{"version":"1.0.0","segments":[{"startTime":1.215,"endTime":3.311,"body":"Today we talk about embryo"},{"startTime":3.383,"endTime":6.071,"body":"reoppsy, giving embryos a second"},{"startTime":6.143,"endTime":9.075,"body":"chance. But is it worth the risk?"},{"startTime":10.335,"endTime":13.061,"body":"I'm, Dr. Mark Amols, and this"},{"startTime":13.401,"endTime":16.301,"body":"is Taco about Fertility Tuesday."},{"startTime":27.931,"endTime":30.723,"body":"Have you ever heard of an embryo getting a second"},{"startTime":30.787,"endTime":33.515,"body":"chance at genetic testing? Well,"},{"startTime":33.563,"endTime":36.043,"body":"today we tackle what embryo rebopsy"},{"startTime":36.067,"endTime":38.875,"body":"is and whether giving embryos a second chance makes"},{"startTime":38.923,"endTime":41.031,"body":"sense for your IVF journey."},{"startTime":41.651,"endTime":44.151,"body":"When you get an embryo biopsy,"},{"startTime":44.531,"endTime":47.111,"body":"what you expect from that is to get a result."},{"startTime":47.411,"endTime":50.059,"body":"And that result is going to help you then make"},{"startTime":50.115,"endTime":52.923,"body":"decisions. But sometimes that"},{"startTime":52.987,"endTime":55.623,"body":"result isn't what you expect. What you're"},{"startTime":55.687,"endTime":58.415,"body":"expecting is either it euloid"},{"startTime":58.503,"endTime":61.503,"body":"means genetically normal, or unemployed means"},{"startTime":61.567,"endTime":64.343,"body":"genetically abnormal. But you"},{"startTime":64.367,"endTime":67.335,"body":"probably didn't know this. Sometimes you can get a result"},{"startTime":67.463,"endTime":69.727,"body":"that says inconclusive"},{"startTime":69.919,"endTime":72.439,"body":"or mosaic or"},{"startTime":72.575,"endTime":75.495,"body":"no result. And the question is,"},{"startTime":75.663,"endTime":78.487,"body":"what do you do in that situation? Well, one option"},{"startTime":78.519,"endTime":81.155,"body":"is you could biopsy the embryo."},{"startTime":81.203,"endTime":83.511,"body":"Again, a rebiopsy."},{"startTime":83.891,"endTime":86.347,"body":"But as you would think, is it"},{"startTime":86.379,"endTime":89.059,"body":"okay, meaning is it going to hurt the"},{"startTime":89.075,"endTime":91.891,"body":"embryo? And so what we're going to talk"},{"startTime":91.931,"endTime":94.467,"body":"about today is this idea of rebopsing"},{"startTime":94.499,"endTime":97.299,"body":"embryo, what we're going to expect"},{"startTime":97.355,"endTime":100.083,"body":"from those results. Is it worth"},{"startTime":100.267,"endTime":102.963,"body":"rebopsxing an embryo? Now, when they take a"},{"startTime":102.987,"endTime":105.955,"body":"biopsy, we are taking a few cells. We're not trying"},{"startTime":105.963,"endTime":108.691,"body":"to take a whole bunch, may maybe like three to five cells,"},{"startTime":108.771,"endTime":111.311,"body":"because we don't want to harm the embryo."},{"startTime":111.691,"endTime":114.411,"body":"And so in ar riopsy, there are two"},{"startTime":114.451,"endTime":117.395,"body":"things that have to happen. The first is"},{"startTime":117.523,"endTime":120.443,"body":"we have to thaw the embryo. The second thing"},{"startTime":120.467,"endTime":123.331,"body":"is then biopsy. Now we have to"},{"startTime":123.371,"endTime":126.291,"body":"refreeze that embryo because you can't put it back right"},{"startTime":126.331,"endTime":129.091,"body":"away because we don't know the results. And so it's going to take"},{"startTime":129.171,"endTime":132.019,"body":"time for those results to come back. And so essentially"},{"startTime":132.075,"endTime":134.441,"body":"you are thawing biopsy"},{"startTime":134.601,"endTime":137.433,"body":"and refreezing. So what's"},{"startTime":137.457,"endTime":139.873,"body":"happening is two things are happening, the"},{"startTime":139.897,"endTime":142.617,"body":"biopsy and the refreeze, which normally wouldn't"},{"startTime":142.649,"endTime":145.497,"body":"happen on the embryo that was biopsied once."},{"startTime":145.689,"endTime":148.513,"body":"Now, your first thought is going to be, well, that probably harms the"},{"startTime":148.537,"endTime":151.221,"body":"embryo because you're taking another biopsy."},{"startTime":151.641,"endTime":154.337,"body":"And a matter of fact, most people think biopsies hurt"},{"startTime":154.369,"endTime":157.181,"body":"embryos, but in reality, we're not actually"},{"startTime":157.601,"endTime":160.529,"body":"biopsying the baby or biopsy the placenta cells and"},{"startTime":160.545,"endTime":163.212,"body":"embr actually do very well when you do, a biopsy."