Fertility and Sterility On Air: Live from the 2025 ASRM Scientific Congress & Expo (Part 3)

Fertility & Sterility on Air is at the 2025 ASRM Scientific Congress & Expo in San Antonio, Texas (Part 3)! In this episode, our hosts Pietro Bortoletto, Blake Evans, Eve Feinberg, and Richard Paulson cover:

• Advancing ICSI robotics: follow up on the transition from remote to fully automated intracytoplasmic sperm injection with Gerardo Mendizabal (01:06)
• Overcoming challenges in ovarian visualization: a case report of a magnetic resonance imaging-guided oocyte retrieval resulting in live birth with Samir Babayev (11:02) 
• Early pregnancy RhD-immune globulin practice patterns among REI physicians and the need for ASRM guidelines for RhIG administration with Nimerta Sandhu (20:30) 
• At-home and mail-in semen analysis: a critical review of scientific validation, regulatory oversight, and marketing claims with Juan Varela (25:00) 
• Preliminary analysis of a prospective cohort study of an epigenetic sperm quality test ("SpermQT") to predict success rates of ovarian stimulation treatment with Cassandra Roeca (31:05) 
• A discussion with the 2025 Ira and Ester Rosenwaks New Investigator Award recipient, Min Yang (34:50) 
• How combining medicine and coaching can empower patients through their fertility journey with Erica Bove (43:45)

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

Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussions with authors, and other special features. FNS On Air is brought to you by the Fertility and Sterility family of journals, in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, Dr. Pietro Bortoletto, Interactive Associate-in-Chief, and Associate Editor, Dr. Kate Devine.

ASRM 2025 in San Antonio. I am Rick Paulsen, and it is also my pleasurable task to speak to a couple of the authors whose abstract and scientific contributions I found to be most intriguing. The group that I wanted to start with is the group that calls itself Conceivable, who has put together the world's first end-to-end AI-powered automated IVF laboratory.

This team has an impressive eight abstracts here at this meeting. I was successful in tracking down Gerardo Mendizabal, who is their VP of Exploration, and who is an electrical engineer and a Ph.D. in computer science. It is really an amazing amount of work that this team has done, and that's what we'd like to begin with.

Gerardo, welcome to the podcast. Thank you very much for the invitation. Tell me about the concept of automation in the IVF laboratory.

As we know, the demand for IVF treatment is growing around the world, and it is evident that there's not enough supply of embryologists. Being an embryologist takes time. They have to train, they have to learn, so it's not immediate, right? There's no such thing as a school for embryologists anyway.

We're aware of that, and also we're aware of other challenges that happen during the IVF. There's variability, you know, embryologists, unfortunately they don't perform to their top every day. It depends, you know, they're emotionally tired, whatever, right? We know that there are many challenges, and we believe in Conceivable that the answer to overcome these challenges is automation, because robots are very good to do repetitive tasks.

They can be standardized, and they don't get tired, so we believe that we can change. IVF treatment has not been accessible to the whole population by adding automation. That is the answer, and that is our mission.

So automation, so the embryologists, they do a lot of tasks. Your automation then has to focus on each of those tasks individually. Tell me how you approach that.

That is correct. So we are aware of all the steps that involve an IVF procedure, from the egg collection to the sperm preparation, dish preparation, fertilization, vitrification. So we are developing a system that can automate every one of these steps.

And I think one of the aspects that is important to highlight is that, of course, there are many ways of doing this. Jaco and I always say that there are like two or three approaches. One of these is, of course, miniaturization.

There are people who are trying to do this with microfluidics, but our approach is different because we are trying to mimic what embryologists do. So every one of our systems is inspired with what embryologists normally do in the daylight. We are using the same instrument, the same principles, even the same protocol.

We're just putting robotic arms or digital microscopes to do that. So that's how we're tackling. So we're not reinventing IVF.

We're just doing automation. And I think that's one of the parts of our success that we have had so far. So where is your team in this process of development? Are you still at the prototype stage or is it in practice? Do you have a system that is functional? Yes, the answer is yes.

Actually, last year we conducted a preliminary study with a small number of patients where we tested three of our systems. One was a system for doing automatically sperm preparation. One more for doing the egg collection, finding COCs in follicular fluid, then washing them and doing the inhalation.

And one more to do the ICSI. So we have already published this year in our BMO line where we reported the first live birth using one of these systems. So yeah, we already finished that study.

I can confirm that now we have 19 live births out of that study, which is wonderful because as a proof of principle, we prove that it's possible to do the IVF using automation. And nowadays we are conducting the second study. So we are not working on the next generation of these systems because the first prototypes were made with something that we had in hand, all built together and tested, but that was not scalable.

So now we want to make sure that whatever we did during the first study, we can do it now with the second study, but using devices that we can procure, like the supply chain and everything is covered. So now we have this new system we call Aura. It consists of seven individual systems.

Each one specializes in a different aspect of the IBS, from dish preparation to culture, egg collection, sperm preparation, ICSI vitrification, and one more that is in charge of moving plates from one plate to the other. I think for us clinicians, I continue to be fascinated when I watch the embryologists do an ICSI procedure because this seems like the most delicate, intricate, complicated thing that someone can do. And I still remember when in the early 90s we were sending our embryologists to go to Belgium just to learn how to do this.

