AI + IVF = Embryo Predict with Dr. Eduardo Hariton

Artificial intelligence is making its way into the fertility lab, including how embryos are evaluated and selected for transfer.

In this episode, I’m joined by Dr. Eduardo Hariton, Harvard-trained OB-GYN and fertility specialist at Reproductive Science Center of the Bay Area, to talk about Embryo Predict, an AI-based technology being used to add another layer of information to embryo assessment.

We discuss how embryologists grade embryos today, what AI may add to that process, and where the fertility specialist's clinical judgment still matters. Dr. Hariton also walks us through the IVF process, from your first consultation and ovarian stimulation through egg retrieval and embryo selection.

We also talk about decisions many patients face along the way, including genetic testing, how age influences treatment planning, how many IVF cycles may be needed, and the considerations involved in freezing eggs, embryos, or both.

This episode may be especially helpful if you are:

• Going through IVF and have more than one embryo available for transfer
• Considering whether or not to genetically test your embryos
• Curious about how AI is being incorporated into fertility care
• Deciding whether to freeze eggs, embryos, or both
• Trying to understand the IVF timeline and what you may encounter along the way

If IVF is part of your fertility plan, this conversation will help you better understand both the technology entering the fertility lab and the decisions you may be asked to make throughout treatment.

Support your fertility journey with Preconception Plan at Health Youniversity. Learn more here: https://healthyouniversity.co/programs

Learn more about Reproductive Science Center of the Bay Area here: https://rscbayarea.com/

Meet Dr. Eduardo Hariton here: https://rscbayarea.com/doctors/hariton/

Follow RSC on Instagram: https://www.instagram.com/rscbayarea/

Follow RSC on LinkedIn: https://www.linkedin.com/company/reproductive-science-center-of-the-san-francisco-bay-area/ 

💻 About Susan Fox: https://www.healthyouniversity.co/about

Take your 5-Element Fertility Quiz:  http://yourfertilityquiz.com/

Detox to De-Stress:  View the FREE Masterclass on the importance of detoxification to prepare for a healthy pregnancy:  https://susanfox1.easywebinar.live/gentle-detox

Learn about our program entitled Your Fertile Health: https://www.healthyouniversity.co/programs

Schedule a Fertile Health Assessment: https://www.healthyouniversity.co/your-fertile-health-call

Let us journey with you as you navigate your fertile health. Connect with me:

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Transcript

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SPEAKER_00 1:25

Hello and welcome to today's episode of Health University, where we talk about all things fertility, pregnancy and postpartum, and perimenopause. This conversation is about fertility, and I'm so excited to have this conversation because it's involving AI in the fertility field. And I'm grateful to have the brilliance of Dr. Ed Eduardo Harriton to let us know about a new process called Embryo Predict. Dr. Eduardo Harriton is an OBGYN and an infertility specialist who received his medical training at Harvard, where he completed a combined MD and MBA, not so not so shabby, at Harvard Medical School and Harvard Business School, and his OBGIN residency at the Brigham and Women's Hospital and Massachusetts General Hospital. He completed his fellowship in reproductive endocrinology and infertility at the University of California, San Francisco, and he practices clinically at the Reproductive Science Center of the Bay Area. He's Senior Vice President of Clinical Growth and Innovation at U.S. Fertility and the managing director of the USF Innovation Fund. He combines his clinical practice and business background to treat patients and think creatively about how to improve the care they receive when seeking fertility services. So once again, I know your time is so busy. Thank you for taking this time to share with us this concept, this new process that you have introduced as the first fertility clinic in the country, I believe, for embryo predict, using AI to predict the best embryo for a patient. So, what is embryo predict and how might you go about using it?