},{"startTime":163.512,"endTime":166.312,"body":"When you compare it to people who don't do biopsies,"},{"startTime":166.432,"endTime":169.432,"body":"they do very well. Similar with regards to"},{"startTime":169.512,"endTime":172.328,"body":"live birth rates when you factor in"},{"startTime":172.48,"endTime":175.328,"body":"euoid status, meaning the embryo was normal. So let's"},{"startTime":175.36,"endTime":178.328,"body":"talk about these Situations of when you would want to"},{"startTime":178.36,"endTime":181.056,"body":"re biopsy. Well, let's say the test"},{"startTime":181.104,"endTime":183.664,"body":"shows that it's inconclusive or no"},{"startTime":183.728,"endTime":186.672,"body":"results. If an embryo comes back with"},{"startTime":186.712,"endTime":189.668,"body":"no result, it's saying that they weren't"},{"startTime":189.7,"endTime":192.58,"body":"able to get the information from the cells. Now, that"},{"startTime":192.596,"endTime":195.308,"body":"could be for several reasons. The biopsy might"},{"startTime":195.34,"endTime":197.916,"body":"have been traumatic to the cells and they didn't"},{"startTime":197.964,"endTime":200.884,"body":"survive. Sometimes the cells when they're inside the"},{"startTime":200.908,"endTime":203.412,"body":"buffer do not survive. And so when they go to"},{"startTime":203.492,"endTime":206.38,"body":"amplify the cells later, it's not able to"},{"startTime":206.396,"endTime":209.196,"body":"be amplified. And what that means is that they lys the"},{"startTime":209.204,"endTime":211.892,"body":"cells to get the DNA from them, and then that"},{"startTime":211.932,"endTime":214.638,"body":"DNA is amplifified so they can run tests on them."},{"startTime":214.78,"endTime":217.65,"body":"Sometimes they do that and they say there was no DNA. That"},{"startTime":217.666,"endTime":220.634,"body":"doesn't mean there's not DNA there. It just means that maybe the"},{"startTime":220.658,"endTime":223.61,"body":"DNA was not intact enough because it"},{"startTime":223.626,"endTime":226.402,"body":"wasn't protected by the buffer. That"},{"startTime":226.442,"endTime":229.298,"body":"then led to the cells not having"},{"startTime":229.41,"endTime":232.314,"body":"quality DNA that could be amplified. So in this situation,"},{"startTime":232.418,"endTime":235.242,"body":"you don't get a result at all. In the"},{"startTime":235.282,"endTime":238.114,"body":"inconclusive result, what they're talking about is that"},{"startTime":238.138,"endTime":240.886,"body":"they got some information, but the"},{"startTime":240.934,"endTime":243.622,"body":"information wasn't clear, and so they"},{"startTime":243.662,"endTime":246.614,"body":"can't make a decision. And so I tell people kind"},{"startTime":246.638,"endTime":249.518,"body":"of think of it like someone giving you clear directions on how"},{"startTime":249.55,"endTime":252.55,"body":"to get somewhere. If it's clear, you can get there. But"},{"startTime":252.566,"endTime":255.518,"body":"if someone's kind of not being very clear, they're like, well, I think you go to this place"},{"startTime":255.55,"endTime":258.494,"body":"and then maybe you take a turn here. You may not get"},{"startTime":258.518,"endTime":261.078,"body":"to the place you want because it wasn't clear."},{"startTime":261.27,"endTime":263.966,"body":"Sometimes the dad is very noisy and"},{"startTime":264.014,"endTime":266.854,"body":"it's very difficult to interpret it. And so in that situation,"},{"startTime":266.918,"endTime":269.91,"body":"they call it inconclusive. The last situation is going to"},{"startTime":269.926,"endTime":272.718,"body":"be an embryo coming back mosaic. And the mosaic embryo"},{"startTime":272.75,"endTime":275.582,"body":"is when the embryo has both normal and abnormal"},{"startTime":275.622,"endTime":278.134,"body":"cells in it. There can also be what's called"},{"startTime":278.198,"endTime":281.102,"body":"segmental anuploid, which is where instead of the"},{"startTime":281.142,"endTime":283.982,"body":"whole embryo being abnormal, it's just a small"},{"startTime":284.062,"endTime":286.838,"body":"portion of the embryo being abnormal. For example,"},{"startTime":286.91,"endTime":289.774,"body":"if the whole chromosome is missing, we would"},{"startTime":289.798,"endTime":292.39,"body":"call that monosomy, meaning it's missing the"},{"startTime":292.406,"endTime":295.278,"body":"chromosome. But if a segmental monosomy"},{"startTime":295.31,"endTime":297.904,"body":"was there, it would be like a small portion of"},{"startTime":298.038,"endTime":301.012,"body":"chromosome 9 of the letiss, say short arm was"},{"startTime":301.052,"endTime":303.94,"body":"missing. So why am I telling you all this stuff? Well, because you need"},{"startTime":303.956,"endTime":306.628,"body":"to know this to understand the next question. Do I"},{"startTime":306.66,"endTime":309.42,"body":"biopsy that embryo or do I put it back in me?"