Stuff You Should Know - How In Vitro Fertlization Works

Episode Date: July 17, 2014

In the U.S. alone, more than 6 million people are affected by infertility and science has taken up the mantle of helping them to conceive. Learn about the clever, though intuitive, methods of assisting infertile couples to have a child. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome to Stuff You Should Know, from HowStuffWorks.com. Hey, and welcome to the podcast. I'm Josh Clark with Charles W. Chuck Bryant. Howdy. Gary. Yeah.

And this is Stuff You Should Know. That sounded sardonic. Yeery. Yeery. The J.S.I. one. Like, yawking. Yawking. I'd never get sick of that movie.

No, it's a good one. I haven't seen the second one. Don't really intend to, but. I'm afraid to. Oh, yeah. Because it might tarnish my love of that character. Because I've heard it's not very funny. So just keep it with the first one.

All right. I'm totally going to watch them just waiting for cable. Oh, yeah? Yeah. Yeah, TBS knows what they're doing with movies that were for the big screen. Yeah. Sizing them down.

Best start ever. So you're doing good? I'm great. OK, good. So we're talking today. Yes. About IVF. Yes.

And in vitro fertilization. Yes. And I have to say, Chuckers, I don't really have, by the way, I don't have an intro for this one. OK. Ta-da. Although I do have a bit of one. All right.

Let's see. In 19, no, in 2013. Yes. A lady named Louise Brown celebrated her 35th birthday. And with her birthday coming and going, she announced that she was pregnant with her second child. This is like mind blowing crazy stuff all over the place. Because Louise Brown was the first human being ever

conceived using in vitro fertilization. Yes. They called them test tube babies back then. Remember that? Yeah, totally. Test tube babies, you don't call it that anymore. No, we've gotten a little more scientific as a society since the 70s.

Yeah, plus I don't think they use test tubes. Yeah, if they ever did. I think maybe petri dishes, culture dishes. Not test tubes, but you know. Culture dish babies. Right. That's weird. Test tube baby kind of rolls off the tongue.

It's got the two T sounds, which makes it a little funny-ish. And intriguing. But that's what she was. She was the first test tube baby. It was 1978 in England. And she was born July 25th, I think. Like just a few days later, I think, the second IVF baby was born in India.

Oh, yeah. Very in very short order. Yeah. Two. I'm sure that their doctors were like, come on. Well, you give birth already. I want to be the first. Nobody remembers number two.

And in the following year, in 1979, the first American IVF baby was born. And that's the history of IVF. Like it just goes back that far. Yeah. Since then, I think more than 35 million IVF babies have been born. Yeah, I think a couple 100,000 each year in the US alone now.

Yeah, it was like in the 60s, 80s. Now it's up to like 100 and something, 100 and change, I think. I got over 200,000. Do you really? Yeah. Really? I saw 61,740 in 2012.

Or maybe it's 200,000 worldwide. OK. All right. Let's just settle on that. I'll bite on that one. But yeah, that's a lot of babies that are born through IVF. And it's crazy how the thing that struck me, and finally, we're getting to the end of the intro,

is that what IVF is, it seems so like whiz bang, crazy futuristic. It's really not. No. It's figuring out, we figured out how a woman becomes pregnant and figured out the ways that we could possibly best help that process along. Yeah.

And that's what it is. Yeah. It's really, there's no crazy new technology. They don't buzz her with a prego laser. Nothing like that. It's strictly catheters and timing and hormones. It's crazy how simple it is. But it's also equally crazy that it's as successful as it is,

considering what in vitro fertilization consists of. Yes. I guess we can go ahead and talk about success rates. In the US, women under the age of 35 have a 30% to 35% chance of conceiving with IVF. It drops to 20% to 25% between 35% and 40%, 6% to 10% over 40%. And that is percentages of live birth cycle, which is. Yeah, per cycle.

So if you go through a cycle of in vitro fertilization, you have that percentage chance, typically. Which is pretty much in lockstep with natural birth rates according to age. Oh, is it? Yeah. Well, I mean, it definitely decreases with age. Oh, yeah.

But it's lower. I'm not saying it's like one for one. Yeah. Yeah, yeah, totally. But I'm saying that I think the depreciation of possibility. Yeah, yeah. It goes down with age naturally as well with IVF too. Yeah.