SPEAKER_01 3:06

Yeah, no, thank you so much for having me. Pleasure. And one of my passions is to think about how do we integrate technology to take care of better care of patients. And in fertility, we're about a 50-year-old field. We are bringing new technologies all the time, whether that's better culture, media, different ways to inseminate sperm, better ultrasounds, and that has led us to improve pregnancy rates. AI is something that I became interested in six or seven years ago. So before all the posse came out where we knew Chat GPT, we were thinking about how do we use computers to make better decisions. So my initial focus was how do we use computers to make better decisions about trigger timing? How do when do we get those eggs out? Because we know we all obsess and want to do the best for our patients. And at the same time, we were looking and seeing, can we select embryos better? So currently, and for the last, you know, 40, 50 years, we look under the microscope, we have a trained embryologist look at an embryo and assign it a grade. And based on how many cells they see, how compacted they are, how advanced is that embryo, we are able to find which embryos are one, two, three, four, five, six for a blastocy, whether it's an A grade or a B grade or a C grade. So kind of like you get your letter grades in elementary middle.

SPEAKER_00 4:24

Exactly what I was thinking. It's a report card.

SPEAKER_01 4:27

Yeah, pretty much. And we report all the embryos and we can pick an embryo based on how it looks. But we know our embryologies are subjective. You know, we have studies where we turn the embryo 90 degrees, 180 degrees, they might grade it differently. So the question is: can we do better? Can we do better than an embryologist who we know is subjective, well trained, but generally subjective, at grading these embryos to pick the better one first? And there's been you know multiple attempts at doing this. We partner with a company called A Life and we were part of their initial study. I feel very strongly that we don't just come up with a technology and drop it in there and see what happens. We got to really do the research and you know be part of that to understand does it work before we put it in front of the state.

SPEAKER_00 5:11

This is not a field, right, where you want to throw a spaghetti against the wall. Yes.

SPEAKER_01 5:15

Absolutely not, especially with such an important mission that we have. So we were participants in that study. This was a randomized control trial where half the patients were randomized to having the embryologists do what they always do, which is select the best embryo based on how it looks. And the second half of the embryos were able to use not just the embryologists, but on top of that, have the AI give their scoring of which embryo would go first. And when we randomized those two, there were over 400 patients that participated across different sites, different types of patients, different ages, and we found that you know the study met its endpoint. So when you do a clinical trial, you want to make sure that it's not inferior, and it looked like it was better than the than the embryology. So about 5% better. People that were older had a bigger difference, so more improvement. People who were not doing genetic testing also had more improvement. So it was a really reassuring thing. We looked at our internal data, we saw that you know, with a lot more embryos, we were seeing the ones that AI would recommend were also looking like they had higher implantation rates. So we got very comfortable with saying, well, we want to be at the forefront of technology. Let's bring this technology as an option for our patients who want to use that to select that first embryo. So now we're the first clinic in the United States that's able to offer that to our patients, and we're very excited about it.

SPEAKER_00 6:38

That's amazing. That's amazing. And I think I heard you say that that the one of the cohorts that seemed to do better with the AI predict, the embryo predict, was the older patient. Did I hear that correctly?

SPEAKER_01 6:50

That's correct. And we see more variability in older embryos, you know, because there's different gradings. The other thing that we see, same thing when you don't have genetic testing, you're picking from some that are normal and some are normal, you just don't know. So the more variability there is, usually the more impact there is of introducing a different way of deciding. So not unexpected, but definitely, you know, a group of patients that we want to help.

SPEAKER_00 7:14

Yeah. It's been my observation on my side of working with with the the uh reproductive uh endocrinologists is that most are doing genetic testing. Um would would it what percentage would you say in in this clinical study chose not to do uh genetic testing? Was it and you don't need to give me numbers, but was it a large percentage, a small percentage?

SPEAKER_01 7:36

You I'd say it's a minority. Obviously, that changes by you know where in the country we practice, insurance coverage, patient preference. I'd say most patients in the United States who are 37 years of older now typically lean towards doing that genetic testing, but there are clinics that are 90 or 100% genetic testing. There's some that are probably closer to like 30 to 50 percent. But you're correct, the the benefit of the genetic testing tends to be larger as the patient ages because you're helping select from a larger population of embryos that are going to be abnormal. So screening out those abnormal embryos matters more when you're screening out 70, 80 percent rather than 30 or 40 percent, like you might when they're younger.

SPEAKER_00 8:21

Right, right. And I don't know, I might be asking a question that is not answerable in a podcast, but what does the AI do? How does the uh embryo predict predict?

