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Season 4 Joyce Harper is Professor of Reproductive Science at the Institute for Women’s Health, University College London, author, public speaker, scientist and host of the podcast Why Didn’t Anyone Tell Me This? Together with expert guests and people with lived experience, this podcast offers practical tools to help you build a life of good health and happiness. www.joyceharper.com Instagram, TikTok: @profjoyceharper Facebook: Global Women Connected
Joyce Harper (00:02)
Hi, I'm Joyce Harper and I want to welcome you to season four of my podcast, Why
Didn't Anyone Tell Me This? Together with expert guests and those with lived
experiences, we will give you some tools to empower you to live a life of good health
and happiness.
Today I'm talking to my dear friend, Anis. We have been friends for many years and we
are going to talk about everything you want to know about fertility treatment. Anis is the
head of the department of obstetrics and gynaecology at Hospital Cantonal and
professor at the University of Freiburg in Switzerland. He is a fertility specialist with
decades of experience, many accolades you can read in his bio.
And he is currently the chair of the largest fertility society in the world, the European
Society of Human Reproduction and Embryology ESHRE, which we will talk about
throughout the podcast. So whether you're trying to get pregnant and having issues, you
may be already having fertility treatment or you may know somebody who's about to
embark on fertility treatment and want to know a little bit more about it. We will go
through everything from intrauterine insemination through IVF, ICSI, embryo freezing,
egg and sperm donation, counselling, the stress of going through IVF, the success
rates, all of that we are going to discuss in this podcast. Enjoy.
Joyce Harper (01:34)
Welcome, Anis.
Anis (01:37)
Welcome, Joyce.
Joyce Harper (01:38)
Always great to talk to you and today we're going to talk about everything you want to
know about fertility treatment. But before we do that, can you start by telling us about
your career and what led you to become a doctor that works in fertility?
Anis (01:55)
Thank you, Joyce, for this question. It's really a pleasure to be here. My path was not
entirely linear. I started with physics because I wanted to understand how the world
works and its most fundamental level, and then I moved to medicine. Surgery,
reproductive medicine, stem cells, and fertility. From outside, it may look like ⁓
Someone who could not make up his mind, but for me there were always a logic.
Understanding life first from laws of physics, then from biology of reproduction, and
finally from the patient who trust us with their most intimate hopes. I came actually to
Switzerland for the most scientific reason of all: love.
Joyce Harper (02:49)
Uh-huh.
Anis (02:49)
I met my wife and I stayed, and more than 30 years later, I have no regrets. And actually,
it's the most long follow-up I have in my career. And fertility medicine became very
personal to my ⁓ to me because my wife has a stage four endometriosis. So she lived
with this disease, with its pain and uncertainty. And after surgery, we were fortunate.
To conceive spontaneously twice. Our children are now adults, and when I meet I met a
woman with a severe endometriosis who wants a child, I do not meet her as a stranger. I
carry that experience with me. And professionally I have the privilege of working in
reproductive medicine in biology and stem cells, including deriving the human
embryonic stem cell and first ⁓ induced I IPS in Switzerland. And today as a chair of
ESHRE I see fertility medicine not only as a medical discipline but as a a deeply human
mission.
Joyce Harper (04:05)
Yeah, thank you for sharing that very personal story. And for me as well, I started in this
field in 1987 without realizing that in the late 90s, I would have a trouble getting
pregnant and I would then be the other side of the table as you've been and go through
years of fertility treatment, which we're going to talk about today. So we've both got the
very personal story of why we're continuing to work in this is very exciting area.
Now I've just recorded a podcast with Nick Macklin and we talked about fertility testing
and that episode is coming out just before this podcast with you. So we've talked about
how we test couples and they then will probably, may end up in the fertility clinic. So
let's move on to that with you. When a couple are told they may need some fertility
treatment, what does that actually mean in practice?
Anis (04:34)
Yeah.
a good question. ⁓ it means that we have moved from uncertainty to a clear pack
picture when the patient really comes to our clinic. Sometimes we identify a cause of
ovulation problems, tubal disease, endometriosis, male factor, ⁓ infertility, ⁓ decrease
of ovarian reserve, and sometimes we speak about ⁓ an explained for infertility which is
common and certainly certainly not hopeless and in practice it should mean a real
conversation not just a protocol the couple needs to understand what we know and
what we do not know and what the realistic options are and I want really to insist on one
point.
Complex fertility problems should not be managed in silos. And this is really a key
message. Women with endometriosis, recurrent failure, severe male factor in fertility,
or complex uterine disease should be discussed by a multidisciplinary team. I mean
reproductive endocrinologists, reproductive surgeon, embryologists, nurses,
geneticists, psychologists, and when appropriate.
Patient representative. And I strongly believe the major scientific societies should issue
a joint statement for this, as in oncology. Every patient should have the same chance of
pregnancy, whether she first consults a reproductive endocrinologist or a reproductive
surgeon. And the patient should not depend ⁓ i in a way in her chances depend on the
first door ⁓ she happens to open. And this is really a very, very important message.
Joyce Harper (07:07)
Yeah, that is so important, Anis. And we're going to go through the treatments now, but
obviously the treatments depend on the tests. So for some tests, as you mentioned,
they might have blocked fallopian tubes, they might have ovulation problems. So as we
talk about the tests, let's talk about which patients are suited for this. And obviously
you've talked a lot now already about endometriosis. So If we've got a couple that have
come to us and they're at the beginning of this fertility treatment journey and they're
obviously, as we said, their tests will depend what sort of treatment they have, but
what's one of the very basic treatments? Let's start with the intrauterine insemination.
So let's talk about who that might be suitable for and what it actually involves. So tell us
about IUI.
Anis (07:59)
IUI have a really real place, but only in the right indications. And because we have really
to make all the investigation properly on site, not at home, because this may induce
stress, as we discussed, and I think both of us agree. ⁓ It can be useful in my male
factor in fertility. Unexplained infertility, ⁓ ovulation disorders, especially in young
women with open tubes and acceptable sperm quality. But IUI should not become a
way of losing precious time. In women approaching 38, ⁓ in significant male factor
infertility, in severe endometriosis or tubal disease. IVF or ICSI offer a better chance.
So ⁓ in my my view is simple. IUI is a good treatment when it is well indicated. It is not a
light IVF and it should not be used to postpone a more effective treatment when time is
biologically important. As I often say to my patients, biology is kind, but it does not
always grant extensions. You see what I mean?
Joyce Harper (09:27)
Yeah.