And live birth is the key here because many times there will be conception and there'll be a pregnancy. But any number of things can go wrong from there. Oh, yeah, sure. Chemical pregnancies. Ectopic pregnancies. Ectopic pregnancies. Apparently, some Chinese researcher

did a survey of 100,000 plus live IVF births and found that there's a correlation. You were three times likelier to have a major birth effect if you were born via in vitro fertilization than natural. Oh, really? And he just found a correlation. Not a cause, but just the numbers for some reason

spit that out. Yeah, well now one of the new things you can do is opt for, at a certain point in the process, PGD, which is pre-implantation genetic diagnosis. And this is a test that will cost you several thousand dollars and it basically allows you to root out certain monogenetic disorders. Like you can get PGD testing and find out

if the baby might have like sickle cell or Huntington's disease or cystic fibrosis or Downs. And then you can make a decision at that point, whether or not you want to continue with the process. Yeah, you know there's a real concern that there won't be, like that Down syndrome, people will be extinct eventually because the tests have gotten so accurate.

I don't think that'll happen. Well, and there's also ethical concerns with PGD about do you do selective termination if you'd find out it's a boy and you wanted a girl. Right, or oh I didn't want to get with brown eyes. Yeah. Yeah, I know there's a lot of ethical. Quadries.

Yeah, associated with it. And it's even more basic than that for a lot of people too. Like if you have a fertilized egg or even just an egg with a potential human life to some people that destroying just the egg that was never fertilized is like a moral problem. Yeah, or let's say you have a chance of multiples, twins or triplets or quads or more.

If you're a certain age that is not good and can be dangerous. For you as the mother and for the kids too. Yeah, so at that point you might have to go through what they call selective reduction, which is now choosing which ones to go with. Well there's a lot of pitfalls to this. But there's a lot of people who are helped by it as well.

And at the very least there's a lot of people who seek the help from it. I saw something like in this article which I think was written in 2006 or seven. Yeah, it's a lot dated. It's a 10. They said 6.1 million Americans are faced with infertility. Which infertility is not like bam, you're infertile.

Here's what's wrong with you. Right. Infertility. Well it can be. Yeah, it isn't always. Technically infertility, the definition of infertility is that you have gotten it on for a year unprotected and no baby's been produced.

Yeah, or six months if you're over 35. Okay. But it depends on the doctor. Like this article talked a lot about, well if you've gone this far and you've done these procedures then they'll move you to this. A lot of the places or fertility clinics or baby factories and you can go right to IVF

if you want to and if they say that they believe in it. So there's not like any hard and fast law. Right. That's the impression after doing this for, how many years have we been doing this now? 80. After 80 years of doing this, I've learned that a house stuff works article

is like it deals in ideals. Yeah. It's not necessarily like this is how it works in the real world. It's like this is how it works according to the law. That's true. Yeah. So apparently about 7.3 million people

are faced with infertility and they turn to IVF. And IVF is far and away the most popular form of what's called a sister reproductive technology. Yeah. Which as we said sounds with bang and futuristic but not necessarily. Yeah, about 50% of ART methods are what they call low tech which is maybe we'll put you on some hormones.

Antibiotics apparently are a huge one. Oh really? A huge stream of infertility. Yeah, they supposedly especially unexplained infertility which affects something between 10 to 30% of infertility cases are just unexplained. Yeah. They're like there's nothing structurally wrong with you.

Right. Your husband's sperm is fine. Yeah. Like there's, we can't figure it out. Well it made getting pregnant isn't the easiest thing in the world. It's not. It seems that way in the movies.

But there's an explanation for things even when it's unexplained. And because there's this whole unexplained thing Chuck there's like a lot of suggestions as to you know what's at play. Yeah. But you're right, it is kind of like a man, woman get together, have child, have another child.

Yeah. Maybe a third and like it's no problem. Yeah. Like you said in the movies. Well and especially when age comes in you know people are getting married later. Yeah. You see you know a 16 year old have a baby

without any problem. It's sort of weird that we haven't, things haven't changed reproductively speaking. Like people are getting married in their mid 30s but you can still get pregnant when you're 13. Right. And it's like. It hasn't shifted.

It's not gonna shift. With cultural attitudes. No. No which is why we're like okay well we need technology then. Right. But like I said about half the assisted reproductive technology methods are low tech.