SPEAKER_01 8:32

You know, that's a good question. And this is one that we call like the black box problem of AI. So there's like, you know, tens of thousands, hundreds of thousands, sometimes millions of pixels in an image. And what the AI does is that it learns to recognize. So it's been trained on thousands of images of embryos. So we give them an image of an embryo and we say this one led to a baby, this one did not lead to a baby, this one did not lead to a baby, these three did, and it starts to see patterns and associations. So when it gets a new image, it says, Well, does this one look more like the ones that led to a baby or the ones that did not? We can't exactly say this is what it is about this embryo that makes me think that it's better. We often don't get an explanation, but you know, we have to test it and be very honest about how we collect that data to make sure that we know that. So, from our perspective, we don't have the perfect answer. We can't say to the patient, I'm picking this one because the AI said this and that, but we can say the AI gives us a score between zero and one, and higher scores are associated with higher pregnancy rates. So we would go for a score that's higher. And you know, we always worry about you know the AI going rogue, and we do have safeguards in place, right?

SPEAKER_00 9:47

So we know we don't want embryo, we don't want hallucinations with embryo prediction.

SPEAKER_01 9:52

Exactly. So you know, the good thing is it's a well-validated tested product, but still we have a protocol where we don't just say let's trust the AI, close our eyes and go for it. We say, well, in our data, we have you know what each embryo score, what the predicted value is internally for our embryologist grading. And sometimes, you know, we might have an embryo that's a day five AA, and then we have a day seven BB, and we would expect those embryos to be meaningfully different. So that one might be like 65 or 70 percent chance of success, whereas the other one might be 40. If the AI tells me that I should go for a BB 7 embryo, day seven embryo, I will say, you know, I'm not sure about that. I'm still gonna trust our own clinical judgment, our data, our experience, and we'll go for what we know works really well. But when those numbers are pretty close to each other, like they are for most patients, that AI can give us an extra lens. So we never say like the AI is picking your embryo. We tell our patients we're picking your embryo, but now we have another tool to help support that decision and bring a little bit more evidence.

SPEAKER_00 10:59

Got it. So I think I want to repeat so that the viewing and listening audience can really hear this. AI is not solely predicting the embryo that will be transferred. The embryologist still has a significant role to play in the process. And AI is an additive, if I may, if I may, if that's an accurate statement, to to kind of give an additional level of assurance that this is the better of the two embryos to transfer.

SPEAKER_01 11:26

That's right. And we call it AI assisted embryo selection, not just AI embryo selection, because it's helping me as the physician, my embryologist as the expert looking under the microscope, and then we add that layer of AI to assist in that decision.

SPEAKER_00 11:41

And at RSC, Reproductive Sciences Center, how how many of your patients have gone through this AI assist process since you brought it on board?

SPEAKER_01 11:52

Well, you know, I don't know the exact number. We just launched it about a month ago, and you know, I've had this conversation with, you know, probably like 20 to 50 patients. I'd say the great majority are very excited about it. You know, some people already have the scores, we're transferring those embryos. You know, I'd say a couple have said, you know, I only have one, so it doesn't really help us if we have a limited amount. So there's a group of people where it might not make a difference. Um, but certainly the ones that are trying to select across multiple embryos, uh, the majority of them have been very excited and want to have that information.

SPEAKER_00 12:28

That's wonderful. Yes, and of course, we're in the San Francisco Bay Area, so this this actually has it comes as no surprise, right? We are very uh AI um uh affectionate, if you will, right? So, and then back to the clinical study. Uh what I don't know if I can ask the question accurately, but what was the the degree or the percentage the uh of of success in selecting the right um embryo versus a control group? Does that did I ask that question properly?

SPEAKER_01 13:00

I would say we're seeing about a 5% increase in the chance of having a pregnancy or baby uh based on using DAI or the average patient, including PGT, non-PGT, older, younger.

SPEAKER_00 13:15

Yeah. And this went all the way through to live birth, or was it a positive pregnancy test? What was the what was the uh testing criteria?