},{"startTime":309.516,"endTime":312.372,"body":"Now, the answer to that question, you need to know some other things"},{"startTime":312.532,"endTime":315.444,"body":"will Reboiopsy hurt my embryo. What's"},{"startTime":315.468,"endTime":317.924,"body":"the chances of me even getting results from the"},{"startTime":317.948,"endTime":320.676,"body":"rehbopsy, and would I be okay with just transferring the"},{"startTime":320.684,"endTime":323.636,"body":"embryo without the results? Now, at first glance,"},{"startTime":323.724,"endTime":326.636,"body":"it seems scary to put an the embryo back that you don't have results"},{"startTime":326.684,"endTime":329.51,"body":"for. But keep in mind, the chance of"},{"startTime":329.526,"endTime":332.422,"body":"you actually having a baby with a chromosomal problem"},{"startTime":332.462,"endTime":335.182,"body":"is very small. I actually did a podcast on the"},{"startTime":335.222,"endTime":337.926,"body":"specific topic. When you think about"},{"startTime":337.934,"endTime":340.534,"body":"it, the risk of putting back ambryo that's"},{"startTime":340.558,"endTime":343.39,"body":"untested is the same thing as everyone else putting back embryo,"},{"startTime":343.486,"endTime":346.166,"body":"not doing testing. So it's not a big"},{"startTime":346.214,"endTime":349.198,"body":"risk. Now, this only pertains to if you have a no"},{"startTime":349.27,"endTime":352.094,"body":"result. If it comes back mosaic, then the"},{"startTime":352.118,"endTime":354.174,"body":"question is, is that mosaic"},{"startTime":354.278,"endTime":357.27,"body":"embryo a concern? For example,"},{"startTime":357.326,"endTime":360.326,"body":"what if it's mosaic for down syndrome? Well, that may be"},{"startTime":360.334,"endTime":363.142,"body":"a little scary to put back, because then you may be worried,"},{"startTime":363.302,"endTime":366.278,"body":"what if it really does have down syndrome? Because it could"},{"startTime":366.31,"endTime":369.19,"body":"potentially be an embryo that has down syndrome. And then"},{"startTime":369.206,"endTime":372.03,"body":"the other concern you may have is if it comes back inconclusive,"},{"startTime":372.126,"endTime":375.014,"body":"does that mean it's more likely to be abnormal or the"},{"startTime":375.038,"endTime":377.83,"body":"same thing? If it comes back mosaic, is it more likely to be"},{"startTime":377.846,"endTime":380.788,"body":"abnormal? Now, if you have no problem putting the embryo"},{"startTime":380.82,"endTime":383.628,"body":"back without retesting it, then that's always going to be your"},{"startTime":383.66,"endTime":386.468,"body":"best choice. Anytime you read biopsy"},{"startTime":386.5,"endTime":389.484,"body":"and freeze and thaw, it's always going to add a"},{"startTime":389.508,"endTime":392.276,"body":"little risk to that embryo. Even if there is zero"},{"startTime":392.324,"endTime":395.044,"body":"risk from thawing it and"},{"startTime":395.188,"endTime":398.164,"body":"bombing it and refreezing it, there's always a"},{"startTime":398.188,"endTime":401.132,"body":"risk that you're handling it and something can go wrong. When you"},{"startTime":401.172,"endTime":403.7,"body":"handle embryos, something can go wrong. So"},{"startTime":403.836,"endTime":406.708,"body":"just in inherent nature, doing it"},{"startTime":406.74,"endTime":409.372,"body":"can cause problems. It'd be no different than like taking planes."},{"startTime":409.532,"endTime":412.244,"body":"If you fly a lot, the landing"},{"startTime":412.428,"endTime":414.872,"body":"and the taking off is the scariest part"},{"startTime":415.492,"endTime":418.348,"body":"because it's the most dangerous part. Being in the air is not"},{"startTime":418.38,"endTime":420.792,"body":"the most dangerous part. So the more that you"},{"startTime":421.252,"endTime":423.908,"body":"take off and land, the higher the risk it is. That's"},{"startTime":423.94,"endTime":426.22,"body":"why direct flights are technically"},{"startTime":426.356,"endTime":429.052,"body":"safer than taking a flight that has multiple"},{"startTime":429.092,"endTime":431.396,"body":"stops. Well, what if you don't feel"},{"startTime":431.444,"endTime":434.412,"body":"comfortable? What if you feel like you need"},{"startTime":434.752,"endTime":437.688,"body":"a clear result? Well, the good"},{"startTime":437.72,"endTime":440.608,"body":"news is that with doing a rebopsy, about"},{"startTime":440.68,"endTime":443.456,"body":"95% get a definitive diagnosis."},{"startTime":443.624,"endTime":446.336,"body":"For example, if you just take the general"},{"startTime":446.504,"endTime":448.84,"body":"embryos that you biopsy and get"},{"startTime":448.896,"endTime":451.528,"body":"inconclusive, what you find is about 50 to"},{"startTime":451.56,"endTime":454.392,"body":"60% of them come back eulooid."