Hatching a Plan

. I'm Emma the Embryologist.

Hello, I'm Simon Tomes, Emma
the Embryologist's husband.

And this is Hatching a Plan.

Let's get stuck in folks,
this is episode six.

So welcome.

Appreciate it's been a while, but
it's good to be back and we are

recording this just by ourselves.

So in the past we've done this
in front of a live audience.

We thought we'd try to record some
podcast episodes with just the two

of us having a chit chat on our sofa.

So today's episode, we're going to
cover three things, so do stick around.

First up, we are going to discuss
the hard truths about embryo grading.

We're going to discuss why schools
matter to the world of infertility.

Emma's going to dive into the
phrase she often hears, Why

did no one tell me about this?

And by the end of the episode,
you are going to find out why

Emma went to the UK parliament.

That is very exciting.

So let's dive in, folks.

We are going to talk about embryo grading.

So before we jump into some of those
hard truths, Emma, for our audience,

can you describe what is embryo grading?

So imagine you're describing
this to someone who is just

starting their journey.

They have no idea what embryo grading is.

They've heard people talk about it.

They've seen some numbers knocked
about or some letters and some

numbers and all that stuff.

And they're like, Hmm,
what is embryo grading?

I want them to hear it from you,
a professional who's been in this

business for a very long time.

Very long time.

Okay.

So, embryo grading is one of the
most talked about topics in my world.

I think it becomes the only tangible
thing that a patient has to hold on to.

Beyond, When they give
over their eggs and sperm.

Beyond the lab doors, no one
really understands what's going

on, which is what we're trying to
break down a little bit, obviously.

So just interrupt, so to put into
simple terms, when people hear the word

grading, I guess they're holding on to
a grade and throughout our lives we've

been graded whether it's at school, A,
B, C, D, level one to nine, whatever.

Something that feels like a
number or a letter is something

we can compare ourselves to.

Is that why people get caught up with it?

Yeah, but I think it's also
really tangible, right?

Because It's the information you're
given from the scientist in the lab,

and it's the only thing that you get
that you can hang on to, write down.

And then the one thing that happens,
because we're humans now, and

we live in a world where you can
access anything on the internet,

is you put that grade into Google.

Yeah, I see.

And then you're looking for
what that grade means, because

ultimately, Desperation sets in.

No one, as I always say, no one goes
skipping into a fertility clinic.

So, embryo grading is full disclosure,
is a language that I would say

embryologists speak to each other
to allow us some understanding

of what we are seeing visually.

in a dish when we are looking at embryos.

There are different places
that you can grade embryos.

So, embryos grow over a number of days.

Day zero is your egg collection day.

It is the day that the eggs are
thawed or they are collected

or they are at the egg stage.

It is the day that we either
thaw donor sperm or use partner

sperm to create embryos.

We don't grade things on that day,
we are creating embryos on that day.

As much as possible with ICSI or with IVF.

Day one is the following day, where
we're looking for signs of fertilization.

We don't tend to grade on
that day, to be honest.

You could put everyone's
embryos in a lineup on day one

and they all look the same.

So you can start to grade embryos on
day two and day three and what you're

looking for is you start with a number
which is the amount of cells in that

embryo and then some places will grade
one to four or four to one, one being

better, four being better, you absolutely
have to understand your clinic's grading

system because, especially day two
and day three grading, it's anyone's

guess what they're talking about.

So it's not a universal global standard.

Oh no, not with day two and day three..
I would use one to four, one being best.

. So the advantages of it is
internally within each clinic

is they can communicate, right?

Embryologists, so the people who are
dealing with sperm, eggs, embryos, and

patients, they can have, they have a
lexicon, they have a language that they

can use to communicate with each other.

I don't even grade day twos and day
threes now, because we grow everything

to what's called the blastocyst
stage, Day five, day six, day seven.

. So, a blastocyst is the stage that
an embryo reaches directly before it

implants in the lining of the womb.

It is the stage that
an embryo can't bypass.

It is a stage that it has to
get to, to make you pregnant.

And it is a stage that comes
along in the laboratory or not.

Some embryos never make blastocysts
because they were never destined to be

able to create embryos that were viable.

So if they do make blastocysts,
there is actually a worldwide

score we all generally use.

Some people choose to go a bit rogue.

called the Gardner grading score.

So when we're talking about
blastocysts, we start with a number.

The number, if you can imagine, a
blastocyst is an embryo that has

gone through multiple divisions
in those first four to five days.

It has then gone through what we call
its first differentiation process.

So, up to day four, early day five,
an embryo is called a blastocyst.

Like a totipotent cell, which
means it has, any cell has the

ability to become anything.

All it's doing is getting
bigger and getting more cell

mass, if that makes sense.

By day five, some of the cells will be
pushed to the outside of the sphere.

It's not a flat object.

It is a spherical ball and they will make
the trophectoderm layer, which are the

cells that Become the placenta, and then
you get a ball of cells that forms in

the middle, and those are fetal cells.

It is now a pl potent entity.

I swear they make us use Latin to
make us sound clever than we are.

But basically what that
means is it's the first time.

an embryo differentiates.

So it has a cell destiny.

