Fertility and Sterility On Air - Roundtable: State Advocacy

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

This month, we are excited to talk about State Level Advocacy with Elizabeth Carr, the first baby born via IVF in the United States, and Dr. Preston Parry.

Elizabeth Carr is a passionate advocate for fertility rights and access. She has presented to audiences around the globe including at the United Nations, ASRM, ESHRE, and the national infertility association, RESOLVE. She has helped companies craft benefit packages and parental leave policies. Her professional experience in the field of journalism, marketing and events, and fundraising. She enjoys marathons and is a writer when not advocating. 

Dr. Preston Parry completed residency in Ob/Gyn at Tufts and went south to Louisville for his fellowship in Reproductive Endocrinology and Infertility. He was in academic REI for 8 years, including as division chief, before opening his own practice, Positive Steps Fertility, in 2017. He is a past president of the Society of Reproductive Surgeons and is currently the chair of ACOG Mississippi. He also is on the Editorial Board of Fertility and Sterility. 

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

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

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

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

I'm your host, Dr. Emily Barnard, and I'm joined by my producer and co-host, Dr. Ben Peipert. This is our very first podcast episode, and we could not think of a more timely topic than covering the views and reviews from the December 2024 edition of Fertility and Sterility. We will be discussing the article entitled "In defense of in vitro fertilization, time to get involved in state level advocacy."

We are joined by two of the esteemed authors today to get their insights and tips on how we can all advocate for our patients and our specialty. Welcome to our guests. I will start with some introductions.

So first we have Elizabeth Carr. Elizabeth, you may know her. She was the first baby born via in vitro fertilization in the United States.

We're really honored you're here with us today. Elizabeth has been in the public eye since she was only three cells old, and she is a passionate advocate for fertility rights and access. She has presented to audiences around the globe, including at the United Nations, ASRM, ESHRE, and RESOLVE, our national infertility organization.

She has helped companies craft benefit packages and parental leave policies. She has professional experience in the field of journalism, marketing and events, and fundraising, and she brings all that background to her advocacy efforts. In her free time, she enjoys marathons, and she is also a published author.

We're also joined by Dr. Preston Parry. He attended Cornell, where he was a triple major, and then he moved on to graduate school at Columbia and later medical school at New York Medical College. He completed residency in obstetrics and gynecology at Tufts, and then he moved south where he went to Louisville for fellowship in reproductive endocrinology and infertility.

He was an academic REI for about eight years, including as a division chief, and then he opened up his own practice in 2017. He is a past president of the Society of Reproductive Surgeons and also currently the chair of Mississippi ACOG, and finally, he is also on the editorial board of Fertility and Sterility. He's very busy, and I know both of you are very busy, and again, we're so honored to have you here today to discuss the article.

We're so appreciative of both of you as advocates, and I would love to hear how both of you got your start in state-level advocacy. So maybe we'll start with Elizabeth. Well, thanks for having me.

I'm so happy to be joining you all. I feel like that's a trick question, to be honest with you. I feel like I got my start in advocacy because I didn't feel like I really had a choice.

I feel like I was thrust into the spotlight at such a young age that I came to realize quite quickly that not everybody agreed with how I came into the world, and that a lot of the time that disagreement with how I got here stemmed from a lack of knowledge of actually the process of IVF and what IVF actually was and wasn't. And so for as long as I can remember, stringing a sentence together, actually by my doctors, Howard and Georgiana Jones, they're the ones who actually taught me the fundamentals of advocacy, which, in my opinion, was being able to explain the basics of the technology and tell your own story. And so I learned from a very young age how to explain what IVF was in my seven-year-old language, which you can imagine is kind of a daunting task, but I muddled through.

And I realized that people wanted to hear from me and my family, and my family made a very conscious choice to not remain behind closed doors. The doctors Jones, gave my parents the option when I was born, you can stay private. We don't have to release your name to the media.

People don't have to know who you are. And my parents felt very strongly, no, people need to know, one, that our child is completely normal and looks like everybody else and sounds like everybody else. And the only thing that's different is the method of her fertilization, really, and how she came into the world.

