{"version":"1.0.0","segments":[{"startTime":0.72,"endTime":3.29,"body":"Today we talk about death,"},{"startTime":4.11,"endTime":6.89,"body":"cellular death in early development."},{"startTime":7.59,"endTime":10.53,"body":"Don't worry, it's not as scary as it sounds."},{"startTime":10.87,"endTime":13.686,"body":"Or is it? I'm Doctor"},{"startTime":13.718,"endTime":16.13,"body":"Mark Ammols and this"},{"startTime":16.47,"endTime":19.33,"body":"is taco. About fertility Tuesday."},{"startTime":30.59,"endTime":33.146,"body":"There are several things in life. Life I don't"},{"startTime":33.178,"endTime":35.27,"body":"understand. One,"},{"startTime":35.97,"endTime":38.95,"body":"how can you put a perfectly normal"},{"startTime":39.33,"endTime":41.91,"body":"EU ploy, genetically normal embryo,"},{"startTime":42.21,"endTime":44.95,"body":"into a, uterus that has been tested and looked"},{"startTime":44.982,"endTime":47.314,"body":"at and not get pregnant?"},{"startTime":47.654,"endTime":50.39,"body":"And two, how my wife can remember"},{"startTime":50.462,"endTime":53.43,"body":"something from six months ago to be upset"},{"startTime":53.462,"endTime":56.23,"body":"with me about, but forgot where she put her keys"},{"startTime":56.302,"endTime":59.126,"body":"just five minutes ago. Both are mysteries to"},{"startTime":59.15,"endTime":61.846,"body":"me, but we're going to tackle the first one"},{"startTime":61.91,"endTime":64.782,"body":"today. In today's episode, I'm not"},{"startTime":64.838,"endTime":67.766,"body":"going to explain every single reason why"},{"startTime":67.79,"endTime":70.766,"body":"Nambryo doesn't work. That's podcasts I've done"},{"startTime":70.79,"endTime":73.766,"body":"before, and there are podcasts I may do in the future. But today I"},{"startTime":73.79,"endTime":76.518,"body":"want to focus on one specific"},{"startTime":76.606,"endTime":79.47,"body":"type of reason. There could be failure,"},{"startTime":79.622,"endTime":82.59,"body":"or reasons that the ECG might be very low and drop down"},{"startTime":82.622,"endTime":84.938,"body":"right away. And, that is"},{"startTime":85.122,"endTime":87.366,"body":"death. Specifically speaking,"},{"startTime":87.746,"endTime":90.442,"body":"cellular death. See, one thing that's very"},{"startTime":90.514,"endTime":92.826,"body":"interesting is that there are"},{"startTime":92.866,"endTime":95.754,"body":"embryos that we thought that were going"},{"startTime":95.77,"endTime":98.706,"body":"to transfer, and they appear alive"},{"startTime":98.786,"endTime":101.126,"body":"and they are. They are completely viable."},{"startTime":101.866,"endTime":104.866,"body":"But at the cellular level, things may not"},{"startTime":104.906,"endTime":107.81,"body":"be what it appears that we are seeing with our own"},{"startTime":107.858,"endTime":110.7,"body":"eyes. And there are certain"},{"startTime":110.788,"endTime":113.316,"body":"cells that are actually undergoing"},{"startTime":113.396,"endTime":116.012,"body":"death even though everything looks"},{"startTime":116.044,"endTime":118.932,"body":"normal. So what do I mean by this? Let's"},{"startTime":118.964,"endTime":121.844,"body":"take me, for example. If I'm going"},{"startTime":121.86,"endTime":124.732,"body":"to die in ten days and you freeze me for ten"},{"startTime":124.804,"endTime":127.804,"body":"years, I'm still going to die once you"},{"startTime":127.82,"endTime":130.356,"body":"thaw me. Ten days later, you just"},{"startTime":130.436,"endTime":133.388,"body":"postponed my death by freezing me."},{"startTime":133.532,"endTime":136.452,"body":"But you haven't stopped the death process I was"},{"startTime":136.484,"endTime":138.816,"body":"going to go through no matter what."