So, the cells on the outside make
placental cells, the cells on

the inside make fetal cells, or
become part of the foetus tissue.

If you can imagine a balloon, a
water balloon, filling up with fluid.

And as that balloon fills up with
fluid, it becomes bigger, and it

starts to push against its own shell.

The aim being that it becomes so
big, it cracks and hatches out of

the shell, a bit like a chicken egg.

So we use that number at the very
front of the blastocyst grade to

determine how big the water balloon is.

So a number 1 is a very early
stage blastocyst, a 3 is a mid

stage blastocyst, a 5 is cracking
through the shell, hatching, and

a 6 is a fully hatched entity.

Which, in the lab, we try and avoid.

We try and either freeze or use
before they are fully hatched

because they become quite vulnerable.

They're also sticky little sticky little
monkeys once they get out of their shell.

We then use A, B, C, and D, A
being best, to grade the two

differentiated cell lines.

The first letter is the inner cell mass,
so how good does those baller cells look?

Notice I said look,
because it's all visual.

Inner cell is foetal?

Inner cell is the foetal
part of the embryo.

And then we use A, B, C, and D to grade
how well the placental cells look.

Again, I've said look.

It's really important that we talk about
the fact that this is a visual grade.

Why is it important that
it's a visual grade?

Because of ambiguity?

I'm going to get there.

Oh, okay.

I'm going to get there.

I'm getting ahead.

You're getting ahead.

So, you will end up with a
number that doesn't actually

tell you anything about quality.

It tells you about journey.

It tells you about size.

You then end up with two letters.

And so you'll end up with
something called A3BB or A4BC.

An A is excellent.

A B is good.

C is average.

D is poor slash, in my
world, degenerating.

So, anything with a D in it, we are really
worried that that embryo is not surviving.

C is average to poor.

B is good.

What do they all mean?

Well, it's just a visual.

it's us looking at an embryo
at a moment in time and saying,

How nice does that embryo look?

So my assumption at this point, and
again folks, I'm not clinical Emma

is, of course, but my assumption
at this point is when you say that,

the moment in time is important,
because let's make an assumption

that a day later it may all change.

Is that true or have I misunderstood?

An hour later.

An hour later, okay, right, right.

Two hours later, four hours later.

So it's a snapshot of time and that's
And actually you're talking about

something that's developing constantly.

So people get this letter, these, this
number and two letters given to them by

their clinic and people come to me or I
get given this information in paperwork

and actually the first question I ever
ask if someone says I've got a 4BB.

. When?

When?

When?

Of course you'd ask when.

Because actually what really correlates to
embryo health is how quickly it got there.

So a 4BB on day 5 In a woman that's
under 35 years old has about a 50 or 60

percent chance of making you pregnant
because it's grown to a point where

it should be so embryos blastocyst
should be there really Mid morning, day

five, maybe late afternoon, day five,
they should be forming, they should

be, if they're not fully expanded,
when I say fully expanded, I'm talking

about your fours and your fives, so
they're really big water balloons.

But they should be there on day
five, , that is, let's say embryos

haven't read the textbook, but
that is what the textbooks say.

an embryo that is a 4BB is a visual
grade given to something, but my always,

always question is what day was that?

Because a day 5 embryo in a woman
that's under 35, has about a 50

60 percent chance of working.

An embryo that is a day 6 4BB
is actually still very good,

but it does drop a little bit.

But a day 7 4BB, same grade,
20 percent chance of working.

Because, how long that journey
takes, correlates to embryo health,

and embryo competence, and embryo
genetics, and all of those things.

So, the grade is the grade that's given
to tell us what it looks like, and

probably, where it is on its journey.

Like if I've got an early stage embryo on
day five, I won't utilize it on day five.

By utilize, I mean
biopsy, freeze, transfer.

I would much rather wait
until it's an expanded entity

where it can tolerate things.

It has more cells.

It's better at coping with
everything we've got to do to it.

And also, embryos can fail between
the early blastocyst stage and

the advanced blastocyst stage.

So why would we put them in the
freezer early when we are then just

putting false hope in the freezer.

An embryo takes from the early stage
blastocyst stage to a fully hatched

entity, which is the ones we worry
about because they're really hard to

work with, it takes about 30 hours.

So we've got time, we've got a day.

and that grading can
change within that time.

I regularly come in in the morning and,
The lab team will say patient Joe Bloggs

has got four that are really early
stage blastocysts, we'll keep an eye.

So we actually do triple
checks on all the embryos.

We do an 8 a. m. check, a 12 p.
m. check, and a 4 p. m. check.

So we're constantly
looking for that movement.

and actually an embryo can be
really early stage in the morning.

And it can be really
advanced by the afternoon.

It's a growing entity.

Equally, it could be really
early in the morning.

So I think it's really important to
understand that embryos have rest phases.

They definitely do massive load
of cell division and they rest.

Wow, that's fascinating.

Yeah, because you have cell cycles, right?

So a cell cycle in embryos takes,
so if you go back to like day

one, an embryo goes one cell and
then it divides into two cells.

And those two cells then go
into a 10 to 12 hour cell cycle.

