Fertility and Sterility On Air - Roundtable: Fresh vs Frozen Donor Oocytes

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 featured in the August 2026 edition of Fertility and Sterility entitled “Fresh vs frozen donor oocytes in contemporary assisted reproductive technology.”

We are fortunate to be joined by three of the esteemed authors of this Fertile Battle publication as well as the Editorial Editor to discuss the issue in depth.

Dr. Eric Widra currently serves as Executive Senior Medical officer and Vice President, Development, for Shady Grove Fertility and USFertility, respectively. He was formerly Chief Medical Officer of SG Fertility, and Associate Director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility. Dr. Widra served on the SART Executive Committee and on the ASRM Practice Committee and was a contributing author to dozens of ASRM Practice Committee documents. He is currently an Editorial Editor for Fertility and Sterility.

Dr. Oisin Fitzgerald is a research fellow at the University of New South Wales, Sydney, Australia. Dr. Fitzgerald’s work in reproductive medicine focuses on the use of real-world data (e.g. electronic medical records, registry data) as sources of evidence for open questions in clinical practice and to build prediction models that inform consumers and clinicians on IVF success rates.

Dr. Kiley Hunkler is a recent graduate from fellowship in Reproductive Endocrinology at the National Institutes of Health. She earned her masters degree from the University of Oxford and enjoys working on curriculum development and advancing patients' access to care.

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 FNS 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 featured in the August 2026 edition of Fertility and Sterility entitled Fresh versus Frozen Donor Oocytes in Contemporary Assisted Reproductive Technology. We are fortunate to be joined by two of the esteemed authors of this fertile battle publication, as well as the editorial editor to discuss this issue in depth.

I would like to start by introducing our guests. First, I'll start with Dr. Eric Widra. Dr. Widra currently serves as Executive Senior Medical Officer and Vice President of Development for Shady Grove Fertility and U.S. Fertility respectively.

He was formerly Chief Medical Officer of Shady Grove Fertility and Associate Director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility. Dr. Widra served on the SART Executive Committee and on the ASRM Practice Committee and was a contributing author to dozens of ASRM Practice Committee documents. He is currently an editorial editor for Fertility and Sterility.

Thanks for joining us, Dr. Widra. Thank you. We are next joined by Dr. Oisin Fitzgerald.

Dr. Fitzgerald is a Research Fellow at the University of New South Wales, Sydney, Australia. Dr. Fitzgerald's work in reproductive medicine focuses on the use of real-world data, like electronic medical records and registry data, as sources of evidence for open questions in clinical practice and to build prediction models that inform consumers and clinicians on IVF success rates. Welcome, Dr. Fitzgerald.

Very much. Dr. Kiley Hunkler is a recent graduate from Fellowship in Reproductive Endocrinology at the National Institutes of Health. She earned her master's degree from the University of Oxford and enjoys working on curriculum development and advancing patients' access to care.

Thanks so much for joining us, Kiley. Thanks so much for having me. And before we get started into our discussion today, we just always want to give the disclaimer with these fertile battles that the authors are chosen to represent the full breadth of opinions.

So individual authors, even if they were kind of speaking from one side of the debate, do not necessarily agree with all the viewpoints expressed. So we appreciate everyone being here today. So just to start us off, I'd love for Dr. Widra to give us a little bit of context to help frame our discussion today about this debate between fresh and frozen donor oocytes.

Thanks so much, Ben. And thanks, Emily. When we were looking at potential fertile battles at the editorial board, it's always a fascinating process.

I'd love to take credit for thinking of this idea, but usually it's a seed of an idea from one editor and we kind of riff on it and usually come up with what I hope is a good and compelling conversation. I think what's especially interesting about this particular fertile battle is that it lies at the intersection of many different possibly competing priorities. So in the setting of donor oocytes, donor eggs, we have the donors who are the rate limiting factor in our ability to provide this care to our patients.

And so our ability to recruit and retain donors and to get them to cycle is a huge priority and one that may drive certain compromises down the road. On the other side are the patients who need these donor oocytes and they want them yesterday. And they put enormous pressure on us.

