SPEAKER_01 0:01

Welcome back to the Fertility Suite Podcast Series 3, where we're bringing the fertility experts to you so you can make the most informed educative choices about your fertility. Hi everyone, and welcome back to another episode of the Fertility Suite podcast. And joining us today, we have Dr. V from Fertilysis in Athens in Greece. And I'm really pleased to have Dr. V here today because I recently went out to Athens to see them and find out more about Fertilysis. So today we're going to be talking a little bit about immunology and specifically the more sort of lesser-known side of immunology. And Dr. V is going to go into a bit more detail. But yeah, would you like to sort of tell people a little bit about yourself, Dr. V?

SPEAKER_00 0:43

Hello. Thank you. Thank you for having me here and Fertilisis and nice to see you again. It was nice seeing you here in Athens. Um yeah, so um uh first of all, a little bit about fertilises and myself. I'm the scientific director of fertilities. Um, fertilisis is uh uh a lab last clinic that uh specializes in infertility, diagnosis, diagnostics and treatment, and maybe more specifically in unexplained infertility, the difficult part that people seem to get stuck on. Um and um uh for this reason, in order to be able to explain what um um is called unexplained, um, we need to uh go a little bit beyond the typical things, tests and approaches uh that could work for many people, but not all. So um with this in mind, um we designed or introduced or included or expanded on um uh methodologies testing uh based on uh latest and not so latest uh research. Um and um essentially we we managed to over the years to um to accumulate a good amount of knowledge and experience in dealing with fertility, and we have the technology and the methodology and science to back up um you know this approach with with uh specialized testing and specialized treatments. Okay, so uh in a nutshell, this is what fertility says, and people we can work with with uh patients directly, we can work with uh doctors, with specialists such as yourself, um uh either remotely or directly here in our clinic.

SPEAKER_01 2:43

Brilliant, thank you. I love that you touched on the fact that actually um the research is not new, like the the medicine of reproductive immunology has been around for a long time, right? But I think we're really just um starting to get it more sort of out there, really, as more people don't take unexplained as an answer for fertility problems. Um lots of this testing, and thanks to companies like you, are becoming much more available, uh, which is great. So, yeah, it's important to understand this is not new medicine, this is something that has correct.

SPEAKER_00 3:17

The reality is that reproductive uh immunology and the uh the basis, the science behind reproductive immunology um was uh is not new at all. Uh it has been around since the late 70s, I believe. Uh uh and uh there is a huge amount of research and material out there, yeah. I mean in scientific publications. And but there are only there is only a handful of specialists that uh follow this route, unfortunately. Um up until relatively recently, it was uh fairly unknown. And um the main reason is that there wasn't um a channel through which people could be um really uh directly informed about this. Um the truth of the matter is that unfortunately, even if I go uh and um you know have a um represent uh fertilities or uh this uh part of science in I don't know, but 20 scientific conferences, um this will not really reach um the general audience. That's the problem. And because even though the science has been around for a very long time, and it has actually been applied and used for a very long time successfully by a selected uh group of specialists and clinics around the world, um, it is still hasn't found its way into the official guidelines. So doctors are not officially or taught about this in their studies. Um many uh societies have not endorsed or included these things in their guidelines, so it is considered still experimental, let's say. Okay, and some sometimes even controversial. Now, um I think this is why this is why it's still uh uh not very well known, but now, thanks to uh social media, thanks to other channels, thanks to this, thanks to things like uh what you are doing right now. Um this knowledge is available for everyone. And people have also all the tools in their disposal to do their own research or to be informed in order to make an informed decision.

SPEAKER_01 6:00

Yeah.

SPEAKER_00 6:01

So I think that the the time now has uh come where the um what we call uh expert opinion is not you know absolute, it's not something that you cannot really debate on and uh you just follow blindly. But rather you have lots of information and you can get um you have the ability to make an informed decision about whether this is something that you feel fits well you or not, etc.

SPEAKER_01 6:31

Yeah, absolutely. And like you said, that's you know one of the reasons why I wanted to get you on the podcast. I think just having um visibility for this area of fertility medicine is really important. I think you're right, like AI and social media have meant that things are more accessible, but I think one of the problems for patients is often understanding then, okay, do I need this test or is that relevant to me and putting that into context to their own clinical picture? So, kind of on that note, would you like to sort of just explain to our listeners a little bit about actually what reproductive immunology means and how that can affect fertility knowledge?

