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Embryo disposition is a sensitive topic for patients even long after they’ve left a clinic. However, there can also be a burden placed on clinics when it comes to making space and cryopreserving embryo, eggs, or sperm for an extended period of time. On this episode of Inside Reproductive Health, we learn more about how one company is working to alleviate the burden for both the patient and the clinic. Listen to Griffin talk to Andrew Gairani of Embryo Options, a web-based application that provides patients with disposition education and resources, along with other features that make storage easier for everyone.
Learn more about Mr. Gairani and Embryo Options here.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
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GRIFFIN JONES 1:13
Today on Inside Reproductive Health, I'm joined by Andrew Gairani. Andy worked in the fertility industry for 24 years. He worked for Organon in the beginning in sales, then went on to a Sales Director role for the National Fertility Division of CVS/Caremark, then went on to work in biz dev for DesignRx. And five years ago, in 2015, he started Embryo Options along with two of his other partners, because of his strong relations in the fertility field and their similar experience in the problem they saw. And the solution that they built, Embryo Options, is a web-based application that allows fertility patients to pay storage fees online, but more importantly, provides patients with disposition education and resources. That's what we're going to talk about today. Those resources assist patients with making disposition decisions for their cryo-preserved embryos, eggs, sperm, and continued storage that's no longer desired. Mr. Gairani, Andy, welcome to Inside Reproductive Health.
ANDREW GAIRANI 2:17
Thank you. Thank you for having me.
JONES 2:20
So I want to start with, what was the impetus for--why did we need a solution for disposition in the first place? What is the problem that providers and patients were seeing with disposition issues?
GAIRANI 2:37
Yeah, well, it was probably back in 2010, that my partners and I were observing that patients, or people, were on Facebook and they were finding each other for the purpose of donating embryos from one couple to another, and we saw that happening and obviously, there's a lot of regulations and there are some important ASRM guidelines that go along with IVF centers conducting embryo donation procedures. And we saw this interaction happening with patients and there really wasn't much structure to that embryo donation offering that was happening in the world. So what we decided to do was create, first, an embryo donation platform that allowed centers, or patients, to donate anonymously to the center, and then the center could conduct an embryo donation procedure following guidelines. And then that quickly evolved into Well, how do we work out offering this embryo donation program to multiple patients who are cryopreserving embryos, eggs, or sperm? And then we came up with the billing platform. So along with every cryopreservation bill that's being paid on a regular basis by a patient, somewhere along the line, they're going to have to make a disposition decision. So that's kind of how Embryo Options was born. The program though it’s apolitical--it does provide patients information about all their options, including if they want to discard, or donate to research, or reusing their own embryos. But there is a robust infrastructure and a program that allows patients to donate embryos back to another couple.
JONES 4:12
So what are some of the legal issues that could arise when it comes to embryo disposition for both the patient and the clinic if it's not done correctly?
GAIRANI 4:21
Well, I mean, you see in the news, right, we've seen in the news in the last few years or so, I mean, it gets a little sticky sometimes when couples develop embryos, they begin to cryopreserve them, and then later on down the road, the couples may have a divorce. Right? And at that point, I mean, we've seen stories in the news where one party wants to keep the embryos and use them for procreation and the other one does not. And so now, there's this dispute between the divorcing couple of where oftentimes, it's gone to court, and usually the courts are deciding in favor of the party who does not want to have those embryos be used for procreation. But we were seeing those kinds of things pop up from the patient side of things. From the center side, I mean, there really isn't much regulation or laws concerning the cryopreservation of embryos, eggs, or sperm. But based on some things that have happened in the industry, and how much story and how much freezing is occurring, I wouldn't be surprised if somewhere along the line the government did step in and regulate freezing and how freezing is occurring at the IVF center level to hold some of those centers accountable for how they handle that.
JONES 5:37
What's the issue with someone just freezing their embryos indefinitely? Maybe they've got some sort of auto-deduct or it's not terribly hard to collect, and they just don't want to think about it and you know, maybe $600 a year is expensive, but maybe it's palatable. What's the challenge just having it go on indefinitely without making a decision about disposition?
