Fertility and Sterility On Air - Roundtable: Egg Sharing

Welcome to Fertility & Sterility Roundtable! Each month, we will host a discussion with the authors of "Views and Reviews" and "Fertile Battle" articles published in a recent issue of Fertility & Sterility. 

This month, we welcome Dr. Lydia Hughes and Dr. Eric Widra to discuss the ethics of egg-sharing, or "split-cycles" for fertility preservation. This is where an egg donor freezes their eggs for their own future use for reduced or no cost in exchange for donating a portion of the cohort.

Dr. Hughes is a second-year REI fellow at Northwestern University in Chicago, where she also completed her residency in Obstetrics and Gynecology. She earned her medical degree from the University of Alabama at Birmingham. Dr. Hughes’s clinical and academic interests include reproductive ethics, PCOS, and ovarian aging. 

Dr. Widra currently serves as Executive Senior Medical officer and Vice President, Development for Shady Grove Fertility and US Fertility, respectively.  He was formerly Chief Medical Officer of SG Fertility, and Associate Director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility, operated through the NIH, Walter Reed National Military Medical Center and SG Fertility.

View Fertility and Sterility at https://www.fertstert.org/

Welcome to Fertility and Sterility Roundtable. This podcast will delve into sections of the journal previously unexplored in the Fertility and Sterility podcast family. Articles that we would consider some of the most timely, cutting edge, thought provoking, and dare I say, controversial.

We will be joined by a couple of the authors each month to explore the themes, debate the pros and cons, and generally expand our knowledge in a conversational format. I'm your host and F&S Interactive Associate, Dr. Emily Barnard. And I'm your co-host and producer, Dr. Ben Peipert.

We will be covering articles in the Fertile Battle and Views and Reviews portions of Fertility and Sterility. This podcast is brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. Welcome everyone to Fertility and Sterility Roundtable.

I'm your host, Dr. Emily Barnard, and I'm joined by my producer and co-host, Dr. Ben Peipert. Today we will be discussing the Fertile Battle from the December 2024 edition of Fertility and Sterility, which is entitled "The Ethics of Egg Sharing". We are joined by two of the esteemed authors today who will go head to head to discuss whether offering a portion of eggs for future autologous use as an incentive for oocyte donation crosses an ethical boundary.

The disclaimer for both of our interviewees today is that they have been chosen to represent the full breadth of opinions, and as individuals, even if they appear to be taking one side of the debate does not necessarily mean they agree with all the viewpoints expressed. So without further ado, I'd like to introduce our guest today. I will start with Dr. Eric Widra, who is the editorial editor for this article.

Dr. Widra received his medical degree from Robert Wood Johnson Medical School, and he did his residency training in obstetrics and gynecology at Thomas Jefferson University Hospital in Philadelphia. He completed a reproductive endocrinology and infertility fellowship at the George Washington University. Dr. Widra currently serves as the executive senior medical officer and vice president development for Shady Grove Fertility and U.S. Fertility.

He was formerly the chief medical officer of Shady Grove Fertility and also the associate director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility, which was operated through the NIH, Walter Reed National Military Medical Center, and Shady Grove Fertility. On a national level, Dr. Widra is a member of the Resolve Board of Directors, and he's been actively involved in many different endeavors, including leadership positions in SART and at the American Society for Reproductive Medicine. Welcome, Dr. Widra.

Thank you for that kind introduction. We are also joined by Dr. Lydia Hughes. Dr. Hughes was the lead author for the Con side of the article.

Dr. Hughes is a second-year fellow at Northwestern University in Chicago, which is also where she completed her residency in obstetrics and gynecology. She earned her medical degree from the University of Alabama at Birmingham. Dr. Hughes' clinical and academic interests include reproductive ethics, PCOS, and ovarian aging.

Thank you so much for being here, Dr. Hughes. Thank you so much for having me. I don't know about you, Ben, but reading through this Fertile Battle article brought up a lot of really interesting ethical discussion questions, I thought.

How about you? Yeah, I really enjoyed reading both sides of this article and hearing the different arguments used to think about this issue. It's so interesting. Just taking a step back, I kind of want to turn it over to our guests today, thinking about the differences of language used by both sides.