},{"startTime":454.552,"endTime":457.24,"body":"Even embryos that rec called mosaic will come back."},{"startTime":457.336,"endTime":460.254,"body":"You plo it. So if you're the type of person who says, I'm"},{"startTime":460.318,"endTime":463.142,"body":"never going to put this embryo back unless"},{"startTime":463.182,"endTime":466.15,"body":"I know it's normal, then the re BPSY would be very good for you"},{"startTime":466.206,"endTime":468.934,"body":"because now you can make that decision to use that embryo and it is"},{"startTime":468.958,"endTime":471.75,"body":"not lost. The way I look at this is if you"},{"startTime":471.766,"endTime":474.678,"body":"will never use that embryo unless tested, then who"},{"startTime":474.71,"endTime":477.382,"body":"cares if it's going to have a risk of being"},{"startTime":477.502,"endTime":480.494,"body":"killed or something when reboing? You weren't going to use"},{"startTime":480.518,"endTime":483.39,"body":"that embryo regardless. But for those of you who are"},{"startTime":483.446,"endTime":486.33,"body":"on the fence where you feel like I'd like to"},{"startTime":486.346,"endTime":488.862,"body":"do the biopsy but I'm worried going to hurt my embryo,"},{"startTime":489.402,"endTime":492.362,"body":"then this is where we're going to talk about the next"},{"startTime":492.402,"endTime":495.314,"body":"step. Does it hurt your embryo by doing the"},{"startTime":495.338,"endTime":498.178,"body":"rhiopsy? Well, as we talked about with the planes,"},{"startTime":498.29,"endTime":500.922,"body":"yes, there is always a risk, but"},{"startTime":500.962,"endTime":503.858,"body":"surprisingly, it's not as bad as you think."},{"startTime":503.97,"endTime":506.914,"body":"We do know that the survival rate after"},{"startTime":506.938,"endTime":509.842,"body":"the second thaw is lower than people who"},{"startTime":509.882,"endTime":512.71,"body":"have a single biopsy. After a"},{"startTime":512.766,"endTime":515.302,"body":"single biopsy and a"},{"startTime":515.342,"endTime":518.286,"body":"single freeze thaw, it's around"},{"startTime":518.334,"endTime":521.262,"body":"95%. And again, that's for the"},{"startTime":521.302,"endTime":523.902,"body":"entire country in these studies, not looking at"},{"startTime":524.062,"endTime":526.642,"body":"our specific clinic or your specific clinic."},{"startTime":527.142,"endTime":530.022,"body":"And then when they looked at for the second thought after being"},{"startTime":530.062,"endTime":533.005,"body":"frozen, again, it was more around 70,"},{"startTime":533.126,"endTime":535.974,"body":"80% survival. They also saw the same thing"},{"startTime":535.998,"endTime":538.812,"body":"in studies showing that clinical pregnancy"},{"startTime":538.852,"endTime":541.644,"body":"rate and the libipirth rate were slightly lower after the re"},{"startTime":541.668,"endTime":544.668,"body":"biopsy, with most clinics being around"},{"startTime":544.74,"endTime":547.244,"body":"50% for a"},{"startTime":547.348,"endTime":550.348,"body":"single biopsy and around 30 to"},{"startTime":550.38,"endTime":552.876,"body":"45% after a second"},{"startTime":552.924,"endTime":555.788,"body":"biopsy. Now, it's important to note that all the babies"},{"startTime":555.82,"endTime":558.804,"body":"are still healthy. That second biopsy has never led to a"},{"startTime":558.828,"endTime":561.708,"body":"baby having more problems. And it's also important to note"},{"startTime":561.74,"endTime":564.436,"body":"that other studies have actually shown almost no"},{"startTime":564.484,"endTime":567.374,"body":"difference in the live birth rates from"},{"startTime":567.438,"endTime":570.118,"body":"the second biopsied embryos and the single"},{"startTime":570.15,"endTime":572.95,"body":"biopsied embryos. In one study, they actually"},{"startTime":573.006,"endTime":575.862,"body":"found that the biopsy itself wasn't"},{"startTime":575.902,"endTime":578.322,"body":"causing any issues, but it was just the"},{"startTime":578.742,"endTime":581.51,"body":"freezing and thawing a second time that actually"},{"startTime":581.566,"endTime":584.302,"body":"compromised the embryo a little bit more. When they dig"},{"startTime":584.462,"endTime":586.918,"body":"deeper into it, what they found is the embryos that"},{"startTime":586.95,"endTime":589.822,"body":"didn't expand as well"},{"startTime":589.982,"endTime":592.894,"body":"on the thaw were the ones that didn't"},{"startTime":592.918,"endTime":595.646,"body":"do as well when it came to live birth rates."