GAIRANI 6:08
I guess there's really not, like, a major challenge for the center, right? I mean, the specimens, they don't get any less viable from what we know, the longer that they're in storage. As long as patients want to continue to store and they're paying their fee, I don't feel like most centers have a problem continuing to store the specimen. But due to the high demand of freezing and tank space, I think some centers maybe finding themselves wishing that they had some type of previous policy that limited the amount of years that someone could store. And so I think the ASRM guidelines have come out and actually recommended that some of the initial consenting should let patients know that there is a limitation to how long this center may store the specimens, but I don't think that's really widely used in the consenting today.
JONES 7:06
How often do you see centers that have policies in place with time limits?
GAIRANI 7:12
Yeah. So it was just--I think it was at the end of 2016, Griffin, that the ASRM was making recommendations that the initial consenting should probably have some information in there about a long center will will store. Another provision was--there was a recommendation on informing patients how old the primary patient could be for them to even participate or allow a frozen embryo transfer to occur. So this type of consenting modification is ongoing, and we see it happening, but I don't think before, I would say, last year or the year prior, there wasn't much consenting around limitations on how long it takes could store at an IVF center.
JONES 8:02
So from your experience, are most centers doing it now with new consents?
GAIRANI 8:08
Well, it's interesting because when we onboard an IVF Center here at Embryo Options, it seems like everything cryo is being looked at, right? And so they're using that opportunity to look at consenting, look at billing options, and things like that. And we are seeing centers who are coming on changing their consents and we'll go ahead and put those in the systems for people to see,
JONES 8:33
But prior to 2016? Just very few of that?
GAIRANI 8:37
I don't think--no. I mean, I can say probably high confidence that there was probably not a lot of information in the initial consents that limited--that informed patients that they had on they could only store for 10 years or they can only store for seven years. Patients understood that by the time they reach the age of 55 or something like that or the age 50, that the center would not, you know, conduct using those embryos of that old of a patient. So, yeah, there wasn't much before that, I don't think, Griffin.
JONES 9:11
So what do you find--now, you've got different disposition options, talk about them in order of most common--most commonly-elected going backwards and then maybe why each one is the most popular.
GAIRANI 9:24
So I would say just because most IVF centers always had the option to thaw and to discard--that was one of the more easier options to offer. Just by virtue of that being like one of the main offerings, I think that most patients are choosing to thaw and discard. Probably it’s number one, to decide when to discontinue--or as an option to discontinue storage. The other one probably is obviously just using your own embryos. So patients will store excess embryos for their own reproductive use and they'll have a child or two, and they'll have maybe one or two embryos remaining, and they'll go back and they'll use those embryos. So I would say that's probably the second most common way that patients stop storage is they end up just depleting their own embryos through subsequent treatment attempts. Thirdly, I would say that donating possibly back to the center’s lab for research purposes, or for quality assurance purposes and training purposes. And then donating to research through embryonic stem cell will probably be the fourth, but that's really just not too common too much anymore. And then donating to another couple is probably the the lowest percentage, but it's becoming more and more popular and it’s evolving because I think that the IVF centers basically didn't have a good infrastructure to offer embryo donation. But through Embryo Options, we're seeing about 8-10% of patients who have embryos, deciding to donate them to another couple. So because now that offering is easily accessible through our application and it's streamlined for the center, we think that the embryo donation is not at its peak yet, that's for sure.
JONES 11:26
Are all of your disposition options available to all of your clinics? For example, there's a small, independent practice that doesn't have a relationship with an academic center or research center, but one of the patients wants their disposition to be donating the embryos for research. So that would mean that someone would have to transfer that to a university system or research facility. Are all of the disposition options open to every Embryo Options clinic?
GAIRANI 12:03
No, it's not. You know, basically we have academic institutions like you had mentioned that they do have IRB-approved studies to study embryos and implantation rates and PGS and biopsy. And so there are some academic institutions that have those types of studies available for patients to choose that option. And we put that information inside their portal, right? But then there are smaller IVF centers where patients want to, for example, donate to research, and those patients will--we give them all the contact information for stem cell research institutions that may be accepting, like Harvard and Stanford and New York Stem Cell Research Institution, and it'll be on those patients to reach out to those programs to see if they're accepting embryos and if so, go through those entities own consenting process. But I can tell you, if there's a smaller IVF center and a patient wants to donate to research, we're not really able to provide that research option from the academic institutions. So the academic institutions are large enough that they're able to recruit enough patients and enough embryos to power their study. So yeah, we're not really able to mix the disposition options together to provide more choice. We're kind of limited as to what the smaller center can provide.