SPEAKER_01 13:21

The endpoint for the study was live birth. But again, just to clarify, the study was not powered to measure superiority. So the study is, you know, that's how the FDA studies are usually done. It is too big of a cohort that we need to met to get superiority. So the the study was like, is one you know better worms than the other? They're not inferior. So it makes you feel good about the safety of incorporating this. And then we have a lot of internal data because we've been taking pictures of embryos, and then we can say, well, if we apply AI to all of these embryos, we know which ones we transfer. All of those were based on the embryologists. Would the ones that the embryologists have picked versus the ones that the AI would have picked where that differs? Is there a difference? And we saw that with a sample size that was like 10 times larger, because we do a lot of embryo transfers across not just our clinic, but our whole national network, we saw that that difference still holds, but now we have the power to say that was significant. So that's something that we're writing up right now. We want to make sure that you know it's not just take our word for it, but we want to submit it to a peer-reviewed journal and be able to, you know, share that with the with the world. And, you know, hopefully that will not only just benefit the patients at RSE, but the patients at you know, many, many clinics nationwide and worldwide.

SPEAKER_00 14:44

Yeah, that's amazing. Please connect with us for a fertility assessment call at the link below. We'd love to learn a bit about you and share our resources. And make sure you subscribe to our YouTube channel so that you never miss an episode. And is there any additional time frame that that is that is incurred? Is it does it take longer to go through the you know, embryologist plus the AISS process, or is transfer time pretty much similar to what it would be if it were just the embryologist grading?

SPEAKER_01 15:15

No, it's similar. So once we take that image, all of our patients get a report when we you know freeze or biopsy and freeze those embryos immediately once the process is complete. And that can include just the images and the grades, or for patients that want to use the AI, it includes the images, the grades, and the AI scores. So the process is the same and it's instantaneous, and then the doctor uses all of those variables to select the right embryo with the patient. So there's no increase in time.

SPEAKER_00 15:44

Okay. So if a patient were to call on RSD today, tell us what that process looks like for you know, so at from from the from the first call, what because we we see and it's it's the the the experience of IVF uh is quite familiar now, but the process is not that familiar. So can you can you walk us through what someone can expect at RSC?

SPEAKER_01 16:08

Sure. So we we're very lucky. We have um you know a team that has worked very hard. I think wait lists and delays tend to be something that we hear a lot about. And we have made it so that our providers are typically available within a week or so for some. Obviously, there's some that have a longer wait list, but for people whose speed is of the essence, they're older, they're stressed about it, or they found out they have a limited number of eggs, they can typically see one of our providers within a week or so, either in person or through telemedicine. So typically the first part is starting with a visit with your physician, getting to know them, sharing your history, understanding your goals, what we're trying to accomplish, and setting a plan together. On average, it takes about a month to go through the fertility evaluation. We're evaluating the ovaries, the tubes, the uterus, and then the sperm. And obviously, some people are freezing eggs, they don't need sperm. Some people do not need to focus on the uterus because they're trying to save eggs or embryos for the future. So it depends on the patient, but generally those are the four parts that we evaluate, and that's a combination of ultrasounds, blood work, and a seminal analysis. And oftentimes we layer genetic testing ahead of time to try to prevent genetic diseases like cystic fibrosis or sickle cell. Once that workup is complete, then your provider and you can finalize the plan. And then, you know, the IVF process takes somewhere in the two to four week range. There's usually a synchronization part to get the follicles to start about the same size, about two weeks of growing those follicles and getting those eggs to get larger, and then we do the egg retrieval where we get those eggs out. From there, we either freeze them as eggs or we inseminate them and grow them for about a week, and then we'll make embryos that we can either freeze or then biopsy and freeze. And this is when the AI takes place. It evaluates those embryos for their potential to lead to a baby. And then for patients that are freezing, those stay frozen with us until they're ready to start their families. For patients that are intending to get pregnant, then typically within a month or two, or once we get enough embryos that we feel like we have enough, not just for baby number one, but to complete their family, then we transition to the transfer phase where we synchronize the uterus to the age of the embryo and we place that embryo into the uterus at a very specific time. So, you know, from end to end, it really, really varies. Some people go a little slower. Sometimes we identify factors that we have to fix. So we need to delay a little bit that start of treatment. Sometimes we do multiple cycles of harvesting before we're ready for a transfer. So it can range, but that's about the average timeline for a patient.