So obviously, egg sharing appears in the title, but then the Con side uses split cycles, and I'm wondering if you guys could comment on that a little bit. So we use the term split cycles because we found that this was, more medically accurate when we're trying to decide how to use the exact terminology, and more medically accurate of what is happening in this model, where one person's oocyte is being split into a cohort of two. One for the patient themselves or that person themselves to keep for future fertility preservation, and then the other half being donated to a donor cohort.

So we found that this term was much more fitting than co-fertility or egg sharing, as these terms imply that both parties have equal benefit. We find that it's only truly equal if future utilization of these stored oocytes by the recipient and the donor, and there's benefit to each of them. Wearing my editorial hat, I think that I have no argument with using split cycle to a medical audience.

And as an editor, I think, hey, what does our readership think? And so for me, I don't have any argument there. However, if I said to a patient, hey, do you want to do a split cycle? She'd be like, what the heck is that? And so I think egg sharing is a more kind of consumer-friendly and patient-friendly word, and that's intentional, right? The people who are promoting this process want to get people in the door and take care of it. And so, yeah, it's intentionally that way.

But I do think that the language that we use sometimes has unintended consequences, and we can discuss whether this is one of those cases or not. It seemed to me in reading this article, even just kind of starting reading the pro side and the con side, that kind of the intent of the person coming into this process seems to be important in the discussion, even in how we're kind of labeling it or what nomenclature we're using. It's maybe different if someone is planning to donate their eggs and kind of later learns about this as an option where they can keep a portion of them versus maybe someone who's looking to freeze their own eggs as their initial goal, and then is utilizing this as a manner to access care.

Any thoughts on this? I can start on this one. I think that to pretend that this is not a mechanism to increase the availability of donated eggs would be unfair and inaccurate. We have excess demand for donor eggs.

We have a problem with diversity in the donor population. And so I think that what we're examining here is, is the incentive that's being provided here ethical? Because that's what it is. It's an incentive to donate eggs.

And so let's not hide from that, right? The good that we're providing here on the pro side is that we are increasing the supply and availability of donated eggs and giving someone the potential to have eggs frozen for the future. And yes, there may be some women who come in and say, holy cow, this is way more expensive than I thought. I really want to save eggs for the future.

Is there something in between? And by the way, that's been done with IVF for decades where women have been offered a discounted procedure for their own IVF in return for donating some of those eggs. So it's not necessarily a new concept, but the goals are very different, right? I really want to have a baby now versus I might need eggs for the future, or I really want eggs for the future. And I think those are all different cases.

Great. And I think for, you know, for our perspective, I think just breaking down, yes, there is clearly a demand for donor oocytes, especially we can get into like the diversity that is needed among that population. But I think when we look at this as this model ethical, and we have to think about the motivations of the patient that is coming to use this model.

And we find that the motivations of a woman who is deciding to freeze her eggs for her future reproductive use is distinct from the woman that is desiring to donate her eggs to an infertile couple. And I know that there's a paucity of data in this really, but when we think about that, that's where we kind of have this ethical barrier, where if we think about if somebody was coming to donate their eggs and they received compensation for that financially, and then turned around and said, hey, I want to use this money to purchase my own autologous cycle, we find that a more ethical way to go about it. I'd like to take a second to dig into that a little bit more and think about the differences between being compensated for your eggs and receiving half the cohort for yourself for your future fertility preservation.

Like, how do you think about the differences there? I think that's a great question. And I think it's in the eyes of the person going through this on both sides, right? So is there a difference between me getting $4,000 for donating my eggs or getting 12 eggs frozen for the future? And I can't value that for you, right? That's a personal decision. But I think that it's legitimate to ask the question, hey, is this something that is valuable to you? Because if it's not, why would they do it, right? Is $4,000 more important to you or is it doing this, having these eggs for the future? I think the key is disclosure.

Everybody knows what $4,000 buys, right? Not everybody understands what 12 eggs means or 10 eggs or 8 or 15. And I think that a careful conversation about that disclosure is going to make a big difference about how we feel about this ethically. Yeah, I do agree with that.

I think that, you know, I think it's really important that, you know, regardless that patients pursuing this model, pursuing OSI cryopreservation are adequately counseled on what the number of eggs means, because I think financially compensation is one thing. And I think one issue is, you know, we said the example 12 eggs, but in, you know, a lot of these cases, I think that there's not going to be 12 eggs for this person presenting to cryopreserve. And what's the meaning of six eggs? What's the meaning of five eggs? We know that there's, you know, new data from an F&S article from Dr. Roelker looking at OC cycles of 6,000 women that came, and most women had to undergo more than one cycle to achieve their age-based recommendation of matured oocytes.