JONES 13:27
Do clinics typically require cryo-storage to be paid for at the time they begin treatment? Or will they start an IVF cycle and then have storage paid for depending on how many embryos they get or after transfer? How are they coupling those together?
GAIRANI 13:48
Yeah, most centers Griffin, they have a global treatment package where patients are, you know, paying a single see and that single fee is inclusive of diagnostic workup and IVF and ICSI or--and usually there's one year of cryo-storage included in that global treatment package. But at the time of treatment, patients who are opting to cryo-preserve excess embryos, eggs, or sperm are asked to enroll into the Embryo Options program. So patients are enrolling at the center using a web URL or a tablet, they're given information about Embryo Options--it's co-branded with the IVF center and so patients understand that they're enrolling into our program and their account will be activated by their IVF center post-treatment in the event that they do have excess embryos, eggs, or sperm. And then any kind of payment method they put on file with Embryo Options will be used according to the to the center’s payment plan. So it's very common that a brand new patient would come into our system, understand that we're partnered with the IVF center, and then they wouldn't engage into paying for storage fees until a year later.
JONES 15:09
Got it. That solves that question mark that I had in my mind. So now that you've been doing this for a few years, are you starting to see an average of how long patients remain with Embryo Options before they choose a disposition? Are you starting to see an average length?
GAIRANI 15:29
Yeah, we are. We actually just kind of looked at that, like, what's the dropout rate? So we started in 2015, with one of the largest IVF centers in the nation, and we just looked at some numbers and it looks like so far, 30% of all of the patients who initially cryopreserved embryos in ‘15, 30% of them have a closed account inside our system at this point, which means a closed account means that they either turned in a paperwork to pursue a disposition option, authorizing the centers to exercise that disposition option, or it's very possible that the patient could have came in and used all of their own embryos in a subsequent FET cycle. So it's about a 30% dropoff from ‘15 until now. There are some studies though that show that, you know, on the average if patients have embryos and they're in their mid-30s, which is about the average age for patients who are seeking treatment, most patients will hold these embryos for five years or so as kind of like an insurance policy for expanding their own family and meeting their own reproductive goals.
JONES 16:49
So now I’ve got another--I’ve got a few follow up questions from there, but in the case of let's say, the patient comes back for an FET, uses the remaining embryos, is it automatic of how Embryo Options receives that information? In other words, the embryos are used and then the account closes? Or does either the patient or the clinic report something to you?
GAIRANI 17:16
Sure. Yeah, no, we have interfaces with most EMRs. In the absence of an interface with the electronic medical record system, we work no problem with access databases and spreadsheets and just really, anything that we can. So we process these databases, and we're able to determine all of the existing patients, for example, whose inventory got adjusted to zero. Those are freeze dates in our account--in our portal that are flagged for closure. And at the same time, we pick up any new freeze dates that are being recorded in the cryo-logs so that we can basically tag or flag those freeze dates to be activated for storage fees.
JONES 17:58
Now that you're starting to see a drop off of 30% of accounts that close from having started in 2015, it could be very well that you've simply inherited a lot of the differences that you solve for clinics. So what is that like? What is the default for you? In other words, if someone defaults on payment to Embryo Options, or is non-responsive about changing their disposition, how do you then solve the very challenges that you've taken off of the plate of clinics?