SPEAKER_00 18:51

So it sounds like minimum expect from the day you call to the day your eggs are retrieved and embryos are made, if that's what your choice, about three months.

SPEAKER_01 19:01

I'd say the faster that we do it, if we have to wait for the genetic testing and all of that, be ready, I'd say about two months. Two months. You know, about a month to get ready, about a month to uh do that. And sometimes it lines up a little better based on the phase of the cycle. Sometimes, you know, we just miss it by a week and we want to wait another three. So there's a little variability there. But I would expect that from first visit to egg retrieval, the fastest is about you know four to six weeks. Most people take two to three months.

SPEAKER_00 19:31

Okay. All right. And then for the for the listeners and viewers, what should they expect in terms of you? You mentioned somebody sometimes you need to go through multiple retrievals. How how often or what percentage of time does a per do you find that a person needs to go through multiple retrievals? Or is that just too vague a question?

SPEAKER_01 19:52

Well, it really depends on the patients and their goals. So, you know, some some physicians might say you need 20 eggs for a baby, or you need, you know, five embryos for a baby, or whatever it is, and it really variables. Um I'd say the things that make it go faster are you're younger and you have more eggs, and then the opposite makes it go a little bit slower. It really depends on a patient's goals. Sometimes you're focused on baby number one, so we don't really need to save any excess embryos. Sometimes we meet someone that might still be young, but their ovarian reserve is quite diminished. So we're trying to protect their fertility and making sure that when they come back for baby number two or baby number three, we're not we might be out of X by then. So we're trying to save that to minimize the chances that they struggle later. So it's very personalized. The average fertility patient does about two to three cycles, but there are some patients that get very lucky and finish in one and we're happy with those goals. Sometimes it takes more than three, and that's okay as long as we we're making progress and we continue to improve. And as you know, unlike trying at home, where it's unfortunately a binary answer, you're either pregnant or not pregnant. The nice thing about going through this process, which is not the fun way to have a baby, is that we get a lot more feedback along the way. We know how many eggs grew, do we see a fertilization issue, what does the quality of the embryos look like? We can find things along the way that we might be able to tweak and improve. So we're constantly iterating on our plans and our protocols to really personalize that treatment to the patient in front of us, whether it's endometriosis, a lining problem, a male factor issue, we really want to understand what's going on with this couple and do what we can to optimize the treatment plan for them.

SPEAKER_00 21:37

Yeah, and I would venture to say, just from my own patient population, you know, what those who are trying to conceive naturally, it's not as much fun when they're trying to conceive naturally either. And they're coming in because they're struggling. It every month feels like a real crisis. Whereas when someone is going through an egg freezing or an or an embryo freezing, that crisis doesn't, once they've made that decision, it's everything doesn't feel quite so on the line because they've got the support of science to really help help with their end goal. They can have fun at other times, but but for the for baby making, it's uh it's I I I have I have found the patients have such relief once they find that they're that they're you know have accepted that you know IVF or you know for either egg freezing or embryo uh freezing is is their way to go. In in your bio, which you had mentioned that you are, or I had mentioned that you are involved in a couple of um startups and then you know innovation and and uh uh other other kinds of services. Is there anything that you can share with us about what might be coming down the pipeline? Like one thing I'm thinking of is gee, is there a future in AI for uh for eggs versus embryos?