},{"startTime":595.694,"endTime":598.682,"body":"Meaning if it was slower to expand"},{"startTime":599.382,"endTime":602.23,"body":"and it took longer to expand, then that"},{"startTime":602.286,"endTime":605.142,"body":"may show that the embryo wasn't doing very well. Embryos"},{"startTime":605.182,"endTime":608.03,"body":"that were slower to expand were already showing"},{"startTime":608.086,"endTime":610.67,"body":"signs of some poor growth and maybe Some"},{"startTime":610.726,"endTime":612.918,"body":"difficulty. And so even though they were re"},{"startTime":612.95,"endTime":615.614,"body":"biopsied, the embry was already showing"},{"startTime":615.678,"endTime":618.58,"body":"signs that it was not as good as other embryos. This is"},{"startTime":618.596,"endTime":621.348,"body":"kind of like day seven embryos. We know that they have a lower"},{"startTime":621.38,"endTime":624.116,"body":"pregnancy rate and that's because it took them"},{"startTime":624.164,"endTime":626.804,"body":"longer to get to the blastocyst stage."},{"startTime":626.988,"endTime":629.94,"body":"Even when looking at things like day five or day six, BPsy"},{"startTime":629.996,"endTime":632.772,"body":"made a difference because again, it took the embryo longer"},{"startTime":632.892,"endTime":635.372,"body":"to get to that point. So that could"},{"startTime":635.452,"endTime":638.412,"body":"also put that embryo at higher risk, not"},{"startTime":638.492,"endTime":641.426,"body":"because of the biopsy, but because, that embryo was already"},{"startTime":641.474,"endTime":644.194,"body":"not doing well. This is a very important concept to"},{"startTime":644.258,"endTime":646.994,"body":"understand in your mind. You may be"},{"startTime":647.018,"endTime":649.922,"body":"thinking, oh, well, the day sixmer are going to do"},{"startTime":650.042,"endTime":652.994,"body":"worse. Yes, but not because of"},{"startTime":653.018,"endTime":655.994,"body":"the biopsy. The biopsy doesn't harm them in any"},{"startTime":656.018,"endTime":658.514,"body":"way. It's just that those embryos were always slightly"},{"startTime":658.578,"endTime":661.57,"body":"compromised because it took them longer to get to"},{"startTime":661.706,"endTime":664.594,"body":"day six or day seven compared to the ones on"},{"startTime":664.618,"endTime":667.426,"body":"day five that were ready for biopsy. This is why many"},{"startTime":667.474,"endTime":670.458,"body":"clinics will actually advise you"},{"startTime":670.49,"endTime":673.244,"body":"whether you should re biopsy or not. So for example,"},{"startTime":673.308,"endTime":676.068,"body":"at our clinic, we do not recommend certainrn embryos"},{"startTime":676.1,"endTime":678.916,"body":"being biopsied because we know that they're going to have a lower"},{"startTime":678.964,"endTime":681.764,"body":"chance of then surviving the thaw later and"},{"startTime":681.788,"endTime":684.54,"body":"leading to a live birth. We know that the"},{"startTime":684.676,"endTime":687.508,"body":"miscarriage rate is slightly higher on these re biopsied"},{"startTime":687.54,"endTime":690.476,"body":"embryos, especially the ones I talked about that were like day"},{"startTime":690.524,"endTime":693.316,"body":"six or that didn't re expand right"},{"startTime":693.364,"endTime":696.196,"body":"away. But the reason isn't so much because of"},{"startTime":696.244,"endTime":699.224,"body":"the embryo being biopsy, but the stress, on that"},{"startTime":699.248,"endTime":702.024,"body":"embryo that was already compromised and making it"},{"startTime":702.048,"endTime":704.904,"body":"worse. I wish I could tell you which embryos is the"},{"startTime":704.928,"endTime":707.776,"body":"biopsy and not. But the problem is every clinic"},{"startTime":707.824,"endTime":710.612,"body":"grades things different. Even the way"},{"startTime":710.992,"endTime":713.8,"body":"embryologist bops dambryos can make a difference."},{"startTime":713.976,"endTime":716.408,"body":"So when it comes to wanting to a re"},{"startTime":716.44,"endTime":718.84,"body":"biopsy, you really need to talk to your"},{"startTime":718.896,"endTime":721.784,"body":"clinic, talk about their experiences with it and"},{"startTime":721.808,"endTime":724.666,"body":"whether they recommend you byiopsite embr or not. Now, go"},{"startTime":724.69,"endTime":727.61,"body":"back to that point. If you're never going to use the embryo, then"},{"startTime":727.642,"endTime":730.578,"body":"what's the harm? You're not going to ever use it. So if"},{"startTime":730.586,"endTime":733.138,"body":"it hurts it, it hurts it. But if you're on that"},{"startTime":733.186,"endTime":736.05,"body":"fence, then I'd say talk to them."},{"startTime":736.242,"endTime":739.17,"body":"And if you really don't care, then just put the embryo back."