SPEAKER_00 7:07

Yes, so um I would say first of all, it's a very, very important chapter in the investigation of infertility, especially unexplained infertility. Um, I mean I believe it's something that all couples should look into uh after uh a while and when they they feel that they are hitting a wall in their progress. Uh, because I I would dare to say that at least uh half the couples that we um uh that we meet have some sort of uh element there that needs to be adjusted. Now, what is reproductive immunology? It all starts um, it always it is all based on the fact that an embryo is inherently um incompatible, genetically immunologically incompatible with the mother. And this happens because half the embryogenetics come from the father, from the sperm, which means that there's no way that in a traditional way the maternal immune system can accept an embryo. Traditionally, the embryo is the embryo is so different that we would expect to be rejected. Now, of course, this is not the case normally, and only in pregnancy there is a process, a special process that takes place which is called active immunological tolerance, where the mother's body essentially uh once once it um knows that pregnancy is taking place when the embryo is successfully identified. There is a process where um the immune system specifically, but all other aspects of physiology as well, uh start to modulate and to adapt in order to accommodate pregnancy. Basically, the immune system becomes more less aggressive, more baby friendly, um, and the the maternal system actually protects the embryo from itself. Um now, more specifically, um this process involves different different stages and different uh um specific other processes. Um one thing, for example, that we check for and we we need to know is um whether the the baseline profile of the prospective mother, um the immunological profile is more aggressive, more hostile than average. Some women have uh a more aggressive uh immune system, higher levels of a class of cells called natural killer cells or MK cells, um, which would potentially mediate an immunological rejection. So these cells could potentially attack the embryo, um, and uh uh higher levels of uh cytotoxicity or generally an immune system that prefers the state of inflammation over a state of calm and um more um acceptance, and um so we have uh markers to to test for that. Um so this is a more aggressive immune system would be a good thing if uh to protect you from getting a cold or the flu or whatever, but on the on uh um on the same uh um at the same time, it is like a trigger happy immune system that is ready if things don't go well, that has the capacity of launching a very effective, very quick and effective attack, uh which can result in immunological rejection of uh pregnancy. So that's one. This is what we call the let's say the autoimmunity profile, and this includes the more traditional uh, let's say, tests for uh reproductive immunology. Now the second part, maybe it's uh a little bit more specialized and uh maybe even um more um important, more significant, is what we call the alloimmunity um part of the testing. Um, as I mentioned, there are a lot of processes that need to take place for the embryo to be protected. So um, in addition for the immune system of the mother to be more uh friendly, less aggressive, you need to actively have um protection. So, for example, the production of protective antibodies is one such process. You can have blocking antibodies that uh recognize and cover um uh potential potential interaction sites between the embryo and the immune system that can lead to a toxic um effect. So this, let's say, very simply put, they can cover the embryo and protect it from the immune system, or neutralizing um antipaternal antibodies that could neutralize the naturally occurring toxic antibodies in the same time. So a mother will, on one hand, will produce antibodies against the embryo, and on the other hand, the antibodies that protect the embryo. So you need to have a balance there, and we can test for that. Um and then we we move on to a very important part, which is called um, we call it immunogenetic incompatibility. And this is where um the two partners, based on specific genetic traits that they may have, uh, may bring some sort of uh incompatibility. This doesn't mean that any one of them has a fertility problem, but the combination may be a little problematic. Um, for example, we we have something called uh HLA DQ alpha map. Um HLAs are proteins that are produced by genes that have uh a high degree of polymorphism. Okay, you have different different uh versions of these proteins called variants, and within any given population, you would have a number of these variants going around, so you would expect the two partners to have statistically to have different versions of this particular uh molecules. Now, and we assume uh that detecting on the embryo the paternal version of this molecule of this protein, which is different than the other, her body