And so if we have a lack of privacy, the education surrounding that is worth the lack of privacy. Thank you so much for sharing that. I think your parents were so brave to come out and be so public about that.

And we're just so thankful that you've continued these advocacy efforts throughout your whole life, really. And how about you, Dr. Parry? How did you get involved in advocacy? Well, first, I never wanted to be in advocacy. I'm an introvert.

I like my books, I like research, all those types of things. And in 2011, I came down to Mississippi to be division chief at the University of Mississippi Medical Center, the only academic medical center for the state. And they had mentioned to me on my way down, that there was a personhood initiative on the ballot, and that was considered the most likely one to pass and ultimately make IVF illegal in the state.

And that vote was three months after my arrival. And I also got very stern warnings as to what I could and could not do. A lot of interesting trials by fire, so to speak.

And again, I think this gets to a little bit of something that Elizabeth alluded to, where even if you may not have a natural inclination, there's a degree to which you can't help yourself, you feel compelled that ultimately, while we may have our natural inclinations, we also have this responsibility to do right by those entrusted to our care. And if we don't speak up, or if we don't act, no one else will. And so that started me down the path.

And fortunately, the personhood amendment did not pass in Mississippi when many thought that it would. And I think that was a lot of local people speaking up, as well as testimonies from patients that were essential at that time. But then also, I started becoming more locally involved with ACOG, and started just seeing how many things were arising, where people didn't know.

I would get cold calls from state legislators. They would be a pastor, they would be running a repair shop, but they'd be on the state legislature. I'd get a cold call, and I wouldn't even know who's on the other end of the phone.

And it says, yes, this is Representative X. So when does life begin? Or, you know, if you have a woman who is assaulted, raped, and she's pregnant, can you transfer that embryo from her into another woman? And I'd get these blind for things, not knowing what I was getting into. And I think that also gave me an appreciation that there are many people out there who may have differences of views, and they're searching for whatever answer that they can get. And if we are not the ones to provide it to them, someone else who might not be informed will.

And that can have deleterious consequences, not just for us individually as REIs, but ultimately the state, and even the country, as we've seen with DOPS. It's interesting, you know, what you were saying, these people are calling you, and I think some of them really don't know, like you said. And I'm so glad that you were a trusted voice, that they were able to ask these questions, because I think there is a lack of knowledge about a lot of things in women's health.

And some of it, I think, is blatant misinformation, maybe, but a lot of it is just lack of knowledge. And how do you think we as physicians and then, as organizations, when we're doing our advocacy, how can we best combat that scientific misinformation, those rumors that are out there that we know just aren't true? Well, I think one of the first things is to be in the space. It's sort of just as those who think themselves above politics are deemed, they will be ruled by those who are not.

Similarly, we are not in social media. We have TikTok disinformation rampant, and we spend half our lives debunking it. If we do not provide a better alternative, the truth may be lost.

So I think that's part of it. I also think we just have to have the humility to listen more to our patients. Part of the rise of turning to people who are less educated is because they want to know how much we care before they care how much we know.

And I think medicine, as well as the economic stresses on the medical system, have a little bit lost our way on that front. The more we can actually listen to our patients and hear where they are, the more we can be trusted and the more we can spread proper information. And finally, we have to just get out there and do things that might not be in our comfort zone.

We have to go to, you know, just local events on public health and we speak up because if we don't, someone else who doesn't know will. I definitely agree with that. And I think you're right, just giving that little extra bit of time and showing that you care does help us gain credibility and trust.

Of course, with our patients, that's what we do every day, but also with elected officials and community leaders and other things like you were mentioning. I could follow up from that. If you look at defeating personhood in Mississippi, as well as some of the many laws that have been attempted or explored afterwards, it was often patients speaking up.

They were saying, my child would not be here without IVF, without care. And so actually, we have a deliberate intent for our patients to speak up and share their stories. And I think for all of these practices out there, the ability to tell our patients, your voice matters.

The more people hear and the more you say, your child should be here and they are important. It is very hard to come between a mama bear and a cub. It's even more insulting to try to tell the mama bear her cub doesn't even deserve the right to be there.