It fascinates me that you have a robot that can actually do this. So you have a robot that can do ICSI? Yes, we do. As I say, we already published the first slide, using this system.

It was very challenging. I have to say that was maybe the most challenging system that we have ever built. Jack Cohen calls ICSI the single-cell surgery, which I think is a wonderful term because that's actually what happened, right? The level of precision that you have to have to not damage the egg and immobilize the sperm, put it in the needle, put it inside the cytoplasm at a micron level.

It's amazing. So that was one of the first challenges. We say, okay, we need to make sure that we can do this.

And then, of course, if we can do that, we can do the rest of the thing. So we devoted ourselves to that mission. And yes, it's a combination of AI.

Our system uses a lot of AI. And that's the good news, right? Now AI is more accessible. You can train models and make them understand what's going on.

So we connected these AI models to some control system and some existing devices for micromanipulation and the microscope, the stage. So it's a very complex system for reality, right? But everything is run by AI. And one important thing that I think is important to mention is that these devices, not only the ICSI, but all of the devices that we're generating, they allow an embryologist to be doing supervision, right? So we have full automation, but we want the embryologists to be there, because in case something goes as unexpected, they can always intervene.

They can use digital controls and take over the system if something goes wrong. I think one of the things that clinicians are afraid of is that we're all going to lose our jobs because AI is going to do everything that we do. And I would speculate that embryologists are equally worried.

Are they going to lose their job? Oh, no, no. Actually, I think it's going to be even more exciting, you know, because now embryologists are going to have better tools, so they can spend their time doing other more interesting things, right? Of course, they're going to be there. They're going to be supervising the systems and acting if it's necessary.

But, you know, most of the work that embryologists don't like, like paperwork, things like that, all that is going to be automatic. So I want to say that Jack Cohen always, like, he said also that this is the best time to intervene in embryologies, and I really think so. It blows my mind that we've gone from the birth of Louise Brown in 1978.

I mean, it took 14 years to get to ICSI, and now 35 years later, it's getting automated in the laboratory. I guess my last question for you, Gerardo, is how soon can I buy this from my laboratory? If I want this very fascinating robotic automated laboratory with standardized procedures and standardized outcomes, how soon do you think this is going to happen? It's going to be very soon. Actually, we have already assembled and deployed the first Aura line, we call Aura D7 system.

It's already in Mexico City in the clinic called Fertility. So we're conducting a second study with a larger number of patients. We are about half of the study.

We're getting really good results, so that is giving us the confidence that this system is going to work and it's going to perform well, you know, with the right quality and everything that needs to be there to make sure that we can deploy to other clinics. Our plan is next year we want to open a clinic somewhere in the states. We'll see where, but yes, it's going to happen very soon.

That sounds amazing. Gerardo, thank you very much for your time and congratulations to you and your team on what I think is an absolutely revolutionary approach to IVF after all of these years. Thank you very much for the invitation.

My next guest is Dr. Samir Babaev from Azerbaijan, where he is the Dean of the School of Medicine and Health Sciences at the Karabakh University. And if that is not a mouthful, his abstract was Overcoming Challenges in Ovarian Visualization, a Case Report of Magnetic Resonance Imaging Guided Oocyte Retrieval Resulting in Life Birth. Welcome.

Thank you. Appreciate it, Rick. So, this absolutely blew my mind.

I have been involved in some difficult egg retrievals, but I've never had one where you could not find the ovaries with ultrasound. So, tell me how this played out. Yeah, so this is a patient, a 33-year-old basically, presented to our clinic.

She's been seen by two other practices before, evaluation for fertility, and they found that she had bilateral hydrosalpinx, but they couldn't see her ovaries on ultrasound. So, one of those two centers was a university hospital. And presenting to us, we tried to look for ovaries on ultrasound.

We couldn't find them transabdominally or transvaginally. Then we tried muck stimulation cycle as well, just to see if we can see ovaries once they pop up. We couldn't see any ovaries again.

So then, we assembled a team. It was a multidisciplinary team of interventional radiologists, anesthesiologists, embryologists, REI, MFM, and decided to offer to this patient to do, you know, an MRI, and then MRI-guided egg retrieval. We did diagnostic MRI beforehand, and we were able to see ovaries, what we thought were ovaries, because she also had diminished ovarian reserve, so she had small ovaries overall, with a lot of inclusion cysts, wrapping those ovaries around, and also hydrosalpinx on top of everything.

So, we decided to offer MRI-guided egg retrieval, because patient was also interested in autologous cycles. She was not interested in any kind of donor cycles. And we basically proceeded with the procedure, so with the cycle.

And cycle was also with MRI instead of ultrasound to monitor development of her follicles. Every single visit when she would come for MRI, we would do ultrasound as well, just to see if we still can't see the ovaries. And during the stimulation, we did like a mock set up on the weekend, just to see that all of our equipment will work as intended.

We had equipment reviewed by MRI safety board as well at our institution, to make sure that all of the equipment is safe, that, you know, our needles are not going to become projectiles and cause unsafe situation. Let's talk about that, because that really, that blew my mind. I was thinking to myself, when you walk into an MRI suite, the first thing they tell you is, take your keys out of your pocket, because it's going to throw you across the room.