},{"startTime":139.486,"endTime":142.306,"body":"Well, the same thing can happen to embryos."},{"startTime":143.486,"endTime":145.79,"body":"We don't know which embryos are going to keep"},{"startTime":145.838,"endTime":148.558,"body":"growing. And there are many embryos that are"},{"startTime":148.622,"endTime":151.534,"body":"never planning on moving forward. But we"},{"startTime":151.55,"endTime":154.326,"body":"don't know that. And we postpone that death by freezing"},{"startTime":154.366,"endTime":157.31,"body":"them. And later we find out"},{"startTime":157.398,"endTime":160.238,"body":"that there was something wrong with them. We actually see this all the"},{"startTime":160.262,"endTime":163.096,"body":"time. There are, embryos on day three that"},{"startTime":163.128,"endTime":166.004,"body":"look amazing. They're the literal Brad"},{"startTime":166.052,"endTime":168.604,"body":"pit of embryos. They're just"},{"startTime":168.652,"endTime":171.516,"body":"beautiful. And yet they"},{"startTime":171.548,"endTime":174.444,"body":"never keep growing. They stop. That's because"},{"startTime":174.572,"endTime":176.9,"body":"the cells have died and they're not going to grow"},{"startTime":176.94,"endTime":179.74,"body":"anymore. Now, we don't wait past day"},{"startTime":179.78,"endTime":182.772,"body":"five at the blastocyst stage, so we don't"},{"startTime":182.836,"endTime":185.74,"body":"know if those blastocysts will keep going on. So today"},{"startTime":185.78,"endTime":188.62,"body":"I want to talk a little bit about the signs of that and explain"},{"startTime":188.78,"endTime":191.658,"body":"why is it that we can't know this? Why is"},{"startTime":191.674,"endTime":194.25,"body":"this always going to be a limitation, or at least for"},{"startTime":194.29,"endTime":196.95,"body":"now, a limitation of our ability"},{"startTime":197.45,"endTime":199.47,"body":"to know if it's going to work or not? Because"},{"startTime":200.37,"endTime":203.306,"body":"one of the things that happens and when it doesn't work is"},{"startTime":203.338,"endTime":206.146,"body":"we are striving for answers, trying to figure"},{"startTime":206.178,"endTime":208.986,"body":"out why this didn't work. Because they just put a"},{"startTime":209.018,"endTime":211.69,"body":"living baby in me and I didn't come away"},{"startTime":211.73,"endTime":214.258,"body":"pregnant. Now, when you look at a human"},{"startTime":214.394,"endTime":216.922,"body":"like myself, or a dog or cat, whatever you"},{"startTime":216.946,"endTime":219.616,"body":"want, you can tell it's alive"},{"startTime":219.728,"endTime":222.728,"body":"by looking at certain parameters. So with a cat and dog, you can"},{"startTime":222.744,"endTime":225.016,"body":"sit there and listen to its heart. See, that's"},{"startTime":225.048,"endTime":227.7,"body":"breathing. Maybe it's panting."},{"startTime":228.56,"endTime":231.512,"body":"With a human, you can talk to them so you know they're"},{"startTime":231.536,"endTime":234.528,"body":"not doing well. But even if you couldn't talk to them, you can look"},{"startTime":234.544,"endTime":237.528,"body":"at certain signs, you can check their temperature. So"},{"startTime":237.544,"endTime":240.408,"body":"there's a lot of things that we're able to look at"},{"startTime":240.584,"endTime":243.58,"body":"to be able to tell if death is coming."