Only 4% of women achieved that with one cycle. I think you bring up a really important nuance here, and it's how is this executed, right? So if it's one and done, yeah, I'm going to have a bit of a problem with that for the exact reason that you mentioned, because nobody's getting the maximum benefit there, right? If the total cohort is 12, you know, the probability of live birth for both people in this arrangement is pretty modest. And it certainly isn't a number that I would be comfortable telling someone that, hey, if you come back in 10 years, you know, that's a good deal.

So yeah, I think that how you execute this and how you set expectations is important, and I would agree. The donor would be disadvantaged more than the potential recipient by a small number of eggs, because the potential recipient is going to find out the outcome quickly. To your point, like, I think if there was, if there existed a framework for patients that, you know, went over these guidelines and they were all adequately counseled and they went in saying, yeah, I'd rather, instead of money, take this, you know, lower reproductive cohort of eggs and donate, I think that that, you know, then they're well counseled patient autonomy.

But I really think that the concerns with this model is that it's market, you know, it's a market. There is, you know, there's financial gain for the company. We can break down the numbers, but I think that that's, you know, the biggest concern is that, like, how are patients counseled going into this and the motivations being different, as we discussed for both parties? Compensation for donating biological material is as old as blood transfusion, right? And at the time, there were really difficult conversations about who's donating the blood and how drunk were they at the time, you know, and I mean, that's a caricature, but that's, you know, that was a real concern, and it's been a concern within reproductive health since the beginning of sperm donation.

So, yeah, this idea of a true measure of what the compensation means, I think, is critical. But let's not forget that that's all, what I guess I'm trying to say is that's always been true, right? There's always been this tension between the compensation and the benefits for both parties, including the altruistic benefits of donating. So, yeah, I get back to my prior point, is that how you execute this, I think, bears very strongly on the ethical argument.

I think if you were to kind of set up a framework of that, what would be some safeguards or some things you'd want to put in place to make sure there was as good as could be informed consent in someone who's thinking about being a donor in this situation? I mean, I think we'd have to review the data, like the data we know, which is, and I think the same is for already planned chronic preservation cycle, not just in this model, but being very, very clear on counseling patients upfront. Nothing is a guarantee, and then to reach an age-based mature oocyte, even that's not a guarantee, but it may require more than one cycle. And going through this process, there is risk going through this procedure, and then the benefit is that you have this future potential reproductive cohort for future use.

But I think there's also a lack of data, too, which is hard. This makes this lack of data, lack of framework for this, that makes it hard. I think that I'm going to try to do this with two different hats.

The first hat is going to be what makes sense medically and biologically, and I think there's a lot of ways you can chop this up. But I think that the donor should have enough eggs preserved for her future as any other woman who comes in and says, I want to cryopreserve my eggs, within reason. Now, many of these donors will be 25, 26, and while we don't have normative data for that, we certainly know that it's a lower number than if you're 35, right? So if we think that the optimal number there is 15, you've got someone going through multiple treatments and the risk associated with those treatments to get to that.

And I do agree that there are problems there. An interesting way to compensate for that, medically, risk-wise, not monetarily, would be to say that this is our goal for the recipient to have eggs, because that number might not be as big, because you're going to use those eggs immediately. And so that might be a more equitable way of offering this to someone.

I don't know if that works in a business model. I haven't run the numbers and I can't do that in my head, but it does speak to the tensions that are here between who gets what out of this and at what cost for both parties. And how many excess cycles and the risk, albeit small, associated with those cycles crosses the boundary? And I don't know the answer to that question.

We have a famous patient in our practice who got two or three eggs and she said, I'm just going to keep doing this. And we counseled her to the ends of the earth and she did a ridiculous number of cycles, but she ended up with whatever, 15 eggs. And so for her, we couldn't talk her out of doing that.

And at the other end of the spectrum, do you want to set that expectation up for somebody who's being recruited by the idea of having eggs for the future? So both of you alluded to this idea that this sort of model could bring in a more diverse group of patients. I don't know the literature as well on this topic, but are you familiar with any research or data that supports that conclusion? Because I see this, if there's not, then there's a pretty good opportunity to do some investigation as to if that actually will provide a more diverse donor population for patients. I'm not aware of any data.

