ASRM Today: Reproductive Technology within Reproductive Rights and Reproductive Justice

In this episode we continue our season-long discussion on reproductive justice and reproductive rights, focusing on how emerging technologies are re-shaping the field of reproductive medicine. Joining me today is Dr. Lowell Ku. Together we will explore how innovation intersects with ethics, access and equity--raising new questions about how technology can expand and challenge reproductive freedom.

Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. Welcome to ASRM Today, I'm your host Jeffrey Hayes. In this episode, we continue our season-long discussion on reproductive justice and reproductive rights, focusing this time on how emerging technologies are reshaping the field of reproductive medicine.

Joining me today is Dr. Lowell Ku. Together, we'll explore how innovation intersects with ethics, access, and equity, raising new questions about how technology can both expand and challenge reproductive freedom. All right, so technologies like IVF and egg freezing are changing family planning.

How are you seeing these options impact patients' choices? Absolutely, it's a great question. So now that we have more advances in egg freezing, in terms of being able to freeze eggs safely and be able to have them survive the thaw, it has actually been a game changer. So that's called oocyte vitrification.

We're able to flash freeze the egg. So the egg is a single cell and it has a lot of water in it. And so when you freeze it, that water can crystallize and damage the interior of the single-celled egg.

So if you flash freeze it and just make sure it doesn't create the crystals and it just freezes it instantaneously, it's less likely to damage the egg. So now that we have that technology of vitrification, vitrify literally means to put in a glass-like state, so it literally just freezes really fast. And now that we can freeze eggs with minimal harm and with good survival rate after the thaw, now a lot of patients who are younger, who have other plans for their careers and would like to not put their careers on hold, you know, like to preserve their fertility, they can absolutely undergo IVF with egg freeze and preserve their fertility and not have to worry about it.

So that's really been a game changer. Additionally, of course, also patients who might need, let's say like chemotherapy for breast cancer or some other cancer, they may want to go ahead and freeze eggs as well before they undergo the chemotherapy that could destroy their egg. So absolutely a game changer.

So I'd be remiss if I didn't mention genetic testing. So genetic testing becoming more common, what sort of are the ethical or privacy concerns do you think patients should be aware of? Like if they come to you and say, hey, we want to do some genetic testing, how do you handle that? Yeah, so basically I tell the patient, we have the technology to be able to biopsy the embryos and to understand what we call the karyotype. In other words, the genetic makeup of the embryo.

And literally we just say, we only know whether the embryo has too many or too few chromosomes. And so every normal human should have two copies of every chromosome. So if you have more or less, then it's a hundred percent miscarriage, a hundred percent not implanting, or sometimes it might make it to term pregnancy, but then shortly thereafter it doesn't make it.

So we don't want that either. So genetic testing is good, but it has a lot of limitations today in the modern era. So we can tell whether, like, for example, I say it's kind of like a book.

The embryo is kind of like a book. The genetic testing can tell us whether all the pages are there, all the chapters are there, and even can tell us whether paragraphs are there or paragraphs have been switched, such as in structural rearrangements in DNA. But sometimes it cannot pick up a misspelled word.

And so that's one of the limitations of PGT or pre-implantation genetic testing of embryos. So though a very powerful tool that we can utilize to make sure that we're putting in an embryo that looks like it has all the DNA it needs, no excess and no deficient, but it still could be missing some information in that we might not know if there's a misspelled word or a mismatch at a base pair at the microscopic level of the DNA. So that's why IVF with genetic testing doesn't yield 100% pregnancy rates, because sometimes embryos, even though we think they might be normal and to the best of our abilities, we say they're normal, they may not be quote unquote 100% genetically normal.

So that's the limitations. Now, one other thing that we are unable to do with genetic testing is designing embryos in humans. We don't suggest and recommend that.

So we can't say like hair color, eye color, but we can definitely tell you if it's got enough the DNA to be able to be normal. We have all these technologies and it makes care more accessible. It makes options better, but it also, let's be honest, it can make it expensive.

Absolutely. In your opinion, is there a gap between who can and can't afford these services at this time? Unfortunately, even my own wife and I are patients and we struggled with infertility and we were very poor students at the time. I had more debt.