GAIRANI 18:29
Yeah, well, that's one of probably the more attractive things about why some IVF centers have partnered with Embryo Options because as you may know, Griffin, most IVF centers, they're experts at treating people that suffer from infertility, right? And they're really good at billing for--at the time of treatment, do a great job at billing. But this cryo-storage bill is a recurrent bill and it's a bill that they're really not really good at doing right. So some centers have challenges with pushing out an entire collections process. So for example, if a patient defaults on paying Embryo Options, we will send a late notice to the patient at 30 days late and a 60 day late and a 90 day late notice and, you know, these notices, let patients know that they're responsible for going online and looking at their disposition options and eventually choosing an option that no longer requires the IVF center to continue to store the specimens. Or we reach out to patients at 75 days delinquent and we just ask them if they need some help with talking to someone at their center if they have questions about disposition or if they have a balance, we can put them on a more convenient installment plan. Given permission from the center, we're sometimes able to take people with hardships or people who are just not sure what they want to do, but they want to avoid not being late on their bill, we can definitely accommodate letting patients make payments that are very low, sometimes $25-50 a month just to buy them some time to figure out what they want to do. I think that some patients may neglect or not want to pay the bill because they think that if I don't pay the bill, then maybe the service will just automatically stop and I won't need to make the difficult decision of disposing of my embryos, right?
JONES 20:37
Right!
GAIRANI 20:38
But that's pretty--that's not the case. And I think that might be the major communication breakdown. We talk to patients a lot at Embryo Options and we hear from patients that--I just figured if I didn't pay, that this would not--I would not be in any trouble for not paying this. And that's just not how it works. So we counsel patients, we basically let them know that the center--you stored these embryos five years ago, and we understand that sometimes--and the center's understand that sometimes people change their minds about what they want to do with their with their embryos, eggs, or sperm. And it's very, very important for them to submit a signed disposition form, a new consent, authorizing the center to proceed with a disposition option that kind of meets their needs, right?
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JONES 23:30
So you're interfacing with the lab and the clinic and how those two interface with each other is often very different from clinic to clinic and lab to lab. They've got different workflows, they have different patient management software, they have different EMRs, they've got different scheduling software, they've got a different billing schedule, sometimes all four of those are different from each other at the same group! And so how do you work with clinics and groups with really different systems?
GAIRANI 24:01
Yeah, that was the hardest part, Griffin, about starting Embryo Options is we built the platform. And we--
JONES 24:08
Seems to be the hardest part for everybody that's trying to break into the field with a software or technical or system solution, right?
GAIRANI 24:18
In a sense. Yeah, I think it is because we're looking at you know, anytime we go into a center, we're looking at either spreadsheets or they use a certain EMR or they use an access database. And sometimes the centers are using different practice management systems, different EMRs, Excel spreadsheets, and so when we work with an IVF center, we are really trying to figure out how to extract or capture all the data that we need to assist the centers with cryo billing all of their past patients. And so yeah, it can definitely--it can be challenging. But the way that I think we've gotten a handle on it is just through experience, right? So you know, we keep continuing to go into centers, and we're seeing trends that most centers will use this program or this program. And we've gotten used to being able to work with the centers and coach them on how to capture the data that we need and get it over to us. And we have agreements with most of the EMR companies out there right now to assist the IVF centers with getting us the data that we need to help them with their cryo billing.
JONES 25:25
So how much do you bend to them versus how much did they bend to you? And maybe it's a question about your onboarding. So for instance, when we work with a client in implementation, we sometimes work with different developers--they’ve got a developer we work with them, if they've got an in house marketer, we work with them, if they have different designers or different people, we can work with them. But our onboarding is first getting everything in accordance to our framework, meaning we can work with your developer, but you still have to get us CMS access to your website. We can work with your developer, but you've got to give us admin access to Google Tag Manager and add us to search console. And we can work with your physician liaison, but we need you to insert these exact data points into the reporting document that we have for you. So it's essentially, you know, we have to be able to work within their terms. We don't just come in and replace everything that they have, but in order to assess what they have, in order to counsel, and in order to help with implementation, we need to really have them adhere to our framework. What's it like for you?
GAIRANI 26:37
Just in the startup world, I mean, we're trying to accommodate a lot, right? I mean, so when we go in, we have our best case scenarios where you know the EMR is--we have a collaboration with them and they send over the data and there's no issues. And in other cases we have to ask the centers to reach out to certain vendors to ask them to work with us. And sometimes that doesn't go as well as we'd like. But like I said, over time, it seems like that Embryo Options is overcoming that quite well, because of basically, the more the program is growing and the more popular it becomes, centers who want the program are inclined to do just about anything to help us get what we need to get them off the ground.