},{"startTime":739.322,"endTime":741.826,"body":"That will always give you a better chance than even"},{"startTime":741.85,"endTime":744.482,"body":"rebiopsing it, meaning not hurting the"},{"startTime":744.498,"endTime":747.378,"body":"embryo. Obviously, if the embryo is abnormal, your chance won t"},{"startTime":747.386,"endTime":750.282,"body":"be low. If you Test andhi as normal it will be higher."},{"startTime":750.338,"endTime":753.316,"body":"But the testing doesn't make the chances better, it just helps"},{"startTime":753.34,"endTime":756.324,"body":"you know that the embryo has a higher chance. So when"},{"startTime":756.324,"endTime":759.1,"body":"it comes to ranking the embryos and determining"},{"startTime":759.252,"endTime":761.716,"body":"if they are going to come back with a good"},{"startTime":761.78,"endTime":764.064,"body":"result, what you find is, is that"},{"startTime":764.524,"endTime":767.516,"body":"no reeds usually do come back with normal"},{"startTime":767.58,"endTime":769.868,"body":"results. Meaning if we're expecting"},{"startTime":769.956,"endTime":772.636,"body":"60% of the embryos to be normal and you"},{"startTime":772.66,"endTime":775.372,"body":"had no DNA or no results,"},{"startTime":775.508,"endTime":778.18,"body":"you would expect the same 60%, the"},{"startTime":778.212,"endTime":781.086,"body":"comeback normal. So there's nothing that"},{"startTime":781.11,"endTime":783.998,"body":"is being told in the no result"},{"startTime":784.126,"endTime":787.11,"body":"like there's something wrong with the embryo. The results"},{"startTime":787.142,"endTime":790.038,"body":"would be exactly the same as if the results came back the first"},{"startTime":790.086,"endTime":793.063,"body":"time. Now, like we discussed, if that embryo is not the"},{"startTime":793.103,"endTime":795.607,"body":"perfect embryo that be biopsied, it could compromise it"},{"startTime":795.655,"endTime":797.815,"body":"slightly and could increase the risk of a"},{"startTime":797.839,"endTime":800.655,"body":"miscarriage. But overall the"},{"startTime":800.679,"endTime":803.191,"body":"differences are minimal. To give you an actual"},{"startTime":803.247,"endTime":806.128,"body":"statistic, around 95 to 90% of"},{"startTime":806.379,"endTime":809.063,"body":"previously inconclusive embryos gave them"},{"startTime":809.103,"endTime":811.975,"body":"conclusive diagnosis after retesting them."},{"startTime":812.079,"endTime":814.911,"body":"And that result tends to be exactly what"},{"startTime":814.927,"endTime":817.887,"body":"the result would be on the first popiopsy. So again, if it"},{"startTime":817.895,"endTime":820.775,"body":"was 60% it would still be 60%, meaning it"},{"startTime":820.799,"endTime":823.519,"body":"doesn't show any tipping to one side"},{"startTime":823.591,"endTime":826.559,"body":"saying that the embry may be normal or abnormal. But what"},{"startTime":826.591,"endTime":829.463,"body":"about mosaic embryos or segmentalloidy"},{"startTime":829.543,"endTime":832.471,"body":"embryos? What happens when you re biopsy those? I"},{"startTime":832.487,"endTime":835.161,"body":"mean, your thought would be probably they're going to come back"},{"startTime":835.177,"endTime":837.489,"body":"abnormal because that's why they were mosaic. Well,"},{"startTime":837.521,"endTime":840.473,"body":"surprisingly a lot of them come back normal."},{"startTime":840.553,"endTime":843.333,"body":"In a study published in 2023"},{"startTime":843.713,"endTime":846.241,"body":"titled Blinded Re Biopsy and"},{"startTime":846.297,"endTime":848.993,"body":"analysis of Non euupoid embryos with two"},{"startTime":849.033,"endTime":851.409,"body":"distinct PGT platforms for"},{"startTime":851.441,"endTime":854.305,"body":"anaploidy in this study they took 100"},{"startTime":854.369,"endTime":857.033,"body":"donated Blastocys originally classified as"},{"startTime":857.073,"endTime":859.689,"body":"abnormal, meaning anaploid or"},{"startTime":859.721,"endTime":862.253,"body":"mosaic by next gen sequencing."},{"startTime":862.633,"endTime":865.433,"body":"Then they performed four rebopsins"},{"startTime":865.513,"endTime":868.377,"body":"on each embryo, they took those"},{"startTime":868.425,"endTime":871.342,"body":"samples and then used a snip array which is a different type"},{"startTime":871.358,"endTime":873.566,"body":"of technology. The results were"},{"startTime":873.63,"endTime":876.59,"body":"striking. Every embryo that had been"},{"startTime":876.622,"endTime":879.318,"body":"diagnosed as mosaic by next gen sequencing"},{"startTime":879.446,"endTime":881.726,"body":"was uniformly euoid on"},{"startTime":881.75,"endTime":884.678,"body":"themp based retest, meaning"},{"startTime":884.766,"endTime":887.698,"body":"snip array. What this means is is