And we lie at that intersection where we want to practice efficient and ethical medicine, but also part of that efficiency is getting these people what they need as expeditiously as possible. So we have all those pressures competing with the data and the science that our authors are going to talk about tonight and try to help our readership, viewership come up with a balanced view of this and one that they can carry into practice effectively. So thank you so much for that background, Dr. Widra.

I'd like to open it up to each side of our debate today just to give a little bit of a summary of their side of the argument. So why don't we start with Dr. Fitzgerald who wrote the fresh side of this discussion? Yeah, thanks, Ben. Yeah, so when I was first approached to write the pro side for this, I think we just published or submitted an article to Fertility and Sterility on comparing fresh and frozen eggs in autologous cycles.

And so I sort of thought, okay, well, this is just this is the same story. It's just in terms of donor oocytes, probably on average, frozen eggs are maybe a little bit worse, but if you go to the right clinic and in the right setting, the difference is probably so small that you've got to see a large number of patients to really see a large impact. But of course, then we quickly realized that when you're looking at donor oocytes, you know, all across the world and within any country, even that the story was, you know, much more complex.

For example, looking, you know, we're looking at, I'm based in Australia and Sydney, we're looking at how many first question was how much are fresh and frozen donor oocytes being used compared to the USA. And for example, in Australia, fresh donor oocytes are still much more popular than the USA where the frozen ones. And that was, that's just a sort of artifact of very differences in regulation.

You know, you can't pay for an oocyte here, or you can't pay for sort of donation of gametes. And then sort of realizing that in the USA, the laws and regulations around sort of payment meant that there was, you know, almost a sort of market for gametes and how that had combined with the success of vitrification as a technology had led to a large industry of egg banks and how, you know, it was again, that sort of the combination of how they operated in terms of batching oocytes and stuff. Like for example, you don't just get all the oocytes from one donor, had an impact on the success rates.

I think our argument on the pro side was, it's quite a complicated story to sort of disentangle. There's, you know, on the frozen eggs, there's a lot more ways that variation in sort of clinical or laboratory performance can be, are introduced. You have the performance of the egg bank and how good is their freezing? You have, does the large transportation of the oocytes impact the success rates over, you know, just being within one clinic, which sort of, you know, the RCTs that generally show equivalence are often within a single center or multi-center under one group.

And how does that impact the quality of the oocytes or their survival rates? And then the batching effects, meaning that you don't necessarily, you're not necessarily getting all of the best embryos from one donor's batch means that, you know, it sort of on average, when you sort of, there's a paper, for example, that shows when you have a fresh donor, you might get, so, you know, all the oocytes, you might get 11 to 12 and get a cumulative live birth rate of 75%. So one patient can be relatively confident if they have access to fresh oocytes that have a pretty good chance of a donor. Whereas if you're going down the, have to use an egg bank, you might end up with less.

But of course I can definitely see the other side of the story that you need to have access to the fresh donor to be able to get that. So yeah, it's definitely not a simple, everyone should be, has to use fresh, but the availability of the frozen definitely means people get access to donor oocytes they might not have otherwise. Thank you, Dr. Fitzgerald.

I do think you highlighted, this is quite a nuanced discussion and nuanced debate. Good job to Dr. Widra for picking this as a fertile battle topic because there is quite a few layers to it. We were approached to write the con side where, you know, just speaking about frozen donor oocytes, admittedly, I do think we're approaching it from definitely a lens from practicing in the United States.

And so in the United States, we know that the utilization of frozen donor oocytes has really increased dramatically over the years. And we have data from various national registries to support that finding. And what we try to argue is that really over time, the data is more and more favorable towards outcomes of frozen donor oocytes, whereas the initial studies maybe not, maybe were not as favorable.

The practice committee opinion from ASRM that came out in 2021 even concluded that pregnancy rates per transfer were similar between fresh and frozen donor oocytes. And that was really from an appraisal of mostly cohort studies at the time. And since then, we have a little bit more robust data to inform our practice.

And encouragingly, a lot of those outcomes have shown to be pretty equivalent between fresh and frozen donor oocytes. But one of the most convincing statistics, I think to us, is using the most recent SART data to look at live birth rates between fresh and frozen donor oocytes with as up-to-date data as possible and to show pretty reassuring outcomes between the two. I think the other side to this discussion that Dr. Fitzgerald also highlighted is that donor oocytes can be quite a scarce resource because what frozen donor oocytes allow is to increase diversity among the very limited pool we have of donor oocytes.