can identify the embryo this way. So we need a little bit or a lot of immunological um of genetic difference in order for the embryo to be identified. Um in cases where well by chance it happens because these variants are not very many. I mean, in any given population, I would say there are not more than 10 or 15 common variants going around. So within the infertile SA population, it is relatively common. It's not rare, it's not rare. Um it's it's I would say uncommon, but not rare. And um when it happens that the the two partners share one such variant, or even worse, share both copies of the genes, uh, so a partial or a complete match, this means that in that particular aspect, the embryo may be a little uh sort of invisible to the immune system. And if it's not identified correctly, then it cannot be protected. So that's one uh immunological problem, uh significant one. Uh another very important, very significant immunological incompatibility problem is what we call um the KIR HLAC mission. Okay. Um it sounds complicated. I will try to explain it plainly. So within the uterus, we have a group of useful cells called uterine NK cells. So these are NK cells, natural killer cells, but they're not toxic like the peripheral blood country. So they're good. And sometimes even specialists make a mistake and uh and uh and uh um think that the uh the peripheral blood, cytotoxic NK cells that migrate into the uterus and are potentially dangerous for pregnancy are uterine NK cells. So this is not true. This is a different uh population, and these are essential for very important processes. Um these um uh are important from the beginning of pregnancy, they are involved in implantation, they are involved in um the uh restructuring and the remodeling of spiral arteries, so they help with building blood vessels that will um bring blood and oxygen and then nutrients to the baby, and then the um development of the placenta, and I assume lots of other things. So the problem is that if these cells do not activate as they should at the right time, then you could have a plantation failure or you could have uh dysfunctional placenta. And this is very well documented. It's one of the few things in productive immunology that I believe there is there are very strong evidence for. Um and very well documented that this can cause um significant infertility, and uh also if we have pregnancy, then we we can have uh pregnancy loss or serious complications of pregnancy. Um, so it is a very document, very well documented, very important factor. Now, how this happens is sometimes in order for these the uterine K cell to activate on their surface they they possess, they have these proteins called CERS. These are receptor proteins, these are molecules that they can get a signal from the outside of the cell and transfer it to the inside of the cell, telling it what to do. And for our purposes, we have two types of CER receptors. We have the activated ones, which are the good ones that can potentially activate uh the cells, and the inhibitory receptors that have the potential, they're not by default active, but they have the potential to uh shut down uterine case cells, so deactivate them. Commonly, women have a combination, a mix of activating and inhibitory receptors. But again, not very rarely within the infertile uh population, women may have a specific combination of receptors with a specific genetic profile called the CIRAA genital. Women that fall into this group only almost exclusively um express inhibitory receptors. And this is considered high risk because given the right signal from the embryo, um, if you have uh a specific trigger for that, then these receptors may activate. They will activate their inhibitory function and they will deactivate utility cells. Now the trigger for this is something typically coming from the male partner. Um It's a specific group of HLAC molecules called HLAC2. The HLAC2 um molecules are molecules that can bind, that can be linked to the inhibitory receptors and activate them. So if you have this and you don't have activating receptors to offset this problem, then you have the problem. This is called a cure HLAC mismatch. And as I mentioned, it's extremely um serious from a very productive point of view. Um I want to mention in this uh point that traditionally we are looking at the male partner, at the father, for the HLAC2 as a source of an HLAC2. But in reality, in my opinion, I think it it has a very strong scientific base, um the mother herself can be the source of the HLAC2 as well. So you could have a mismatch with yourself. Or in cases of donor egg, for example, it could be the donor, which means that because you have lots of combinations between partners, between donors, we can have surrogates, we have lots of different things. Um, it is a good idea to have the testing organized in such a way to get the right information, and then somebody that can uh uh can explain the problem and the significance of whether this applies to you or not. So, yes.

