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Why do some IVF patients seek donor egg treatments at a different center than where they began? It could all come down to one simple question—one that our latest guest, Dr. Andy Toledo, CEO of Reproductive Biology Associates, frequently asks.
With over three decades in the field, Dr. Toledo shares his approach to counseling patients about donor eggs and third-party IVF without the hard sell.
Tune in as Dr. Toledo discusses:
The key question he uses to convert IVF patients.
How he counsels patients without being salesy.
The evolving role of REIs as automation becomes more prevalent.
Why pre-visit testing might not be as beneficial as it seems.
Discovering the untapped market in embryo preservation.
Dr. Andrew Toledo
LinkedIn
Transcript
[00:00:00] Dr. Andrew Toledo: But my first question to them is, do you envision having more than this one child if you get pregnant with this? Because if I transfer this embryo into you and you get pregnant, it's great. Two years down the road when you're ready to make baby number two. If we don't have embryos stored, you're not going to be as reproductively successful.
And that's the couple that will then do more what we call embryo banking, so that they're good now, but they also know when they come back for later, they've got embryo that's set at that age. So they may be 39, 40, but that embryo is 37.
[00:00:35] Griffin Jones: Then, Dr. Toledo talks about how he leverages My Egg Bank.
[00:00:40] Dr. Andrew Toledo:Learning to meet the needs of the people out there that are utilizing the bank. Listening to them. If you take the people that run our egg bank, Deb Mecerod has been around, she is the clinical person that really listens to these couples and what they need and what they want and works with the various centers.
[00:01:04] Griffin Jones: Why do IVF patients go through treatment at one center, here they need donor egg, and then go to a different fertility doctor for that donor egg IVF treatment? It might come down to the answers that stem from asking one question. I talk with Dr. Andy Toledo. He's been doing IVF since 1985 and is now the CEO and one of the principal partners at Reproductive Biology Associates in Atlanta.
Dr. Toledo has seen hundreds of patients for donor egg and third party IVF who had already sought treatment at other centers. He uses a variation of one question about family building goals to counsel patients on donor egg, gestational carrier, etc., without ever having to feel like he's selling them. In addition to sharing his process for converting so many donor IVF patients and his personal story about IVF, Dr.
Toledo describes what the REI's job will look like after the automation revolution. He makes a case against the increasingly popular view of having patients do their testing prior to first visit. And he points out a market for embryo preservation that, if obvious to you, has been largely untapped in marketing to the public.
If you're doing a lot to grow your donor and third party programs, you might be missing some really effective practices that are a lot more simple to implement. Enjoy this conversation with Dr. Andy Toledo, CEO of RBA.
[00:02:15] Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you, but the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser.
The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:02:36] Griffin Jones: Dr. Toledo, Andy, welcome to the Inside Reproductive Health podcast. Thank you for having me, Griffin. Great to be here. I'm told that there is a question that you ask patients, or maybe it's a series of questions.
What is that for the first time you see a patient, and how do you phrase it? Sure,
[00:02:53] Dr. Andrew Toledo: a lot of times the question will be based on the history that I've taken from that patient or that couple. So for instance, if the couple are just coming in, doing a straight up infertility evaluation because they're not getting pregnant, then the questions would be, what have you done so far?
And what would you like to get accomplished? And do you have certain parameters which you will go to and not go to? For instance Some patients aren't going to do injectable medicine. Some patients aren't going to do IVF. Some patients aren't going to do any kind of donor or anything. That patient is the newbie or the new patient where you're just starting to know them.
Most of my patients, though, Griffith, have already done things. They've already been maybe to another center or they've already tried other treatments. So I'm getting them. At a different time, then that patient I can more directly say, you've done this, how do you feel about going to, let's say, egg donor treatment because your reproductive age and or your previous treatment with IVF has shown Poor results, or in the husband or partner, male partner's case, we haven't gotten good results with medications on you and your parameters are not very good.