And here you've got a needle. So, what is the characteristic of the needle that allows you to use it in that magnetic field? So, it's many things. It's amount of material.

It's how ferromagnetic it is. And what is made from, the alloy itself as well. So, things like, I believe, titanium, brass, are not as ferromagnetic.

So, you can use them safely in an MRI environment. In fact, people do, like our anesthesiologist used, we did general anesthesia for egg retrieval here, because patient has to be completely still. So, all of our equipment was MRI safe and non-ferromagnetic.

So, our needle was tested just in case, because that was a Cooke egg retrieval standard needle we use in our practice. The international radiologist did test it in the unit just to make sure that it's going to be fine, that it doesn't create any kind of artifact, that it's not twerking during the procedure. All those aspects were tested, and only after that, we decided to proceed.

So, you're telling me that this is a standard needle. You did not have to have a custom-made needle by some special company. In fact, we started the procedure by using, well, mock procedure anyway, by trying the prostate biopsy needle, which is what they use, what they're comfortable with.

But then, looking at the characteristics of our needle, the international radiologist felt that this would be a better suited needle for what we're trying to do, and he was right. How long does an MRI take? The MRI that I think of, it takes a half hour or 45 minutes, but I'm guessing you must have used an abbreviated or focused MRI that took a little less time than that. Well, the entire procedure actually took about three hours to complete.

So, because during egg retrieval, we're used to do it under ultrasound, so it's real time, but with MRI, it is basically scan, advancement of the needle, checking where it is, advance a little bit more, and then scan again. So, each scan takes about 30 to 60 seconds. We, in fact, use two needles to access both ovaries at the same time so that we don't have to do double amount of scans.

That makes sense. So, you're telling me the monitoring MRIs that you were doing as the patient is undergoing ovarian stimulation, those also took only 60 to 90 seconds? Those took a little bit longer than that, just because we needed a better resolution, but again, it wasn't more than about 15 minutes or so. So, one of the things that I always worry about on an egg retrieval is, what tissue am I going through as I approach the ovary? And I was thinking, how many different planes must you go through if the ovary is not even visualized by ultrasound? So, did you figure out what you were going through? Are you going through pseudocysts or through what? Excellent.

That's basically, to plan the procedure well before procedure, during one of those diagnostic MRIs we did for the patient, we used a special software to track exactly how the needle will go and through which tissues it will go. So, in fact, we access the ovaries transperineally. That's also not standard in our world.

We usually do everything transvaginally, but because the type of the guide that is used here, like a prostatic biopsy guide, you can't fit it inside of the vagina, basically, and then it has to stay sterile, and you will break sterility that way. That approach was transperineal. Transperineal, so not transabdominal, but rather from below, but not from within the vaginal canal, rather the perineal skin that you lined up with.

Yeah, so then once we accessed the follicles, we were able to aspirate a few follicles on the right side and then a few on the left side. Her left side ovary was smaller. We didn't get any eggs from the left side, but on the right side we got two eggs out of five follicles.

Fortunately, one of the eggs was a mature egg. We used ICSI to fertilize that egg. There were some sperm parameter issues there.

That's why ICSI, and we were lucky enough that it developed in the blastocyst and we were able to freeze it. The other egg did mature during the day, but it became an embryo, fertilized, became an embryo, but arrested at nine-cell stage. The other part of the story was that we discussed this all with MFM, and the patient had a consultation with MFM as well, and they've decided that they will proceed with gestational carry treatment for her, just because of how complex her past surgical history was.

She had ulcerative colitis, multiple surgeries from colectomy to J-pouch, then multiple complications of those surgeries, like fistula development, revisions. As a result, it was felt that it's not going to be safe for her to get pregnant and carry a baby, so that's why we decided to proceed with gestational carry treatment. It worked out just fine, a full-term delivery of a baby girl.

Well, I congratulate you on your innovation. I have to say the reason this intrigues me is because I envision a future where MRI will be continuous, the same way that we have ultrasound. Once upon a time, ultrasound was also static.

The patient went to the radiology suite, they took static images, and then they sent us the pictures, and now I have a probe in my hand, and I'm hoping that one day I get to have an MRI machine in my hand. Well, until that time comes, I do believe that transvaginal egg retrieval will still remain a gold standard, and I don't propose that MRI-guided egg retrieval should be a plan B. I do think it should be probably plan C or D, before you consider it, and to be totally honest, as an idea, it sounds like, oh, what it is? It's just a biopsy of the ovary, but once you realize all the different things that have to come together for you to achieve egg retrieval by MRI, you understand that it has to be in resource-rich settings. You have to have an MRI machine, obviously, trained personnel, and anesthesiologists, the equipment, the embryology team, all prepared for it with their equipment, and all the logistics worked out as well.

So definitely not a plan B. I don't think even plan C, but maybe plan D. Very good. Well, thank you for your time this morning, and congratulations on your accomplishment and on your willingness to think out of the box and have something truly innovative. Thanks so much.

My next guest is Dr. Nimrata Sandhu. She is actually a resident in obstetrics and gynecology. She's a PGY3 at the University of California, Davis, and her abstract intrigued me.