And then the last piece of this puzzle really to talk about is cost and logistics. And while we absolutely want to maximize outcome per patient, we should be mindful about cost on both the individual level and also the level of the clinic as well as how complex it can be to try to synchronize both the donor and the recipient cycles and what ease of logistics a donor oocyte can afford us. If I can add something to the conversation that maybe comes from the perspective of a lot of gray hair.

You know, when I first started in this field and we were transferring four or five embryos hoping that one stuck and finding ways to cleverly demonstrate that your success rates were better than the guy down the street, the world has changed dramatically. The distribution of success rates in reproductive technology has changed. The bell curve is narrower and moving in the right direction.

I think a future where this is much more ordinary and much more routine and much more predictable is one that can allow us to use different resources depending on the setting in which we practice. Yeah, I think one of the things I was thinking reading this, and I don't know if either side specifically touched on it, but you know, we know the age of having first child or having children in general is going up. So I'm be curious for Dr. Widra's perspective too, but to either of you is donor oocyte, I suspect being utilized probably in all countries more commonly and has that sort of helped facilitate this discussion as well.

Like maybe it's a little challenging for all of the cycles that are needed now with how many patients are utilizing donor egg to coordinate all these fresh cycles. This was sort of a solution that we found to help more patients, like we've been saying. The demographics and the ironies of reproductive aging around the world are fascinating, but I certainly would defer to these experts on what the data show us about those trends around the world.

The number of oocyte cycles has increased pretty remarkably in the last two decades, speaking mostly from U.S. data, but the overall cycle number has increased and then the proportion of the donor oocytes that are frozen has also drastically increased. But I think to your point too, when we think about a patient population who uses donor oocytes, and you know, of course it can be more diverse than this, but generally speaking, probably an older reproductive age, because I know a critique of the frozen oocytes is it's in a batch of, you know, six to eight oocytes, and is that enough? Are we optimizing their reproductive outcomes enough? And you know, there's been survey studies looking at patients who are requesting donor oocytes and what their family building goals are, and I think for many patients they might not be as expansive of a family building goal as patients who might be in younger reproductive years. So I do think there's at least some survey data to support that these cohorts are enough to match family planning goals and specifically with trying to optimize outcomes.

But I do think the trends are increasing everywhere. Yes, according to my very quick research, utilization rates in Australia and New Zealand are increasing year over year in response to demand and increasing maternal age. So the story in our southern hemisphere is not much different than our northern one.

My suspicion is no, but I don't know if either of our authors would ever say in all circumstances we should move to using frozen donor oocytes or in all circumstances we should use fresh. So I'd be curious if there are certain scenarios where maybe you could see the pros and cons of both. You know, maybe like we mentioned an older couple or an older individual maybe would only want to have one child versus someone with maybe premature ovarian insufficiency might be looking to have multiple children.

Just be curious the different scenarios maybe that might arise where fresh versus frozen could be more advantageous. I definitely think that's one scenario where, you know, reproductive age could drive that decision making. I think another one to think about, and again this is mostly just from my research of survey data when we were preparing for this fertile battle, is patients who desire a specific type of donor oocyte that might be an even more scarce resource.

So a particular ethnicity or something that is even harder to find and is not in kind of their geographic region. Because just broadly speaking most of the time a fresh donor will be geographically somewhat near the patient versus having the frozen oocytes ready available from anywhere they need. So I do think frozen makes sense when we're thinking about patients who have a very strong ethnicity preference or something that might be any making a scarce resource even scarcer.

I can say as a clinician that the pressure that the patients and we as providers feel is often about, hey, I want my children to be genetically related. I'm already making this huge compromise. And so that is certainly an argument for single donor or fresh donation.

But the economics are complex. And, you know, I think if you look around at least the United States, you see at least the larger and more forward-thinking practices looking at ways to try to balance those competing demands of cost availability and the desire for related offspring. And there's no one answer.