So it takes about that long for the
next cell division to happen, so

that's how long it takes to see the
fourth, the third and fourth cells.

A little two break.

A little two break.

Has a, has a break, has a KitKat.

Has a little KitKat.

This episode isn't sponsored by KitKat,
but if uh, if uh, KitKat wants to do that.

Nestlé are interested, then,
then we're open to that, right?

So, they have breaks and they rest,
and the thing is with embryos, they

don't hold up flags, and they don't
say, I'm having a little rest.

So we don't know.

We're just, so some of them will expand
really quickly, and they'll be completely

different entities by the afternoon of
day five, other than need overnight.

Ultimately, it is incredibly unusual
for an embryo to go from an early

stage blastocyst to a fully hatched
entity in less than 24 hours.

It takes time.

Because they've got, the whole
process is about cell division.

So the grade, going back to what we
talked about and you got ahead of

yourself, is only part of the story.

Yeah.

And also, this is where the
time lapse comes into it.

The time lapse is the incubators
that have the cameras on.

Because what does correlate to embryo
health is embryo development patterns.

So every cell should make another cell.

Yeah.

So you should have a one cell
fertilized entity that makes two cells.

Each cell should make another cell.

Four cells.

Each of those cells
should make another cell.

Eight cells.

That process of division is
crucial in how we then know that

an embryo has the capabilities
to go on to make, A, blastocysts,

B, go on and make pregnancies.

That is exactly what AI uses when
it's using predictive values.

It's looking for cell
division timings and patterns.

So if you don't, I had someone
ask me the other day, my embryos

all looked fine on day three.

And I said looked fine or were fine,
because an embryo can be at the 8

cell stage on day 3 but made multiple
aberrant problems with divisions.

But if you haven't got a camera
on top of those embryos, you

don't know how it's divided.

Did it go, did it go 1 to 3, 3 to 6?

So you visually go back and you see,
you use the time lapse to go, ah,

we can see it go 1 to 3, 3 to 6.

And then you would go,
ah, there's a problem.

No, no, no, you would say, so if
someone's, so if an embryo is 1 to 3 And

you take that embryo out of the incubator
on day three, and it's a sick cell.

That's normal for day three.

Okay, right.

But, it's not normal because it's
done abnormal divisions, right?

So, just because something looks
okay on day three, doesn't mean

it is okay, because actually
one to three is embryo fatal.

So why isn't there a new grading?

Like, I think I mentioned this in
another episode where I think You should

create, you should create your own model
called the Whitney grading model, and I

absolutely, absolutely believe you should.

That's saved my free time.

It feels like there should be one
based on time, because it feels like

the snapshot approach, the current
grading model is utterly flawed.

It isn't to me.

All right, okay.

And I think that's the point.

It's not to me.

But to the patients, they misinterpret.

Exactly.

Okay.

They misinterpret something
that's incredibly scientific.

Okay, there you go.

And ultimately, the point is, the
fixation on the grade is because it's

the only information they're getting
from their lab that is tangible.

And it's simple.

It's a number and some letters and A
is better than D, et cetera, et cetera.

And this is why we're going
to talk about education.

That's cool.

Because if the patient understands
everything that I've just said,

that grade becomes less important.

A conversation with your embryologist
becomes far more important because

I can tell you all of this.

I can tell you what I think an embryo's
chance of working is based on your age

and how it grew and all of these things.

But I can't, you're not going to get that
from a letter, two letters and a number.

And that's a lot.

And unfortunately, that's a lot of What
people get, and that's all they get.

It's like, I think of it in terms
of like, systems thinking where you

can't just look at one piece of the
puzzle to understand what's going on.

That's, for me, you know, and again, just
to reiterate, I'm not an embryologist,

but a husband of an embryologist.

I kind of hear it, it's just one tool,
it's one indicator at a point in time.

But there's so many other things, like
the fact that you can look at time

lapse and then you can see how things
are divided, things are progressing.

You've got so many other factors, and
age, which you keep on talking about.

So yeah, the age of the embryo,
the age of the egg that creates the

embryo at the time it is created.

I'm not talking about when they're thawed.

When it was created, so when
that egg collection happened.

The age of that egg.

is still, without PGTA testing, which is
in another episode about genetic testing

and embryo health, without PGTA testing,
the age of the egg that created that

embryo is still the sole defining factor
around whether or not embryos will make

healthy pregnancies, because it's to
do with reproductive aging in females.

So that is why if someone says to me, I've
got a four BB I ask multiple questions.

How old were you when
that embryo was created?

Has it been biopsied and
screened for PGTA testing?

What day did it reach
the blastocyst stage on?

Was it under time lapse and do you
have developmental patterns of points?

What time of day was it scored?

Because ultimately an 8am blastocyst
on day five is very different to

a 4pm, sometimes very different
to a 4pm blastocyst on day five.

someone said to me the other day, I had an
eight cell on day three and I went, when?

Because actually by day three afternoon,
it's completely normal for them to

be 12 or 16 cells because they've
moved into that next cell phase.

Yeah, I see.

And also maybe.

And I think this comes down to
trust, right, because maybe you

don't need to know any of this.

But it's all the
information you're getting.