JONES 27:26
How much of it is actually getting better at just knowing that okay, if you're using this EMR, it's going to take about this long and these are going to be the challenges versus how much of that improvement really just comes from setting the expectation properly with the program and saying, this is probably what we're going to get caught up on. This is some of the challenges that you can expect.
GAIRANI 27:49
It's both. It’s both, Griffin. And really I mean, where it's becoming easier is like, as we grow, we're hearing from the centers, Okay, well, we use this system and this system or we use this this type of program. And we've already had to work with those entities prior with another center. And so we've--I think we've exhausted understanding all the different systems out there now. And I can tell you that for the most part, we know who to talk to at those entities. They've already worked with us to help launch another center. And so it seems to be getting better and better in that regard as we learn the landscape of all these different systems and actually make--form relationships with people who are overseeing those applications and IVF centers.
JONES 28:43
So talk about the adoption and retention of the centers because often someone can roll out a portal that might be a great solution for a group, but it's just one more darn thing. They start to get into it and then they just abandon it all together. So how do you all keep groups active, keep programs actually participating with Embryo Options, utilizing the solution and adopting it into their practice workflow?
GAIRANI 29:13
Yeah, it's not been as challenging for Embryo Options, I think, as compared to other new technological applications because really Embryo Options is being used as an application to cryo bill all patients who are cryopreserving embryos, eggs, or sperm at the center. And so a lack of compliance or use of our program would negatively impact the center's revenue.
JONES 29:46
That helps, doesn't it?
GAIRANI 29:50
It does, yeah! We have pretty strong compliance with that. And we don't see centers really deviating from having one system do all of the cryo billing. So for example, in any one of our centers, it's not common at all where they would say, Okay, well, let's let Embryo Options cryo bill for these patients, but the center will remain billing these patients. So they don't want to use two different systems for cryo billing. So once we start with the program, they usually just have Embryo Options 100% take care of the billing.
JONES 30:26
So Embryo Options is taking care of the billing, the patient is paying Embryo Options, Embryo Options is paying the clinic?
GAIRANI 30:42
Yes, that’s how it works.
JONES 30:33
Then that's why you get good compliance!
GAIRANI 30:38
Yeah, I think that's one of the main reasons.
JONES 30:41
Are you also partnering with--do you only partner with clinics? Do also partner with storage facilities as a means of--well, an alternative to disposition, I suppose? In other words, there are people that save things for decades that are much less valuable than embryos. I could see a certain segment of the patient population that would just want to store their embryos indefinitely. Do you partner with any storage facilities or groups where ongoing or very, very long term storage is an option?
GAIRANI 31:13
Yep, yep, we do. So there are definitely IVF centers that we have that they don't have the capacity to store embryos, eggs, and sperm long-term and they outsource to long term storage banks. And so while Embryo Options is working with those centers who are not going to hold specimens for a really long time, we are partnered with a long-term storage facility to help that IVF center and that long-term storage facility, facilitate transferring those specimens. There's quite a bit of paperwork that has to be transferred and medical records and things like that. So for those IVF centers who only own for a short period of time, we have a long-term storage partner that can help streamline the transfer of those specimens from the IVF clinic to the long-term storage facility at a time period where the center and we would like it to move and, you know, patients give authorization to allow that to happen.
JONES 32:35
Your, perhaps, your company's vision going in the next five years... Let's start--yeah, let's ask that! Where do you see Embryo Options going in the next five years?
GAIRANI 32:25
I definitely think that it's growing rapidly right now in the US, we're probably had about a 20% market penetration. And it seems like more and more centers are jumping on board and I think in the US, we can do much, much better than 20% market penetration. It's interesting that you bring the question up because we go to many of the regional and national meetings and we run into international physicians and we're understanding that they have the exact same issues: where cryo billing is difficult, there's a lot of nuances to it, it's tough, patients don't have all the options, and they need to do a better job. And so we feel like with more growth, we're going to be able to get into other countries, no problem.
JONES 33:15
Have you gotten yourself on a plane to Shanghai yet?
GAIRANI 33:19
Not yet! Not yet. Maybe in the future!
JONES 33:25
We might be talking about new markets in five years?