And so the more we speak up, the more the politicians hear our voices, the less likely they are to infringe on our right to have families that we love. Yeah. Elizabeth, I should hand over to you on that one.

I mean, you're the perfect example. Yeah, I was nodding feverishly along with you here because I think that's the one thing that, you know, with the personhood bills, I personally, you know, I make myself quite available. If you want to get in touch with me, I purposely make myself available.

You want to send me a note, you can go right on my website and get in touch with me. If you want to get in contact with me on social media, you can very easily send me a message. And I don't have a team.

I don't have somebody else, you know, screening my stuff. You send me a note, you're that on purpose because I want people to be able to ask questions. And if I don't know the answer, I will find you a resource or another human who does.

And I will connect you with those people. And I pride myself on that as somebody who is a journalist and in this space, in this community. But the flip side of that is that you can imagine I do get a level of rather unpleasant commentary directed in my direction.

And when we saw some of the fallout from Alabama, I had people outright telling me I don't deserve to be here. I don't deserve to exist as a human simply because of how I came into the world. And I just kept thinking, you know, there's 10 million some odd plus, plus, plus, right? IVF children, adults, humans on this planet and other, you know, methods of conception.

And, you know, they are contributing members of society. They have lived full lives. They are policymakers.

They are teachers. They are, you know, doctors and, you know, wonderful humans. And, you know, to just sum it up and say, well, none of that really matters because you got here in a different way, really struck a nerve with me in particular.

And so I felt like I needed to use my particular voice to stand up for, you know, the byproduct, the outcome of this technology and say, hey, everybody, I'm going to take the flag for us. But just know, like, it's okay if you're feeling uncomfortable in this moment because you do deserve to be here. You already are here.

And we can't undo Pandora's box, by the way. It's not like we can just, you know, decide that we're going to put you all away now, right? I just felt like, you know, I wanted more people to say, hey, don't pick on my friends. You know, I think that's where I really wanted more people to just say like, you know, you don't want other people to say you don't want, you know, you shouldn't be here.

Why would you say that to anybody else? Just common decency, right? And, you know, I've made myself kind of, I've opened myself up to a little bit being a target because I also feel like I do have a duty to kind of shield other people from this kind of attack. And I recognize that, you know, IVF clinicians and nurses and embryologists are kind of in a similar situation that, you know, in a way they're shielding their own patients from this kind of attack on a regular daily basis. And I appreciate that and understand it's a very difficult place to be.

But I also think it's so important for your patients to know that you see them and that you understand that, you know, in some places and in some communities, the stigma is still very strong and very real. To interject, I think you have been a lightning rod for these just simply because of your role and that we have a whole culture where we're, you know, online has such vitriol and all these trolls to make things difficult. But we also have to remember, and this was in the paper, you know, 78% of those who call themselves pro-life believe IVF should be available.

83% of Christians surveyed did that. And 86% of women believe IVF should be made available. But it even goes beyond that because remember, as you look to the remaining portions, the majority of that remaining portion that isn't supportive, the majority actually is undecided.

They don't really know. So it's even a narrow window that doesn't support it and is actively against it. But the thing is, many of those actually don't understand what IVF is.

And if you can actually teach and educate as well as precede it through your conversations, many of those people will too come around. And this is where I start getting into the preceding the conversation and preceding the votes. So many of the votes are part of social proof.

You know, if you believe the truth, it is, you're simply logical. If you believe a lie, you find a community or an identity. And this is why actually so many people with anti-vaxx and Latter Earth and things like that actually are finding connection in a world they find increasingly less to have that.

And so the more we can have people speaking up about their experiences, their journeys, and the fact that this is normal, this is a part of building society, it's a part of creating loving families, the more there is the network that ultimately are protective and is valuable for all of us. Everything we face right now on a reproductive standpoint was 50 plus years in the making. And it's going to take a lot of grassroots effort from all of us individually to reclaim spaces that we should have.