Yeah, I think one of the most challenging parts about this conversation when you're thinking about the supernumerary embryos that you could create from both situations is, you know, there's the advantage that we're talking about with the fresh donor cycles, where you get to take all of the donor eggs. And that could give you supernumerary embryos, which could be a pro for some patients who desire two or three children, but could also be a con in terms of deciding what to do with these supernumerary embryos. And I think both of you talked a little bit about this in your discussion, but I would love for each of you to talk a little bit more about kind of that tension and where you see the pros and cons of these approaches for given those concerns.

I think from what we looked at, yeah, I think, like Kiley said, there is maybe some differences of evidence out there then in terms of how many children people might want when they're doing IVF. But yeah, I can definitely see the argument that certainly in Australia, for example, I think the age of couples using donor oversights are in their early 40s. So it might be a point where only having one child is sort of enough.

The risk of the frozen oversights might be that at the end of the day, if they really only do get a small batch, just like, you know, I'm not thinking clinically here, I'm at, you know, from a pure statistical point of view, you know, around half of them might not end up with a child. And so they'll simply have to do another round of paying for a batch of frozen oversights. And so it just, you know, in that sense, it might actually, it might end up being quite expensive compared to if they did have a frozen donor available.

But of course, even here in Australia, I think other than half of the donor oversights are frozen. And so they're largely being imported from abroad. So you can see even in a country where the regulation is, you know, ambiguous around you, you can't pay for a frozen, can't meet here.

And so the advertising can't be, you know, you can't buy. If you look at the egg bank websites, it's not going to say buy six, so it's going to be, you know, it's framed as, you know, covering costs. Dr. Peipert, I think you identified a true struggle for many of our patients.

I do think the disposition of embryos is fresh on every patient's mind, as our political environment continues evolving, not just in the United States, but abroad, as Dr. Fitzgerald said, where regulations can be even more pronounced. I do think it's extrapolating from data that comes from non-pharmacologist cycles and, you know, how many retrieval cycles a patient goes through. But to Dr. Fitzgerald's statistical point with frozen donor oversights, you would think you were going to end up with less supernumerary embryos.

And so I do think this is probably a bigger counseling point when you have a patient who is pursuing a fresh donor oocyte cycle. But I do think it should be a point of our counseling, regardless of if they're using fresh or frozen. Something that's fascinating to me about this discussion is how big of a driver the batch size is in this conversation, because ultimately the six to eight egg cohort has been determined based on the ability to achieve at least one embryo for transfer.

But really, that's an artifact of these egg banks and the businesses and operations surrounding them. And there could be a world where you're actually just comparing, instead of purchasing the right to six to eight eggs from a given donor, you have the same arrangement that you have with a fresh donor, where you say, you know, theoretically, person A, who is donating eggs, I would like to purchase their entire cohort of eggs, in which case you have the same relationship in terms of the expected number of eggs that you could get from a fresh versus a frozen cycle. And that would actually mitigate a lot of the comparison that we're talking about here.

So this isn't really a question for either of you, just more of a comment that I think that this batch size is such a driver of some of the differences that we're seeing here. And I'd be curious kind of to see how that changes in the future, especially as we see people deciding if they want to have more than one child from a single cohort. Following that, like I mentioned earlier, before doing this, we just compared fresh and frozen oocyte outcomes in autologous patients in Australia.

And the difference over time had become remarkably small, such that from around 2022, there was remarkably little difference between them. And so my first thought was, if this is all we have to write about, we'll have to be thinking in terms of how many thousands of patients does it take before you lose one live birth. But then all this whole other layer of the batching seems to just change the picture completely.

So yeah, if it was really just the case that they got the exact same number of oocytes, whether they're using fresh and frozen donor eggs, it would be, you know, probably we wouldn't be needing to debate. It would be just such similar outcomes. I think especially when you consider today's thaw survival rates, then if you're really evening out the batch size, what we're really debating here is the game of logistics and timing recipients to donor cycles or not.

But I think it's a great point. I think it's worth mentioning or digging in a little more into the ethics and economics of this. Our field has both rightly and wrongly been accused of focusing too much on the finances and ignoring the cost burden on some of our patients.

And so at least in the United States, when you look around, you see a wide range of pricing models ranging, you know, from some that are outright predatory to others that are kind of simple to others where it's very straightforward. This many eggs cost this much to risk-sharing programs. And, you know, the way of balancing all that out is a fertile battle all its own.