It is called Current REI Practices Regarding Rh Immune Globulin Administration in Early Pregnancy, and I was intrigued by this because we in REI produce a lot of pregnancies. A lot of those are lost, and when they are lost, the question is, do we need to be administering ROGAM? Do we need to stock it? Do I need to keep worrying about it? So welcome to the podcast, Nimrata. I'm looking forward to hearing your opinions about this.

Yes, thank you so much for having me here, Dr. Paulson. Well, so tell me, other than what I said, why do we care about immune globulin administration in the aftermath of an early pregnancy loss? Yeah, so one of the things that I think, one of the most important things we have to remember is that Rh immune globulin, or RHIG, it's not unlimited. We don't have an unlimited supply, unfortunately.

So RHIG, it's collected via apheresis from human donors, and there are no national and global shortages of this product. So it's important that we're mindful and we think about when we're giving this and who we're giving it to. And what did you find, by the way, in your survey of practices among REI practitioners? Yeah, so right now, current professional society guidelines, we have guidelines from ACOG, the Society of Maternal Fetal Medicine, and Society of Family Planning, but all of their guidelines are slightly different, and in my survey of REI physicians, a lot of them are not following specific guidelines from any of these three organizations, but there is widespread administration of RHIG and testing routinely for all patients with early pregnancy loss.

So ranging for patients who have a miscarriage, which are medically managed, for patients who have a miscarriage, and it's managed with a DNC, as well as with an ectopic pregnancy. So it would be very helpful to have actually evidence-based recommendations, and I wonder, when exactly does hematopoiesis begin? That would be, I guess, the time that we first start worrying about it. Yeah, so I think that's a really interesting point, as well.

Very interesting to think about kind of the primitive hematopoietic cell development, and that actually starts in the yolk sac. It occurs within two weeks of fertilization, but those cells, they actually don't produce red blood cell antigens on the cell surface. The definitive hematopoietic cell development, it begins a little bit later, and fetal RBCs display red blood cell antigens around six weeks of gestational age.

That sounds like around the time that we would first be seeing fetal cardiac motion. Yeah. I've always wondered, do we really need to be using RhoGAM in an embryonic gestation, or what about a biochemical pregnancy? What do you think? Yeah, I think we can start to reach a consensus that we probably do not need Rh testing and RhiG for an embryonic gestations, for pregnancy losses without fetal cardiac activity, and probably not for pregnancy loss under six weeks.

What was your call to action from your abstract? Did the REI practitioners, did they think that maybe ASRM should have its own guidelines? Definitely. I think most, the majority of our respondents indicated that they would change their clinical practice patterns if ASRM develops a specialty specific clinical guideline. So my call to action would be to develop this specialty specific clinical guideline, likely in the form of a practice committee document, specifically for RhD testing and RhiG administration for reproductive endocrinology and infertility.

All right. Well, that's fascinating, and I really appreciate your work and to look into this. I think it's very important that we do develop some sort of guidelines, because I think it would be helpful for all of us to be able to practice evidence-based medicine, and we may or may not be doing that when it comes to RhoGEM.

Yes, thank you so much again for having me. Hello everyone. I am Blake Evans, Media Editor for FTS Reviews.

I am here today, honored to talk to you with Juan Varela of University of Florida. He's a third-year medical student. Welcome.

Hi. Thank you so much for having me. Absolutely.

So you have a review article that you spoke about at the meeting, and it's called At Home and Malen Semen Analysis, a Critical Review of Scientific Validation, Regulatory Oversights, and Marketing Claims. Did I get that right? Yep. Awesome.

Well, fill us in a little bit about your study. Yeah. So the main purpose of the study was to evaluate the major at-home and malen semen analysis companies under four critical domains.

First of all, their clinical purpose, whether they were for wellness purposes or they were for diagnostic purposes. Okay. Their regulatory oversight, like at what level they were being overseen, if it was federal or state-by-state.

The sort of scientific validation that they had for their methodology and their semen analyses. And then lastly, importantly, their marketing claims, like the patient-facing side of things. So we took analysis of the 11 major companies that we found in a specific time period.

11 companies, you said? Yeah. Okay. And we assessed them using those domains.

Wow. And so what did you find? Are they all valid? Can we rely on these? So we kind of separated them into at-home tests and those that are malen. For the at-home tests, we found that while they had validation, they had FDA clearance at least stage two, a lot of them weren't for a clinical purpose or didn't have clinical utility.

They were more so for health and wellness purposes and information for patients to use as insights into their own health. But we found that a lot of that marketing wasn't really transparent with that. Interesting.

So with these analyses, have some of these studies validated and looked at an actual andrologist testing this and compared it to the at-home test or malen test? As far as I saw in the validation studies, the usability was usually for laypersons. Some companies, I think EO did have some sort of professional versus layperson analysis comparing how well can an average user use their product at home and get an accurate result. And they had validation and sufficient evidence of usability, but they still, at least for the legal facing side of things, they couldn't claim that it was for a clinical purpose.

Interesting. So it's safe to say at this point, we're getting there. We're not quite there yet.