that a lot of"},{"startTime":887.706,"endTime":890.65,"body":"the mosaics then are not through the whole embryo"},{"startTime":890.722,"endTime":893.682,"body":"because the other biopsies showed they were normal. And so it's"},{"startTime":893.698,"endTime":896.482,"body":"either possible that the technique before"},{"startTime":896.618,"endTime":899.17,"body":"caused the mosaic or they got the cells that"},{"startTime":899.202,"endTime":901.776,"body":"were only abnormal causing the mosaic"},{"startTime":901.88,"endTime":904.752,"body":"diagnoses. The other good news in that study"},{"startTime":904.928,"endTime":907.896,"body":"was that the embryos that were considered fully Anaploid,"},{"startTime":907.96,"endTime":910.608,"body":"meaning there was no mosaism were"},{"startTime":910.696,"endTime":912.972,"body":"confirmed when they did the SNP array."},{"startTime":913.148,"endTime":915.492,"body":"Overall, if it's mosaic or segmental"},{"startTime":915.548,"endTime":917.988,"body":"anyloid they were less concordant"},{"startTime":918.116,"endTime":920.964,"body":"versus if it was a whole chromosomal problem"},{"startTime":921.084,"endTime":923.716,"body":"it was highly concordant. So this"},{"startTime":923.74,"endTime":926.452,"body":"should reassure you that if you are concerned about a"},{"startTime":926.468,"endTime":929.22,"body":"mosaic embryo and you don't feel comfortable pointting it"},{"startTime":929.252,"endTime":932.108,"body":"back, there's a very good chance it's probably normal"},{"startTime":932.156,"endTime":934.436,"body":"anyways. And so unless it's one of those"},{"startTime":934.58,"endTime":937.38,"body":"abnormal mosaics such as down syndrome or"},{"startTime":937.492,"endTime":940.456,"body":"significant condition, you might feel comfortable just putting it"},{"startTime":940.48,"endTime":943.184,"body":"back because it's likely normal. But on the same"},{"startTime":943.224,"endTime":946.056,"body":"token you can also biopss it and feel comfortable"},{"startTime":946.12,"endTime":948.808,"body":"that the results will give you some clarity"},{"startTime":948.936,"endTime":951.856,"body":"and make your decision much easier. In the end, it's"},{"startTime":951.88,"endTime":954.608,"body":"a personal decision you need to have with your doctor. But it's"},{"startTime":954.656,"endTime":957.608,"body":"important to know that reiopsies can"},{"startTime":957.696,"endTime":960.284,"body":"provide results and most of the time do."},{"startTime":960.624,"endTime":963.056,"body":"I've seen patients who have had"},{"startTime":963.16,"endTime":966.054,"body":"abnormal embryos and don't believe it and"},{"startTime":966.094,"endTime":969.022,"body":"they've re biopsied it. And in at least the history"},{"startTime":969.078,"endTime":971.638,"body":"I've had with patients, I've never seen anyone with an"},{"startTime":971.686,"endTime":974.43,"body":"anaploid embryo ever come back"},{"startTime":974.582,"endTime":977.486,"body":"with a normal embryo after retesting it. Now keep"},{"startTime":977.51,"endTime":980.262,"body":"in mind when I say that I'm talking whole chromosome and"},{"startTime":980.278,"endTime":983.086,"body":"theloidy, not segmentals, not mosaix,"},{"startTime":983.19,"endTime":986.07,"body":"but actual the whole chromosomes missing. In"},{"startTime":986.102,"endTime":989.086,"body":"my experience I've never seen one come back normal. That"},{"startTime":989.11,"endTime":991.898,"body":"doesn't mean it can happen. We know the test isn'terfect."},{"startTime":991.946,"endTime":994.874,"body":"There's always the possibility that an abnormal embry"},{"startTime":994.914,"endTime":997.794,"body":"could be normal, but it's very very unlikely"},{"startTime":997.914,"endTime":1000.45,"body":"compared to the chance that it's actually correct."},{"startTime":1000.642,"endTime":1003.394,"body":"So in summary, if you really are not that"},{"startTime":1003.434,"endTime":1006.338,"body":"worried and just want to put the embryo back, you can"},{"startTime":1006.426,"endTime":1009.402,"body":"and the risk of having a child with some genetic problem is"},{"startTime":1009.458,"endTime":1012.362,"body":"very very low. This will give you the highest chance of"},{"startTime":1012.378,"endTime":1015.314,"body":"the embryo implanting and your pregnancy rate"},{"startTime":1015.354,"endTime":1018.322,"body":"and live birth rate would be exactly what it would be if you didn't"},{"startTime":1018.338,"endTime":1021.076,"body":"do testing. If you're someone who would"},{"startTime":1021.14,"endTime":1023.46,"body":"never feel comfortable pointing the embryo back unless's"},{"startTime":1023.492,"endTime":1026.252,"body":"tested, then you really have nothing to lose"},{"startTime":1026.348,"endTime":1029.212,"body":"because if you're playingning to discard the embryo, rebopsy gives your"},{"startTime":1029.228,"endTime":1032.092,"body":"embryo at least another chance without any additional"},{"startTime":1032.148,"endTime":1034.964,"body":"risk since you weren't going to use it anyways. So in that"},{"startTime":1035.004,"endTime":1037.628,"body":"situation I'd always recommend reiopsy."