Anis (09:27)
And this is very very important in a way to go step by step and go for precise indication
for IUI. And especially actually in countries where IVF IVF is not reimbursed. And in
these countries, actually, that may have happened some ironic things. You know, ⁓
people were inseminated with ⁓ azospermic ⁓ samples. It just to have the
reimbursement and this is pity for some p for patients. And you see how when
indications are not correct then it's very tough and we patients may lose time.
Joyce Harper (10:12)
So an azosperm example, let me just explain, that means that there's no sperm in the
sample. So IUI, just explain to us, obviously we need sperm for that, we need open
fallopian tubes. So tell us for the patient, if you're going to do IUI, if the tests for the
male and female are okay, and they're gonna do IUI, tell us what actually happens from
your point of view as a clinician, how do you prepare the patients and what do they need
to go through?
Anis (10:17)
Yeah. Okay, then first we study the cycle ⁓ the the ovarian reserve. The age of patient is
very important also as I said before. Then we have to investigate ovulation if she
ovulates spontaneously or she had problems of ovulation like in ⁓ PCOS ⁓ now we call
it PMOS. ⁓ If they have ⁓ the sperm is okay, we make the migration test and we see
how many motile sperm we have at the end. And one everyone's everything if she
patient history of the patient, if she have a kind of connization or a cervical disease,
make ultrasound to be sure that the uterus is okay, no fibroids, or at least if there are
fibroids they have no impact on the cavity. And all these criteria will indicate really the
good chances to success of IU.
Joyce Harper (11:54)
What is it? What's actually going to happen to the patient during IUI?
Anis (11:58)
okay. Then there are several protocols. In a way we can make IY with spontaneous
ovulation, but actually it's not really recommended because the chances are really ⁓
less than when we stimuli stimul stimulate the ovaries. In a way we give ⁓ either kind of
pills like ⁓ aromatase inhibitors And then we will follow and once we have one, two,
maximum three follicles growing, then we trigger the ovulation and thirty-four hours
later we prepare the sperm, ⁓ select the motile ones and then inject them inside the
uterus in a way To bypass the cervix and make them nearer to the ovulated egg. And of
course, for every kind of stimulation, either for IUI or for IVF, we have to tell the patient
that there is a risk of multiple pregnancy. And this is a very, very important issue.
Joyce Harper (13:20)
What's the success rate of RUI just generally? Obviously it's going to vary.
Anis (13:28)
the the success rate of IUI normally for three cycles is about successive cycle is thirty
three percent. Is eleven to twelve percent per cycle per stimulation let's say.
Joyce Harper (13:40)
Good. Yeah.
So you said you've explained exactly how I do with, with IUI, we're bringing the egg and
the sperm closer together. So with the sperms in the womb and a few more eggs are
being released. But as you said, if a woman's got blocked fallopian tubes, then that's
not going to work because the egg and the sperm still need to swim or the sperm swims
down the fallopian tube and the egg needs to come up the fallopian tube and that's
where they meet. So if the fallopian tube is blocked then the couple have to go for IVF,
full IVF. So let's move into IVF now. So with IVF, we're now going to really bring the eggs
and the sperm right together, because we're going to do that in the lab, and we're going
to totally bypass that fallopian tube. So it's the treatment that most people have heard
about. So tell us about IVF now. What's going to happen to the couple, both preparing
them and when they go through the IVF cycle?
Anis (14:38)
Thank you, Joyce. An IVF cycle has several steps. First, we have to stimulate the ovaries
with hormone injections for around 10 to 14 days. And the aim is to obtain several
mature follicles instead of one. And during this period, the monitoring by ultrasound
and blood test is essential. And this is where nurses play a key role because They guide
and reassure and coordinate the daily ⁓ reality of treatment. And then when the size of
three eggs at least ⁓ we compare to the hormonal dosage reach 17 to 18 millimeters,
then we have to trigger. And 34 ⁓ 34 ⁓ hours later. We will go for the comes the egg
retrieval, usually under sedation. It is a short procedure and most patients go home the
same day. The eggs there are then fertilized in the laboratory. And this is the
embryologist moment. The quality of laboratory is important, the culture conditions and
the skill of the embryology team, all of this matters enormously.
And then ⁓ once fertilized, the embryos are observed for several days, often until the
blastocyst stage around five to six days after fertilization. And then one embryo is
transferred to the uterus, or the embryos are frozen for a later stage. Physically, IVF is
usually manageable. Emotionally, it can be roller coaster. The i the the the science is
complex but the communication must remain simple and humane. Did I explain it well?
Joyce Harper (16:47)
Yeah.
Yes, that's perfect. Really perfect. So I'm so glad you brought up the emotional. So we
did a survey several years ago, which we published, with patients who had been
through IVF and asked them why they stopped. We asked them many questions, but
one was why they stopped. And emotional was the top reason. It is a roller coaster.
Yeah, I've been there. I've been on those drugs and those drugs make you feel
Anis (17:10)
⁓ you
Joyce Harper (17:16)
Yeah, you feel, I felt crazy actually. Yeah.
Anis (17:18)
Okay.
Nice and and that's and the and and that's why w we really we have to combine not only
the physical treatment but also also emotional treatment. That's why in some time the
patient association is really needed in a way that patient can share their experience, at
least to see that they are not alone and they l have this same or different experience in a
way to really overcome and go over this emotional ⁓ we may say crisis also because
the couples can broke during the treatment too.
Joyce Harper (18:05)
said the word alone, yeah, that is really how you feel as a woman. I know it obviously all
of this treatment involves two people, but it is a very lonely journey and it's a lonely
journey. It's the woman that takes the fertility drugs, it's the woman that has the egg
collected and it's the woman who's going to get a period or get a pregnancy. So it is very
hard journey for both of the couple, but I think for the woman it's really a lot of
emotional pain for sure. And it's not a simple thing, is it? I think the media do present
IVF as a very simple, ⁓ they can just have IVF, but having been through it, there's a lot of
discussion about really PTSD, even when we have a family, I have a family from IVF, but
I still feel it 20 years later, I still feel the pain that I went through those years.
Anis (18:48)
They can go.
Joyce Harper (19:04)
of treatment and failure for not getting pregnant for many, many months, many years. It
is very hard on the woman, but on the couple overall, isn't it?
Anis (19:17)
Yeah I I I I fully agree. That's why it's not really a technical ⁓ or a medical ⁓ technique
because we are feeling human and the we have to have this compassion ⁓ in a way to
support patients and really ⁓ make them feel not feel alone and
they share with them their experience, their feelings. Sometimes in some clinics, you
know, you have them you have patient on the row and you don't really spend enough
money. People patient they feel really ⁓ desperate. In a way, they don't have time to ask
questions.