I had more debt than I had dollars in my bank account. So, and we had to unfortunately undergo IVF. So I feel that struggle.

I've been there and it was very difficult on us financially and emotionally and physically as well. So I do see this in the patient populations that, that, that come to our door in our offices for seeking help. And you know, it breaks my heart when finances might get in the way of perhaps fulfilling the dream of having a family.

And so it is very hard. Luckily, there are some many, there are a lot of resources online that are available that can assist. For example, there are a lot of grants that are out there that you patients can apply for.

So there's one company that I am on the board of, it's called the BabyQuest. So BabyQuest has helped hundreds of couples have babies over the years with literally a grant. They will give you all the money you need for IVF as well as for the medications.

They'll even negotiate with a physician to see if, and the practice to see if there can be a discount applied. So yes, there are deserts where it may be difficult financially for patients to afford the care, but there are lots of ways to at least try to mitigate that. Yeah.

One, one way that access to care has changed is through telehealth. What kind of difference has that made for you and your patients? Oh, a tremendous amount. You know, before COVID, we only saw patients physically in the office and that meant our geographical reach was within 20, 30 miles of our practice.

Now we're able to see, because, and then during COVID, we were only able to see patients via telemed because that was safest for social distancing. Remember that social distancing? Oh gosh, yes. Right.

So after COVID, you know, went away, or at least the epidemic went away and, or global pandemic rather went away. We have kept this, this nice ability of telemed to be able to see patients from all over the world. I have patients from all over the world, almost any country you can name, I've seen patients from them.

And, and so we're very cognizant that they are, are out of town guests. And so we'll do everything we can to make sure that we can minimize their travel and that the majority of things can be done remotely, specifically telemeds, laboratory tests. We can find local sonographers who do sonograms, et cetera, for us.

So, so the telemed also has revolutionized how we can care for patients. So we can see a patient anywhere in the world. Fantastic.

I got one more question for you. So looking ahead, are there technologies that you think will shape reproductive rights, excuse me, reproductive rights in healthcare over the next few years, or maybe even over the next decade? So are there technologies that could shape policy for? Just again, for access to care, are there certain technologies you're excited about? That, that, yeah, yeah. So that, that, yes.

Yeah, absolutely. I can tell you one of the things that of course is on everyone's mind is artificial intelligence or AI. So like any, any tool, it can be used for good.

And of course it can be very dangerous if used improperly. So AI is the same. I think AI, if used in a proper manner in healthcare, specifically even in infertility care can be tremendously helpful.

For example, if a patient is in a quote unquote desert in an area where they don't have care available and telemed perhaps is not available for them as well, it certainly can at least begin with initially wearing an AI engine, perhaps chat to the team. Now, of course, everybody has to understand that AI is, is filled also with incorrect thoughts and mistakes every time. So sometimes, so you have to be very careful about how you utilize AI, but it could be a good start for patients who are struggling and it's been six, seven, eight months of trying and they haven't conceived and they're just frustrated and they, and the next appointment is three to four or five weeks later and they want to know answers now, AI is a great place to start.

So I think that's a great way to at least increase some access initially and then start with telemed, see your patients or see your physician from afar. And then if you have to fly in or drive in, then that can be the next step. Yeah.

Look at, you got them all mapped out. Yeah. We hope to help as many as possible.

And it's, I remember when, like I said, my wife and I struggled, it was so hard. It was in the dream of a family was disappearing and we were very worried about that. And it was sort of a embarrassing because I was in fellowship at the time for infertility and I could get my patients pregnant, but I was struggling to get my own wife pregnant.

So it was very hard. So I get that. And so when patients need care, we're here for them.

Thank you for joining us for this episode of ASRM Today. I'd like to extend a special thank you to Dr. Lowell Ku for sharing his insights into the vital relationship between technology and reproductive rights. For more information about ASRM's initiatives, research and educational resources, visit asrm.org. Until next time, I'm Jeffrey Hayes, and this is ASRM Today.

This concludes this episode of ASRM Today. For show notes, author information, and discussions, go to asrmtoday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM. ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.