I know one thing that is clear is that people who come in to freeze their eggs are not particularly diverse from a socioeconomic and demographic standpoint because of the financial barriers to entry. So yes, it is logical to presume you could open up that option to more people, but then you get into the very gnarly area of taking advantage of people who are in different socioeconomic or demographic groups and circles back to the points that we've been making about how do you make this equitable and fair? Books can be written about this stuff, not necessarily with egg freezing, but in other areas of healthcare. So yes, is it logical? Sure.

But are there data? No. Yeah, and that's what I was similarly saying. I don't know of any data, but I think my greatest concern is the potential threat to healthcare justice in the sense that considering minority groups and considering a lot of minority groups may be from lower socioeconomic populations, there's a very real possibility that off-screen coverage may attract individuals that really desire fertility preservation and otherwise cannot afford it.

The biggest priority should be for our patients is that we're increasing oocyte cryopreservation for individuals and not necessarily through this modality. And I think if there was with this plan, I think it obviously omits the alternative here where if somebody truly wanted to donate their eggs and they've got financial compensation and then spent that on an autologous site, that just in terms of ethically avoids this sort of conundrum of patients that might be coming to try to do both. I think those are excellent points.

And if I can put on my RESOLVE hat for a minute, what is clear is we are not serving the broader population of couples and women who need infertility services. I mean, I've worked in Washington, D.C. and I saw hundreds of African-American and Hispanic women who came from the east side of the river who wanted to freeze eggs and it was sticker shock. But once again, then do you cross another justice boundary by doing this? And yeah, it's a very sticky issue.

On the other hand, it's what's fun about what we do. We've been at the forefront of so many different ethical conversations in this field and it's part of what's exciting about it. And I don't think we should ever throw out an idea until we've had a chance to really explore it.

And I also wonder, do we happen to have data on like do a dozen oocyte donor or how many oocyte donors, which typically are in their 20s, end up later going on to go through egg freezing cycles in their early 30s? Well, that's always been one of the real sticky issues around oocyte donations. Doc, is this safe for me for my future? Well, we know you're not going to change their egg supply. And barring a rare complication, they're probably not going to have any physical consequences.

But the data on this, there have been a couple of small longitudinal studies and they're reassuring. But yeah, we don't live in a medical—and again, this gets back to how our field is always in these ethical discussions because there's just no way that's going to happen in the United States and in countries where they do have great registries and longitudinal studies. So we're kind of stuck trying to do the best we can with the information in front of us.

And also speaking of longitudinal studies and sort of the benefit, or maybe lack thereof, of doing oocyte cryopreservation too early is that future use. And we do know through several studies that there's actually pretty low return use of these cryopreserved oocytes seven years down the line, 10 years down the line. I think that's also a concern in general with the whole practice of freezing eggs as future use.

For sure. But you know, the less you need it, the cheaper your insurance is, right? So yeah, I mean, if you're 27 and you freeze 15 eggs, there's a very high probability you're going to have a baby from those 15 eggs and a very high probability you'll never need them. What I think we're required to do is counsel people about those two realities and help them decide.

Whereas at 34, I think the math is very different in both directions. When you think about the ethics for any of these issues, there's multiple parties at stake. And so here we have the ethics related to the recipient and the ethics related to the donor.

Right now, we know we have a lack of diversity in terms of the eggs that are available for recipients. And so one of the interesting things that this article brings up is that perhaps this is a way of making sure that all populations who need donor eggs have access to donor eggs that will provide offspring that look like them. Where does that fit into this discussion? Because I think we focused a lot on the donor, but this recipient side of things is so interesting to me.

The question that is at the root of this is why don't more diverse populations donate eggs? And there are some data on there that there are cultural and religious factors involved. But I do think there is probably an element of access to health care, period, that we see less diversity in women coming to donate. And we were in the preamble to this.

We were talking a little bit about this desire to have somebody who is like you. And the comment I've made to my patients over the years is, your 26-year-old twin isn't out there. You're going to be making compromises here.

And they can be difficult. But yeah, you come up against some very hard compromises that just don't work. Yeah, I will be curious to see, because I think when Ben and I were reading this article, there's a lot of citations on different research studies, and we didn't really notice one that showed that diversity is improved with doing this type of model.