GAIRANI 33:29
For sure. Absolutely. 100%. And that's an exciting thing too, because we want to be in the international space because ultimately, you know--I'm going to circle back to the embryo donation--in the embryo donation infrastructure that is set up today is set up where an IVF center has an embryo donation infrastructure using Embryo Options in a private setting, and most centers may want to keep it like that. But ultimately, we feel like more patients would be inclined to donate if they could set a condition that the recipient lived maybe in a different state or X miles away or maybe in another country. And so ultimately, the main goal, I think, of Embryo Options was to create a network of IVF centers so that patients could donate to one another, and it's in a setting where it's safe, governed by the healthcare providers, but provided patients more comfort in donating based on geographical.
JONES 34:30
I haven't thought about this before, but how does the rise of donors and the rise of oocyte preservation affect embryo donation or embryo storage or the disposition of embryos is there a corollary effect somewhere?
GAIRANI 34:53
Well, I don't think so quite yet. Right? I mean, egg preservation’s still fairly new and we do see centers growing in that area where young women are coming in and they're electing to cryopreserve their eggs. But you know, really the main purpose of--the bulk of the business today, Griffin, is still egg freezing with the intention to fertilize these eggs to create embryos to conduct treatment to help overcome infertility. So, I'd say the bulk of the elective egg freezing is really not impacting the amount of embryos--I don't think yet--that are being created. I do think that our eggs are being cryopreserved. I think that some centers who do a great job at it are doing that intentionally for letting the patients decide, Okay, let's create--we have 15 eggs, let's fertilize one or two or three instead of all 15. And so we are seeing some centers where the patients have cryopreserved eggs, embryos, and sperm. And so the amount of embryos being created, I think today may be increasing because egg freezing has gotten so popular and so good, so effective.
JONES 36:12
What are the big changes on the horizon either for donation or disposition options or embryo storage? What are the big changes that you see happening in the field in the next 3, 5, 7 years?
GAIRANI 36:27
You know, I think that like I said, I think embryo donation will take off as long as patients are provided more choice and able to potentially engage in an embryo donation in an open setting where they want to know the recipient on some level, and would be kind of defined in our world as an open donation, very analogous to an open adoption. I think that could definitely evolve. I think that some patients holding embryos are anguished about what to do with them. And if they had more outlets to do things that were altruistic with those excess embryos, such as donating to research or donating to another couple, I think that they would find themselves doing those versus the thaw option. In way of the future, I mean, there could be regulation put on how long a patient can store embryos. I think in in the UK, there's a limitation that you can only store for five years, don't quote me on that, but there is some, you know, five to 10 years something like that, and then the patient has to make a choice. But as far as donate to research, we don't see that on probably much as an option anymore. Most embryonic stem cell research institutions are focusing on adult stem cells versus embryonic. So most of them are not accepting embryos for research any longer. So, you know, I think those are the main things, more altruistic options in way of embryo donation would probably be the biggest change, I think, anybody could probably see in this space in the future.
JONES 38:08
How would you want to conclude with our field about where you want to see the direction go or the awareness that you would want the field to come to know about options for embryo disposition, storage, and donation?
GAIRANI 38:23
Yeah, I feel like this would probably be a message to the fertility industry as a whole. From working with up to 100,000 patients now, we take many inbound calls, we talk to patients, and there's definitely a conundrum that patients are dealing with concerning excess embryos. They oftentimes will lose contact with their healthcare providers and you know, over the course of storing for four or five years, if there's not enough education or support for the patient, and there's not easy ways for patients to pay using payment plans such as monthly or things like this, I think, you know, the industry will continue to see patients not making payments, abandoning specimens. But you can really, I think, stop that with more education, easier ways for patients to pay, easier access to disposition forms, more choices like embryo donation available to patients and making patients just more aware that you do have a responsibility to pay these fees. And you do also have a responsibility to make a decision when storage is no longer desired. And the way that you can do that is through optimal building and good education. And that way, there's no there's no gap between the IVF center and the patient as patients continue to store embryos for four or five years beyond their treatment.
JONES 40:02
Mr. Gairani, Andy, thank you very much for coming on Inside Reproductive Health.
GAIRANI 40:07
You’re welcome. Thank you, Griffin.
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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.