Have you talked about, are you considering using anonymous or directed donor sperm? And then of course, if the couple have been through multiple failed treatments or the patient, the wife or female has issues with her uterus or with some kind of medical issue, Then the question is, how do you feel about using surrogacy as the mode to help y'all achieve a successful pregnancy?
It's a loaded question and it all starts with where have they been and what are they willing to do?
[00:04:49] Griffin Jones: Why is it the case that you tend to see patients that have been through other treatments or other providers? Is it just because You've been doing this a while, and you've established a name for, here's the guy that we go to if we haven't had success elsewhere, or are there other things that you've built your practice that way?
[00:05:12] Dr. Andrew Toledo: That, what you just said is primarily the reason, because I've been doing this for almost 40 years, and I'm pretty established in the Atlanta metro and Georgia area, yes, and what I have noticed, especially of recent, is Not to get too far off subject, but most of the physicians that I started off with when I came to Atlanta in 1985 that would refer me patients have either retired or regrettably died.
Most of what I get now is by social media, word of mouth, and that's a very clear driver for me because those are patients who have had maybe failure in other clinics, centers, and they also know that I deal with the more difficult patient. That's a little older that has been told she wants, she should do something she doesn't want to do.
She'll come to me, they'll come to me as an alternative.
[00:06:06] Griffin Jones: You said that you get their history in advance and take a look at that. Do you also have them do their labs and their tests in advance of meeting you? Do you, what's your view on that? Should it come before the first visit or should it come between the visit and follow up?
[00:06:21] Dr. Andrew Toledo: Usually I won't make them do tests before I see them. Usually I want to see what they've done, talk with them. Sometimes they've had recent tests that I don't want to repeat. And, of course, if I can get their records and review them beforehand, then I can give them some guidance. Before I see Jane Doe, let's repeat her AMH.
Let's get a day two, day three gonadotropin profile. Let's update her saline sodal Instagram. Or Jane Doe's partner, let's get his updated semen analysis. Rarely DNA integrity test because that's plus minus, but no, I'll usually get what I can, review, talk with the couple or the person. And then that sets the tone for what we're going to do next.
[00:07:07] Griffin Jones: I've heard some people say that they give the most value to patients when those patients have done tests ahead of time. You're seeing patients that have often gone through other courses of treatment. Why not have them do the tests ahead of time?
[00:07:24] Dr. Andrew Toledo: Number one, I don't know if what they've done is recent, and they tend to not like to repeat things they've already done, especially if it's recent.
It tends to set them off, here we go again, especially if they've been through a lot of treatment. They tend to push back against that and feel like, for lack of a better term, I'm doing it just to generate income, generate more dollars in my pocket. The last thing I want to do, Griffin, is make couples or patients feel like I'm just trying to make more income off of what they've already suffered from.
So I tend to watch, certainly, if they haven't done anything recently, I help them to understand I think there's value to this. And even in some of the FDA testing, I know that some of the questions we're going to talk about today have to do with third party reproduction. Any IVF treatment requires Updated, what we call FDA labs, Federal Drug Administration requires updating the STD labs on a yearly basis.
Couples hate doing that, but we have to tell them, look, it's a requirement for our center. I don't want them to do other things. I know that sometimes we're going to have to repeat some of these things. I'm really after, what are you going to repeat for me? For instance, if they've never done day two, day three gonadotropin levels, there's value in that.
If they've never done a basal antral follicle count on day two or three with that lab, there's If they're reproductively more mature, i. e. older, then there's value to that. If their Mullerian Hormone level hasn't been done in over a year, there's value to that. And I will want them to try to get those things ahead of time if I can get them to.
But it's interesting how couples push back and patients push back. On a lot of these tests, when I've tried to do that,
[00:09:12] Griffin Jones: there are those that paint a picture of the fertility center of the future where a patient might get all of their tests in advance. They might go through an online learning module and do all their informed consents.