So I think it will be interesting to see if this does bring in more diverse populations, because there is compensation monetarily currently. And maybe we're still struggling to get different ethnic groups. So I don't know if this particular model will bring more people to the table who are interested, or if we may still be met with kind of the same challenges.

I think this gets to one of our biggest problems in health care in general in the U.S., is that to actually measure that takes time, money, and effort. When it comes to those types of questions, we're resource limited in this country. A lot of health care is done in the private sector, where there are pressures on budgets.

And in the academic sector, there's limited funds to do this kind of thing. So it is really a challenge. And so, yeah, I think that Lydia and I would both challenge the people who offer this to measure and to report it, and to see if it is having the positive benefits, and not be afraid to back down if they don't exist.

How about we talk a little bit about kind of patient autonomy and thoughts about patients who would rather do this egg sharing or split cycle model than being directly compensated? What are your thoughts on that, on these patients kind of coming to the table and wanting to use this model rather than being paid for their eggs? That kind of doesn't feel good for them. I mean, I think that's very fair, that there are patients out there that may be like that. But I do think that, you know, adequately counseling patients, going back to kind of talking through their reproductive potential, and understanding what they're getting with this model, both the donor and the recipient is important.

Getting back to what we talked about a little earlier, this person is being compensated. They're being compensated with the potential to use eggs in the future. And that's a very nuanced form of compensation that I think, as Dr. Hughes points out, needs to be, you know, transparent at the outset.

I do think we get a little too focused on the market aspect of this sometimes as well. I really do believe there are people out there who get benefit from being altruistic. They donate blood, they sign their organ donor cards, they, you know, they do bone marrow.

So yes, you don't get nearly the number of donors without compensation, but you don't get none. And so I think that it is important to recognize that element of autonomy. But is that a large number or a business model? No, it isn't.

So let's not pretend that this isn't really an incentive to increase the number of eggs that we have. Yeah, I agree that, you know, altruism exists, but it's not something that should be presumed supportive with this model. And so the concern is not that patients don't have altruism.

I think that's absolutely there for a lot of donors. But I think our concern with the, you know, the marketing aspect is like, worry about this being exploited, just in certain, you know, how they're frankly like very heavy feminism themes and sisterhood advertising by companies is, you know, what kind of concerns us. But I don't want it to muddy the water or just or say that, you know, that there isn't altruism because there's certainly patients out there.

I just want to make sure that patients on both sides, the recipient and donor are being adequately counseled. You know, and I think that your comments about the way it's marketed are resonant. But having lived through all kinds of transformations in our field of medicine, I can say that you got to get the phone to ring to have the conversation.

And so I'm sympathetic in both directions. Right. I'm sympathetic that you can you can deeply believe that you're doing this right and doing it ethically, but need to send a message that gets people to come in.

And I think you can be predatory and mercenary and, you know, not disclose that and still use the same marketing. So, yeah, it's it's a very sticky situation. And I will say it does sound like based on reading the pro side, it does sound that the studies where this model, you know, in the UK is one of them where they, you know, patients that have gone through this model seem to really they get a lot of benefit and there's a lot of positive feelings from it.

So I will say that I did look at that. And I do think that there is something there. And I think that that does speak to the altruism of patients coming and actually proceeding with this model.

The reason for that is there's no financial compensation in the UK. Yeah. So it's either pure altruism or a deferred compensation in terms of frozen eggs.

And so, yeah, that's a you know, that's a that's a study design problem there. Right. Totally.

Shifting gears a little bit, I want to think a little bit about the ethics of disclosure. And so when Emily and I were talking about this article before our conversation today, we were thinking about what is the obligation of the provider to disclose to the donor if the recipient has a bad outcome with those eggs? And how do you think through that? Because that may be relevant to the donor at this point if there's something that indicates their reproductive potential could be compromised in the future. I think that's really challenging.

It's a really it's a really good question. But I do think that ethically, you'd be obligated to be transplanted if it would impact the future reproductive ability of that of the donor. And, you know, even if this information is uncomfortable, because of it, I think denies the patient the agency and potentially could cause harm.

But that being said, it must be compassionate and data driven and sensitive. Not sure quite what happened in these scenarios, but I'm sure this does come up with the model today. The dogma on biological donation is you don't get to know.

Yeah, you don't get to know. And now and are with exceptions. So in the sperm donor world, donors don't get to know unless something comes up that's that is clearly assignable to the donor, like a genetic problem.