Clomid is a big probably the most popular fertility drug treatment. Yeah they've been using that since like the 50s right. I don't know. Did they say 50s? Either 50 years or since the 50s. Okay. Well it's an oral medication and it is used to induce

ovulation and actually now men have seen have used it to increase testosterone. Oh yeah. Because an NFL player just got banned for using clomid for fertility. Huh. Because they said it increases testosterone so it was a performance enhancing drug.

But he was using it to try to get pregnant? I mean that's what he said. Oh that's not fair. Yeah Robert Mathis of the cult so he was suspended. But clomid with clomid alone you have an 85% chance of ovulation success and about a 43% chance of pregnancy success over three cycles. And after three cycles that number goes way down.

Oh really like it becomes less and less probable that you'll conceive after three cycles? Yeah it's the same through three and then that's just with clomid. Oh okay. And then after that like what people generally do is try a few different methods before moving on to IVF. Right.

Like just the hormones or what we'll talk about now which is artificial insemination. Right and that like assisted reproductive technology. Yeah. It's an umbrella term. Artificial insemination is an umbrella term underneath the ART umbrella. Yeah.

And it's basically anytime you try to give the sperm a leg up and it's race toward the egg. Yeah it's inseminated artificially in other words it doesn't come directly from the penis into the vagina. Right. Why does that make you laugh still? I just felt like I was in the kindergarten class. Yeah it's when the sperm is harvested

and for AI for artificial insemination it's either implanted intravaginal or intracervical. Right. So in the vagina or in the cervix. But if you're gonna put it directly into the cervix or the uterus you have to wash them. Yes. You can't put untreated sperm directly into the uterus

because you will have what's called a uteral contraction. Which apparently is extraordinarily unpleasant. The sperm have some sort of, that's called protaglandins I think. Yeah. That you have to wash off the sperm if you don't. Protaglandins will set off these contractions in the uterus.

Exactly. And I said utero I think I meant uterine contractions. They're pretty violent. Yeah. So yeah you wash the sperm and not only does it remove those protaglandins it eliminates any substance that'll get in the way and make the sperm motile and motile means they're good swimmers.

Right. That's another advantage of using artificial insemination is you can say you're cut, you're cut. You made the team. You're cut. Right. And then you put together the stream team of the best sperm and you say go get them.

That's right. Right. Yep. So you wash sperm and directly onto the uterus that's called IUI intrauterine insemination. And that's just kind of one step further than AI. Like artificial insemination you can do the turkey baster method at home.

Sure. If you want. That's a thing. Yeah. Like they have kits. That's a form of artificial insemination. That is artificial insemination. Yeah.

I mean it's an umbrella term. Well yeah if you're using the turkey baster at home you're artificially inseminating. But you're probably inserting it directly into the vagina. Maybe the cervix. You're not doing intrauterine insemination. No you can't do IUI at home. No.

Unless you have a sperm washer. Right. Which you can afford one of those these days you know. That's right. So if those fail then your next step is probably going to be IVF. But like I said depending on your age and what's going on you can skip straight to IVF if your doctor says that's okay.

Well we'll skip straight to IVF after a message break. How about that? Smooth. I'm Mangeh Shatikulur and to be honest I don't believe in astrology. But from the moment I was born it's been a part of my life. In India it's like smoking. You might not smoke but you're going to get second hand

astrology. And lately I've been wondering if the universe has been trying to tell me to stop running and pay attention. Because maybe there is magic in the stars. If you're willing to look for it. So I rounded up some friends and we dove in and let me tell you. It got weird fast.

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Stuff you shouldn't know. All right, so let's talk about the IVF process, huh? Yeah, again, pretty low tech, high tech stuff. It's neat. Yeah, it'll cost you about 12 grand. 12 to 20, I saw. Yeah, I mean, that's a, I hate the ranges for these procedures because it really,

it depends on where you are. And if you have insurance, I think 15 states require insurance to cover it. You know, let me interject here. There is an argument that the lack of standards in pricing for medical procedures is the single problem for why the healthcare system in the U.S. is broken. Yeah.

That it's not necessarily insurance, that it's not necessarily chronic disease, that it is, if you came up with standard pricing, you could solve quite a bit of the expenses. Like car mechanics. Yeah, that's supposed to be a standard. Yes. I always, I never knew that with car mechanics.

If you, when they say how much time it takes, it's really not how, they don't time how long it takes. There's a manual that says, you know, changing a carburetor is 1.5 hours. I didn't know that. Yeah. I just know that Mr. Goodbrant posts his. Does he?