They might see an advanced practice provider on the first visit. They might, any ultrasound they have is done by an ultrasound tech aided by artificial intelligence. Many of these different solutions we have in the market right now haven't quite come together in that ecosystem and in that world they paint the picture of the REI as someone who sees the complicated cases of people that haven't been able to get pregnant by doing other courses of treatment already.
Is the practice that you have. Today, what the practice of a fertility doctor, the average fertility doctor, might be in some years time?
[00:10:12] Dr. Andrew Toledo: No I, we're definitely moving to a much more AI driven, patient, getting through a lot of the testing ahead of time, and as many of the mid level providers doing a lot of the legwork front end so that by the time someone like me gets it, we've already laid out, okay, here's where we're going.
And that's an efficiency model that says, we're going to move you very quickly to a Some aspect, usually, of IVF because, let's be honest, that is the most efficient and successful way to get most people to, to pregnancy. Now, it may be, ideally, it's usually the patient wants to use her own oocytes, her own eggs, and if she's got a male partner, his sperm, but in some cases, the patients that I've gotten have already been through multiple cycles, have had poor results.
And their best bet is to move to anonymous or directed egg donation, where we're already established, okay, you got to do this. Or in some cases, they've had multiple miscarriages or some kind of damage to the uterus, or they have some kind of medical complication that says to them, okay, we need to move to a surrogate.
And lastly, some of these patients have been genetically tested, because you know we're doing a lot of that now. And they need to have genetic testing of the embryos because they're carrying a a molecular defect like a cystic fibrosis mutation or spinal muscular atrophies. They're coming to me saying, I need to do genetic IVF with genetic testing to avoid having a child with one of these very significant abnormalities.
But to get back to your question, I think in the next couple of years, not too long from now, that's what we'll be doing. Now, again, I'm old school. I've been doing this for a long time. I still like the sit down, sit the person and that person in front of me right there in those seats. Although we do a lot of telemedicine post pandemic, but there's to me still nothing like that because it lends itself a level of person, of a personalness where when you do what you just described, there's not much attachment that I think the couple feels or the patient feels to the process.
And to me, I'm getting a lot of the patients that have felt that way. They're coming to me because they know that I'm somebody that likes to engage in the couple, and the person, and the patient, and take a more personal view. And I'm not saying mine's the right way. It works for a lot of patients but for the patient that's very boom, I just give them the answers.
I don't need a lot of hand holding. I don't need a lot of extra. I just want to get through the process. What you described is perfect, and I think we'll get there for the majority of patients.
[00:12:57] Griffin Jones: And I don't think the boom replaces what you do. I think the boom replaces the several hundred thousand, millions of patients in North America that don't get treatment right now because it's not cost effective, it isn't accessible.
And I think there is a space for the personalness that you've described, especially For the populations that you're seeing, when you're seeing patient populations with so much past, are you able to talk about the future beyond just the next child, the next six months? Do you ask them at that point how many children they want to have total?
What they want their family to look like? At the end of the day,
[00:13:41] Dr. Andrew Toledo: yeah, and it's especially important, two scenarios. Let's say I've got a younger couple or a younger patient, but a younger couple who unfortunately she's gone through premature ovarian failure or somehow lost her reproductive ovarian function early in her 30s.
And this couple are going to want more than one child, usually at least two. If that patient's going to go through, let's say, anonymous or non directed egg donor where they're going to choose an anonymous egg donor source, that's the couple when we talk we're talking about, okay, let's take MyEggBank, which I know you know about, has this source of eggs.
That's where I get most of my egg donor sources from. In the MyEggBank system, there's usually only the eggs are frozen as opposed to fresh eggs. And they're frozen in usually lots of six to eight. That works well when we're trying to get one. But in this couple, she and he are going to need maybe more than that.
So that's a push, the couple that I'm going to say, look, you're probably going to, if you want to keep the same egg donor source to keep genetics the same, then we need to make more embryo creation from this process, which means maybe we're taking an egg donor out of my egg, And she's going to run through a fresh cycle and you're going to, the patient doesn't need 30 or 40 eggs, but maybe she's going to need 12 to 18 instead of a lot of 6 to 8.