Is that kind of the gist of what I'm hearing? It's tough to say. I mean, there are a couple of companies that kind of met all the parameters that we set out to look into, but it really is kind of a wild west for most malen companies. And I think the goal was to just raise awareness that for patients who might not be as experienced or have the health literacy to understand the product they're getting, that while it's useful maybe to find information about their health, it doesn't replace the visit to an andrologist.

It doesn't replace something with diagnostic capabilities. Okay. Yeah.

Because I, you know, for example, I had a patient recently who had actually a repair and he has been following his counts under the discretion of his urologist with these at-home tests that print out a report or send it to his phone. So the report looked good and legit, and it had the parameters that I would care about, but I didn't know if it was actually valid. And should I truly trust this and recommend fertility treatments based off this at-home test? So what are your thoughts on that? I mean, I think there might be nuance to that from the at-home test that we saw.

They didn't give parameters that were sufficient for use in a clinical setting. A lot of the companies didn't assess semen parameters or like concentration, for example, below 20 million, which doesn't give you a lot of information. Right.

Yeah. And, you know, for example, in the patient I was referencing, his numbers were a can we consider IUIs or should he just do IVF? And so that's obviously two very different things, and I don't want to give him the wrong recommendation. So I don't know that I feel completely reliant on those yet, but I think it's great that those are available.

And hopefully one day we'll get to a point where we can very conveniently have patients utilize these without having to come to the hospital, to the clinic and travel hours away to have an analysis done. So I know it's difficult for patients to do. Yeah.

And I think the utility of mail-in testing is that it is, first of all, more convenient for patients. They have the privacy of their own homes. And in some future, these tests might bridge access to care where patients have to drive hundreds of miles to see a fertility specialist.

Sure. There's definitely a future where we should be incorporating these different tests. Yeah.

We just need to make sure that they're accurate, they're validated, and then they have some sort of federal oversight. Right. Absolutely.

And so when we have patients collected home, for example, and bring it in, we usually say bring it within an hour. And so I always get concerned about these mail-in tests that are done and they're shipped, I don't know how far, states away or several hours away. And I know they probably have some sort of preservative, but is that going to be affecting the parameters? Are you aware of that? Yeah.

That's actually something we looked into. One of the subcategories for the validation that we were looking to was whether they adjusted it for some sort of decline in semen parameters. Very few companies did do some sort of algorithmic adjustment, but I think that's something that we need better transparency about, especially we're using these kits to keep track of patients like fertility.

Right. I think we need to make sure we're looking at the validation. Do they have some sort of algorithmic adjustment? Because many times we might be labeling them as more severe, like an IVF range, and that might lead to misclassification and over-diagnosis, over-treatment.

Yeah, absolutely. Very interesting. Well, I know you've got a flight to catch and I really appreciate you stopping by.

Thanks for chatting with us and best of luck to you in your application process. Yeah. I appreciate it so much.

Thank you. Yeah. Thank you.

Hi again, and welcome back to the FNS OnAir podcast, live from the ASRM 2025 annual meeting in San Antonio. We're coming to you live from day three, traditionally the slowest day of the conference, but I got to tell you the energy is electric in the expo hall. A lot of good science still being presented.

I'm here with one of my very favorite clinician investigators, Dr. Cassandra Roca. She comes to us from the University of Colorado Shady Grove Fertility Practice. Dr. Roca, welcome to the podcast.

Thank you so much for having me, Dr. Bordoletto. We would love to hear how this meeting's gone for you. What's the science that your team has showed up to present that you think has been most interesting and well-received? Well, I'd like to highlight an abstract that my fellow Dr. Dana Siegel, our stellar third year, will be presenting today at one of the oral abstract sessions.

It is a prospective cohort study that we have been doing congruent with inherent biosciences, and it's called preliminary analysis of a prospective cohort study of an epigenetic sperm quality test, the SpermQT, to predict success rates of ovarian stimulation treatment. I have heard of the SpermQT test, but I'm not sure that I've ever used it clinically. Tell me more.

Right. Well, I think we can both agree that there is limited assessment of male contribution to infertility. Sure.

How much does it swim, and how many heads does it have? Exactly. It's honestly more of like a yes, no. Yes.

But the SpermQT is an analysis to look at DNA promoter regions within the sperm to help predict, hey, who's going to have a good chance of success proceeding to spontaneous pregnancy or conceiving with IUI versus who really needs to be fast-tracked to IVF and who has a significantly lower likelihood of conceiving with lower tech modalities. And the SpermQT test tells us yes, no, or it tells us degrees of success predicted? There's still ongoing recruitment, but we're seeing about a 10% difference in success rates with IUI within the first two cycles between those who have a good or normal SpermQT versus those who have a low SpermQT. Though this hasn't reached statistical significance, the p-value is 0.06. It suggests something's there.

So you're saying there's a chance. Yeah. So it's exciting.

It would certainly be a new tool to offer patients that can help, you know, fast-track to more aggressive treatment potentially from the get-go. If you fast-track them to IVF based on the SpermQT result, do you do anything differently during the IVF or is it simply just get them to IVF? You're always thinking ahead, Pietro, and that's why I love you. And that's what we hope can come out of further analysis of this cohort down the line or potentially a new study altogether.