And that's what I think makes
me cripplingly sad, is this

is the only information you're
getting from your clinic.

So maybe if we just had more trust
and faith, and we had more openness

around the laboratory processes, we
wouldn't be Well that's my point,

like, if you think about it in terms
of trust, that is about information

and getting access to information.

do people just go, Oh, well,
you know, I know this clinic

has got good success rates.

I've just got to trust the system.

Or is there more information or more
questions they can ask if the clinic isn't

giving them the answers that they need or
the information they need, like what are

those questions they should be asking?

Because at your clinic, you're transparent
about the process, it's very bespoke.

We're involved quite a lot as
well, so we're on the journey.

You're not hidden away from the patients.

I've said this before, but I
really want these t shirts made

up that say stay in your lane.

All right, the lane thing.

Here we go folks.

Here's Emma, here's Emma
getting into the ranty mode.

This is, this is an important one.

What is the lane?

What is the stay in lane, I don't
understand why doctors talk to

patients about embryo growth.

Here we go.

I won't talk to you about
your lining of your uterus.

or anything to do with your stimulation
meds, but I don't, it's not my field.

I will never ever give medical
advice because I'm not a medic.

So you're a clinician.

I'm a clinical scientist.

So you provide clinical advice
as opposed to medical advice.

Based on my field, which is
embryology, embryology and embryos.

So why would, so why do doctors
talk to patients about embryos?

I don't understand it.

Talk to your embryologist about
embryos, they're the specialists.

So, so folks Stay in your lane.

So, putting more of a positive message on
that, the recommendation is essentially,

if a doctor is talking to you about
your embryos, you have every right to

say to them, please could I speak to
an embryologist in the embryology team?

That's a fair, fair question, right?

Absolutely, and they should, because,
you know, We're really good humans.

We're really nice people.

But I will say, let's talk
about subjective bias.

So I have been in this job
for 23 years this year.

That makes me feel really old.

But I have been doing
this 23 years this year.

I honestly don't think I will give out
as many AA grades as a junior colleague.

Ah, okay.

Interesting.

Because I think I've got
subjective bias, right?

I've seen hundreds of
thousands of embryos.

And I also have a picture in my head.

Yeah.

And I'm probably a bit of a harsh grader.

And I don't think that means I'm a bad
grader, I just would grade differently

to maybe a junior embryologist.

Also, I think you've then got to
flip it on its head and say, what

else was in the lab that day?

If you had a 25 year old patient with
loads of AA grade embryos that you've

just finished grading, does the person
next to that whose embryos don't look

as textbook, then get a lower grade.

I think this is exposure bias.

Yeah, we're humans and we're fallible
and that's part of the process, isn't it?

But how, how then?

Okay, well So my point is,
don't take too much into it.

Yeah, that's, so I was going to say,
how would you reassure a patient?

You would, you would just have
to say to them, please do not

read what's on the screen.

I always thought we should
start using buckets.

Good, average, and poor.

Okay, yeah.

Here it is folks, this is Emma.

Emma exploring the Whitney
grading system right here live.

So I actually think, if
you put, what's that again?

Good, average and poor.

Good, average, poor.

So I actually think, if you put
an embryologist in a room and

show them a load of embryos.

And we do this quite a lot
of work actually, it's called

internal quality control measures.

and we would show people
pictures or videos of embryos.

It's actually something we actually do.

And we have external quality as well.

So if you were to put embryos into a,
like an embryologist in a group, if you

go and put embryologists in the room
and said, right, what's that embryo?

I reckon you would, if it was a
good embryo, they would give you

a, a aa, A, B, B, B, B, A. Right?

Mm. Good.

They all go in the good bucket.

Good bucket.

Right?

And I think then you would get us all to
agree that they were slightly average.

Yeah.

Yeah.

And I think we would all
agree that they were poor.

But we won't give the same letters.

Ah, okay.

So just go with that.

Go with the three.

So Here it is!

How would you add time to that?

Is it just you'd say,
you'd say good Day five.

Date.

Yeah.

Day, not, not Day, date, time.

Well actually we do
everything in hours actually.

Yeah.

And I don't want to
confuse people even more.

But actually a day five
blastocyst is between 115 and

118 hours since it was created.

So you could have like, say again,
115118, so you could have that

number and then people know that
that number is the hours after it

Yeah, I think you created a model.

No, it's all right.

I haven't got time to work that one out.

Anyway, don't worry folks
We'll work on that model.

So the take home message is It's so I
think you were gonna go on to hard trees,

but yeah, it's subjective It's human led.

AI is definitely coming,
but it's not grading.

AI is giving like scores, and
the score that AI gives is based

on what we call morphokinetics.

So that's the really fancy word
for how do the cells divide.

Right.

Again, I swear that's Latin.

Well, morphology is Latin.

But it's, so AI is definitely starting
to come around and give us Models that

help us understand prediction of growth,
which is really helpful, but it won't

grade embryos It gives it it gives
like a quality score We've just started

using AI and it's it's fascinating and
it can't at the moment detect genetic

status It's not correlating well enough
for us to stop biopsying embryos.

I think it will come.