On the board. Well, good for him. Like McDonald's. What? Like, oh, a menu? Yeah. Yeah. Anyway, I agree with you about the medical standards.

It makes a lot of sense. I mean, surely, yes. Chronic disease is a huge problem, especially preventable chronic disease. Oh yeah. But that's not the only issue here. It's the fact that you can be charged almost literally in arm and a leg,

depending on where you go. That's right. So IVS, it'll cost you some money, but if you have good insurance, then that'll help out. So here are, there are basically five steps. The first is ovarian stimulation. This is one that you're gonna be taking fertility drugs. It could be a couple of weeks of that.

Some are oral. Sometimes you're gonna be given shots to your wife, or if the lady's on her own, she'll be given shots to herself. Because the good thing about IVF is, you don't need a live man, necessarily. No, you just need the sperm. Yeah.

So a lot of- And it could come from anywhere. Yeah. Single ladies or- All the single ladies. Or ladies in the LGBT community. I always wanna mix up those letters. Oh, yeah.

Like there doesn't need to be a man involved. No. I mean, at some point, I guess if you could grow sperm, in a lab, from stem cells. Not directly involved. Then technically you could do that. But no, you doesn't have to be involved. You can harvest sperm from a sperm bank.

It could be, yeah, anonymous donor, friend of a friend. Yeah. Transient who's just passing through town. Sure. Whatever your standards are. You could conceivably get your hands on some sperm. And then bam, you don't need a man. I, was it from the basket?

I could get you some sperm by 3 p.m. That is a great movie, man. I saw that again for the first time in a while recently. Oh, man. I think you're talking about a big toe. I can get you a big toe by 3 p.m. But yes, you will need sperm if you're the husband and it's just your regular old husband and wife

trying to conceive or just man and woman. Then the husband will deposit that sperm in a little room designed to make that happen. And then they will take the sperm and wash it and hold it. And it's all timed out appropriately, of course. Gotcha. They can't hold on to it forever. And so that's the ovarian stimulation.

Like you're trying to get the eggs to come along and not only are you trying to get the, and eggs to come along, you're trying to get several to come along. Yeah, that's the whole point if you want multiple eggs. Right, so you know, a woman is born with all of the approximately 400,000 eggs she'll ever produce in her life.

Yeah. And that number just goes down. Right. During her menstrual cycle, one of those eggs enters a fallopian tube and it becomes mature, right? So what these hormones do is get a bunch of those eggs into their fallopian wrappers

and get them to mature over time. And the doctor, I guess, pays attention to how they're maturing. And when he decides these eggs are ready to go, that's when you hit step two, which is the egg retrieval step. That's right. And that is not super complicated either.

It's called the name sounds complicated, transvaginal ultrasound aspiration. But what it really is, is a mild sedative and a suction device that sucks out the eggs. And that's really all there is to it. Yeah. It's pretty amazing. If you cannot use the TUA method,

you will have to undergo a more involved procedure called laparoscopic surgery, which isn't super involved either. It is also a short process, but there's a small incision and the abdomen to locate your ovaries. Yeah, they put a little video camera in there. Yeah.

So I'm more involved, obviously, because it is a surgical procedure, but it's not like you're staying in the hospital for a week or anything. Right, yeah. It's just more involved because you have to use more anesthesia, too, which automatically increases the risks.

Exactly. But with the other one aspiration, I guess you just need a mild sedative, it says here. Yeah, it's like a Twilight Sleep. Gotcha. All right, so step three, you've got your eggs. You've got your multiple eggs. They're all looking good.

Then you... Yeah, because they go through when they look at them and say, this one looks good, this one looks good. Man, not this one. Yeah, and I'm not sure when PGD can take place, I think after fertilization. I would guess, sure, I would think. Yeah, yeah, I guess it would have to be.

Yeah. Okay, that makes sense. So then you've got your insemination, and like I said, you've got your sperm. However you got it, we ain't asking. Whatever. It was a transient on the street, more power to you. They examine the eggs and say, these look robust

and juicy and full, and these are the best ones, so we're gonna use these, and that's when the sperm is added, and the best sperm is picked, and then it's in a culture, and it's doing its thing. Right, and depending on the sperm, they might inject it directly into the egg, which is called ointrocytoplasmic sperm injection.

They could also just. Great banding. Right, that's like, the sperm doesn't have to go into the egg, it gets put into the egg. Right. But more traditional methods are just inserting it into the, near the egg, in the culture, right? Yeah.