Joyce Harper (19:58)
There are another two things I want to mention about IVF. One is it does take time. So it
takes time out of your life. You said about the blood tests and the scans and then going
in for the procedure and then the two week wait that we talk about while we're waiting
to hear whether we get pregnant or not. So it is quite invasive to a couple's life. But I
also wanted to talk about the money and the finances. in some countries it is funded,
but in many countries the couples have to pay. So can you tell us a bit more about how
many visits would a couple need during the actual cycle to come to the clinic and how
could this impact their life?
Anis (20:41)
I I actually d during the simulation period patients they start to come at the ⁓ the when
they started the simulation they start to come at day six, day seven for the first checkup
and then every two days to the trigger. The majority of time during this period women
they came alone. Unfortunately, because ⁓ the majority of the clinics, if not all, they
started monitoring in morning and then the husband in ⁓ is in the job and then the
women or the patient ⁓ comes alone waiting for the results what the doctor will say he
will di is he will ⁓ willing in to increase the dosage or not or to cancel the cycle. It's
really and then we which means th th they will make come between the simulation and
the egg collection four or five times.
Joyce Harper (21:44)
Yeah, it's a lot of chips. Yeah.
Anis (21:44)
And yeah, it's a long trip. And occurly for the egg collection. In some clinics that I
visited, the husband may enter to the room during the egg collection. In some countries
is not is forbidden. Then the the women stays alone in any case facing the doctor. it is
challenge and is a emotional border burden.
Joyce Harper (22:13)
Yeah. And in the next podcast, I'm going to talk to Becky Kearns, who has been doing a
huge amount of work in the UK to support women as they going through this journey,
especially how they do this during their workplace, so how they juggle this with their
their job, as you said, visits every couple of days. And you obviously you're the chair at
the moment of ESHRE our biggest European, well, biggest society in the world of
fertility, but it's the European Society for Human Reproduction and Embryology. And we
have our conference in London coming up with probably about 12 or 13,000 people. It's
a fabulous conference. So you know what's happening worldwide. So how does the ⁓
cost of this treatment vary? Because where I've been sitting, it's not something that's
got cheaper. over the years. They often say that when we invent new techniques, they'll
get cheaper. But I haven't seen IPF get cheaper. In the UK, it's just got more and more
expensive and the prices have really varied. So how much might a couple pay across a
few EU countries for fertility treatment?
Anis (23:24)
Actually, the in in the website we ⁓ there is a map of Ashray, there is a big map showing
the countries where treatment is reimbursed, what kind of treatment is reimbursed,
because for instance in in Switzerland they reimbur we reimburse only three IUI cycles
and the cycle of IVF/ICSI may cost without PGTA around 10,000 Swiss francs, meaning
12,000 euros, which is a huge amount. Now we have also patients they go to Spain, but
in any case they have to pay the travel and also the whole treatment. And the treatment
in itself in Spain is 7,000 to 8,000 euros ⁓ in France they reimburse six cycles of IEF. In
Belgium, three cycles complete, treatment included. In Spain they pay medication, but
not the work up and the clinical, you know, processes. And you see Europe is big and
heterogeneous, and that's why We cannot there is no, you know, a kind of common ⁓
legis European legislation in a way to say we don't reach now in Europe population is
aging. There is no country have now the renewal rate of generation, two point two child
per woman. All European countries are under this number and they don't have a
strategy to ⁓ to help the patients. And that's why if you look for this disparity between
national strategies, reimbursement, and also the offers like foster mothers, egg
donation, is not allowed in every country. And therefore this is a kind of an engine to
promote the touristic IVF, to go to travel from one country to another. And this is
actually increases the burden of the emotional stress of couples and women
especially.
Joyce Harper (25:51)
Yeah, yeah, I'm glad you mentioned that. we are the core reproductive tourism or cross
border reproductive care where couples go to different countries, either the treatments
not allowed. Some of these treatments will get onto illegal in some countries. And as
you say, the cost, the cost varies hugely. And in the UK, it depends where you live. So
some places you'll get maybe if you're incredibly lucky, three cycles funded.
Anis (25:53)
Yeah.
Joyce Harper (26:19)
It's quite rare, but in many places where I live, for example, you don't get any. So that's a
really hard situation for couples. It's such variation, as you said, across Europe. And
what about the success rate of IVF?
Anis (26:37)
⁓ the the the ⁓ the success rate of ⁓ IVF i is really we can say is ⁓ good is very good. ⁓
the it varies between thirty-five to some ⁓ labs claiming to fifty percent, to eighty
percent, you know. There is a range we cannot really because it depends how you
calculate. But it's really a good a good number and ⁓ a good chance.
What is very difficult is when you fail ⁓ when patients don't have really
Have a good actually there is a failure for treatment. And with honesty, ⁓ the most
important factor is usually the age for the success of the eggs. Egg quality declines with
age, and this remains one of the central biological limits of fertility treatment. The other
factors matter too: the ovarian reserve, the sperm quality, the uterine health.
Endometiosis, previous pregnancy, lifestyle. I know you are fighting for lifestyle, it's very
important, of course, to improve, but is less considered unfortunately, and the quality
of the IDF lab. And ⁓ always tell patients statistics describe groups, and you are not a
group, you are two sp two specific people.
With a specific history, with a specific biology. And success rate should guide decision,
not define people. And we must be honest without being brutal and ⁓ hopeful without
being unrealistic. And that balance is really the heart of fertility medicine.
Joyce Harper (28:41)
Yeah, and you mentioned age. So the age of the woman is so important in the success
of all of these treatments. And this is the biology and this is where we are stuck at the
moment. So we just have to make sure people understand that in all the data I look in
different countries, including the UK, the data is normally grouped for women under 35.
So the success for women under 35, which is the highest.
And then it's grouped normally in two year batches. So the UK, it's every couple of
years, so 35 to 37, et cetera, et cetera. And then you can see, if you look at the data
from our Human Fertilization and Embryology Authority or the data from ESHRE, then
we can see that over age 35, the success rate goes down very rapidly with the age of the
woman. And then in the 40s, the data normally stops at age 45.
We don't we don't normally go beyond that but the data over 40 is very very low And I
was discussing with Nick that on my social media I'm seeing a lot of clinics really
Promoting that they can get women in their 40s pregnant and I find this a little bit
worrying Because I think it can give the impression to some women. Oh, I can wait there
is celebrities getting pregnant in their late 40s and that I'm seeing all these IVF clinics
promoting getting pregnant over 40. So it's okay, I can wait till I'm 42 before I start trying.