That's how we'll handle it. Whereas, let's say a patient comes in and now she's in her 40s, remarried, maybe never had kids, married late. Maybe the new partner has kids from a previous marriage. Maybe he doesn't, but they usually are looking at one. They know that because of age and just general time, they're probably going to want to go with one.
And so I try to feel that or tease that out when we're talking. And don't get me wrong. It doesn't mean that some of the older female patients aren't going to want to have two, but on, on average, I'm asking. What do you see your family size as? And most of the time, if the couple have never had a child, they're going to want at least two, sometimes more, but, and if they're older or, maybe there are kids on one side of the family, they're really shooting for just one.
[00:16:06] Griffin Jones: You talked about how the answer to that question can affect how you counsel patients on egg or sperm donation. How does it affect? Your approach to gestational carriers, if they're planning for multiple children and need a gestational carrier.
[00:16:23] Dr. Andrew Toledo: And that's interesting. I thought about that question today because I currently, I talked with one of my patients today, and they have an ongoing pregnancy with the carrier.
And they have They're in the process of making more embryos with their own gametes. And they've already elicited a discussion with the carrier that when she's had the child, she's going to stay with them and do it again for them. But here's the problem, Griffin, with most gestational carrier situations.
As most gestational carriers are coming out of agencies, now some are not. Some are finding each other, the carrier and the intended pair. They are finding each other through the internet separately, but most carriers are working through agencies. So when the carrier has had the child, she tends to go back to the agency if she wants to continue to attempt pregnancy via this route.
And she may get tied up in another couple. What I try to do is I tell couples that are going to do this, Alright, talk with your carrier. They've usually established a pretty good relationship. In fact, I think that's one of the most important things to a gestational carrier, intended parent relationship is, Do you have a good relationship with this person?
Then you talk with them. I have them talk with the carrier. Not me talking to them. I'm going to take care of the carrier and the couple, but I can't tell the carrier, Hey, I want you to stick around and do this again for Jane Doe and her husband or partner. So it's usually done vis a vis the couple's talking to the carrier who then agrees, Yeah, I'll stick around and do this again for you.
And that's just a relationship kind of model.
[00:18:08] Griffin Jones: Is there ever a sort of advance payment or a letter of intent to try to secure a gestational carrier's availability ahead of time?
[00:18:20] Dr. Andrew Toledo: I don't think so, not to my knowledge. Now, let me be clear on how we work this. When we're dealing with these situations, of course there's a lot of, this is real third party.
Because This is where the FDA really steps in and says you have better dotted I's and crossed T's. All the appropriate labs have to be done. So when I tell couples that are doing this is here are the requirements. The FDA has a bunch of requirements that say that we've done everything to the gametes, the sperm egg embryo to protect the carrier, the gestational carrier from getting any kind of infectious disease or any kind of damage that could occur from this.
Because in essence, the FDA looks at this process like an organ donation. And so back in 2005, all of these New criteria got created by the FDA. And it's painful. That's one thing. Then, of course, they have to go through a psychological evaluation to make sure everyone's okay. They have to sign legal contracts.
We don't. And in the legal contracts is usually where the money is for who. And I stay out of it. We stay out of it. Our job is to make sure there is a legal contract to protect both the carrier and the surrogate. And there's psychological evaluations done that says, It's a lot crazier than anybody else in this world today.
It's a lot of crazy going on out there, particularly politically. And I won't get into that, but, make sure everyone's okay. And then it's, all right, let's make sure we're using the right protocol. And are you thinking about doing this again? If you want Nancy Smith here, the surrogate, to do this again, you should be talking.
They may create some kind of monetary or binding piece of paper, but we're not privy to it.
[00:20:02] Griffin Jones: I didn't ask you about fresh versus frozen during these considerations. Does the number of children that they're anticipating, given their current state, affect how you counsel on fresh versus frozen?