I hope it will come but ultimately AI
makes our work life balance easier and

anything that makes an embryologist work
life balance easier is just gonna be

golden because it's better outcome for the
patients, better outcome for the patients.

You've got less stressed.

Embryologists.

We are under some of the most
amazing stress in a laboratory,

in any fertility clinic.

You know, we are, yeah, of course.

We're mostly in a basement without windows
and we work eight hours a day creating

potential human life, high pressure.

It's really hard.

High pressure and high risk right?

AI is a big player for me in
work life balance and helping.

People be people and humans and stuff and
giving them some support in their day to

day, which can be incredibly stressful.

So the hard truth, Garn, you're the host.

Well, let's go back.

So what was that word you used earlier on?

More for kinetics.

More for kinetics.

So if that isn't on the glossary
that's available, so if you

head over to emilyembryologist.

com and look for the glossary.

So this is a glossary of terms that
we're putting together to try and help.

Because there's a lot of Complicated words
out there and acronyms and all that stuff.

So head over to the site and
do check out the glossary.

So we will, Novo Kinetic
should be on there.

We will make sure that was
on, is on there if it isn't.

but yeah, let's go.

let's gimme another hard
truth about embryo grading.

cherry picking.

So we know that there is a correlation
between more average quality

embryos, those with Cs in them, so.

So, A's and B's, A A, B B, B A,
A A, B B, whatever that is, they

are good quality embryos, right?

We know that they are the
most optimum chance of having

a pregnancy and life birth.

We know that.

However, you then start using C grade
terms when the visuals are not optimal,

and so you may get a 4cc, a 3bc.

So when there's a C involved,
we start to think of them as a

little bit more average quality.

What I will say, this is comes back to
what we talked about a minute ago is a

4BC on day five will give you far more
pregnancies than a 4AA on day seven

because the time element is so important,
which is what people don't like find

out about when their embryos are graded.

So when we start talking about C grade
embryos, we know that the, relationship

between pregnancies and I don't mean
outcome of pregnancies because once

you're pregnant with an embryo the
miscarriage and live birth rates and

all of those are actually quite similar
but getting pregnant with a anything

with like a cc grade in it is definitely
lower we know that and so some clinics

won't use them because it affects their
success rates and that's the hard truth.

. So you're saying there are some clinics
out there who want to make sure that their

stats, their numbers, their marketing
that says, Hey, we've got success rates

of this amount, whether it's a percentage,
I guess it's a percentage, right?

They don't want to impact the stats.

That's a hard truth.

That's a really hard truth.,
Is that private clinics?

Is it NHS?

Any.

Any clinic?

Okay.

Poor quality graded embryos
are much harder to work with.

So there are clinics that don't
culture, majority clinics don't

culture embryos to day 7, for example.

Which I think is because the success rates
with day 7 embryos is incredibly poor.

I would say even in my tested embryos,
so I'm talking about categoric

genetically normal embryos, day
7 embryos, your pregnancy rate

is still around, only around 20%.

So it's low.

It's, it's lower, but It's 20%.

Yeah.

And they're your embryos.

So 20 percent is better than
0 percent or 19 percent like

you're, that's your point, right?

Exactly.

Don't put it back, then you get zero.

If you do put it back, you might
get 5 percent and those are

your percentages, risks to take.

Risks, however you want to term
it, but that is a hard truth.

Yeah.

Okay.

These are, and then, so they
are, some clinics will state

that they don't freeze very well.

Yeah.

What do you mean by that?

When you freeze an embryo, you
rely on its quality to allow it

to survive that freezing process.

Ah, okay.

Right.

And a lot of the quality, when we
talk about quality, is the grade.

And it's to do with how the embryo is
visually appearing, how many cells it's

got in it, all of those that definitely
correlates to better freezing outcome.

True.

100 percent true.

So if I say to you that an embryo
that is a 4AA, so has that AA in

it, has probably a 98 percent chance
of surviving a freezing process.

Yep.

A CC has about a 92 percent chance.

Oh wow.

So why are we not freezing them?

Yeah, it's still high, right?

It's really high, especially
now we're in vitrification now.

So we freeze embryos with a
process called vitrification,

which is rapid stage freezing.

it protects the embryo better.

They survive beautifully.

I agree that when we were
freezing with slow freezing,

which was back before 2000 and.

10 in the UK.

They didn't used to spy.

I agree, 100 percent
agree, but they do now.

Now, let's move on to a recent
trip to our daughter's school.

So, there's a thing at our daughter's
school where parents go in and they

talk about their jobs and what they do.

I've done it already and it was a
lot of fun to a bunch of year eights.

They asked some brilliant questions
and we're not going to go into that.

Because Emma went into school
and, well, you've done two now.

So you had a group of 115 year 11 females.

Yeah, and then 100 odd year 12 and 13.

So they're what, 17 and 18?

16, 17, 18. 16, 17, 18.
And why did you go in?

What did, what did, what was
the, what did you want to get

out of going into the school?

Well, I suppose I sit in front of it.

I think it came up on
my Instagram last week.

It's one of the things I get asked most.

In the last 20 odd years is
why did no one tell me this?