I should make a note of that. But I think that that's kind of in some ways the elephant in the room here, which is, you know, in markets where there isn't as much incentive either for the donors or the practices versus markets where those incentives are quite high, it can really change the perspective of all the participants, the providers, the patients, and the donors. Yeah, I think a lot of clinics have found a lot of creative programs and ways to try to help patients out because using donor egg is so expensive.

And, you know, there are programs historically or probably currently who have split fresh cycles and other, you know, kinds of things in order to kind of mitigate that risk of having a lot of supernumerary embryos if that wasn't what a couple desired. And one of the things I was thinking about as I was reading this is, you know, a lot of egg banks have a blast assist guarantee, or there are some ways where we try to take that into account, you know, perhaps if there was a, I won't say bad batch, but something like that of frozen eggs, you know, and I guess, what do the authors think about that? Do we think as we move more towards using frozen eggs, should that be required or something that's strongly recommended to have some of these guarantee programs or have some things in place like that to try to give some consumer protections to patients? Before the authors answer, I think one of the things they both, I read into their pieces was the need for transparency on the data. I saw an absolutely maddening headline in the paper last week of couples going to, you know, southern Europe to do their IVF cycles because it's too expensive here.

And I was like, well, that's outrageous. First of all, buyer beware. And second of all, you must have gone to a really, really expensive IVF clinic to decide, you know, you should go somewhere.

But that, again, speaks to the transparency and the sometimes uneven economics in our field. I could not agree more. I think anything we can do to improve access to care for our patients, we should be doing.

And we've all made a mention of this, but, you know, it's however way we slice and dice it, donor oocytes are undoubtedly cost prohibitive for so many patients. And so the more that I think what we're calling shared risk, but really financially protective to increase access, I think we should be doing. But also to Dr. Widra's point, it goes both ways, because there's also, you know, donor oocytes we want to protect during the cycle and not be pushed to a spot that's unsafe.

And I do think that pressure is on whether we're doing a fresh or a frozen cycle. And we need to be honest and transparent with our own clinic practices and how we protect both our recipients and our donors. Just editorially, this is not part of the podcast, but I kind of stepped on Emily's question a little bit in terms of, you know, whether there should be guarantees or things, you know, guarantees for blastocysts or other protections in place with my comments.

If you guys want to come back to that, I didn't mean to redirect it. I guess, yeah, both in terms of the guaranteed number of blastocysts and the issue of transparency. Something that was definitely that struck me is that, you know, both in the Australia here, we have the Urivy of Success website, so anyone can go on.

And there's, I think, four or five different measures of how that clinic is doing, you know, to aim to give a somewhat comprehensive overview of their performance. And I think in the about 90 to 95 percent, I forget the exact number, of clinics sign up for that. I think in the U.S. that it'll be the same on the start clinic report, right? Yeah, exactly how you would do something like that, I guess, for egg banks and, you know, given that they or send their eggs out to possibly multiple clinics, you know, there'll be something to think about.

But, yeah, it did strike me that it is sort of like what in Australia eventually ended up in, I think, some sort of intervention in terms of what IVF clinics can say sort of on their website about their success rates in terms of sort of, you might call the free-for-all sort of days that the egg bank sort of like there is a lack of very clear transparency and tracking that a patient can just get a very independent sense of, okay, well, this is my chance of success. Because I guess, yeah, you could have the guarantee of one blastocyst, but you still might want to know how good those one blastocyst guarantees are from that egg bank, I guess, because if their overall processes are very poor, maybe that would impact that blastocyst's chance of resulting in a live birth. Yeah, because I think there was a very good paper from Europe, I think the clinic might have been based in Italy, where they showed, I think, 30 to, was it nearly 60 or 50 percent variation in they received the same batch size, I think, somewhere between six and eight, and I had dramatically different live birth rates per patient in terms of the cumulative success rates across the transfer of all embryos resulted from the very similar batch sizes they would have gotten from the egg banks.

So definitely some degree of greater transparency around these egg banks would be great, but of course, it's very complicated because, of course, they might operate across borders and they're providing services to multiple clinics. So I don't have a good answer for how you do that. I think part of it is also transparency for who qualifies for those shared risk programs, so patients don't get too far down the line with that being a surprise.