SPEAKER_01 22:54

Yeah, absolutely. I mean, I think one of my biggest focuses is AI. So I work with a couple of AI companies helping them think about product development, A-Life, the one that we use being one of them. So for full disclosure, I am an advisor to them and I've been helping them for over five years think about these products, help understand what they need, how do we help more patients? So it's very excited to see these products come back to fruition. There's other companies that look use AI to help patients predict how many eggs they might get. So, to answer your question of what does that look like? How many cycles might I need? You know, if I get the average of what I expect, what would my chances look like? So they help find patients that look like them and then give them more personalized predictions so we can help a patient, not just say, What does the average 33-year-old do? But it's like a 33-year-old with your diagnosis, your AMH, your ovarian reserve, your sperm parameters, on average those like this. So they can make a more educated decision. There are companies, there's a company called Future Fertility, for example, they try to do something similar with eggs. So one of the challenges we have is when someone freezes eggs, we know their age and we know the number of eggs, and we can give them the average across those patients of how many babies they might have or how many eggs might make it to embryos. So when I think about the eggs, it's really challenging because sometimes we do better, but sometimes we do worse. And oftentimes those women don't find out that their eggs didn't do as well as we hoped for until they're 38 or 40 or whenever they come back to use them. And by that time, their ability to make more eggs might be more limited. And so getting a better clue of how good those eggs are is helpful. And future fertility has a model that helps you predict out of your eggs how many blastoces you're going to get. And it is better than just saying, on average, you get this. So that's an option that some are using for um for kind of freezing eggs and you know getting a better estimate of success.

SPEAKER_00 24:59

This question is kind of out of left field, but do you find that that uh that women who are going through um and uh egg retrievals will choose to do like one bank of embryos and then just freeze eggs for for the remaining, or are they uh making embryos for for you know the whole the whole batch?

SPEAKER_01 25:20

That's a great question. And I think it really depends on the woman, their relationship status, their goals. I was just having this exact conversation with the patient right before this uh recording. So this is a patient that is in that relationship, and she wants to save embryos. This is her committed partner, but we are also pragmatic and we know divorce rates are about 50%. And no one's thinking about divorce when they're preserving their fertility or trying to get pregnant. But the reality is that a lot of our patients might end up in that situation. You know, I try not to be morbid during the consult, but I say to my patients, no, this is fact that yeah, male, yeah, male partners can continue to get someone pregnant at 35 or 40 or 45 or 50. So we as males don't have the same biological clock, but my female patients do feel that a lot more acutely. So I talk to them about the trade-offs. So when we get eggs, we preserve flexibility. If that relationship is going strong and that woman wants to use them with their current partner, wonderful. Those eggs will be there and we can do that. The downside of eggs is that we lose a little bit of visibility. We don't know how many are gonna thaw on average about 90 to 95 percent, how many are gonna fertilize on average 70 to 90 percent, and how many are gonna progress to blastosis, which really varies by age. When we're making embryos, we get that feedback, and it's not that freezing eggs and embryos is that much different in the end result, but that feedback comes to us right away. We find out fertilization the next day, we found out the blastosis a week later, and if we're doing genetic testing within a couple of weeks, we have the end result, and it's still not guaranteed, we still have to use those blastosis to get someone pregnant, but we're a lot closer to our goal of a baby with a genetically tested euploid blastosis, so we can give a bit more certainty to the patient that we didn't fall off the curve during the culture process or we didn't get super unlucky on the genetic testing. So when I tell my patients is you know, do you want some certainty? Do you want more flexibility, or do you want a bit on both? And together we decide based on all those factors what's the right plan for her? Do we want to do half and half? Do we want to prioritize one or the other? Or sometimes if the numbers are low, some patients do end up doing multiple cycles where we focus on one, on embryos for one and then on eggs for the other.

SPEAKER_00 27:41

Got it, got it. Yes, I was attending um one of the one of the um the the or uh national organizations and there was a whole conversation about by by a legal representative on this very very topic. And so I was uh thinking about AI, thinking, oh gosh, if we could really hone in on eggs quality, you know, the the the likelihood of eggs turning into viable pregnancies, that would make this decision perhaps a little bit easier. It wouldn't just be flexibility versus some level of certainty.

SPEAKER_01 28:11

Yeah.

SPEAKER_00 28:12

So hopefully we'll get there. Hopefully we'll get there.

SPEAKER_01 28:14

I hope so.

SPEAKER_00 28:14

Yes, yes. Well, is I I want to be mindful of your time and of the viewers' time, but I also want to make sure that there's nothing that I have missed in the conversation that you want to say, ah, but I really want people to know this and think about that.