And the culture can be artificial, but it's also often made of the endometrium from the woman, or in addition to possibly like her cervical fluids. Yeah. So like, it's basically mimicking what would be going on in like the fallopian tube or something like that.

That's all they're doing, is taking the process that normally happens inside the woman's body and doing it outside for a little while. I'm Mangesh Atikulur, and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking, you might not smoke, but you're gonna get second hand astrology.

And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention, because maybe there is magic in the stars if you're willing to look for it. So I rounded up some friends and we dove in and let me tell you, it got weird fast. Tantric curses, major league baseball teams, canceled marriages, K-pop, but just when I thought

I had a handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed. Whether you're a skeptic or a believer, I think your ideas are gonna change too. Listen to Skyline Drive and the iHeart Radio app,

Apple Podcast, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough, or you're at the end of the road. Ah, okay, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass

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And so you've got the egg and the sperm in the same culture and within possibly an hour. Yeah. Fertilization might have taken place. There's an open bar. Everyone's getting to know each other. Everyone's getting friendly. A little icebreaker happens.

And like you said, it can be hours when they are doing the fertilization dance. Right. And the next day, your doctor's going to confirm visually that there are two pronuclei. And that is the basis of your embryo right there. If you see that, then that means things are headed in the right direction.

Because the pronuclei from the sperm and the pronuclei from the egg are going to fuse to make a single nuclei. And that becomes the embryo, which divides into, well, that becomes a zygote, I'm sorry, which divides into two cells. And then I think by the time it's either two or four cells, it becomes an embryo.

Right. Yeah. And then. And that's a couple of days after fertilization is when you get to that stage. Yeah. Yeah, the cell division is very slow at first. But then it starts to pick up time.

By the time you reach day five or six, you've got what's called a blastocyst. And by this time, there's fetal tissues growing in embryonic fluid cavity. And this thing is. Is it placenta? Yeah, pretty much. The doctor is not normally going to see this.

They're going to observe the egg, the fertilized egg, or embryo for maybe a couple of days to make sure everything's progressing normally. And then they'll put it back into the mom. Yeah, I mean, that can be done after one day. But your doctor, they'll have a plan of when they think the best time is. And you're being monitored.

And not you, the man, but the woman is being monitored. Sure. They don't care about the man. And then depending on where they put it, that's the type of assisted reproductive technology that's being used. So if you are using IVF, the thing's been fertilized outside of the womb, outside of the body,

and then introduced into the uterus. Yeah, it's called a transfer. Yeah, and they basically just use a catheter, right? Yeah, it's suspended in fluid to, I guess, just make it easier to get in there. It's like those peanuts, the foam peanuts for shipping. It's that version. Exactly.

So it's suspended in the drop of fluid, and it is a long, thin catheter. And it's placed into the vagina, past the cervix, right there in the uterus, and squirt. There it goes. Yes. And it's really that easy. There's another process called zygote intrafelopian

transfer, where it's the same process, but instead of depositing the fertilized egg into the uterus, they put it into the fallopian tube. Right, and I think that has not as great a chance as IVF. Is that right? I think you try, ZIFT is what it's abbreviated as, before IVF. OK. But again, all those rules are subject to change,

depending on your doctor and your situation. And then your embryo, hopefully, will attach to the uterine wall. If it attaches, I think we said, eptopic pregnancy is when it does not attach to the uterine wall, but outside of the uterus, but usually the fallopian tube, I think. Right, it never descends into the uterus.

So you can't get pregnant that way, or you can't have a kid that way. No, you can't. Even if the kid starts to develop, you have to terminate the pregnancy, because it will kill you. That's right. Or you can get what's called a chemical pregnancy, which

is basically just a really early miscarriage, super early in the process. Chemical pregnancy? Yeah, OK. And those are just a couple of things that can go wrong along the way. It's a stressful time for the couples, because it's probably their last step toward having

a natural, as they call them. Sure. And then the woman is also getting injections for hormones throughout that can be rough on the lady as well. I can imagine. Yeah. So in addition to being injected with hormones, having your eggs harvested, getting laparoscopic surgery,

like your husband being in a room where he has to ejaculate into a cup, and all of this stuff, there are actual risks involved, like physical risks. So like we said, if you get the laparoscopic surgery when your eggs are harvested, you have the risk that comes from any kind of anesthesia, any kind of surgery like that. So there are things like chest pains.