So what's your view on this, Annis? Is this a problem? Should we be encouraging people
to come in when they're younger or is it safe to wait till you're 42 to start trying to have a
child?
Anis (30:28)
⁓ y y you said all ⁓ choice. ⁓ I agree with all you said. nature is done we cannot really
compete with nature. This is a reality. Some people will offer or sell not offer sell hope
promoting add-ons. Some people actually go beyond the ethical limits. We know
clinical they will promote Egg donation in for women or embryo donation for women
aging over 50. And then I think first we have really to make aware population that the
chances are related to age. Actually, for fertility preservation, what we call it social ⁓
fertility preservation ⁓ many of the women who froze ⁓ froze their eggs actually ⁓ only
12 percent used their eggs to have pregnancy meaning the rest they don't use it
because they had the pregnancy in the time between freezing and the decision to thaw
them to fertilize them and obtain pregnancy and and that shows that the awareness is
And education is lacking. And i in Europe and in the world, that's why we have to
promote and encourage people, make them aware that of course the most important
period is till the th age of thirty-five. And then investigation is very important. The
chances are very high. And therefore the more the more we await, the more ch less
chances we will have. And by this awareness, this education probably will solve many
issues and let them know that if we have a pregnancy at the latest age, also their
pregnancy are at risk. Pre-eclampsia, intrauterine growth, retardation, many
consequences are related to age. Even autism, the spectrum of autism, trisomy and so
on and so forth. And by being really aware of all this, maybe people will change their
behavior and of course they optimize their chances too if they wish to have a child.
Joyce Harper (33:10)
Yeah, so it's obviously something I've been very passionate about for 40 years. So I will
put a link in the show notes to the resources, including information leaflets on
everything we've been talking about that we made with our International Reproductive
Health Education Collaboration, which is part of ESHRE as well. So I'll put a link to that.
So let's move on to male infertility. So if the sperm is very low or there are other
problems with ⁓ maybe as we said earlier, azo-spermia where there's no sperm in the
ejaculate. There is a procedure we can use called inter-cytoplasmic sperm injection,
which is similar to IVF, but it's not the same. So can you tell us about ICSI? And also if a
man has problems, there are ways we can get sperm from, directly from the testicles.
So we'll start with ICSI and then we'll move on to some of the procedures to try and get
the sperm if it's not in the ejaculate.
Anis (34:08)
Yeah. as you said, ICSI is the intracytoplasmic sperm injection. This is what it means. In
a conventional IVF, eggs and sperm are placed together in the laboratory and
fertilizations occur naturally in the dish. In the ICSI, ⁓ the biologist will select one
sperm and inject it directly in the egg using a micro microscopic needle. ICSI had really
transformed actually the treatment of severe male infertility. Men who a generation ago
had almost no possibility of biological fatherhood can now become fathers. But ICSI is
not automatically better than IL and this is very very important.
When sperm parameters are normal, evidence does not show that ICSI improves
outcome for everyone. It adds costs, complexity and laboratory workload. So again the
key is indication. Good medicine is not using the most sophisticated technique for
every patient. Good medicine is using the right technique for the right reason.
And here embryologist training is really crucial because you can imagine a very tiny
microesopoic sperm that you can select and then hold the ⁓ the the egg to inject
inside. The person behind the microscope is central to the outcome. And that's why
Escher's education and certification programs for embryologists and reproductive
medicine professionals are so important.
Joyce Harper (36:06)
Yeah, and as you said, it's XC is not going to make if you're a fertile cup, well, if you're
you're not for fertile, if you're a couple where the sperm is okay, they don't need to do
ICSI, but it is there for male infertility. And so there are these procedures as well. If
there's we can do ICSI quite easy if there's a few sperm, a low sperm count in the
ejaculate. But if there's nothing there,
Can you tell us about the procedures like TZ and things to get the sperm directly from
the male reproductive system?
Anis (36:41)
Yeah. Then ⁓ this actually this procedure is done under also ⁓ anesthesia, the mango
to the OR. T C meaning that we will go and puncture the ⁓ testicular cord to have
actually a a sperm that is ⁓ motile but did not really ga go through there. We have
Test first disease dies or what we call. If the result is negative, meaning after this
puncture we don't have any sperm there, then we will go to make a testicle testicular
biopsy in a way that we have to open the testis and then go have samples there, give
them to the biologist nearby, and then he has to dissect.
And try to isolate ⁓ some sperms or round spermatid, meaning not a mature sperm,
and then try to freeze them for the ICSI procedure because you can imagine that these
sperms are not really motile, then we cannot really do IVF, and this is actually a good
indication for ICSI. You see and when The biologists say well we cannot find what we
call it Sertoli cell syndrome only, in a way that there is only epithelium, no sperm, no
round spermatid, meaning there is no production and we cannot use ⁓ own ⁓ the ⁓
male ⁓ germ cells, then we in ⁓ the indication of donor sperm is ⁓ litig.
Joyce Harper (38:38)
Yeah, so for all of these, well, for ICSI and IVF, if they haven't been successful, let's
actually, let's just first talk about the success of ICSI and the cost of ICSI. So the cost of
ICSI is normally a little bit more than IVF. As you said, the embryologist has got a lot of
work to do. And the success of ICSI, is it, you mentioned that it's not higher. So is it the
same as IVF?
Anis (39:04)
⁓ is i it's actually the same as IVF but is lower if the indication for instance if because I
know many labs or many centers they use ICSI systematically and evidence based
showed that if you don't have male factor ICSI have less ⁓ lower results or success rate
than conventional IDF. That's why indication is really Very very important. And the costs
are different because since you are manipulating egg by egg, the cost of ICSI is higher.
Then the question that rises, why make the patient ⁓ pay more to have lower results?
Joyce Harper (39:57)
Yeah, and when I was going through my treatment, the lab said, do you want to use
ICSI? And I was like, no, why? Why would I do it? So I didn't use ICSI, the sperm, my
partner's sperm was fine. So we never used ICSI, but the fact that I was even asked the
question made me a little bit annoyed, but anyway, we'll park that. Yeah. No, it's not
needed. It's not needed.
Anis (40:17)
Nothing. You are right and its costs that are not need.
Joyce Harper (40:24)
Totally agree with you that we don't need it, we shouldn't do it. Now you mentioned
about freezing embryos and my twins were born from frozen embryo transfer. So if after
IVF and ICSI, have, so often we have some, as you said, we normally transfer one in
most cases so that we don't have multiple pregnancies. So those remaining embryos
are very precious. So we obviously want to keep them. So we freeze them, the
embryologist will freeze them.