},{"startTime":244.34,"endTime":247.116,"body":"But that's different when it comes to cells. With a"},{"startTime":247.148,"endTime":250.012,"body":"cell, there isn't really an obvious"},{"startTime":250.076,"endTime":253.052,"body":"sign until after the fact. And"},{"startTime":253.076,"endTime":256.004,"body":"this becomes very difficult, because if you can't tell,"},{"startTime":256.052,"endTime":258.988,"body":"the cells are having problems. How would you know when you"},{"startTime":259.004,"endTime":261.988,"body":"put the embryo back? What if there was a way for us"},{"startTime":262.004,"endTime":264.964,"body":"to know before we put the embryo back, that"},{"startTime":265.012,"endTime":267.892,"body":"something was already wrong and not put that embryo back, or"},{"startTime":267.916,"endTime":270.498,"body":"at least give the person the"},{"startTime":270.514,"endTime":273.138,"body":"foreknowledge, then, no, it may not work."},{"startTime":273.314,"endTime":275.954,"body":"To be able to do this, we would have to have some type of"},{"startTime":276.002,"endTime":278.826,"body":"signal, something that would let us know, because there is no"},{"startTime":278.858,"endTime":281.474,"body":"heartbeat with that cellular"},{"startTime":281.562,"endTime":284.482,"body":"organism. There is no discussion to"},{"startTime":284.506,"endTime":287.034,"body":"have with it. We can't tell if it's not doing"},{"startTime":287.082,"endTime":289.578,"body":"well. We have to look at things like"},{"startTime":289.714,"endTime":292.27,"body":"proteins and cascades that occur"},{"startTime":292.73,"endTime":295.474,"body":"within the cytoplasm of those cells that tell"},{"startTime":295.522,"endTime":298.188,"body":"us death is occurring."},{"startTime":298.364,"endTime":301.34,"body":"Now, when we're talking about cellular death, it's"},{"startTime":301.38,"endTime":304.236,"body":"basically broken into two parts. One is called"},{"startTime":304.308,"endTime":306.42,"body":"apoptosis, and the other one is called"},{"startTime":306.46,"endTime":307.44,"body":"necrosis."},{"startTime":308.14,"endTime":310.956,"body":"Apoptosis is a programmed"},{"startTime":310.988,"endTime":313.516,"body":"cell death, meaning the cell is"},{"startTime":313.588,"endTime":316.036,"body":"itself triggering the"},{"startTime":316.068,"endTime":319.044,"body":"death, whereas necrosis would be an"},{"startTime":319.092,"endTime":322.012,"body":"unplanned death. It's going to be more like when you think of"},{"startTime":322.036,"endTime":324.938,"body":"something, a cell exploding. And that's exactly what"},{"startTime":324.954,"endTime":327.946,"body":"we see. So most of the time when an embryo"},{"startTime":328.058,"endTime":330.994,"body":"stalls on, let's say, day three and doesn't keep"},{"startTime":331.042,"endTime":333.97,"body":"growing, it's apoptosis, a"},{"startTime":334.01,"endTime":336.626,"body":"programmed cell death, where something, let's say with the DNA is"},{"startTime":336.658,"endTime":339.546,"body":"bad and causes that embryo to not"},{"startTime":339.578,"endTime":342.45,"body":"move forward. It's a very clean death, and there's actually"},{"startTime":342.49,"endTime":345.45,"body":"very little inflammatory factors there versus"},{"startTime":345.53,"endTime":347.642,"body":"in necrosis cell death. It's"},{"startTime":347.706,"endTime":350.41,"body":"unplanned, which can be due to, let's say, outside"},{"startTime":350.49,"endTime":353.322,"body":"factors that then cause the cell to rupture and"},{"startTime":353.346,"endTime":356.228,"body":"release all of its contents. Now, it's important to understand"},{"startTime":356.324,"endTime":359.228,"body":"that apoptosis isn't just"},{"startTime":359.284,"endTime":362.276,"body":"through genetic problems. There can be other things"},{"startTime":362.308,"endTime":364.708,"body":"that could be wrong that can cause self destruction."},{"startTime":364.844,"endTime":367.652,"body":"Sometimes some of the cells in an embryo"},{"startTime":367.716,"endTime":370.62,"body":"are undergoing apoptosis, but the other cells are not."