Yeah, and that's, I totally agree. It's a good segue into kind of thinking about how can we frame our conversations, you know, whether that's with friends and neighbors, or whether that's with elected policymakers, what kind of strategies or really just how do you talk about IVF when you're advocating for access or when you're explaining what it is? What kind of framework do you use to talk about it? I think, first of all, as someone who's not always socially gifted or conversationally skilled for things I'm learning for my patients, I would say, you know, I used to just come, here's where I stand, here's what I believe, and that's, you know, that was my natural inclination. I found people don't like being lectured to, you know, and the reality is they want to tell you their beliefs more than they want to hear yours.

And so the ability ultimately to listen is going to be a huge part of being effective. And the ability to connect with people on their fears, on their desires. For example, you know, one of the things is there are a lot of people who are worried, oh, this is, you know, genetic engineering or things like that.

And to say, really, look, this is just sperm and egg meeting and having a baby. We're just helping it along just as cancer care gets support, just as all these other things. This is just biology, and we're giving it a bit of a helping hand.

One of the most important things, if I had, one thing to take away for sort of, you know, my thing that I think needs to be out there that is not, is there are people who are very worried that IVF destroys embryos. And I think this is a misconception. If for the personhood movement, where they're saying every, the moment a sperm and egg meets, that's considered life.

And there are various religious disagreements on that. There are all kinds of views from the Bible to, you know, all kinds of faiths for that. But what is lost in that conversation is that sperm and egg meet in the body too.

And not all those embryos make it. If you take a person with one, two, three or four eggs, and you do insemination, so plenty of sperm find the egg 50 times more than from intercourse. And you compare that to IVF.

From the papers I saw that were comparing those numbers, and these are older papers, so the stress rate is even better now. You have three to four times the live birth rate per egg with IVF, as you do with insemination. So what that means is, yes, not every embryo survives in the lab, but it's a heck of a lot better than in the body.

And the people who get up and say, you should not do IVF because you're destroying embryos. What I see that is like, someone is in a bad car wreck. They're brought into the emergency room.

They're bleeding internally. And everyone says, okay, we need to get them to the OR to save their life. And all of a sudden, someone from outside the field says, stop, you can't do that.

They might die on the operating room table. And everyone just turns to them and says, yes, but they're four times more likely to die if you do not take them to the OR. And so one thing is, if we are to have people who are having conversations that are truly and sincerely caring about embryos that are formed and giving them every chance, and not the ones who are just using it as excuse to justify their social circles or anything like that, the people who are sincerely caring and interested about that, say, why do you want more embryos destroyed in the body by allowing for inefficient care? And I think that's something as we, again, the start of this conversation where I get on this tangent was on how do you connect with people? If you can connect with them on the issue that is most important to them, and that is what they're saying, protecting the embryos.

And IVF does a far better job of that than natural conception can. I think for me, I always take the tact of, again, I was a journalist, so I always start with a question. And the question I always lead with is, and I always come from a place of whatever technology they're giving me a hard time about, and nine times out of 10, it's IVF.

So I always start with the question, tell me what you know of IVF. And I ask them to explain to me their understanding of IVF. Because then I can gauge how much they got right, how much they got wrong, and just see if we're even close to speaking the same language.

And often, what I will do is listen to their version of what they think IVF is and say, okay, well, here, let me tell you how IVF was used in how I was brought into the world. And then I will go through and explain, you know, often, it's come up around, people think we use IVF to make designer babies. And that has been a narrative forever.

And, you know, I always say, well, my mother had three ectopic pregnancies, and one of her tubes blew up, the other had to be removed, because it was so damaged. And she had scar tissue. And she didn't have the parts to, you know, conceive the traditional way that you would.

And that was a problem that IVF could overcome. And so, you know, that technology overcame that problem. But you can understand that, you know, you can't make a car go if you don't have the parts of the engine, right.

And so, I will often try and understand and gauge, you know, their understanding of that process. And I often find that if I ask them questions, and get them to, you know, at least comprehend different analogies, or at least understand why it was used in my case, or in any other case. And, you know, that now I've at least overcome the hurdle of we're speaking the same language.

And I think that's the biggest key to the educational component is a lot of us, you know, because we do know the procedures, you know, so well, we will try to explain it in a certain way that we're just used to rattling off. And I've had to really train myself to say, you know what, every single time I have a conversation with somebody, I have to explain it a different way. Because of the different ways that people learn and understand information.