Can you tell us a little bit about frozen embryo transfer and the success of this
treatment?
Anis (41:00)
Actually this is one of the really the most important advancement in in IVF. Today we
use vitrification. Vitrification is an ultra-rapid freezing technique. ⁓ In where we put the
embryos in the sugar, water will go out, sugar will enter them, and then we plunge them
in minus 196 and that makes a block.
Comparing to slow freezing, meaning that we will freeze the water within the egg and
this may crystal, and that may harm the nuclear of the embryo and the cytoplasm. This
is the main difference. And actually, with this ultra vitrification, survival rate ⁓ after
thawing are very ⁓ high ⁓ in good laboratory laboratories and this allow us to preserve
good.
Quality embryo and give patients more than one chance from a single egg retrieval. And
it is also always a safer strategy. For example, in women at risk of hyper ovarian
hyperstimulation, we can freeze all embryos and transfer them later on. In some cases,
also, ⁓ frozen embryo transfer in a more natural environment hormonal environment
may be preferable. We can in a way when we give we stimulate ⁓ the women before ⁓
egg collection, the endometrium is where the embryo will stick and grow, is exposed to
many hormones and may be improper to implantation. That's why in some situation we
prefer delaying the transfer and then freeze the embryo.
Freezing also is central to fertility preservation for cancer patients, for women who wish
or need to postpone pregnancy for a disease or social issues or family, and for some
transgender patients before treatment. It has a chance, ⁓ it has changed the way we
think about time in reproductive medicine, also. And it does not stop biology
completely, but it gives patient options that previous generation did not have. And this
why that's why I said it's a good advantage advancement and a new tool in reproductive.
Joyce Harper (43:42)
Yeah, it's worked very well for me. So I'm very happy. And you've mentioned egg
freezing. So I have done a podcast previously with Dr. Lucy Vanderbilt, all about egg
freezing. So if anyone wants to know more about that, they can listen to that podcast.
And as you mentioned, ovarian hyperstimulation syndrome. Are there other risks to the
couple or the woman of going through fertility treatment that we need to discuss?
Anis (43:55)
No
Actually the egg collection is a surgical procedure, as I said under sedation. And then
the patient has to know all the risks ⁓ related to the procedure. ⁓ first the ovarian
hyperstimulation meaning that the women will collect more than eight eggs. We have
some signs during the process of stimulation. By looking at the level of hormones,
especially the estradiol. And this is one sign in a way to delay to ask the permission and
discuss with the patient to delay the embryo transfer because otherwise, if we transfer
during ⁓ the ovarian hyperstimulation, this will impair and endanger the health of the
patient. And this that's why we have really to make it later. There is a risk also.
When we go and puncture the eggs hemorrhage. And that's why patients have to know
that risk of hemorrhage because we are going with needle to aspirate these follicles.
And sometimes bleeding start you cannot manage. You ⁓ you will ⁓ actually notice it
later on, ⁓ two, three hours post the procedure, the risk of an infection, the risk of
harming nearby organs, the rectum, the the big vessels, and then of course it it is really
rare, but then when you need to go, then you have to go in laparoscopy and of course
repair the damage. And that's why a patient before going to the egg collection they have
to know all the Swiss.
Joyce Harper (46:02)
Yeah, yeah, as we've said, it's not easy going through IVF. And I do get annoyed with the
media when they say, just go through IVF. It's a really complex procedure in so many
ways. And, Annis, you've mentioned this. So it's not always successful. So if the cycle's
not successful, obviously if it's the first cycle,
Anis (46:13)
Yeah. I
I agree with you.
Joyce Harper (46:30)
with the success rate even in the UK for under 35s, it's about 33, 34%. So that means
the majority of cycles will not be successful, but I know patients get very upset when
they don't get pregnant. So if a couple have been through a few cycles, I think they have
to think about this as a few cycles, it's going to improve their chances, but they've been
through a few cycles and they've not been successful. What would you advise them for
their next stage?
Anis (47:02)
⁓ you you see ⁓ sometimes I actually as a doctor the the patient may have this feeling
of failure. Doctor also too because he feels also and leave this failure and that that
means that first we must recognize the emotional impact because ⁓ before that both
Are really even to find words to discuss why it does not really work. It's very difficult. A
failed IVF is not just a negative test. For many patients, it feels like a loss. And that's why
I said, well, recognizing the emotional impact is really very important. And then we
analyze the cycle carefully with the patient and
How and we say how did the ovaries respond? We how many eggs are retrieved? Why
fertilization is normal? Was fertilization is normal or not? Did embryo develop well? Was
the transfer technically easy? ⁓ were there uterine or sperm factors that need
reassessment? And all this
Of course, making the patient participating and making these analysis transparently
with them, it may help them to find the way. A failed cycle is really painful, but it can
also give information. And that's why in a way you know you go step back to jump better
sometimes the right decision is to try again with small changes. Sometimes we need
surgery or genetic counseling, donor gametes, or different strategies. Sometimes we
must also have the courage to discuss the limit. Don't only offer hopes, but by
discussing the limits is really very important. This ⁓ this is where patient associations
are also very important.
Fertility Europe, as you know, and National Association provide a peer support that
medicine alone cannot offer. And Esche values this collaboration because patients'
well-being does not stop at the door of the clinic. And all this is really issues that have
to be considered when failure happens.
Joyce Harper (49:38)
And you mentioned right at the beginning about your wife's endometriosis, so how
successful and what treatment would you advise for a woman that comes in with
endometriosis?
Anis (49:51)
this is actually a good question because you know, for endometriosis ⁓ evidence is
really you know, it depends if you are a surgeon or endocrine endocrinologist, patients
don't have the same chance to pregnancy. That's why I said from the beginning that we
need this multidisciplinarity. ⁓ actually the results and the facts showing that at the
end of a procedure of IDF or treatment.
When we compare endometriosis with no endometriosis, the success rate of the
delivery life birth rate is the same. The difference is in the qua the quality between ⁓
brackets eggs, but actually they have the same life birth rate, the ovarian reserve, they
need more hormones for stimulation. This is the main difference. But
What is really confusing is that patient having endometriosis, half of them of them will
have a joint disease, endometriosis with adenomyosis, that is the endometriosis of the
uterus. And now we know more and more about this disease, and we know that is
Actually, have the bigger impact than endometriosis alone on the implantation rate and
the ⁓ you know ⁓ recurrent pregnancy failure. And that's why it's really very important
in a way this multidisciplinarity to personalize the treatment and give the patient.