[00:20:13] Dr. Andrew Toledo: Especially if you're using egg donor.
If a couple are going to use their own eggs, or you're going to use a patient's eggs, IVF cycle on her, and there will be more. And you're going to just freeze the embryos because obviously you have to create embryos but for now and for when the carrier is going to come back and do this again for the couple.
When you're doing egg donor, as we talked about earlier, there's a situation where the couple envision having more than one child and they're also going to want to use the same surrogate if they can get her to do it again. You're going to do a fresh or some component of a fresh cycle in the egg donor so that you create more than maybe one.
What we have created via the MyEggBank system is, we know that if we use six eggs and fertilize them, partner spur, or donor spur, there's, if this is a single woman going through, or if the husband partner doesn't have his own spur ability, We know that out of that six, we're usually 70, 80 percent of the time, we're going to get one child from that.
But we may not have enough embryos left over, created baby number two. So in that situation, we're usually going to recommend a FRETCH cycle where the egg donor, in this case, anonymously, is going through. What she normally would do, but she'll get more of an allocation of those eggs. Say for instance, in the standard MyEggBank creation of eggs for use in the bank.
If, let's say, the egg donor produces just to keep it simple for Matt, 18 eggs, we'll have three lots of six, usually, in that. That means three different couples get to use those eggs at some point. Yeah. The donor, if the intended couple want more than one child, either she's going to buy more eggs of that lot, maybe she buys two lots instead of one lot.
Or, ideally, we'll take that same donor that they like, and we'll run that donor, or my egg bank will run that donor through a fresh cycle. And that patient, that couple will get a greater cohort, like 12 of the 18 eggs fresh. So fresh is good, especially when you're dealing with a couple like you're talking about, want more than one child.
Down, now, future, same thing with embryo preservation. This couple are doing embryo preservation or want to preserve or the patient comes in and says, my partner and I, we're not ready to have kids, but we really want to have kids down the road. And we know that when I'm 39, 40, I'm 35 now, but when we're ready to have kids at 39, 40, it's going to be more difficult.
They've already learned that or I've told them that. Then they're going to do embryo creation. Even before we put embryos back into uterus, and so there you're going to be doing some embryo creation using a fresh egg situation.
[00:23:22] Griffin Jones: That's interesting because we don't talk about that a lot. We talk about egg freezing, but we, and for single women who want to defer for career reasons or finding a partner, we often don't talk about embryo preservation for couples who are partnered already.
They're just not ready to have children. How common is that? Is it becoming more common? Is it still a very small percentage of who you're seeing?
[00:23:48] Dr. Andrew Toledo: Yeah, I think it's still small. It's certainly less than 10 percent of what I do, but I think, Griffin, it's starting to become more common. I'm seeing an upward trend in that because number one, women are much more aware of their future fertility or their liability and waiting longer.
They have now been taught by their OBGYNs, by people like you in the media that Make them aware of just data that says, Hey, you're, you, if you wait until this age, you're going to have a much lower chance of achieving success. So yes, we're seeing that. And a lot of couples as you are marrying later, they're getting through their careers.
They've already figured out, Hey, we should be front end on this, create the embryos so that when we're ready, we're not worried about process.
[00:24:40] Griffin Jones: When you do see it, is it often that they're waiting for child number one, or they're coming to you for child number one, and you're educating them on embryo preservation for childs two and three, because without embryo preservation, there likely won't be a child two and three.
[00:24:56] Dr. Andrew Toledo: Both scenarios. I've seen couples come in, And they have not had any kids and they don't want to have kids yet because they're traveling in their jobs or they just got married. They want to have, they want to have a, they want to have a non kid or non children time their relationship before they settle into taking care of a family.
So I see that and we'll do embryo creation and in that situation, or the couple are coming in and they want to have a child now. But here's a scenario maybe you've alluded to, she's 37, so she's towards the end of the reproductive success zone, and they're getting ready to do IVF, or they've done IVF, and we've got a normal embryo, maybe just one.