},{"startTime":370.78,"endTime":373.772,"body":"And the purpose of apoptosis then is to not harm"},{"startTime":373.796,"endTime":376.42,"body":"the other cells. Once apoptosis has"},{"startTime":376.46,"endTime":379.06,"body":"started, the cell starts to shrink,"},{"startTime":379.22,"endTime":381.934,"body":"its DNA gets cut up. The cell eventually"},{"startTime":381.982,"endTime":384.87,"body":"breaks down to small little packages that are quickly"},{"startTime":384.91,"endTime":387.806,"body":"removed by the immune system without causing any"},{"startTime":387.838,"endTime":390.782,"body":"type of inflammation. But the process is"},{"startTime":390.806,"endTime":393.51,"body":"very energy dependent, meaning the cell"},{"startTime":393.55,"endTime":396.502,"body":"requires energy to carry out its own death. We'll get"},{"startTime":396.526,"endTime":399.422,"body":"back to this a little bit later because this is where mito"},{"startTime":399.526,"endTime":402.374,"body":"scores come into play. Necrosis, on the other hand,"},{"startTime":402.422,"endTime":404.854,"body":"is more violent and uncontrolled form of cell"},{"startTime":404.902,"endTime":407.55,"body":"death. It usually happens when a cell is"},{"startTime":407.59,"endTime":410.07,"body":"injured or deprived of essential nutrients or"},{"startTime":410.11,"endTime":413.028,"body":"oxygen. Usually the cells will swell and"},{"startTime":413.044,"endTime":415.668,"body":"they burst, like I said, spelling their contents"},{"startTime":415.804,"endTime":418.228,"body":"into the surrounding area. And this causes"},{"startTime":418.284,"endTime":420.876,"body":"inflammation and can actually damage cells"},{"startTime":420.908,"endTime":423.556,"body":"nearby. If you had to think of these two"},{"startTime":423.668,"endTime":426.508,"body":"in kind of less like human terms, imagine a"},{"startTime":426.524,"endTime":429.16,"body":"building that we wanted to take down."},{"startTime":429.82,"endTime":432.676,"body":"Apoptosis would be taking each brick, brick"},{"startTime":432.708,"endTime":435.308,"body":"by brick, taking the building down, very"},{"startTime":435.364,"endTime":438.23,"body":"controlled, whereas necrosis would be like an"},{"startTime":438.27,"endTime":440.71,"body":"uncontrolled explosion that made the whole building"},{"startTime":440.87,"endTime":443.862,"body":"collapse. Now, when it comes to embryos"},{"startTime":443.926,"endTime":446.894,"body":"not growing or stalling, most of the time that's going to"},{"startTime":446.902,"endTime":449.718,"body":"be apoptosis. It's not the necrosis form of"},{"startTime":449.734,"endTime":452.622,"body":"cell death. The necrosis form of cell death is"},{"startTime":452.646,"endTime":455.606,"body":"usually going to happen due to extreme conditions, such"},{"startTime":455.638,"endTime":458.502,"body":"as when the culture environment has ph"},{"startTime":458.606,"endTime":460.99,"body":"issues or toxic environment. Apoptosis,"},{"startTime":461.728,"endTime":464.564,"body":"can also occur from those things, but it's"},{"startTime":464.612,"endTime":467.524,"body":"definitely associated with DNA issues or an environment"},{"startTime":467.612,"endTime":470.4,"body":"where it's not able to thrive. Now, it's important to understand, when an,"},{"startTime":470.4,"endTime":472.94,"body":"embryo is uploid means genetically normal,"},{"startTime":473.36,"endTime":476.2,"body":"that uploid means overall, from the"},{"startTime":476.24,"endTime":479.184,"body":"big picture, the chromosomes are normal. That doesn't mean at"},{"startTime":479.192,"endTime":482.072,"body":"the low level that the DNA is normal. There"},{"startTime":482.096,"endTime":484.704,"body":"are times that the embryo can be considered euploid, but still"},{"startTime":484.752,"endTime":487.48,"body":"have small DNA issues inside