A common view of these different specialists, ⁓ to and she had the right to choose
because these patients also they have pain. And it's actually a big topic in itself, and we
cannot really discuss it during this podcast. But it's really a very complicated disease
because patients have to choose between the pregnancy.
Joyce Harper (51:56)
Yeah ⁓
Anis (52:06)
or the quality of life, ⁓ social life and living with this pain and all the consequences. And
this balance has to be kept and it is not really easy.
Joyce Harper (52:21)
Yeah, and I have done a podcast with our friend, Ertan, Sarah Dogan, so about
endometriosis. So if anyone wants to listen to that, they're suffering from
endometriosis, but there is a lot we can do because I know that, I know some friends
that were told, you have endometriosis, you won't ever get pregnant. So that is not true,
is it?
Anis (52:46)
Yeah, this is not true. I agree.
Joyce Harper (52:48)
Yeah, yeah, yeah, okay, that's good, good news. And ⁓ actually, also, let's just talk
about PCOS, which we now call, as you said, PMOS. Again, I've heard people with this
disorder being told, you won't get pregnant or you won't get pregnant naturally. So
what's the outlook for women with PMOS?
Anis (53:11)
Is it is not true actually that that they don't they ⁓ because they c they may ovulate. I
have many patients, it's not rule, but many patients they don't have their menses and
they come and they are pregnant. Because they ovulate once everywhere and it
happens that they get pregnant. And actually it depends on the symptoms we have.
That's why we have really to dis dissociate two issues symptoms that the patient have
with the hair ⁓ appearing in really disgraceful places ⁓ and there are women they want
their regular menses then we have specific treatment for that for conception is different
because the likelihood sometimes there are women they don't have they don't have
actually regular cycles they may ovulate three or four times a year
And therefore they need the help in a way to stimulate the egg to obtain the pregnancy
in a way to really synchronize everything. Which means that their chances are the
same. Of course, if they would go to IDF, they have a higher risk to ovarian
hyperstimulation because they have many follicles and then the answer is an e ⁓ is in
⁓ you know you can inexpectable in a way we don't know how they react and that's why
we have to be careful when we simulate these patients.
Joyce Harper (54:47)
And let's go back to the the donor eggs and sperm. So if a couple can't get pregnant with
their own eggs, you've mentioned ⁓ donor sperm already. So donor eggs and sperm is
absolutely a possibility. Tell us a little bit about that and the success rate of using these
treatments.
Anis (55:07)
⁓ donor sperm can be used in cases of ⁓ severe male infertility. Or for ⁓ in some
countries, actually not in Switzerland, for a single woman, the law changed recently,
very recently, and for a single women or ⁓ same-sex female couples, depending on the
legal framework of each country. ⁓ donor eggs are often used when ⁓ women's own
eggs.
Cannot offer a realistic chance, for example, in premature ovarian insufficiency or after
IVA, repeated IVF failure, or at advanced reproductive age. These are some examples of
conditions where donor egg is indicated. Medically
donor egg treatment can be very effective because egg age is a major determinant of
success and normally the centers who practice this ⁓ kind of treatment or offer they
collect eggs in women they have normally proved to have live births and of course ⁓
they are tested
And they are less than 35. But this is not only a technical decision, it involves identity,
genetics, family story, laws, ethics, and psychology. And I always insist on counseling.
It's really very important. Patients need time to reflect. The future of the child also has a
story, and that story should be built with honesty and care.
And parenthood is not reduced to DNA. Pregnancy, birth, love, daycare, emotional
presence are also biology. And there are also family. And this is to be considered.
Actually, the success rate is good in these selected groups. ⁓ it ⁓ make them ⁓ reach
the normal rate of IVF and XE is around ⁓ around
Or two forty percent of success.
Joyce Harper (57:37)
Yeah, and inumentant counselling there. So most fertility clinics for all patients, they
offer counselling as we as we've said, this can be a very difficult journey. So counselling
is there in I believe all fertility clinics for any couple, obviously those going through egg
and sperm donation, but for anyone, and it should be something that's really embraced.
It's a difficult journey. So ⁓ is counselling a good thing?
Anis (57:39)
Mm-hmm. Okay.
No counselling is very important. However, for some countries when they go for egg or
IVF donation, they will do it in other countries. And I don't ⁓ I believe that this part is
really missing in a way, all this follow up ⁓ because counselling in choosing the correct
donor or and also psychological counselling is very important what to say to the child,
the born child. How to because it will not stop in the procedure. It ha and the most the
majority of these patients are lost because ⁓ they are seeking how to someone advise
them and counsel them how to say, how to grow with this child, how to exchange,
because it will not stop in the delivery. It's a long process too.
And that's why it's really very important counselling from the beginning and the follow
up of the counseling. It's very important.
Joyce Harper (59:07)
Yeah.
And also after a failed cycle, when that period comes and there's no pregnancy, this is a
really important part of time when a couple might want to seek some counseling to just
discuss their feelings and their sense, you said sense of loss ⁓ at not achieving a
pregnancy.
Anis (59:27)
Yeah.
Joyce Harper (59:29)
Annis, you have mentioned lifestyle. Let's almost at the end, let's just talk. think
lifestyle, obviously, I think that's really important. What advice do you give a couple
when they're coming to you and they're at beginning of their journey regarding their
lifestyle?
Anis (59:46)
⁓ probably I will say a joke, but do that ⁓ what I say but not do what I'm doing You
understand.
Joyce Harper (59:59)
We won't tell people what you do.
Anis (1:00:04)
I I will give really ⁓ simple ⁓ give simple evidence based advice because patient
actually, you know, we have to give them really effective advice. First, do not smoke.
Smoking clearly harms fertility and accelerate ovarian aging. ⁓ aim for a healthy weight.
⁓ Because both obesity and being underweight can affect ovulation, implantation, and
pregnancy outcome, limit alcohol, sleep well, exercise moderately, ⁓ take folic acid
when trying to conceive, and for men, lifestyle is matter too: smoking, obesity, alcohol,
anabolic steroids, heat exposure.
and some medications can affect sperm quality. But I'm careful not to really create a
guilt. And this is really very important because when you start to talk about weight,
behavior, people they may ha have a guilty they feel guilty and when there is a failure in
the treatment they it really
it impairs actually this feeling. Lifestyle can support fertility, but not all infertility is
caused by lifestyle. And this is very important. Women with severe endometriosis or low
ovarian reserve should not be told simply to relax and eat better. That is not science and
it is not kind. My message is really improve what you can but
Do not blame yourself for what you cannot control.