Right. So now we screen for 500 things. But in the days before we screened for 500 things, if you know, a baby was born from donor sperm that had a genetic abnormality, there's a duty report and that duty still exists.

It's just much less common because the genetic screening is the same for egg donors. But none of your recipients got pregnant, you know, or your eggs look like crap. I mean, you know, you just that's not clinically actionable information.

Totally. Yeah, I agree. You know what would happen to the kidney you gave up or the bone marrow? You know, yeah, it's great to find out that the bone marrow recipient is in remission.

Not so great to find out they died. Yeah. So, you know, that's a good point.

This is really a thorny issue. And I'm not pretending to have answers by bringing these out. But these are the things that we've dealt with for decades.

And once again, it's something that's so unique about our specialty, because, you know, as I tried to explain to somebody about a medical record a million years ago, we don't have one patient. We've got X patients and X could be, you know, the intended parent, the partner, the donor, the embryos, you know, and so, you know, there's there is some responsibility to all of those in the work we do that's completely unique. And so it's hard to compare it to a kidney or bone marrow, but it's also not irrelevant.

Yeah, I agree what you said, too. And I think to your point, exactly, I think it's not really a translatable outcome yet, you know, that how if your eggs don't look great, or there wasn't a live birth from the cohort of eggs, the six eggs you might have donated, like, how does that translate to you? And should that would that cause undue anxiety? So I think that that could cause harm in a way. So I don't know if we have the right answer.

To your point. Yeah, we live in a world where many people feel that the more information you have, the better off you are. And it's not necessarily the case.

Yeah, I feel like as a reproductive endocrinologist, we're often asked to play this role of assuaging people's anxieties, but also causing undue anxiety often when we're offering services that patients interpret as meaning something is wrong with them, when it doesn't indicate anything about their ability to conceive unassisted. So how many how many guys have we seen with low sperm morphology? Yeah, in an absolute lather, it's like, I don't know what it means. I would say I was gonna say low AMH and people freezing that we have so many, I mean, we're in, I'm in Illinois.

So we have a lot of ability to do ovarian cryopreservation cycles, particularly within my own academic community. And we have a lot of well educated patients finding out they have low ovarian reserves. And it's really distressing, even though it I don't mean low as in like, premature ovarian insufficiency low, but just a lower normal.

And what that means for the reproductive potential, it's it really causes a lot of anxiety, even though we know that that for natural fertility doesn't impact outcomes. Yeah, I fought very hard at a local level and ASRM level for many years to not be screening women who aren't trying to get pregnant. But then egg freezing came along.

And I do think that there is an autonomy argument that if you have something that is different than average, and you can act on it, that that's within your autonomy for a technology that's turned out to be pretty good. My summary in support of offering this is that with proper disclosure and proper counseling about expectations, and an equitable distribution of resources, this may be a very good way to help everybody. It can potentially increase availability of eggs, give people peace of mind for the future, and potentially increase in diversity.

But as I've mentioned several times during this discussion, the execution has to be really good. So I'll give the summary for the con side, my co-authors and I would agree that that split cycles are unethical. From a medical standpoint, we believe that neither party truly benefits from the reduced reproductive potential.

From a financial standpoint, we believe that companies are benefiting from this, not necessarily the donor or the recipient. And then ethically, we think for consent and counseling is really paramount here in terms of patients who understand that and reduce reproductive potential of doing this model. Thank you so much to our guests, Dr. Eric Widra and Dr. Lydia Hughes.

We hope all of our listeners enjoy this spirited discussion. We would love to get your input. If you are a listener, please leave us a rating or review, look for us on social media and let us know what you think is egg sharing or split cycles an ethical option.

Until next time. This concludes our episode of Fertility and Sterility Roundtable brought to you by Fertility and Sterility in conjunction with the American Society for Reproductive Medicine. The podcast is produced by me, Dr. Ben Peipert.

Fertility and Sterility Roundtable was developed by Fertility and Sterility and ASRM as an educational resource and service to its members, other practicing clinicians, and members of the public. The opinions expressed are those of the discussants and do not reflect the views of Fertility and Sterility or ASRM. Fertility and Sterility Roundtable was developed by Fertility and Sterility and ASRM as an educational resource and service to its members, other practicing clinicians, and members of the public.

The opinions expressed are those of the discussants and do not reflect the views of Fertility and Sterility or ASRM.