But my first question to them is, do you envision having more than this one child if you get pregnant with this? Because if I transfer this embryo into you And you get pregnant. It's great. Two years down the road, when you're ready to make baby number two, if we don't have embryos stored, you're not going to be as reproductively successful.
And that's the couple that will then do More what we call embryo banking so that they're good now, but they also know when they come back for later, they've got embryo that's set at that age. So they may be 39, 40, but that embryo is 37 or the age of the egg is 37.
[00:26:26] Griffin Jones: When I hear people ask, how do we increase our donor egg IVF volume or donor sperm IVF volume or our gestational carrier, third party volume?
I think a lot of those answers are based in the longer term planning, the thinking ahead that you're describing. I don't know how many people are doing that. I think many people are often concerned with the cycle in front of them. How do you balance the cycle that's in front of you right now while still making sure that they're thinking about that?
Because if they are at that 38 and if I transfer this one embryo, you'll have this one baby, Hey, but you also want them thinking so that they have opportunities that doors don't close. How do you weave those two together?
[00:27:10] Dr. Andrew Toledo: It's straight up talk. It's without being pushy. And I think to me, that's where we have to be careful as good doctors that we're not trying to sell.
The last thing I ever want my couples or my patients to feel like is I'm trying to sell them. I will flatly tell them, what is your vision of what the size of your family? Do you envision having more than this one child that you're here for talking to me about helping you with? And if the answer to that is yes, I'll say, here's what we're going to do, but if we don't have more than what we need, then When you come back again, there'll be more of an issue.
Now, that's fine, and we can do whatever, but there is some benefit of creating more potential now because it's more favorable. We'll get more potential success, 35, 37 year old embryos, or eggs from embryos created from that age patient than when you come back at age 40. And they get it. They do get it. Now, if they're not interested, then okay, I've done my job, and it's the same thing when they ignore it.
I will have patients come in who've been through other centers, patients, I can't, I will tell you that I see now a huge number of patients who come to me and they're in their 40s. I am that doctor, fortunately, unfortunately, however you want to call it, that gets that patient and they've been told by other centers, you need to do egg donor.
Your chances of achieving pregnancy with your embryo, with your eggs is less than 2%. That's the true statistic. http: TheBusinessProfessor. com And what I will tell them is that is true, but if it's important for you to try, I'm not looking at my statistics as the reason we don't do this. We're going to try, and if I've been honest with you, and you know that I'll try some other things or some alternative protocols, as long as you know I'm not trying to sell you land in the Everglades.
I'm not, I can always go to sleep at night, Griffin, if I've been honest with couples or with patients. If I've tried to Selum snake oil, that's not going to make me sleep well at night. But I see more and more of that all the time, where a patient will come in and she says, I know I don't have much of a chance here, and I'm willing at some point to do EGDAR.
And look, I'll be real personal with you. I don't mind being personal, everybody knows my, maybe you don't know my story. You can see if you're looking around my office, I've got pictures of kids here. I have three kids from a first marriage that I had when my ex wife and I were in our late 20s. You know what?
I don't mind. It works well. And back then, that many years ago, that was the Tennessee. People had their kids earlier, but divorce, kids go off to college, meet my now wife, who's the love of my life. She's older. She knows I've been, I've had a vasectomy. I'm just being very blunt and truthful. And she says to me, when we start dating, if you're not interested in having kids, Don't waste my time, because although I'm older reproductively, and I won't tell you her age or she'll shoot me, but she basically said, this is what I'm going to try.
And I tell her as a reproductive endocrinologist, honey, there's a chance we may have to consider egg donor here because of your age, and she said, no, we're going to try this. We were fortunate. Now, it took us five cycles to do it, and every time she had a procedure, I had to be our wonderful urologist, Dr.
Witt. And I had to do testicular aspiration on me. We were both going through it, but the point is, when we started the fifth one, I told her, I said, we can't keep doing this. And she said, let me do it this one more time. And then I'm ready to do egg donor. Now thankfully it worked, and that's how I have my two girls from this wonderful marriage.