Joyce Harper (1:01:58)
Yeah, you mentioned weight loss. actually, let's just briefly talk about these weight loss
injections. We're seeing now a lot of women getting pregnant. What's your view about
what's happening there?
Anis (1:02:16)
Y you know, g going through kind treatment is really personal. In a way, you have to
distinguish bet we distinguish between that between people they have a disease,
obesity, disease, and then they need within their treatment these kind of injections. And
others they have ⁓ no moderate obesity
But they don't they don't feel comfortable with this and then they started in a way the
doctor they said, Well you have to decrease your weight and then try to and inject this,
you will lose weight, probably you will ovulate spontaneously and it will improve ⁓
improve. That's why it's very important that the patient don't feel guilty and the doctor is
not his work to make guilty the patient. He has to help them.
If a doctor sees the patient taking these injections, he has really to follow her to support
her ⁓ in her process, and actually, as you said, ⁓ there are results coming showing that
people with the regovir and other treatments they have ⁓ spontaneous ovulations and
⁓ good live birth rates. However, there is a lack now ⁓ of evidence in combining
Both treatment IDF or simul ovarian stimulation plus the the injections. But probably
evidence is coming.
Joyce Harper (1:03:52)
Yeah, yeah, we're working on it. we'll hopefully see some things that are here some
things that are annual conference in July. Also, I wanted to talk about social media. So I
recently did a post when I found out this terrible myth that eating McDonald's fries will
improve your chance of getting a baby if you eat them on the day of your transfer. And I
was horrified when I heard this total misconception. And I did a couple of videos on
social media and then I got bombarded by very angry couples saying, dare I tell them
not to eat McDonald's fries. So it's a crazy world out there with social media. So as far
as social media goes and fertility treatments, do you feel it's a problem or?
Are we getting the correct information from the influencers?
Anis (1:04:53)
You you mean the most ⁓ common misconceptions and the social media made it
worse. This is what ⁓ Well ⁓ the biggest misconception is that IVF always works. This is
you said it. It's not is really a light procedure. Go for it. But it does not. It is really ⁓ it is a
powerful treatment but not a magic.
Joyce Harper (1:04:57)
Yeah. Yeah.
Yeah. Yeah.
Anis (1:05:19)
Another misconception is that fertility can always be postponed. And society has
changed faster than ovarian biology. The third misconception is that every failure
means that someone missed something. Sometimes the embryo simply did not have
the capacity to continue. And social media has also, however.
Also positive aspects. It can reduce isolation, create community, but it also amplifies
the exceptional stories, miracle cures, and unrealistic expectation. That is why public
education is really ⁓ very important. Ashley supports the education of professionals
but also the information of lay people through such ⁓ IRHEC that you are the chair and
through collaboration with patient organizations at Fertility Europe and we need to
communicate evidence in a way that is clear, honest and accessible. Not to remove
hope, but to protect hope from misinformation. And you see they they have good aspect
in a way to avoid isolation. But we have also what we can say fake news.
Joyce Harper (1:06:53)
Yeah. Yeah. But for me, for me, one of the biggest misconceptions I see a lot is about
IVF add-ons. And I very briefly discussed them with Nick and we haven't discussed
them yet, but I think that's a good place to finish our conversation. So it's something I've
been very passionate about for many years. I was involved with the HFEA that govern
fertility treatment in the UK. was involved with making a traffic light system to help
patients understand this. And I was part of the ESHRE group that wrote about IVF add
ons and we wrote about 42 of these IVF add-ons. So these are treatments and tests that
are suggested that they're going to improve your chance of getting pregnant with this
fertility treatment. And there's many of them there. They can have a look at the ESHRE
document which lists these. So,
I think they're all made with good meaning. They're all made and designed to try and
improve. But in my view, the evidence, and we need to look at scientific evidence,
unfortunately, in almost every case doesn't actually show that they deliver what they
say they're going to deliver. So, Anis, what's your view about these IVF add-ons?
Anis (1:08:15)
I will be really direct. Many IVF add ons are offered to patients, like in the material
scratching, immune treatment, special tests, supplements, laboratory techniques.
Some may be useful in selected cases, but many have level limited evidence of routine
use. The problem is not really the innovation. We need innovation. I think we agree both.
The problem is selling hope with strong evidence. Before ⁓ proposing an add-on, we
should ask: is there good evidence? Is it safe? Is it useful for this particular patient? And
is the patient receiving transparent information? Actually, your work with AFEA and the
work of ESHRE is trying to Answer to this main question in way to give a
recommendation. Patient in fertility care are vulnerable because they are hoping for
something deeply important. That vulnerability must never be exploited. And such
scientific societies like Ashre have ⁓ or HFEA regulatories have a responsibility to
produce independent guidelines, evaluate evidence.
And help patients distinguish between medicine, innovation, and marketing. And hope
should be really part of care. It should not be an item ⁓ on an invoice. This is the and
what we notice is the majority are going to the last the latter one than the first part of my
study.
Joyce Harper (1:10:05)
Yeah, when I was going through IVF, I was offered add-ons. I didn't take the add-ons. I
didn't take supplements. ⁓ I've got some research coming out. We've done a few
research projects now about fertility supplements. I didn't take any of them. I don't
think anything's changed. I took folic acid, obviously, which is very important, but ⁓ I
didn't take anything else. So it's a minefield. As you said, we are vulnerable. When we
are here,
Anis (1:10:28)
Mm-hmm.
Joyce Harper (1:10:33)
If someone, even now on social media, an influencer says, this worked for me, then it
gets in people's heads and they think, okay, I must try this, I must try that, I must try
something else. And it can be overwhelming, but I think keep it very simple and be
aware that a lot of this, as you said, is absolutely marketing. Now we've recorded this
before our big annual conference, our Escher conference that's going to be in London,
very exciting. Do you think there's anything on the horizon any new technology that's
going to really change fertility treatment.
Anis (1:11:10)
⁓ I I ⁓ there there are there are several promising areas, but we must be precise and
cautious. ⁓ artificial intelligence. ⁓ I know many people are working in that and it may
help embryo assessment, improve laborative ⁓ workflow. Genetics is improving our
understanding of embryo reproductive disease, but also it helps
They have to be framed. This is your field where your expertise is, Joyce. Fertility
preservation is also advancing, especially for ovarian tissue transplantation after ⁓
cancer treatment, stencil research, and in vitro gametogenesis is fascinating. But for
human clinical use, they remain future possibility, not routine treatment today. In
endometriosis, we are learning more about inflammation, the immune environment,
the microbiome, the endometrial receptivity, and this may open new therapeutic
strategies. And I believe one biggest revolution may not be technological, it may be
organizan organizational. We need really I come to this because we are preparing a
statement for that.