it"},{"startTime":487.6,"endTime":490.48,"body":"that could potentially cause things like apoptosis, or"},{"startTime":490.6,"endTime":493.598,"body":"I can cause problems with energy production and"},{"startTime":493.614,"endTime":496.07,"body":"that energy production can sometimes"},{"startTime":496.11,"endTime":498.75,"body":"cause issues with a cell continuing to grow,"},{"startTime":498.91,"endTime":501.782,"body":"leading then to apoptosis. What would"},{"startTime":501.806,"endTime":504.662,"body":"be ideal is if there were markers that we could look at,"},{"startTime":504.686,"endTime":507.022,"body":"such as biomarkers, to help us figure out"},{"startTime":507.166,"endTime":509.774,"body":"which embryos are undergoing cellular"},{"startTime":509.822,"endTime":512.774,"body":"death. Now, at this time, there is"},{"startTime":512.822,"endTime":515.75,"body":"no way to look at this in the form of"},{"startTime":515.79,"endTime":518.65,"body":"being able to determine which embryo to transfer."},{"startTime":519.27,"endTime":522.206,"body":"This is because there's a short amount of time from the point when you"},{"startTime":522.238,"endTime":524.646,"body":"thaw the embryo and then when you transfer"},{"startTime":524.678,"endTime":527.646,"body":"it. A lot of this testing takes"},{"startTime":527.678,"endTime":530.292,"body":"more time and is very difficult, to"},{"startTime":530.316,"endTime":533.292,"body":"do because you would have to take the cells of the"},{"startTime":533.316,"endTime":536.196,"body":"embryo and lyse them to find these different"},{"startTime":536.228,"endTime":539.1,"body":"biomarkers. So what some people have looked at is"},{"startTime":539.14,"endTime":541.924,"body":"what is called spent media. This is the"},{"startTime":542.052,"endTime":544.908,"body":"media the embryo is in. And it may be releasing"},{"startTime":545.004,"endTime":547.96,"body":"certain proteins into that media that"},{"startTime":548.0,"endTime":550.592,"body":"may show there are some issues, such as markers of"},{"startTime":550.616,"endTime":553.536,"body":"apoptosis. One of those things can be"},{"startTime":553.568,"endTime":556.536,"body":"cat spaces. Caspase three is"},{"startTime":556.568,"endTime":559.496,"body":"one of the markers of apoptosis. So we were able"},{"startTime":559.528,"endTime":562.368,"body":"to see that in the media. We would be able to know that something"},{"startTime":562.424,"endTime":565.336,"body":"is happening. Other things that we'd be able to look at are"},{"startTime":565.368,"endTime":567.94,"body":"things like DNA fragments,"},{"startTime":568.36,"endTime":571.224,"body":"nexin five, lactose"},{"startTime":571.272,"endTime":573.828,"body":"dehydrogenase, reactive oxygen"},{"startTime":573.884,"endTime":576.204,"body":"species, S 100 proteins,"},{"startTime":576.332,"endTime":578.836,"body":"hiegshop proteins and even mitochondrial"},{"startTime":578.868,"endTime":581.748,"body":"dysfunction markers. Next. And five is a molecule"},{"startTime":581.764,"endTime":584.516,"body":"thats usually in the cellular membrane. And gets"},{"startTime":584.548,"endTime":586.828,"body":"everted out whenever there are problems, such as"},{"startTime":586.844,"endTime":589.612,"body":"apoptosis. That gives a signal for the embryo to"},{"startTime":589.636,"endTime":592.204,"body":"be cleared away. Whereas lactate"},{"startTime":592.252,"endTime":594.532,"body":"dehydronase, reactive oxygen"},{"startTime":594.596,"endTime":597.436,"body":"species and S 100 proteins"},{"startTime":597.508,"endTime":600.298,"body":"and heat shock proteins are going to be"},{"startTime":600.434,"endTime":602.714,"body":"indicators of stress."