And then just back to one more comment on the cost. I'm sure there's been several cost-effective analysis along it. We quote one that showed a $7,000 difference in cumulative ongoing pregnancy when you're using fresh versus frozen, but both of them were over $30,000.

So I think it just illustrates, and this is for a non-insurance paying out-of-pocket person at this particular clinic, but I think the point is there of while one it may be more costly than the other, both are pretty astronomical for many patients. Yeah, and I'd love to see some of that cost effectiveness research also think about how this equation changes for fresh versus frozen when you're talking about having multiple kids, because I think that there's really a paucity of data on that in the literature. And I think the devil's advocate will say, and for fresh to also include a delayed or a canceled cycle, whereas frozen donor OS sites should be readily available, but absolutely.

When we look at the data on just the raw efficacy of fresh versus frozen donor OS sites that Dr. Fitzgerald was talking about before, and both sides talked about in their article, a lot can be said for the changes in technology and the advancements that we've had in both vitrification and transportation of these OS sites and showing improvements. I think one of the challenges we face, not just with donor OS sites, but also as a field is, as we get better at using frozen OS sites, I think we risk de-operationalizing the ability to use fresh OS sites in a clinic. And I think that one thing that both sides, especially the fresh side talked about is that, you know, when you have a clinic that is successfully operationalized, fresh coordinated donor OS site retrievals, the burden of access to patients is decreased.

And so I would love to hear a little bit of your thoughts on kind of, is it worth preserving the ability to do fresh donor OS sites retrievals for patients as we get better and better at doing frozen donor OS sites? It's a really interesting way of thinking about it. And without being overly cynical, it's hard to imagine a lot of programs doing a lot of fresh cycles into the future. And one of the reasons for that is, and I know I sound like a broken record for those young enough to know what that means, but the economics are going to force this on us.

The, you know, we live in a very unusual, in the United States, in a very unusual economy where we cannot control what we charge for our services. And so in spite of inflation, cost of living changes, the amount of money we get paid for being doctors in all fields goes down over time instead of up. And with that added pressure and the true benefit of increasing access through insurance and other means, you're going to be forced to make decisions that make this economically viable across an organization.

My opinion is, is that we will find that there are good reasons to maintain some access to fresh donor cycles in the United States, but that that's going to be a very small minority of cycles over time for mostly good, but many practical reasons. I was just going to add that just to reassure us, you know, one of the only direct comparisons with an RCT of fresh versus frozen, that study that we both referenced in our arguments by Kobo et al. in 2010, showed the same, no different, I should say, showed no difference in live birth rates between the two.

And then the SART data in ours, we, we quote the 2012, because at the time the 2023 wasn't published, but just, I, I just look, so the most up-to-date SART as of 2024 is 516 fresh donor cycles compared to 2400 frozen donor cycles. And the live birth is 36.6% in fresh compared to 39.1% in frozen. So I think to, not quite the point Dr. Peipert was making, but I do think to circle back, we are getting much better at it with, you know, more robust evidence to show for that.

That's really encouraging. Thank you so much for mentioning that. I mean, I think that's helpful to tell our patients, you know, that not only does this have all the benefits we've discussed, but it seems to be equally successful.

You know, we're not compromising their chance to have a baby, you know, just for clinical efficiency or something like there actually are so many benefits. So that's, that's really great to know. I think it's worth mentioning what a remarkable success story this is for our field.

And here we are, what is it, 10 or 15 years after we removed the experimental label from autologous egg freezing, that we're having a debate that is really intellectually interesting and clinically not a huge deal. And I think it's a real, it's a great story for our field to be able to tell that we don't do such a great job with. Look at all the children we're helping come into the world.

Look at how few twins we have. You know, we're, we're so fortunate to be, you know, practicing our area of medicine and researching our area of medicine for Dr. Fitzgerald at a time where things are getting better and better and better. And we get to argue over how much better one thing is over the other.

I think it's, it's just a great thing to see. Thank you so much to all of our discussants joining us today for this fertile battle. We hope all of our listeners found this really interesting.

We always love to hear any feedback. Please do not hesitate to reach out to us on social media. If you have any insights on your enjoyment of the podcast and we hope you listen next month to Fertility and Sterility Roundtable.

Thanks so much, everybody. 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.