SPEAKER_01 21:35

So if someone has a PGTA upoloid embryo, so it's been genetically tested, and we know that it's chromosomally normal and it's their embryo, it's not a donor. So this could still occur, this mismatch, um, or it wouldn't occur at the point of the embryo being created. This happens at the the point of implantation is when that takes effect.

SPEAKER_00 22:01

No, definitely it can. It can, it can be a problem because this has to do the the problem starts with um from the interaction between the embryo and the maternal immune system, uh, which means that uh in in um case are we going to uh not to use an embryo, but let's say that we have an embryo. Let's even let's take a more difficult scenario and assume that there is uh uh donor neck, for example. Donor there is an unknown parameter, we have a donor that we don't know the HLA profile, then based on the maternal profile, we will assess the risk. And if we believe based on history and based on her results, that there is a significant risk of her nose matters, then we can provide the treatment even prophylactically. So we will use the embryos, but we will also use treatment. And another characteristic, because I mentioned um the history, the clinical history, these types of immunological problems have uh a very characteristic um history because we are we are usually looking at uh couples that have been struggling for a very long time. They have absolute failure no matter what way they try to get pregnant. And because this is a very specific, highly important problem, but for the same reason, once we treat this problem, we have rapidly a completely different outcome and we have success very quickly because we know what the problem is and we have a specific solution. So it is when you have this type of, or rather, when you hear, when I hear such um uh a medical history when such is being described, my mind could go to that right away to that sort of problem.

SPEAKER_01 24:06

It makes sense, right? I think with everything you're saying, it's really clear how much of an impact the immune system has. Like the immune system is the root of fertility, essentially. Yes, genetics from the embryo perspective are really important, but um, you know, you've got to have healthy eggs and healthy sperm, but actually the immune system is the root of um how a pregnancy sort of starts and progresses.

SPEAKER_00 24:32

Yes, of course, it it's a major player. Um, this is why we have this, this is called the um the paradox of pregnancy, because the immune system shouldn't work this way. So it's a very special process. Yeah, you're absolutely right. Once you eliminate the common causes, obviously you could have um randomly occurring occurring chromosomal abnormalities of the embryo, for example. You cannot do something about that. Um, you could have um problems with sperm quality or air quality, block tubes. Um, another big aspect would be microbiome and also that we could talk about some other time. But when you are dealing with unexplained infertility, you definitely need to look into protective immunology, is one of the major factors.

SPEAKER_01 25:22

Yeah, it's really interesting because this is the typical cases that we see a lot in our clinic are, yeah, like you said, patients that have been trying for a long time, either with unexplained infertility or with recurrent pregnancy loss. And I think it's it's really great that these tests are becoming more readily um available. Um, I think perhaps probably for people listening, the next sort of sensible question is like, what can we do about this? Like someone's come to you and and identified the issues, whether that is um the HLA uh DQ alpha or the KIR um mismatch. Um, like the important thing is to understand that these things are treatable, right? Like there's definitely out there for people that um maybe have these issues.

SPEAKER_00 26:05

Correct. So obviously, some things can change uh because there are factors that can change, uh uh, like the the levels of NK cells, whether your bad is more uh angry or calm or whatever. Some are genetics uh which do not change, they're uh the permanent. And the question would be okay, I have this problem, so can I fix it? Um well, the answer is yes. And uh especially in the case of a uh KIRHNAC mismatch is a resounding yes, because again, we have very strong evidence from uh uh small-scale trials and research that by giving the right um uh treatment protocol, um there are medications for that, um you can completely um bypass the problem. So research has shown that women that had this problem, once given the right protocol for treatment, the um the success rates and the life birth rates much or even surpassed a little bit the control rate. So in this case, because we can give specific medications that bypass the inadequate signaling by utility and case cells. But these are specialized protocols that need to be monitored uh correctly in order to be safe. When when you do so, they are very safe. We haven't had any problems ever. But we need you need to be safe and you need to be successful because if you try to randomly you know throw everything at the same time, you won't succeed. But when you do it etiologically, uh it's extremely the results are extremely good. The same goes for the HLNTQ alpha matching, for example. Um a lot has been uh discussed about uh uh a treatment called LIT, lymphocyte immunization therapy. Well, this again is a very old suggestion. Uh I mean it has been uh tested and um investigated again from the late 70s, early 80s, I believe. Uh and and this um started as a way to try to improve outcomes for uh transplantations, essentially teaching the the uh the um recipient's body to accept to be more familiar and less aggressive towards the um transplant, which is very similar to what happens during pregnancy. Um, long story short, after many years of research and trial and um experience, we have arrived at something called lead. Basically, it is like uh a vaccination, like a vaccine, a natural vaccine that we create from a donor's blood, which is usually the male partner. And we get um I isolate specific types of cells that have high levels of these HLAs, these proteins, these signals that the embryo has. And we introduce that to the mother's body um diadermically with very uh shallow injections in the skin, similar to what's an allergy test of the mother. And basically, this triggers uh a good immune response, um, or at least this is the the theory. Um, this will tell the maternal body to prepare for pregnancy, to start um developing immunological tolerance. So we would expect more protective antibodies to be produced, an immune system that becomes more regulated and less aggressive and overactive without immunosuppression. There's no immunosuppression whatsoever. And because it leverages on a natural process, um, it has significantly good results. It's an overall overall fertility booster. Um and it works many levels, even in levels that we don't know about. Um there has been uh significant research uh showing that it is safe. Uh again, it is considered controversial. It's not within the official guidelines, and there are very few places that you can have this treatment, but it is absolutely safe and extremely effective. It's a not at all, as I said, fertility poster that um we use um on every chance that we have based on the results. Um and this uh seems to help with the HLA problem, but also with an overactive ecosystem and so on and so forth. Again, because this is a specialized neurological protocol, in order to be safe and in order, most importantly in order to work, it needs to take place in a specific way, uh based on on its um woman's and couple's special characteristics, um, and in a background of a complete immunological and other type of investigation, so you don't have to stop us from other areas. Okay, so you need to combine these treatments based on the the overall results and um clinical uh periods.