And beyond that, okay, yeah, you know, looking at cohorts like we did IVF, conventional versus split, versus XC. I love a good split cycle. More than the average person.

What an elegant way to answer questions. Split sibling oocyte studies. Love it.

Yeah. Well, Dr. Rocha, thank you for making time on your Wednesday to stop by the FNS booth. And thanks for highlighting the work of your fellow.

Yeah. Thank you so much for having this platform for all of us to share exciting research. Hi, everyone, and welcome back to another episode of Fertility and Sterility on Air, live from the 2025 annual conference taking place in San Antonio, Texas.

We're coming to you live from the last day of the conference. It's Wednesday morning. We're only the survival of the fittest.

People who are still here are usually here for a very good reason. And I'm delighted to have as our first guest on the Wednesday podcast, Dr. Min Yang, who is a basic scientist at the University of Washington. We're delighted to have her here with us to tell us a little bit about her prize paper that she was nominated for the Ira and Esther Rosenwax Young Investigator of the Year Award.

Welcome to the podcast. Thank you so much. I'm really honored to be here today.

There is so much good research being presented and so many people doing such good science at this meeting. However, a jury of your peers felt that you were the one doing the most interesting work this year. Tell us a little bit about what you've been working on and what you've been presenting at this conference.

Right. Yeah. So I guess my work is kind of interesting to the audience of this conference because I study, our lab study annual ploidy in early development.

So basically annual ploidy, aka the cells with abnormal chromosome number. So it's a big thing now in the IVF world because it's basically judged as a standard to discriminate if the embryos are good or not. However, you know, no one actually really know what's going on with those type of abnormal cells in the fetus or during the fetal development.

So as a scientist, we are determined to kind of provide some insight of how those kind of cells developed or grow in uterus in the baby. So our study kind of focus on to study the cell phase of the annual ploid cells, the abnormal cells during the whole early and critical stage of early embryo development. So basically that's what we study.

And I think that's got us the prize. And I think it's a truly honor for us to got some credits from the providers and clinicians, which are the major components of this conference. So anyway, so that's our research.

What's the most interesting discovery that your team has made that you feel opens up the door for the next kind of phase of your research? Right. So that's a very good question. So this journey actually started a few years back when I was a postdoc at Rockefeller University in New York.

So basically we collaborated with my co-mentor, who's Dr. Glasher in the Center for Human Reproduction in New York. So basically his interest was they have a lot of older patients who have a lot of annual ploid embryos. So his research interest was knowing how those embryo, if they can, if or how they can develop to turn to produce like a healthy baby.

Never waste a good embryo. Yeah, never waste a good embryo. But anyway, so we have the model system using stem cell to model the embryogenesis, the embryo development process.

You know, it's actually very hard to study embryo, you know, because due to ethical or technical reason. So we have been using the embryo models to kind of mimic how the cells will actually behave in the culture dish. To kind of see how those cells, if they can survive or how they can survive.

So our major finding back then was just, which is truly interesting, is we found that annual ploid cells, abnormal cells, if they can choose, they will actually like to become the placenta type of cells instead of the fetal type of cells. And the placenta are more tolerant towards this type of abnormal cells. And the fetal part, the actual baby part, during the whole pregnancy process, they actively eliminate the abnormal cells.

So they have a more proactive exclusion of them from... Yeah, exactly. So it's kind of a miracle, right? Miracle, right? So the baby have like the capability to correct themselves, to get rid of those abnormal cells during this whole journey. So anyway, so we found that the cells are getting actively eliminated or get rid of during the whole process.

However, the placenta was the place, like tolerates this type of abnormality. And our current study are focusing on the interesting placenta, why they can tolerate such high level of abnormality. So yeah, so that's a current... Is there any vision to try to more dynamically change that? Right now you're observing and trying to understand the how and the why, but are there aspirations to try to more proactively induce other cells to be more tolerant as well or other parts to be less tolerant? Now you're asking all the right questions and good questions.

That's actually one of our project right now. So basically we're trying to understand what determine the fitness of different type of cells, the abnormal cells, different type of abnormal cells. For example, Down syndrome cells, they are the trisomy 21 cells.

So those cells are apparently more fitter than the others. But we are thinking like if we can modulate this type of fitness on cellular level in the embryogenesis, embryo development process, can we actually change the dynamic of the embryo? Can they actually grow better if we give them some kind of boost or treatments for the embryo to help the embryo to eliminate the abnormal part? Particularly the older embryos, I think there's a real opportunity for us to help these women on these extremes of age we're trying to conceive. It's only a group that Dr. Gleicher is very familiar with in his clinic and you have lots of experience with.

What are you most excited about in your lab for 2026? What keeps you up at night in excitement about what's possible as long as the funding, the scientists and everything is still there? Yeah, so I think there are a lot of things I'm excited about. So science itself, of course. So like I just talked about the project we have to study the fitness level of different type of chromosome abnormalities.

And I'm also excited about the placenta aneuploidy project. Basically, we think placenta is like a cancer type of tissue. They're very invasive, proliferative, and also carries a lot of like chromosome abnormalities just like cancer.