And so, I have never had the same conversation about IVF in my life, it's always a different conversation. That is such a good point. I think IVF, our field is so technical, there are so many abbreviations and other just kind of complicated medical words that are second nature to us.

But I think that is such a good tip when someone is, you know, kind of learning how to do advocacy, how to communicate even just to make sure that I'm kind of speaking in a language that everyone can understand. And I liked some of the metaphors that both of you were using to kind of explain it, put it in a different framework so people can really understand. And I'm sure you've had these experiences when I've done advocacy work, it's amazing how many people have been touched by in vitro fertilization, even when you're talking with a 20 year old staffer, you might think, well, they haven't even tried to build a family yet, maybe this won't resonate with them.

But now some of them have actually been born via IVF themselves, which is always kind of interesting to hear. And I think so many people say, oh, gosh, my, my sister, my friend, you know, there's so many people who've been touched by IVF, that it can help open those doors for some of those tough conversations. And, you know, speaking of tough conversations, you know, sometimes when we're in a meeting with a policymaker, it's, we're all kind of on the same page.

And those are always good meetings, we can kind of think how we're going to move forward. But sometimes we're in a meeting that is maybe a little more adversarial, we know the person doesn't have the same feelings on the issue that we're talking about. And I wondered if any of you have any experience with that, and maybe some ways you've been able to connect with people who you thought maybe you wouldn't be able to on this issue.

One of the first things I think if you're going in to meet your legislators, both at the state and federal level, don't wing it, don't go it on your own. There are people who've been doing this, they make their career out of it. In fact, one of the most important things, if we are to invest in protecting things, I believe every reproductive practice should be collaborating, but ultimately have a lobbyist that can actually know the political waters and say, this person will listen, here's how this person, you know, unfortunately, they're not particularly open-minded on this subject, I wouldn't be wasting your breath.

I also think that while many legislators may not agree on you with everything, the ability to find common ground, and at least to say, I don't think I can convert them to a yes, but I can make them a softer no, or I can make them a neutral, their political relationships might not allow them to vote in a particular direction, but they can even abstain. And there may be ways, again, of moving the needle without it being that instant score, so to speak, that everyone's looking for. I also think that relationships take time.

And the ability to be starting these at a very early level and continue it and be a constant presence is essential. So I, again, there will be hard conversations, but the more you practice, and you know that rather than do a cliff dive, you let someone, you know, swim the waters first and say, here are the rocks that you might hit, don't dive there. That's a good start.

You know, we are currently recording this podcast via ZOOM. And, you know, I think advocacy used to always kind of be in person, but now, post-pandemic, we do a lot of things virtually. That's how the American Society for Reproductive Medicine and RESOLVE have been doing their advocacy day these last couple of years.

How have you found the effectiveness of this tele-advocacy versus in-person advocacy? And do you kind of see a role for both? I personally think, you know, we've seen attendance through the ZOOM advocacy go up, and we've had a lot of participation across different states who feel like now they can make the advocacy day work because of the nature of being via ZOOM. And you can jam-pack a lot more meetings in a day because you're not, you know, walking through the halls trying to, you know, race from one end of a congressional building to another. So on that respect, it's been very effective.

I think the key to it is in, of course, the follow-up, right? And the follow-through. And so if you don't actually follow up and take notes, you know, and actually pay attention to how the meeting went and gauge the reaction, which I know is a little bit harder sometimes over ZOOM than in person. And again, taking those notes and saying, oh, they asked a poignant question.

And even if you didn't know the answer, then to make sure that you get them the answer and follow up and send the literature or whatever you were going to send. And continue the conversation and just, you know, read an interesting article, send it to the staff member that you were speaking with. Or, you know, hey, I thought this might be of interest to you.

You know, this was from your district and it might impact you or, you know, whatever the case may be. Because again, as Preston said, relationships take time and you can still build them over ZOOM. You know, even just a quick little, thanks so much for a great meeting.