SPEAKER_01 31:49

So, like what you're saying is lit therapy kind of nudges the body to do what it should do naturally rather than immunosuppressing the body. And um into in it's really, and this is something again we talk about a lot in the clinic, but in order for immunological or immunology medications and treatments to be effective, they need to be run off the back of the right testing. It's important that they're not just sort of picked randomly without running the right testing, and also looking at the context of the clinical picture and the history of the couple, uh looking at the overall picture, right?

SPEAKER_00 32:26

Correct, absolutely right. As you said, it works, it leverages a natural process. That's why I know that it goes, um, it leads you towards the right direction, even if I we don't know exactly how it works, we know that it works in the right way. Uh, so it is natural. Um, it basically we train uh your body to be more prepared, more for pregnancy, more tolerant. And as you said, if these there are clinics that try to uh um to offer all treatments by default. Yeah, if that was successful, then we wouldn't have be having this talk now, because this is uh the easiest uh thing would be you know to just give all proposed medications and hope that something will stick. Uh actually it doesn't work this way, because for example, exactly because no one knows exactly how how we have lots of knowledge, but don't know exactly how the immune system works during pregnancy, and we don't have a way to check every aspect of that. If uh I, for example, I suppress the immune system across the board. Um, I'm not saying that definitely so, but maybe there is a chance that I uh dysregulate a little bit, you know, of course, and in baggage sample, because we know that as I mentioned, we have the bad NK cells in quote unquote, um, but we also have the good NK cells. We have the T-regulatory cells, which are good, they promote immunological tolerance. We have so if I suppress everything, maybe I'm you know uh messing around with the balance.

SPEAKER_01 34:18

Yeah.

SPEAKER_00 34:18

So yeah, we need you need to do only what you need really to do.

SPEAKER_01 34:24

Because you you do need some sort of immunological response in a good way to be able to carry a healthy pregnancy as well. It's a balance, isn't it? It's not about I think sometimes when people have these conversations around um the immune system and reproductive immunology and how that fits in the bigger picture, the idea can sometimes be from a patient's perspective that the whole immune system needs suppressing, and that that's really not the case, is it? It's yeah, it's tailoring the balance um and getting that right according to results.

SPEAKER_00 34:53

Yeah, correct. Obviously, yes, you need because as I said, passive immunological tolerance is out of the window right away. The embryo is is sufficiently um different genetically uh that cannot be accepted, but it cannot go under the radio. So you need the immune system to actively act in protecting it. Secondly, even if you had the the way to completely suppress the immune system, that would be extremely dangerous. You cannot live without an immune system. And so what a let's say a moderate and mild immune suppression does is on one hand, I believe, again, this is my personal opinion, right? But I believe that a mild suppression general of you know across the board will not be enough if your immune system wants to attack something, it will do so. The way the same way that it will protect you from a virus and you won't die from a cold. Um, so in the same way, if your immune system wants to attack the embryo, it will do so. On one hand, on the other hand, as I mentioned, you may be suppressing um processes that should take place. So without saying that some sort of immunomodulation by steroids that some doctors uh use are not effective, but only in by having experience in using that in a context of a well-organized rational um protocol.