I'm very specifically excited about this project. And if we can understand how placenta can tolerate this abnormality, maybe this can inform beyond the reproductive field and informs about cancer treatment to see why those abnormal cells can self-regulate and not becoming cancer. So that's what I'm most about in this coming year in my science in the lab size.

And also we are a new lab. So we established a couple of years ago. So now the lab is growing with a lot of talented people to postdoc and students.

So I'm very excited to work together with all those talented people and kind of expand the science scope and area. So that's one thing. As a new mentor, I'm very excited about the journey I'm basically going to take with all the people in the lab.

Yeah. Other than that, I'm expecting a baby. So that's one thing I'm excited about in this coming year.

We're excited to interview you again next year and see how the lab and researchers come along, but also hear about your baby. Congratulations. Thank you so much.

Yeah. It's so interesting because I'm 30. I just turned 36.

I thought I'd be determined as the young scientist, young investigator or whatever. But in the reproductive field, I'm an advanced machine. Yeah, you are.

Yeah, you are. When I was seeing a doctor, it was really funny. I have to take special treatment because I'm older than 35.

Experienced. Experienced. Anyway, so I think that's how my vision for science is.

I want to kind of prolong the reproductive window for women, especially I think this is going to change a lot of things for women for who want to pursue a career. You want to kind of prolong your reproductive age. So this is not, you know, an obstacle for you.

You have to think about when you have to produce because you have limited time. So I think the mission of my science is one thing is just to kind of help the women to suffer less. I think there's a lot of people that are very excited and rooting for you.

Thank you so much for coming by the podcast. It's really an honor to be here, like I said. Thank you.

Thank you. I am joined by Erika Bove, who runs Love and Science. And we're just going to talk a little bit about what she does and how she helps all of our patients.

Yeah, absolutely. So, you know, I'm a physician just like you, a fertility physician. And I was in my clinic and really feeling disheartened because I felt like I was having a hard time reaching my patients.

And at the same time, I was, you know, accessing coaching services for my own personal life. And I started to make the connection that I was like, how can I reach these patients better? I think it's the coaching tools that's going to help them get into their bodies, make, you know, connect with their values, make more empowered choices. And so that's really why I started Love and Science was rooted in my clinical experience, having a hard time feeling like I was really making a difference, helping people make empowered choices.

And I think that's great. I mean, let me back up a little bit because I've certainly thought about the idea of a physician coach, like what is a physician coach and who might be the type of person who uses one? Yeah, absolutely. So I think, you know, coaching has definitely gotten more attention in the last few years, definitely different than therapy, which goes way back to the childhood.

But coaching is very action oriented. And over the last several years, there's been hundreds, maybe thousands now, but to my knowledge, hundreds of physicians who have sought certification in coaching tools. You know, the interesting thing is just like we take boards to become, you know, to get our shingle to be, you know, certified and validated.

You can get a coaching certification in a day. So you have to really careful about, you know, what, you know, what training did each person get? What is their coaching certification? But I will tell you, I went to the most rigorous coaching program. What are some of the more rigorous coaching programs? Like what should I be looking out for if I'm trying to recommend a coach to a colleague or to a patient? Yeah, absolutely.

I would say a coaching school that has like a structure, you know, definitely where there's coaches who have been vetted, where, you know, they basically, if you have a curriculum, I always look for a curriculum. I think a day is not long enough. My coaching program was six months and we had, you know, many exams, including oral exams.

I think, you know, there's different kinds of coaching too. There's executive coaching, there's personal coaching. So it kind of depends on what people are.

So going into those academic coaches now. And so weight loss coaches, nutrition coaches, coaches for divorce. I have a friend who has a divorce coach, like different than their mediator and different than their therapist.

So there is one certification called the ICF, which is the international certification. I don't remember what exactly what it stands for, but there are coaching programs that are ICF certified. And that definitely is a feather in the cap of a coach if they have that.

Although I will say, you know, because of political reasons, you know, my coaching school will never be certified by ICF. And so you can't say, oh, they don't have ICF certification, but that is one way to say, okay, you know, either if it's a life coach school certification or ICF certified, you know, those are good signs, I would say. Yeah.

Great. So then you got this idea to start specifically a coaching program for female physicians who are going through fertility treatment, correct? Yes. Yeah.

So how do patients find you and what do you do with that coaching? Is it group coaching? Is it one-on-one coaching? Tell us a little bit more about that. I think it's fascinating. Absolutely.

Well, I think, you know, we would all agree that people going through the fertility journey need some sort of emotional support. It's, you know, I've never seen a journey that was straightforward. I've never seen a journey that was without.

Still waiting for that too. I know, stress, heartache. So, I mean, just to back up, when I meet a patient in my clinic, I say, I need to know all about you.

I need to understand who you are, what makes you tick? How long have you been with your partner? If you have a partner, where are you from? How many kids, you know, I'm sure you do the same thing. Because I say, listen, we are setting ourselves up for success by having a trusted relationship together. So whether that's in my doctor role or whether my coach role, I have a very, you know, sort of deep philosophy that that rapport, that initial relationship really matters.

And so, you know, by getting to know the person that is, or the couple that really helps to establish that trust because there's going to be highs and lows. And so I could not agree more. So it's like helping people to stay.

You think about a marathon coach, a marathon coach helps people, you know, get their workouts, figure out what they need to do, keep their mindset where it needs to be. And so. For sure.