And, you know, I'm happy to answer any questions you might have, even if you didn't have any today. Because often, you know, those questions do come, but people can get stage fright, right? You still get nervous, even on a ZOOM meeting. And you still maybe don't want to ask the question that you're asking, you know, if it's in a ZOOM room with other advocates or, you know, what have you.

So I've given out my personal number. I mean, you know, so I think that's the nice thing is that, you know, a lot more people can participate now. So first to echo one thing, you know, it takes 5 to 25 impressions for something to resonate or be associated with the truth for people.

So the follow through where you are continuing to provide that information is essential. I do think, though, the balance of virtual versus in-person depends a lot on the community you're a part of and, you know, how busy they are, how engaged they are. For instance, we know that with ZOOM, people are less engaged.

They will have the dogs barking in the background. They will have, you know, the phone that's out in front of them. You know, when you are there in person, there is a different level of focus.

I think also that there is a different level where they see your commitment and your seriousness to the issue. It's not that you need the quantity, but you also need the quality. And for me in the Deep South, those personal connections are really a part of the cultural identity where I think there's more emphasis on that than there are necessarily in some other locations.

I was in DC a month ago meeting with several representatives and the staffing for our senators. And to be there in person and then all of a sudden to have one-on-one time just talking with them, they'll remember you from being physically there when not many people are willing to make that effort. So I think it's a balance of things, but I do think there's something irreplaceable about in-person for stronger connections.

Let's kind of think about how new advocates, maybe people who have never dipped their toe into these waters before, like we mentioned, it can be a little intimidating. How would you recommend that people start getting involved in advocacy efforts? May 20th, Advocacy Day. ASRM, we have a day where partnering with RESOLVE, we can actually get people to be virtually present with legislators, but also you can become enmeshed with a community that will support you by getting directly involved with ASRM and advocacy work.

And don't forget, with Advocacy Day, it's the perfect time to get involved because you get training, you get talking points, you don't have to reinvent the wheel, you can share your own personal story, or you can choose not to and just stick to the talking points. So it's the best of both worlds. You can see it in action for yourself.

You get a group of colleagues and a cohort to practice with. There's a cram session, so even if you have no idea what you're doing, you can go to the cram session. It doesn't take a lot of time, and it's a really wonderful experience, and the training is top-notch.

You get all the information you need. I've gotten very involved with State ACOG. I am a chair for Mississippi ACOG, and I have very good connections with people in neighboring states, and actually, we've collaborated together on various issues as they arise.

And also, I have gotten involved a bit with the State Medical Association, and they actually came out and talked about legislative non-interference and made it a position last summer on a lot of the reproductive health issues. And I think the more you can build a community, not just of fellow REIs, but of fellow OBGYNs and fellow physicians, you have more people on your side, and they also, by being more experienced, may be able to help and guide you to points where you can have more of an influence than you would just through using only one line of attack or development. Yeah, I agree.

I find the RESOLVE and ASRM partnership for Advocacy Day so powerful when you have a group of people. Some are physicians or mental health professionals, or maybe they're even in pharma, or they're more on the clinical side of things, and then you have patients who have been through so much and are so brave to share their stories, or not, or just to be present. But I have found it to be such a powerful event, and as Dr. Parry was mentioning, there are amazing opportunities through ASRM and ACOG, for those who are physicians listening in, to get involved in larger or smaller Advocacy Days.

Most states have Advocacy Days. Scripts are there, so you don't have to go totally off the cuff, like Elizabeth was saying. I think that's so helpful, because sometimes you just kind of freeze up.

You get a little nervous or starstruck if you're talking to your member, but I think it's just always so important to remember these are just people too, and they're many times so interested in learning about our field and all these wonderful tips that you've given today, how to share about what we do as physicians, and how we experience IVF as patients. It really is fundamental, I think, to what we do, and it really is helping bring so many wonderful people into the world for families that otherwise might not have been able to. And I'm just so appreciative for both of you as advocates.

You're both such leaders, and I'm sure we're going to be inspiring future generations of advocates, hopefully, from hearing from you and how passionate you are. We hope this podcast inspires both those experienced with advocacy efforts and newcomers alike, as this is a critical time in our field, both with potential opportunities and new challenges. Thank you so much for listening.

Until next time. 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.