},{"startTime":602.882,"endTime":605.882,"body":"And the fact that the cell is undergoing apoptosis and"},{"startTime":605.906,"endTime":608.706,"body":"necrosis. Now, although we don't currently check"},{"startTime":608.778,"endTime":611.538,"body":"myochondrial dysfunction markers, there is a test called"},{"startTime":611.634,"endTime":614.618,"body":"a mitoscore. The mitoscore is actually"},{"startTime":614.674,"endTime":617.618,"body":"looking at the DNA in the mitochondria, which are"},{"startTime":617.634,"endTime":620.538,"body":"the powerhouse of the cells. If"},{"startTime":620.554,"endTime":623.466,"body":"there is a higher amount of mitochondrial DNA,"},{"startTime":623.538,"endTime":626.332,"body":"then it means there's more mitochondria there, which means the"},{"startTime":626.356,"endTime":629.308,"body":"cell needed more energy. And"},{"startTime":629.324,"endTime":632.308,"body":"so the times the cell would need more energy are either going to be"},{"startTime":632.324,"endTime":635.188,"body":"in very fast development or when"},{"startTime":635.204,"endTime":638.116,"body":"it's being stressed. What they do is they take"},{"startTime":638.148,"endTime":641.092,"body":"that mitochondrial DNA and"},{"startTime":641.116,"endTime":644.068,"body":"then they look at comparing it to the"},{"startTime":644.204,"endTime":647.156,"body":"normal DNA within the nuclear DNA."},{"startTime":647.348,"endTime":649.956,"body":"And then they can come up with a score that"},{"startTime":649.988,"endTime":652.644,"body":"tells if it's higher than normal. Not every"},{"startTime":652.692,"endTime":655.516,"body":"company has a midoscore, but if your company"},{"startTime":655.588,"endTime":658.236,"body":"does, what's important to understand is, yes, it"},{"startTime":658.308,"endTime":660.964,"body":"does tell us that there is more"},{"startTime":661.012,"endTime":663.732,"body":"mitochondrial DNA inside the"},{"startTime":663.756,"endTime":666.636,"body":"cell, but what we don't know yet is there is no"},{"startTime":666.708,"endTime":669.084,"body":"absolute correlation between that."},{"startTime":669.252,"endTime":671.64,"body":"Admitting the embryo is not doing well."},{"startTime":672.02,"endTime":674.892,"body":"Now, if you have two embryos that are equal, so let's"},{"startTime":674.916,"endTime":677.708,"body":"say embryo one and two, both are"},{"startTime":677.724,"endTime":680.5,"body":"the same grade, everything looks the same,"},{"startTime":681.0,"endTime":683.84,"body":"and you have to then have a tiebreaker. That's where the minus"},{"startTime":683.88,"endTime":686.608,"body":"score comes in. And so you'd want to use the one that has"},{"startTime":686.624,"endTime":689.472,"body":"the lowest mile score that would"},{"startTime":689.536,"endTime":692.528,"body":"never take over for choosing which embryo"},{"startTime":692.544,"endTime":695.544,"body":"to put back. So what I mean by that, what I'm saying is"},{"startTime":695.592,"endTime":698.576,"body":"that you would never pick an embryo just because of a minor"},{"startTime":698.608,"endTime":701.328,"body":"score. You would only use a minor score to"},{"startTime":701.384,"endTime":704.232,"body":"help pick an embryo. But it is the last thing"},{"startTime":704.256,"endTime":707.004,"body":"we look at, because there's just not good evidence yet"},{"startTime":707.192,"endTime":710.1,"body":"to show that it's going to mean that the embryo will not"},{"startTime":710.14,"endTime":712.468,"body":"work. It just means that it may have lower"},{"startTime":712.524,"endTime":715.428,"body":"implantation potential because of the fact that it's requiring"},{"startTime":715.484,"endTime":718.044,"body":"more energy, meaning it might be under more"},{"startTime":718.092,"endTime":720.52,"body":"stress. Unfortunately,"},{"startTime":720.94,"endTime":723.172,"body":"all