Because we have if if the scientific societies really don't write this statement, it will not
really respect it and put in place. ⁓ the we need the multidisciplinary boards for
complex fertility patients. Reproductive endocrinologists, all specialists of our field
have to sit and work together. And this is especially important for really many diseases
of our specialties, endometriosis, recurrent plantation failures, C DMAL infertility.
Complex and surgical, and I would like to see a joint statement really ⁓ of all major
scientific societies saying clear, every patient deserves the same chance, regardless of
which specialist she sees first. The question should not be who owns the patient, the
question should be what is the best pathway for this patient. And these are probably the
things that are going to be discussed during the the annual meeting
Joyce Harper (1:13:40)
Yeah, I'm really going to be looking forward to that. It's going to be a really powerful
statement that that's going to be produced. And actually another burning question is if
the couple are now deciding to go through fertility treatment, they sit there and they
look at the fertility clinic website. So I know that they do this. They'll sit there and they'll
look at different clinics within their area. And I've done a lot of research looking at the
clinic websites.
And you will see clinics that have all this new technology and you'll think, that's a great
clinic. They're offering this egg imaging and AI for embryos and blah, blah, blah, blah,
blah. But in real terms, as you've said, and I've said, there's no evidence that these will
help, but they're great marketing tools. So it looks great. If you see this website that has
all this new technology, you think it must be a fabulous clinic.
But my view would be, be very cautious about that. Be very cautious about, as you said,
they can over amplify their data. In the UK, we do have a find a clinic from the HFEA and
it will on their website, I think it still does, tells you the success of the clinic from the
data that they submit to the HFEA. So any advice on how a couple should decide which
clinic to go to?
Anis (1:15:08)
actually the ⁓ I I would say that probably the ⁓ scientific societies probably all
regulatory country regulatory ⁓ institutions have really first to protect the patient in a
way to state as HFEA said ⁓ with the with the lights. We this is really very important,
and actually they have to stop also some clinics of advertising things that are really not
proved in a way to protect ⁓ the patients also from a decision. And of course if these
laboratory or clinics they don't really ⁓ answer or in a way ⁓ adhere to this regulation
then probably ⁓ stopping these clinics is But it needs courage in a way to go and stop
these clinics advertising things that are not really evidence based. And we have ⁓ and
we have to and also there is one step it's very important and actually Higher EC and
patient association have to do is awareness. I know for instance, ⁓ for some
endometriosis patient association, they are making and ranking clinics.
according to their results because they have to be certified centers, they have to
publish their results, they go to patient association and then they rank. And of course in
the IVF field this is not will be welcomed because there are
Joyce Harper (1:16:50)
Mm.
Anis (1:16:51)
Big financial issues there for endometriosis. If you are competent in surgery enough,
but then if you are not, of course, you will not go like cancer centers. You know, it is
specific center with specific competency where you have. But for IVF, since the media,
social media, society say, well, it is not really difficult, it is an easy procedure, then
People they may say, well, it's easy, let's go. But when they go to this process, they see
the complexity, which is what is evidence, what is add-ons, what is marketing. And it's
really difficult to advise patients because they are free, they go by their own, they have
easily access to information. And I think it is better that they go back and cross-check,
don't choose the first choice go and ask other clinics or other experts to see if really it is
it is the same. ⁓ they would have the same answer. If it is not then they just go for one
that is really in their country.
Joyce Harper (1:18:04)
Yeah, yeah, think that's excellent advice. So I hope anyone listening to this is trying to
conceive. I hope we've provided some really useful information and I'll put some links in
the show notes to some of the websites we've talked about, such as our International
Reproductive Health Education and also ESHRE, where there's a lot of information for
patients trying to get pregnant and fertility Europe and the HFEA. I'll put those in the
show notes.
But Anis, I finish my podcast always with brightening things up, asking some questions
totally unrelated. Now, I know that you're a very good singer because I've heard you sing
several times. You're a fabulous singer. But I wanted to ask you what makes you happy
and where is your happy place? It might be singing, but it might not be. So what makes
you happy?
Anis (1:18:54)
Singing, as you said. Dancing. You know that you like both of us dancing. ⁓ my family,
my children, my patients when they come back with the baby. Sometimes they send a
picture years later and the child is going to school. my happy place is the sea.
Joyce Harper (1:18:55)
⁓ I thought you'd say that. Yes?
Anis (1:19:22)
I like swimming, but not in cold water as yours doing. I love the moment when the sky
and the water seems to merge and become one. You no longer know where one ends
and the other begins, and it gives me perspective. Maybe it is also the physicist in me.
or maybe it's just a man who occasionally need to feel very small in front of something
very vast. And yes, after difficult weeks the sea is sometimes cheaper than therapy and
although unfortunately not reimbursed by insurances.
Joyce Harper (1:20:11)
think the C is the best therapy, definitely, whether it's warm or cold.
Anis (1:20:14)
Yeah, free.
Joyce Harper (1:20:21)
And Anis, I have one more question. So this is sometimes a tricky one for people, but
what advice would you give your younger self? It may be specifically to you or it may be
to younger people who are now coming up through life. What advice would you give to
your younger self?
Anis (1:20:40)
I would say do not be afraid to live between disciplines. You know, some people thought
when I started my career, I was too scientific to be a surgeon. Others thought that I was
too surgical to be an academic. But the most interesting work often happens at the
borders between surgery and biology, between laboratory and clinic, between evidence
and hope. And I would
Tell my younger self, take care of your tea. Embryologist who stays late, the nurse who
notices the patient is not coping, the biologist who checks one more detail, the
colleague who changes your plan, and they are all part of the outcome. And finally, I will
say stay humble. Science moves fast, but patients remember how you may.
make them feel. Clinical excellence is never a solo performance, it's always an
ensemble. And these are the really the advice I'd would give to ⁓ youngers.
Joyce Harper (1:21:58)
They are very beautiful words to finish this very informative podcast. Anis, thank you so
much. I'm looking forward to seeing you in a few weeks and thank you for being on the
podcast.
Anis (1:22:10)
Next week, huh? Next week
Joyce Harper (1:22:11)
Yes, it's coming. ⁓
I will see you then, thank you.
Anis (1:22:18)
I'm really happy to see you then and to dance together