really sit down and we think about in our heart of hearts,
59:57
there is discomfort at being involved in these decisions in
1:00:02
some way, and for many of us. I know.
1:00:06
Again, for myself, it was a defense mechanism.
1:00:07
I just squashed it. So I, you know, I know it was
1:00:10
said. I need to focus on on trying to
1:00:12
have this outcome that this couple so desperately wants.
1:00:16
And so we need to not ignore that discomfort.
1:00:22
We need to question why am I feeling this way?
1:00:27
Oh, because I really do, in my heart of hearts, understand that
1:00:32
that embryo is a new, unique, substantially whole human being,
1:00:38
and I am making decisions about that embryo's existence.
1:00:46
So we need to really remember that.
1:00:49
Very important stuff. Thank you so much, Lauren.
1:00:52
Doctor RuPaul, excellent. Thank you.
1:00:55
Thank you for tuning to the podcast.
1:00:56
Yeah. I appreciate it.
1:00:57
Thank you for having me. Thanks so much for listening to
1:01:00
this episode of the Lila Rose Podcast.
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