},{"startTime":1037.796,"endTime":1040.236,"body":"Why discard an embryo if it could potentially have a"},{"startTime":1040.26,"endTime":1042.66,"body":"chance? And if view are like most people"},{"startTime":1042.812,"endTime":1045.74,"body":"where you really are in the gray zone where you really don't"},{"startTime":1045.772,"endTime":1048.756,"body":"know what to do. Part of you wants to put it back, but"},{"startTime":1048.78,"endTime":1051.7,"body":"part of you scared then this episode was"},{"startTime":1051.732,"endTime":1053.964,"body":"for you to help you make that determination."},{"startTime":1054.124,"endTime":1056.804,"body":"Rebopsies can clarify ambiguous"},{"startTime":1056.884,"endTime":1059.764,"body":"results and can rescue embryos that you"},{"startTime":1059.764,"endTime":1062.544,"body":"are maybe not going to use. But there's a trade off."},{"startTime":1063.124,"endTime":1065.948,"body":"You might get the clarity, but it does have a slight"},{"startTime":1065.996,"endTime":1068.812,"body":"reduction in the implantation. And that's"},{"startTime":1068.868,"endTime":1071.28,"body":"because as we talked about the thawing and"},{"startTime":1071.312,"endTime":1073.768,"body":"freezing, we also discussed that there are some"},{"startTime":1073.816,"endTime":1076.376,"body":"embryos that are more suitable for re"},{"startTime":1076.4,"endTime":1079.369,"body":"biopsy. And unfortunately I can't tell you that at ah"},{"startTime":1079.448,"endTime":1082.16,"body":"your clinic because each clinic is different. But there are"},{"startTime":1082.192,"endTime":1084.976,"body":"some general ideas that make some embryos"},{"startTime":1085.04,"endTime":1088.016,"body":"better than others. Most of all, the"},{"startTime":1088.04,"endTime":1090.36,"body":"findings are very reassuring. Mosaic"},{"startTime":1090.392,"endTime":1093.12,"body":"embros often come back"},{"startTime":1093.312,"endTime":1096.12,"body":"eulooid, allowing you to use it versus discarding"},{"startTime":1096.152,"endTime":1098.26,"body":"them just like segmental"},{"startTime":1098.292,"endTime":1100.756,"body":"anaploids. Studies have shown that"},{"startTime":1100.78,"endTime":1103.196,"body":"there'no negative neonatal"},{"startTime":1103.26,"endTime":1106.156,"body":"outcome by having a second biopsy. No"},{"startTime":1106.18,"endTime":1109.164,"body":"matter what. The decision is going to be tough, but"},{"startTime":1109.204,"endTime":1112.172,"body":"hopefully this information is going to help you if you run to"},{"startTime":1112.188,"endTime":1115.14,"body":"that situation. I hope you liked this episode"},{"startTime":1115.172,"endTime":1117.86,"body":"and found it helpful. Unfortunately, if you're in this"},{"startTime":1117.892,"endTime":1120.716,"body":"situation, I know it's very tough. I think one thing"},{"startTime":1120.74,"endTime":1123.676,"body":"to remember too is that a lot of time these companies will not charge"},{"startTime":1123.7,"endTime":1126.66,"body":"you to reiopsy these embryos. So if that's the situation"},{"startTime":1126.732,"endTime":1129.5,"body":"like at our clinic, then there's at least no financial"},{"startTime":1129.532,"endTime":1132.492,"body":"repercussion. If you have a lot of embryos then you"},{"startTime":1132.508,"endTime":1135.356,"body":"may not have to worry about this decision. But if you do, I"},{"startTime":1135.38,"endTime":1138.3,"body":"hope this episode was helpful and helped you make a decision."},{"startTime":1138.452,"endTime":1141.3,"body":"As always, remember to talk to your doctor and your clinic"},{"startTime":1141.372,"endTime":1144.184,"body":"because those situations can be slightly different."},{"startTime":1144.644,"endTime":1147.612,"body":"If you liked this episode, as I always say, please tell your friends"},{"startTime":1147.668,"endTime":1150.204,"body":"about us. Give us a five star review on your favorite"},{"startTime":1150.244,"endTime":1153.196,"body":"medium is because of you of why this show is"},{"startTime":1153.22,"endTime":1155.996,"body":"becoming more popular and I can't thank you enough"},{"startTime":1156.1,"endTime":1159.052,"body":"for helping me. As always, I look forward to talking"},{"startTime":1159.068,"endTime":1161.7,"body":"to you again next week on Taco about"},{"startTime":1161.812,"endTime":1162.484,"body":"Fertility Tuesday."}]}