of the factors I was talking about looking at,"},{"startTime":723.196,"endTime":725.532,"body":"apoptosis and cellular death,"},{"startTime":725.676,"endTime":728.508,"body":"cannot be seen. Unfortunately, we just"},{"startTime":728.564,"endTime":731.46,"body":"don't have the ability to do that this time. And so we're"},{"startTime":731.5,"endTime":734.372,"body":"limited. And unfortunately, that limit limits us"},{"startTime":734.396,"endTime":737.2,"body":"to knowing the next day, which is too late,"},{"startTime":737.7,"endTime":740.652,"body":"or we're able to look at things like mitoscores, which"},{"startTime":740.676,"endTime":743.516,"body":"are just not that good at, ah, correlating between which"},{"startTime":743.548,"endTime":746.308,"body":"embryos will be the best and which ones will not."},{"startTime":746.444,"endTime":749.044,"body":"What this means is there are embryos"},{"startTime":749.212,"endTime":751.892,"body":"that we are transferring into the body that"},{"startTime":751.956,"endTime":754.58,"body":"never had a chance. And unfortunately,"},{"startTime":754.62,"endTime":757.476,"body":"there's no way for us to know this. This is why"},{"startTime":757.508,"endTime":760.156,"body":"some people get zero implantation, no"},{"startTime":760.188,"endTime":762.996,"body":"hcg, not because the embryo couldn't"},{"startTime":763.028,"endTime":765.816,"body":"find a good place to park implant, but"},{"startTime":765.848,"endTime":768.544,"body":"because the embryo wasn't even"},{"startTime":768.592,"endTime":771.528,"body":"alive by the time it was ready to implant. If"},{"startTime":771.544,"endTime":774.544,"body":"we were able to watch the embryo, maybe another day later,"},{"startTime":774.672,"endTime":777.624,"body":"we would have seen it wouldn't grow. This is what we see"},{"startTime":777.672,"endTime":780.592,"body":"in culture environments. Many embryos that look"},{"startTime":780.616,"endTime":783.46,"body":"like they're going amazing all of a sudden stall,"},{"startTime":783.88,"endTime":786.768,"body":"and then after the fact, we can go, oh, I guess that embryo"},{"startTime":786.792,"endTime":789.752,"body":"wasn't growing anymore. It was on its way to death. The reason"},{"startTime":789.784,"endTime":791.476,"body":"why this is important is because"},{"startTime":792.376,"endTime":794.896,"body":"cellular death is common and it's not"},{"startTime":794.936,"endTime":797.848,"body":"preventable. And unfortunately, it can lead to"},{"startTime":797.872,"endTime":800.304,"body":"a normal embryo to not"},{"startTime":800.36,"endTime":803.208,"body":"implant. And the problem is, we"},{"startTime":803.232,"endTime":806.08,"body":"blame ourselves. We assume it has to be something"},{"startTime":806.128,"endTime":808.976,"body":"wrong with us, that maybe someone did something wrong"},{"startTime":809.136,"endTime":811.276,"body":"or that there's some other factor,"},{"startTime":812.096,"endTime":815.08,"body":"and there can be. But it could"},{"startTime":815.128,"endTime":817.826,"body":"also be something as simple as the"},{"startTime":817.866,"endTime":820.778,"body":"embryo never kept growing. This is why"},{"startTime":820.922,"endTime":823.738,"body":"if someone puts back a euploid embryo and it"},{"startTime":823.762,"endTime":826.626,"body":"doesn't implant, I don't get scared yet. And"},{"startTime":826.666,"endTime":829.538,"body":"most clinics don't. Most will actually say, wait"},{"startTime":829.562,"endTime":831.962,"body":"till your second transfer with a euploid"},{"startTime":831.994,"endTime":834.746,"body":"embryo before we start hitting the panic button"},{"startTime":834.866,"endTime":837.81,"body":"and start looking at some of those other