SPEAKER_01 28:29

No, I mean, I think we covered a lot about embryo selection. I think certainly we've worked hard to uh stay at the vanguard of medicine. We don't want to be too early, but we certainly want to be able to use the tools that we have at our disposal to help our patients find their babies as quickly as we can. So I think this is one of those many technologies. We're proud to be able to offer it. And certainly it's not for everyone. We want to make sure that our patients get to pick how and what they engage with across the process. But I'm excited that we're able to finally offer this. It's been a long time coming, and I think it's definitely gonna improve the chances for a lot of our patients and hopefully help more families grow, which is our ultimate goal.

SPEAKER_00 29:11

Absolutely. And and did I hear you say that you that still RSC is is the sole clinic that is doing this at this point?

SPEAKER_01 29:19

I believe so across the US. I'm sure there will be more to come because the data is very exciting. But as far as I know, uh as of now, I think we're still the only one that can do this. Because this technology, it's I don't think it's even been three months since the FDA approved it. So it's uh brand new.

SPEAKER_00 29:35

That's amazing. So then, therefore, if people who are out of the San Francisco Bay Area think, oh gosh, I would like this added layer of of um of certainty or to use AI for embryo predict for embryo predict, um, do you are you taking patients from you know out of state or other parts of the state because California is a pretty big state?

SPEAKER_01 29:58

Yeah, I mean, people come to us even before Embryo Predict, we had people that came to us from all over the US, you know, internationally from China, Singapore, sometimes from Europe, that come because they like our outcomes, they look on SART, they appreciate our success rates and what our doctors do. So we have that. We have seen a little bit more interest in people coming and saying, I really want to use this technology. I don't know where it's coming through my coast. So, you know, I'd like to start. And a lot of those patients, you know, they can see us remotely, we can work them up, you know, through Quest and Lab Corp at home seminal analysis. So a lot of that process happens there, and then they start their monitoring cycle from home, and then they come here for about a week or so around the retrieval. So we try to make it as least disruptive as possible to their day-to-day life. So we do have a good number of those patients coming.

SPEAKER_00 30:50

That's important, and I want to make sure that the viewers and listeners understand that you're not going to have to fly in and out of the San Francisco Bay Area for your diagnostic testing and for you know for your stims. Uh, you're gonna be able to just come on in for your retrieval, correct?

SPEAKER_01 31:06

Correct. Yeah, I mean, we typically I would say you want to come in a couple of ultrasounds before I get really picky about picking the perfect day to get those eggs out. I want to make sure that I can look at those follicles. We have those levels. So towards the end of the stimulation, I prefer if patients come.

SPEAKER_02 31:21

Yeah.

SPEAKER_01 31:21

Realistically, they only need to be here for the retrieval, but I usually will have people come a couple of days before to kind of pick that perfect day, get their egg retrieval, and then people usually fly out one to two days after.

SPEAKER_00 31:34

Yeah, so it's so it's one trip. So they're not having to fly in and out. So it's not one day, but it's one trip. So you show up a a couple of days based upon you know um the the the tests come that coming in, you show up a couple of days before anticipated retrieval so that you have control over you know trigger shot. Now it's go time and and we'll be retrieving soon.

SPEAKER_01 31:57

That's right.

SPEAKER_00 31:58

Excellent, excellent. Well, Dr. Heritan, again, thank you, thank you, thank you for your time. Thank you for your ingenuity and and and interest in creating these new ways of improving the field, because as you say, it's only about 50 years old, and there's been so much advancement. I've been doing it for now 24 years on my side, supporting this whole field. Um, and the and the advancements have been remarkable, and yet there's still so much more that can be done. So I'm excited to um to to continue to shadow you and learn about these as as time unfolds.

SPEAKER_01 32:33

Absolutely. And thank you, Susan, for your partnership. You've held so many patients, and it's always wonderful to take care of people together.

SPEAKER_00 32:40

I agree, thank you so very much. And so, viewers, listeners, again, thank you for your time. We know it can be held anywhere, and we appreciate you taking the time to be in this conversation. And if this conversation triggers a thought of, oh, my friend, my coworker, my neighbor, please pass this podcast along, and all of the information for RSD will be in the show notes and Dr. Heriton and Embryo Predict, it's all up through in the website as well, so that you'll be able to collect your information and then contact RSD at your earliest opportunity because you might be the one person in making the referral to someone else that helps them realize they're doing the family.