The point is, she had to work through a progression of, hell no, no way am I going to do that, to okay, now I'm ready. And that's what a lot. of women that I see feel like, I know that this will work for me and it makes sense from a statistical success rate, I just emotionally am not there. So for that patient, even though I know we're dealing with lesser numbers, it's important for them to try.
And of course, we're I'm going to do, as long as we're not doing anything illegal or unsafe, I don't have a problem with a patient trying that, as long as, at the end of the day, if it doesn't work, she knows, okay, we talked about this, and now I'm ready to do that. But I do think that as we progress, and as you mentioned even earlier in this interview, I do think that a lot of the couples coming out now are much more cut and dry.
I see, are much more willing to take on some of these things that we're talking about without as much of the emotionality to it.
[00:31:57] Griffin Jones: How do you leverage my egg bank? I'm more interested in you as a physician at RBA, as a client than I am You, as one of the founders of My Egg Bank, you started it for a reason with your colleagues.
So that must have meant you wanted something specific from it. How do you use it?
[00:32:16] Dr. Andrew Toledo: Let's take the history of My Egg Bank. My Egg Bank started because we, along with some other pioneers, figured out how to freeze eggs, right?
Egg freezing was terrible. You'd freeze eggs and maybe only 10 percent of the eggs would survive when you thawed them. Once we figured out, once my brilliant embryologist, Peter Nagy, figured out, along with some others, how to do this, how to do this vitrification process that now everybody does, we, as we were using this technology, my colleague, Nagy and said, you know what, I think we can make an egg bake here because we've got this technology and it's working.
The first iterations of this were just using frozen eggs and making sure that we were getting some pregnancies. Now, it's very, we've blown into this, blown up into this huge egg bank that's national, even international, because we get the egg donors coming from other parts of the world. And it's so great that I can tell a couple or a patient, look, you have multiple ways to use this egg bank.
You can use it standard, just a set of six eggs. Husband, partner, sperm donor, and we do it. Everything else we've talked about, which is, hey, we need to maybe pick more than one lot, or maybe we need to do a fresh cycle. All of those things can be done, and I don't have to sell the egg bank. I know it's there.
Again, that's the advantage of having an egg bank. In my practice, it's said, and again, there, there are other places that do some of this work. I think, I'm biased, I think we do it better than most because we were the originals. What do you
[00:33:58] Griffin Jones: think the big differentiator is in egg banks today? Again, putting your physician hat on rather than your egg bank operator hat on.
What do you think the differentiator is today? Tactics in vitrification have caught up. Now what makes this difference?
[00:34:14] Dr. Andrew Toledo: It gets being able to meet the needs of the people that need to use the bait, right? You have to be flexible and willing to say, no, we're just going to do this. This is the way we're going to do it.
For instance, some patients just want standard, just make me an embryo from this. And some people want, like I said, more opportunity to make more than one embryo. Some people want to genetically test the embryos. Theoretically, there's not as much benefit to genetically testing the embryos because these egg donors are all in their 20s.
The chances that the embryos created are going to be chromosomally abnormal are very low. But again, you can do that in this bag. I think the answer to that is learning to meet the needs of the people out there that are utilizing the Listen to me. If you take the people that run our egg bank, and I know maybe at some point you've interviewed Deb Messerad, but Deb Messerad has been around, she started here at RBA in, what, 97, and she's watched lots of centers develop, she's the clinical person that, that really listens to these couples and what they need and what they want and works with the various centers, including RBA, to say, we should be doing this.
I think it's a long answer, but the short answer is learning to listen to what people want and then finding a way to make the egg bank do that. Most of the time we can do that.
[00:35:43] Griffin Jones: Is accommodating providers a part of that? What are some things that you, Dr. Toledo, needs that you have to have your egg bank accommodate you or it's not going to work?