Why did no one tell me
that getting pregnant?

staying pregnant And all of that in
between was going to be this hard

Yeah, and I realized that actually I
can't change the person sat in front

of me But I can start to change The
people that are going to become the

women of the future, the parents of
the future, the mothers of the future.

And that starts in school.

So I went in and it started off as
a, what does an embryologist do?

I mean, let's face it,
it's quite a cool job.

but actually what I used it as, and I
told the teachers I was going to do this,

and they were really on board, The girls,
females, however you want to call them.

they were brilliant.

They were absolutely amazing.

And I started by getting them
engaged by putting up my slide

that said, Why do men have nipples?

So why do men have nipples?

Why do men have nipples?

It's a great question.

It's a good icebreaker
Anyone for a dinner party?

A big, great one.

And I had them then, and then we went
through the whole fertility journey.

Hang on, you can't not
answer the question.

Oh, why do men have nipples?

Or wait until the end of
the episode to answer.

Yeah, yeah, I can tell
you why men have nipples.

I'll do that at the end.

And that's what I did
to the girls actually.

I said to them, If you
listen, you will find out.

And then they were all like, Brilliant.

We're so doing that for this episode.

so I spoke about fertility
and reproductive aging.

And I think the most big take home
for me was that I want them to

understand that They are, there are
certain things that is not normal.

You should not bleed
like heavily every month.

You shouldn't be crippled
in pain every month.

You should be able to go to your GP
and ask if things aren't quite right.

If your periods are irregular,
all of those things.

And I think they totally resonated
because a lot of them are struggling

with menstrual cycle stuff already.

And I think it was really important to
tell them that some of it just isn't

normal and they need to get some support.

We talked about contraception and the
fact that it I actually did some myth

busting that TikTok tells you that
contraception makes you infertile.

I was like, it absolutely does not.

but actually the big thing was what
causes infertility that you can control.

Yeah, yeah.

And what did you, you
covered vaping, didn't you?

I covered vaping.

And their little faces.

Oh boy.

Looked absolutely horrified.

Yeah.

So what's the fact about vaping?

The fact about vaping is vaping
is the single most harmful thing.

Hertility, which is a, a group,
Hertility is a company that allows

you to get at home blood tests so
you can look at your reproductive

health, through a fingerprint.

brilliant, brilliant company.

And they did a study based on the
lifestyle factors of women having

these tests and then they published it.

And the single most damaging
thing for sperm health and

ovarian health was vaping.

and ovarian health.

That's fascinating.

Um, and they didn't quite want to
hear that, but that went on the list.

And then we talked about what you can
do to protect yourself from, we'd call

it causative factors of infertility.

some things to do with infertility
like menstrual cycle disturbances,

endometriosis, PCOS, all of those things.

It's inherited.

there's not a lot you can do about it.

It's inherited.

But there are some things you can like not
catching chlamydia when you're 20 because

that causes tubal blockages so we talked
a lot about condom use and They got it.

They've really really got it and I
had but I think the most mad thing

was I said to them at the very
beginning This is your safe space

There is nothing you can say to me.

I don't hate parents.

I'm not I'm not here to judge
you I'm not here to judge you.

I'm here to be really open and honest What
reproduction looks like and actually I

asked them at the very beginning how many
of you want children and I'd say 80 that.

They knew, they know they want a
family and then I said to them, you

know, let's talk about how this looks,
what we can do to protect ourselves

and all of that, and I said, there
is nothing that you can say to me.

That I have not heard before.

Well I was wrong.

Yeah, yeah.

So one of them came up to me and went,
Is it true that pork makes you infertile?

It's a great question.

It's a great question.

And I said to her, Where
did you hear that from?

She went TikTok.

I went, Ah, Dr. TikTok.

Excellent.

So we've gone on from Dr.

TikTok.

Well, there's Dr. Google, Dr.
TikTok, and now Dr. Chat GPT.

Yeah, brilliant, brilliant.

Those are the three nemesis.

But then I also got told by one of
the other girls when she said, I

hear they're making vapes better.

And I went, better for who?

The environment?

The industry.

The industry.

The vaping industry.

yeah.

Exactly.

So, It's scary.

It's really scary.

But it's misinformation to young folks.

And I know we both sound really old now
saying like, these kids on social media.

But it is.

It's really scary.

They're getting a lot of random
information or generated information

that is completely false.

But I think, yeah, so I got, I managed to
get through to them a little bit, I think.

And do you know what?

If I've managed to save two of them
from getting horrendous chlamydia

infection at the age of 18, that
goes undiagnosed, because when I

actually said to them, do you think
these diseases come with symptoms?

They all said yes.

I said they don't.

Yeah, that's a really hard truth.

So, you know, it's about them taking
precautions or, but it was brilliant.

So the next school is in two weeks.

Yeah.

I can't do them all.

But I do love it.

It's a lot, it's a lot of fun.

It's amazing and it's so
cool that you're doing this.

And I think, you know, let's continue
to do this., no doubt I can imagine a

lot of those girls went away telling
their parents or guardians like,

wow, I had this woman come in today
and she told me this isn't this.

And I couldn't believe it.

Even though they're a little
bit scared, understandably,

or they're actually grateful.

And they're like, wow, that
has really helped me out.