SPEAKER_01 36:32

Yeah, absolutely. So if someone's listening and they're thinking perhaps they are falling into this category of unexplained infertility and they've maybe had a bit of a complex history, they've been trying for a long time, and they're thinking, okay, this is something I want to look at. Like these are like what type of tests are these? Are these blood tests? Are they biopsies? Can you just explain a little bit about the process of the testing?

SPEAKER_00 36:55

Yeah, so for reproductive immunology, all these are blood tests, common blood tests. They use different types of um vials because we need different types of uh um of uh decoagulation because uh not all types of vials work with all methodologies, but having said that, it's just a simple blood draw. Um we you know we can send the vials uh and instructions so you don't have the the person that performs that blood collection doesn't need to know happening in order whatsoever. We have the instructions. Um these uh we need blood from both partners, obviously, because the the autoimmunity part, obviously, the the the profile, the maternal profile is only hers. But um, when we're talking for about incompatibility, we need blood from both partners. As I mentioned, in absence of a male partner, um then we these tests still have great significance. Um may not be possible, like the HLATQ alpha machine, but the KAR, for example, is extremely important, even more important, uh, in case we detect the high risk genotype. So it's a simple blood draw. Um that's it basically. Uh it doesn't have no biopsy, nothing invasive. Just a simple blood raw.

SPEAKER_01 38:27

And if someone comes for blood and something's identified and they go on to have treatment with maybe something like lit therapy, uh like what are the treatment times? Like, can someone, as soon as they've had the therapy, like start to try immediately? Because like for lots of patients that have obviously been waiting a very long time for a healthy pregnancy, like this whole process of testing and treatment, it can feel like such a long time. Yeah, something that I'm sure you hear all the time in your clinic is like when can we try? Like it's the most common question, right? So, what are the time frames around this?

SPEAKER_00 38:59

Pretty, pretty fast, I would say. So um, some, like for the uh I don't know, KRHLH mismatch take place, or intralipid infusion or other sort of thing, take place uh in parallel to the attendees. So while trying either naturally or um a few days before embryo transfer, for example, for ADF, then you start the protocol. So you don't have any waiting period whatsoever. Lit, on the other hand, needs a short uh time before trying um in order to be effective because it leverages all an immunological process similar to a vaccine, which means that the first shot needs, let's say, three to four weeks for the mother to develop these protective antibodies and this response and immunological memory that we need. Um any so that's I would say that's the the time frame. Uh then depending on on her profile and test results, uh we may we may opt for a booster shot, for example. So but this can take just you know a few days before the attempt. In terms of natural uh attempts, you can have the litter start drying right away. At some point, it will reach its maximum effect. And then we believe that it's still effective for about let's say four to six months, although I wouldn't push it to six. Okay, depending now on the problem, more or less uh the sessions are required. And uh we are strong believers in uh the in-pregnancy lit as well. We believe that uh during pregnancy you need to have one or let's say two sessions as well.

SPEAKER_01 40:51

And how does that work for someone that's maybe um suffering with secondary uh fertility or loss? If someone's had a healthy pregnancy already after lit therapy, do they then have the antibodies or does that need a top-up lit therapy before they were to try for a second child, or would you run the testing again?