causes. Not"},{"startTime":837.858,"endTime":840.778,"body":"everyone has the fortunability to be able to"},{"startTime":840.962,"endTime":843.498,"body":"have multiple transfers. They might only have one or two"},{"startTime":843.522,"endTime":846.384,"body":"embryos. And in that situation, obviously you do"},{"startTime":846.4,"endTime":849.296,"body":"the testing you need before your transfer. But the important"},{"startTime":849.376,"endTime":852.336,"body":"point of this podcast is I wanted you to know about"},{"startTime":852.376,"endTime":854.872,"body":"at least this one specific type of"},{"startTime":854.904,"endTime":857.68,"body":"cause that they may not be implanting,"},{"startTime":857.848,"endTime":860.744,"body":"that in that situation the embryo may"},{"startTime":860.76,"endTime":863.512,"body":"have never even been alive by the time it was"},{"startTime":863.544,"endTime":866.512,"body":"ready to implant, and unfortunately, there is no"},{"startTime":866.544,"endTime":869.312,"body":"way to know that before transferring the embryo."},{"startTime":869.464,"endTime":872.44,"body":"Maybe you're going through IVF and this was helpful. Maybe you have"},{"startTime":872.448,"endTime":875.304,"body":"a friend who's going through it. The important part is"},{"startTime":875.36,"endTime":878.24,"body":"it's very difficult when you put back an embryo and it"},{"startTime":878.248,"endTime":881.064,"body":"doesn't work, and it's so easy to go down rabbit"},{"startTime":881.08,"endTime":883.944,"body":"holes. And so if you know someone or this"},{"startTime":883.96,"endTime":886.92,"body":"is you, please let this episode give you at least"},{"startTime":886.968,"endTime":889.624,"body":"some comfort in knowing"},{"startTime":889.76,"endTime":892.752,"body":"that it isn't something you did wrong, it isn't something you"},{"startTime":892.784,"endTime":895.416,"body":"missed, but that there is a natural"},{"startTime":895.536,"endTime":898.426,"body":"cellular death that occurs, and that unfortunately,"},{"startTime":898.466,"endTime":901.002,"body":"we have no way to know which embryos are"},{"startTime":901.034,"endTime":903.162,"body":"undergoing it even prior to the"},{"startTime":903.194,"endTime":906.122,"body":"transfer. And that is very possible, although it"},{"startTime":906.154,"endTime":908.646,"body":"seems very unlikely and it doesn't happen often,"},{"startTime":909.186,"endTime":912.086,"body":"that the embryo that was put back, even though it looked beautiful,"},{"startTime":912.506,"endTime":915.034,"body":"may have been on its way out due to cellular"},{"startTime":915.09,"endTime":917.922,"body":"death. I hope this episode was helpful to"},{"startTime":917.954,"endTime":920.826,"body":"you or someone you know. As always, if you like this"},{"startTime":920.906,"endTime":923.874,"body":"podcast, please give us a five star review on"},{"startTime":923.89,"endTime":926.89,"body":"your favorite medium. Tell your friends about us,"},{"startTime":927.058,"endTime":929.586,"body":"and if you can even let me know, it only"},{"startTime":929.626,"endTime":932.594,"body":"encourages me to do it more. If you have topics you want me to"},{"startTime":932.61,"endTime":935.606,"body":"go over, please send me a message either through Facebook,"},{"startTime":935.946,"endTime":937.602,"body":"Instagram, or to"},{"startTime":937.674,"endTime":941.058,"body":"tbftirectionfertility.com"},{"startTime":941.242,"endTime":944.162,"body":"and let me know what you would like me to do. The most important part,"},{"startTime":944.194,"endTime":946.994,"body":"though, is keep coming back, and I look forward to talking again"},{"startTime":947.05,"endTime":949.89,"body":"next week on Taco Bell fertility"},{"startTime":949.938,"endTime":950.526,"body":"Tuesday."}]}