And I think for a number of those
people who are there, they're a

member of that, particularly in their
careers, when they're thinking about

like, Ah, I've just got to focus on
my career, and I have, I'll focus on

starting a family much later, it's
fine, I'll just have IVF treatment,

and it'll be easy, and all that stuff.

We talked about family building
as well, which was really

cool, about planning and stuff.

Wow, amazing that you've gone to
these schools and have an impact.

Let's get Emma into more schools.

It's really important.

Or anyone.

I don't think it needs
to necessarily be me.

It's just about how you,
you get the message across.

I think that there is an opportunity here.

Because they were so grateful.

They, genuinely, they just want
to be spoken to like adults.

And I'm not a teacher and I'm not
their mother and I'm not, you know,

and it definitely resonated with
them, especially when I told them

why men have nipples, Which we'll
come to at the end of this episode.

Stick around folks.

So, so we're going to, just finish up on
another story of what Emma's been up to.

So loads of good things, including
the schools, but you recently

went to the UK parliament.

So how's the parliament?

You rock up, go through security.

Oh, it's like an airport.

Yeah, it is, isn't it?

That's really funny.

And then, so why were you there?

And , what did you end up doing?

I mean, if there was a, a cap that
could have said imposter syndrome

on it on the day I walked into
Harlem, I would have been wearing it.

So I was, I, I mean, Instagram
is an incredible platform.

For lots of reasons.

I think there's been this level of
community We always say in the fertility

world that it's not a group you
wanted to be part of but my goodness

There's some really lovely people.

Yeah in the world of infertility
treatments and actually through Instagram

I've met some amazing amazing humans
like just brilliant and I I got I've

become quite close friends with Katie
Rollins who runs fertility action

Network and Amber Itso who also does
quite a lot of like her own profile

for her journey to parenthood, but she
also is, involved in the company called

Gaia, which is a fertility insurance
payment, situation to try and help

people get through fertility treatment.

And between them, they started a movement
called Fertility Access Campaign,

which was about trying to level out the
postcode lottery that exists in this

country and how every single borough,
there's 40, I didn't know this until

I went to parliament, there's 44 ICBs,
which are independent commissioning

boards that choose what access you
get in the NHS to fertility treatment.

And so they've done a lot, a
huge amount of work in this area.

They are both incredible humans.

And then because this campaign becomes.

about the science, it becomes about
the medicine, it becomes about the why.

They reached out to me and a few other
brilliant humans, um, and said, not that

I'm calling myself a brilliant human,
I'm just saying other brilliant humans.

And I came along for the
ride with my imposter hat on.

and we, the idea was to get through
the doors of parliament and put forward

the campaign as it will be, which is to
Fight for the rights for everyone in the

UK to access fertility treatment fairly
Brilliant doesn't matter what walk of life

you're from what your sexuality is Whether
your partner has got a child all of these

things I Mean some of it is just bonkers.

And solo mother by choice.

Like it's about building families And
having the right to build a family and

not being discriminated against because
of how you come to that family journey.

In some parts of the country you
don't have any access to fertility

treatment, in other parts of the
country you're entitled to three cycles

of full funded fertility treatment.

And it's just completely unfair, and
there's so much disparity, and there

are, there's just no regulation.

At the end of the day, infertility,
however it is, infertility is infertility.

If you are a same sex couple
Trying to have a family.

You are infertile, whether you, because
of circumstance, whatever, but you

are, and you should be entitled to that
family building journey like anyone else.

, even now, you have to prove
you're infertile to get treatment.

How can you, how can you do
that if you're on your own?

, Ultimately, the problem we have
is we are now facing a fertility

pandemic in this country.

It's called the, I always
get this word wrong, but it's

called the fecundicity rate.

Fecundicity?

Yeah.

Oh, that's a great word.

That's a great word that I
think I probably said wrong.

it is the amount of children per
person that we are having as people.

To allow a population to grow
and be economically stable,

that number should be 2.

2 something, because people die
and that's the reality of life.

We are at 1.

44. We are almost the
lowest country in Europe.

At reproductive rates.

And that, I guess, thinking in terms
of the MPs that were in the room with

you, who were very interested and it
really resonated with them, is from a

pure economics point of view, they're
saying, well, there's not enough people

going to be entering the workforce
to pay taxes, to pay for an ageing

population where the pension bill goes up.

Like that, for them, they're also
thinking pure numbers, aren't they?

Yeah, but also they're, they're
delaying this, this time it

takes you to get NHS access.

It's actually, so we, we basically went
in and we gave them some really hard

facts about reproductive aging and how
if you delay a woman, the woman in the

relationship that is going to carry
the baby, , I'll get onto the men thing

in a minute, but it, it fundamentally
makes the treatment less likely to work.

So, We are in a place where These these
couples women same sex couples are

going to their GPs for help and then
being forced into a three year two

year one year Whatever waiting list
it is, but it's still making you older

and actually if you just gave them the
treatment They would need less treatment

and it would be more successful.

So this essentially basic
math is basic maths.

Yeah Yeah, so also we then talked about
the fact that GPs I've got a huge Huge job

to do and they're not educated in this.