SPEAKER_00 41:09

It depends. Um it's it's up to them really, uh, because as I said, one part of our job is to uh try to adjust protocols uh and treatments to what the patient needs can afford, uh not only financially and monetary, but also in terms of time, availability, and so on and so forth. So, for example, to answer your question, um following a live birth, a successful uh pregnancy, then the lead, but also the natural process during pregnancy may have uh developed enough immunological tolerance and mechanisms that lead is no longer necessary. Um in some cases. Um in more severe cases, more more significant problems, um maybe it's uh more difficult because the effects of leads are not permanent, as I mentioned. They over the time they will wane uh at some point. Um but the easiest way, there's an easy way. You can test, you can test the latest, for example, to see the levels of protective on the bodies. Or um or you can have it anyway. I mean if if after all of these struggles, this therapy, which is not really expensive, um helps you get a healthy baby home, then maybe you can have it anyway uh as you know to protect your next attempt. If we're talking if we're talking about assistive production, definitely I would push for that. If we're talking about natural attempts without uh miscarriages, because you want to avoid a miscarriage. But if if the problem is just not getting pregnant, then the cow could give themselves uh some time trying naturally if it works perfect. If not, then they can opt for the treatment. So each case is uh is different. Also, also I want to mention here that having an initial successful pregnancy and then faced with infertility doesn't ensure that you don't have uh even a genetic incompatibility problem because it is a matter of statistics. A partial match gives you 50% chances of having an unmatched embryo, so no problem. But um, if you have a partial HLA match and a partial mismatch, these add up. So I have a significant number of cases I counted where they had the first kid very easily or less easily anyway, but then they are faced with a very, very long period of infertility, and sometimes this is the case.

SPEAKER_01 44:12

They were just lucky first time, so it you it can those you off the yeah, that's really important to talk about because I think there can be a lot of gaslighting in that area when couples are told, well, you've got a healthy child already, so there can't be a problem, and that's just simply not always true, is it? So that is really important to mention. So thank you. Um, yeah, I mean, this has been brilliant. I've learned a lot, thank you, about the immune system. And um, so if people are are listening and they're thinking, okay, I really want to get in touch, and how can I um arrange to go and see Dr. V or have this testing? Like, what's the best way to get in touch with you guys?

SPEAKER_00 44:50

So there are lots of ways because we have a lot of people uh you know want to get information on whether this tests are for them or not. The easiest way, the simplest way is that we have uh uh an online um uh form that they can fill. They can just go on the website. Um uh it's uh called a suggestions form. So they fill in a short um questionnaire about their fertility history, and then we have uh trained personnel here, scientists, midwives, uh uh uh patient coordinators, that can uh tell you whether you could benefit from these uh tests or not, or and to what extent? So we we will be relatively precise on our suggestion. So we'll say that this is strongly recommended, this is optional. Uh and uh if you're happy with that, uh you may go ahead and place an order in a few days, you'll get that box and we'll take it from there. So it's a very quick and be very quick process. If you have a more specific question, again they can send an email to customer. Um take this uh in the case. Um if I need to be involved, uh or uh another uh or somebody else, a specialist, a doctor or urologist, whatever, um, will be involved and we'll get back to them uh with our uh uh answers. Um we have an option for uh free consultations online, but you can understand that there's a limited availability because I can uh uh and also it's not a bad idea to follow us and find us on social media, on Instagram, on Facebook, so you can get a very uh rapid response there if it's something uh more general uh question, um from our staff, but also from other people that have tried our services and have an opinion. Um the the the one thing that I want to ensure is that once you have the tests and you will receive your um results, diagnosis, treatment suggestions, uh we will be available to work with your specialist, with your doctor, or the patient directly to help them with understanding the results, treatments, uh etc. So all will be done in a specific with with the purpose of getting the treatment. You won't be left, you know, angry.

SPEAKER_01 47:41

Yeah, that's so reassuring to hear, and uh, I'm sure a lot of people listening will um yeah, feel reassured by that because yeah, it's all one thing fair and well is is running the tests, and nowadays you can do a lot of reading on, like I said, like AI and social media and sort of maybe work out what testing you need. But at the critical bit is yeah, the what does the treatment plan look like and how is it in context to the bigger picture? So again, it's really important to reiterate, so reassuring to know. Thank you. Thank you so much for joining us. It's been very, very educational, and hopefully our listeners will learn a lot from that one. I know they will. Um, but yeah, thank you for joining us.

SPEAKER_00 48:17

And um well, thank you for having me and having fertilizes and uh and helping people uh you know um get this information and helping them moving forward with uh with their attorney.

SPEAKER_01 48:29

Thank you, Dr. V.