And I'm going to shout out to Mark Trollis who volunteered to be my marathon coach for Chicago 2026. That's amazing. Is that the one you're doing for a patient? Is that right? Yeah.

That's amazing. So, you know, in my coaching role, I am the support person to partner with the REI to say, okay, no, this person has additional emotional needs. You know, maybe they feel isolated.

Maybe they feel especially triggered. Maybe they feel just caught up in their analysis paralysis and they're having a hard time figuring out what they really want to do as their next step. And so I always start with, you know, a values clarification.

You know, who are you? What do you value? Because once we can make values based decisions, that's really when the decisions are aligned. Yeah. So then how, how do you split your time between being an REI and being a coach? Yeah, it's, it's a tricky one because there are only so many hours in a day.

And I think, you know, we do realize that we need sustainability, right? We need to sleep. We need to, you know, eat well and all those things. And so I have this wonderful arrangement with the university of Vermont where I actually split my time between Albany, New York and Burlington, Vermont.

And so I have a 0.6 FTE position. I'm also the fellowship program director. And so I see patients in the office and I do the fellowship, you know, director role.

And when I'm not doing that, I do my coaching. And it's interesting because I actually am a divorce person. How far, how far apart are Albany and Vermont? Three hours.

Wow. So where do you actually live? My house is in Albany, New York. Okay.

Due to my divorce agreement, I will remain rooted there for the next seven years or so. But my former spouse is a hospitalist actually. And so we have this checkerboard schedule where he works his, you know, seven day shift when I'm, when I have the kids and then I work, you know, sort of in Vermont where it's more clinically intense, where I'm, you know, sort of away from my geographic area when my home, when he has them.

And so it works, it's, you know, I never would have foreseen it this way, but I have amazing partners at UVM and, you know, I tell my people I'm always accessible wherever I am and the fellows know they can always get ahold of me and I have great nurses. And so, you know, it really is about your team. And so then the time that you're not at UVM is the time that you're spending coaching? Primarily.

I mean, I never take off either hat, you know, Wednesdays we do our fellowship didactics. And so I always log in for those. And, you know, sometimes I give lectures remotely and things like that.

You know, I think COVID kind of opened us up to these possibilities, but in general, it's like a week by week blocks of time where I never quite take off either hat, but my time is primarily in either of those directions. And when you engage with a patient for coaching, how many weeks, months, years do you spend coaching? Is this a short-term relationship? Is this a long-term relationship? Great question. So I think a three-month buy-in is important because the coaching concepts unfold over time.

And so I actually have a course, a 12-week curriculum, which I'm actually about to launch independently of any coaching. So people, anybody even like nurse practitioners, anybody who's fertility adjacent will be able to learn about this with actually CME attached, because we all know that there are certain things that people undergoing their fertility process need to hear. And it's especially hard if we work in the medical field.

So, you know, what I do is I have this 12-week curriculum where people do roughly one module a week. They have homework because all of our, you know, all of our super nerds and they can listen as they drive and whatever else. They don't have to watch the video.

And then I coach them individually every other week. So they have that individual time to really talk about their particular situation. But I will be, you know, be very transparent that I did not foresee this, but the most powerful part of the whole experiment of love and science has been the group, support groups, because people see their stories in each other.

I think the number one thing that people tell me is this is just so isolating and I feel like I'm the only one and I'm in, yeah. And the support groups are online. So if we have patients from Chicago who want to join, like they can join.

And so our colleagues who listen to this podcast from probably around the U.S. may have patients that they want to send over. So how do they get in touch with you? Yeah, so the most comprehensive place is my website, loveandsciencefertility.com, where people can learn about my services, book a discovery call to see if working together would be a good fit. Some people only want the group element and the course.

Other people want a little bit more tailored coaching. And so I always meet people where they're at. But I say, you know, three months is really how long it takes to understand the coaching concepts.

You know, if people get pregnant in the middle of it, as many people do, then we coach together until that time is complete. We all know that early pregnancy can be sometimes even more difficult because it's like, when is the other shoe going to drop? And then my goal, and I say this every day when I meditate, is every client of mine graduates as a parent. And it's really important to me.

If that is their deepest desire, then we will find a way. And so there's a membership. So once people finish with the three months, if they want to continue working with me, we do a month to month until they feel their time is complete.

And usually that is, you know, graduated from their REI. And I actually now have a support group for pregnant people because there was such a need. There were so many pregnant clients.

I was like, we don't want to stop coaching. So I'm like, well, this is a great problem to have. Yeah, no, congratulations.

I think this is great work. And thank you so much for coming on the podcast and highlighting the work that you're doing. Thanks for having me.

This concludes our episode of Fertility and Sterility on Air, brought to you by Fertility and Sterility in conjunction with the American Society for Reproductive Medicine. This podcast This podcast is produced by Dr. Molly Kornfield, Dr. Adriana Wong, Dr. Elena HogenEsch, Dr. Selina Park, Dr. Carissa Pekny, and Dr. Nicholas Raja. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource in service to its members and other practicing clinicians.

While the podcast reflects the views of the authors and the host, it is not intended to be the only approved standard of practice or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.