No, and you wouldn't expect them to be
right because it's a specialist topic.

Yeah, and they don't know
where to signpost you to.

And they're so under pressure.

GPs like seeing way more people
than they can manage, right?

. So the topic discussion as well
was about getting the focus around

male fertility because it is,
we know it's a 50 50 thing now.

We know it's the way it is.

And the GPs are not educated
enough to know what to do with

men to the point where they can't
even read a basic semen analysis.

They don't know what it says.

So, it was an amazing day.

They listened.

They really listened and they
got it and I think that it will

become something very powerful.

There is more to come on that, which
I'm sure we will talk about as it comes.

But for a first session.

Walking into Parliament that
day, it was, it was amazing.

It was very moving and very humbling
to be part of something so big.

and hopefully, if it doesn't help the
immediate generation, I hope that it

helps our daughter's generation, or
maybe before that, to try and access

treatment at a more manageable rate.

It is a disease, , it's the only
disease that we don't treat.

And I think that was the
real take home message.

You walk into a GP or a hospital
or anywhere with a disease and

they will offer you treatment.

This is the only disease
we're not treating.

Yeah.

That's fascinating isn't it?

I kind of, I know when you, we chatted
immediately after that you'd been on the

phone, you were just like, The MPs got
it and they were genuinely interested.

And, you know, it was
a lot of cross party.

There was no, like, it was
just one party or another.

So there's a potential to
set up a cross party group.

and yeah, what's this space for
fertility access UK, you know,

good things are going to happen.

And this is really just the start of it.

it's a group that can lobby and put
pressure on the UK government to Really

pay attention and go, this is, this is
so important for the future of the UK.

not just on a, you know, this is the right
thing to do because why should someone

not have the right to have a family?

I think from the MP's perspective,
when they're talking about costs

and the pressures that the NHS are
facing right now and cost cutting,

it is also economically as well.

So, you know, there's two sides to it.

It's great.

It's amazing, Em.

So, why do men have nipples?

Why do men have nipples?

Men have nipples because, so
when we talk about genetics in

humans, men are 46 chromosomes XY.

And women are 46 chromosomes XX.

, most chromosomes have a different
number of genes on them.

A gene is something that creates
proteins to, basically like

the blueprint of your life.

so genes are the instruction building
blocks of our lives, of our bodies.

And when we are a foetus,
gender is already predefined.

Because the sperm brings the gender,
the X is, the egg is always X, and

then the sperm are either X or Y.
It's actually not 50 50, but I'm not

going to go into that on this episode,
it's actually a little bit out.

So, um, that's a whole other conversation.

That's a whole other conversation.

Um, anyway, so, if the sperm
brings a Y chromosome to the

foetus to create the embryo, it's
an XY, so it is a male embryo.

But that embryo goes on to grow for six
or seven weeks in a default pattern.

And the default pattern
is as a female, amazing.

The Y chromosome has
actually not a lot of genes.

It's a bit of a dud chromosome
kind of makes sense.

Just not as clever as the X. So
the X chromosome, for example,

has probably 2000 genes on it.

I think the Y chromosome has, I
was going to say, is it like five?

It could be more than that.

Hello?

But one of the genes is called the
SRI gene, which is a switch that

basically turns the developing
foetus from the default female

into the man, into the male.

That's about six weeks.

Six or seven weeks gestation.

So you're already pregnant.

So you're saying No, no, no, I'm finished.

Oh, okay.

Okay.

So by the time the switch comes
on, the nipples are already formed.

where the breasts would be.

So, men then have the remnants of
what they were in the womb, where they

were women for six or seven weeks.

Functionless nipples.

It's amazing.

And I love to think a bit about
the fact that it's a little memory.

So when you look down on your
chest, you know where you came from.

You totally do.

So I said to the teenagers in the room.

This is going back to the school.

Going back to the school.

Yeah.

Yeah.

I said take home message guys, don't
vape, use a condom, women are amazing,

and men were actually women, and their
nipples are there to remind them of it.

And the school emailed me at the end
of the day, last week, and said all the

boys are walking around being told by
all the girls why they have nipples.

So good.

So good.

That's, I mean that's gonna spread.

Facts, and that is.

That is why men have nipples.

And that, that, not that I'm checking
TikTok, but I want to see if that

is now spread, spread across the,
the next generation of TikTokers

that they are sharing those facts.

And that's real facts, that's not
misinformation or information about pork.

There we go.

Yeah, there we go.

That's why men have nipples.

And I like to think of it
as a little reminder to you.

100%. that we are definitely
the stronger of the species.

Indeed you are.

Indeed you are.

Okay, folks, we are going to wrap
up this episode of Hatching a Plan.

Thank you so much for joining us.

We'll be back soon.

And in the meantime, if you are not
following Emma on Instagram, please do so.

She is at emmatheembryologist.

And also head over to emmatheembryologist.

com.

Sign up to the newsletter for free.

And Emma will send you updates,
lots of helpful information,. In

the meantime, I'm Simon, Emma the
Embryologist's husband, signing off.

I'm Emma, Emma the Embryologist.

So weird.

That's the one.

And we'll see you on another
episode of Hatching a Plan.

Bye for now.