[00:35:54] Dr. Andrew Toledo: The very first thing that I need, that everybody needs, is some variety. And some, clearly, even today. There's a greater need than there is supply. And that's because these young women that are considering egg donation or being egg donors know that they can go to multiple centers. And who's going to give me the best price?
They're capitalists, right? This isn't Europe or Spain where, women do it because they're compassionate and they want to be altruistic. No. These women are being courted for their qualities. One of the first things that I love about my egg because that we're very We're not good at going out there and finding these good donors.
And so for me as a provider who needs the egg bank, I'm saying, give me some individual. I need an Asian donor. I need an Indian Asian donor. I need something other than that because those are hard to find. We're not trying to find Ivy League scores perfect, that, we're not doing that. But we are trying to find very high quality.
Young ladies who are also committed to helping couples. So my ask to the egg bank is, find me the best donors, find me variety, or find me enough eggs for my couple that I can do this. And are they local? Are they going to be through the donors we find at RVA? Are they going to be at one of our satellite centers like NYU or Orlando?
Just find me that. And then it's, I need more than just this bunch, this little batch of six. To me, that's what I'm asking. I know my, I know the quality of these donors is going to be excellent because I know the people that are screening. So I know that, and that's what I tell couples all the time is, hey, you're going to get, you don't have to worry that donor X has not been vetted to the max.
She has been screened medically, psychologically, genetically, STD, drug, you name it. She's been screened. Those are my things, but I have to say the biggest problem I still have, Griffin, is Access, because patients will look at what we have and say, I don't see enough of what I'm looking for that looks like me or that I'm looking for in, in what this donor should be.
And then all I can say is, okay, keep looking because we're constantly replenishing. And I don't want it to sound like it's some meat market here. No, it's very base, it's based on good medicine. And just so you know, and again, this is the, my egg bank side that I'm putting on my head. When we. Take care of egg donors.
Let's say the donors that we take care of here at RVA, because those are the ones we're dealing with. We absolutely take care of those donors. We make sure that they understand, Hey, you're a patient in this practice. We're going to take care of you. If you have any issues, complications, we're going to take care of you.
We have a little program in the egg bank where if a donor does a certain number of collections, every certain number, we're going to put eggs away frozen for her. If, God forbid, she has an issue down the line, she's got fallback, because she was so good to help us with that. But to get back to your question, as the provider, I want lots of choice for my couple.
I want easy access to those eggs. If they're not here at RBA, how do I get them from whatever center to here? Do we have to send partner sperm to that center to do embryo creation? I want a lot of creativity. And what I really want, is I want high quality embryos that are going to lead to pregnancy.
Because if you create high quality grade A blast embryos, even if they haven't been genetically tested, we're going to see that 70 80 percent pregnancy rate. And then you want more embryos if that couple envision more than one child down the road. So all of those things have to be addressed. But in the end, it gets back to the very first question you asked me, which is, you have and this is where I think we have to be careful, because some of the new technologies may cut out some of the questions that you're asking me that I would ask the couple or the patient.
And that's where we don't want to go. We want to make sure that in the end, we got a, I've got a good handle on what Jane Doe and her partner herself wants. And I don't think you can sometimes get that with all these efficiencies that we're creating. That's my advice.
[00:40:19] Griffin Jones: It's a tempering word of caution as we embrace into the benefits of technology that there are those human factors that we have to consider. Dr. Andy Toledo, it sounds like you built a heck of a practice there, especially with donor egg IVF and third party. Thank you so much for sharing a lot of what you do with our audience.
[00:40:39] Dr. Andrew Toledo: Thank you for having me, Griffin.
[00:40:41] Griffin Jones:Wait, what was that Dr. Toledo said about how he leverages My Egg Bank?
[00:40:45] Dr. Andrew Toledo: Learning to meet the needs of the people out there that are utilizing the bank, listening. If you take the people that run our egg bank, Deb Mecerod has been around, she is the clinical person that, that really listens to these couples and what they need and what they want and works with the various centers.
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