What else? Well, there's one risk called OHSS, ovarian hyperstimulation syndrome. And that's when your ovaries swell up, which is super painful. And about 30% of patients experience that, but it can range from mild cases where you just take over-the-counter meds to more severe cases, moderate

to severe, where gas, nausea, and vomiting, and no appetite. And I think only 1% to 2% of women experience severe OHSS. Yeah. And that means you're probably going to go to the hospital and gain a lot of weight, like things that women don't like. And that's the result of those fertility drugs, like the ovaries is like, whoa, whoa. I did not sign up for this.

You're overstimulating me, and I'm fighting back. Pretty much. But yeah, it does sound like it's fairly common, at least in a mild form. And in the mildest form, apparently, it clears up on its own. So then, like I said with egg retrieval, you have the general anesthetic issue.

And then even with the lighter aspiration procedure, there's still problems like you can get an infection. You can have structural damage. But speaking of structural damage, in addition to in-vitro fertilization, you could also try surgery. That's another avenue that some people tried to solve their infertility.

Like if your fallopian tube is blocked or whatever, they can go in and get rid of that. Yeah, like if you have a physical problem. Yeah. So, Chuckers, we already mentioned ZIFT. Have you heard of GIFT? I have. Gamete intrafallopian transfer is similar to IVF,

but it's in the fallopian tubes. Now, what's the difference between ZIFT and GIFT then? OK, I'll explain. Oh, wait, wait. ZIFT is in a lab. Yes. GIFT is in the fallopian tubes. Yeah, like you go in and artificially

inseminate the egg in the fallopian tube. OK, that makes sense. Yeah. But if you have damaged fallopian tubes, you can't use the GIFT method. No. But the GIFT method, the advantage of it is it much more closely mimics natural birth

or natural pregnancy. Yeah. Because the egg is inseminated in the fallopian tube, and then it just goes about its normal process from there. Yes. So aside from having sperm introduced through a needle, it's totally natural. Yeah.

But it's not used. It's only like 2% of cases. And I think ZIFT is only 1%. Yeah, I saw even less than that. I saw that both of them are less than 1%. Yeah. The big blockbusters in vitro fertilization. And then there's something called ICSI,

intracellular plasma sperm injection. And that's a treatment you'll do alongside IVF. Yeah, remember I was saying, depending on how the sperm is introduced, that's one way that it might work. Yeah, and about 40% of cases, I think, they use the ICSI method. And that's just injecting the sperm basically into the egg

itself. Well, a single sperm. That's like, your sperm has problems. And so we're going to pick out one dude. Hercules. Hercules. Hercules. And the cool thing about IVF is, literally, yeah,

if you have multiple eggs that are really great, you can freeze the ones you don't use. And if you want to go back for round two, you can skip the first part of the harvesting and go directly to the next steps. Yeah, I guess you could skip all the hormones and all of the possible overstimulation of ovaries. Yeah, the initial hormones.

But you still have the ones on the backside. It's being able to skip that first bit is a big relief to a lot of women. I can imagine. Yeah. Yeah, I'm sure it's worth the expense, too. Auto-freeze them. Yeah.

Oh, yeah. So what's crazy about all this, Chuck, is that not all insurance covers this. A lot of insurance treats IVF procedures as an elective procedure. As a result, some states, I think 15 states, have laws on the book saying, if you're an insurance company operating in our state, you have to, at the very least,

cover infertility treatments. Yeah, and I mean, just check with your insurance if you're interested. They may cover some, but not all. But you'll probably get some assistance. You hope. Yeah. Or you can just move to a state like Massachusetts that

has the law. Yeah, basically, the law is like you cover IVF. And apparently, they have some of the best IVF doctors up there. Oh, really? Yeah, I read an article that interviewed this one couple. And they were some state that didn't have any insurance laws about IVF. Yeah.

And they moved to Massachusetts. And they said it was like going from a hospital that didn't even have X-ray technology to going into the most cutting edge type of hospital you could possibly imagine. Just because it's required there, the doctors, by nature, are all just experts at it, because they've done so much work on it. They're trying to make little baby liberals.

Right. Little Ted Kennedy's running around. Exactly. You got anything else? I got nothing else. Got speed couples out there going through this stuff. Yeah, God's being good luck. Yeah.

We wish you well. And if you want to learn even more about this, you can type in vitro fertilization in the search bar at howstoveworks.com. And that brings up listener mail. I'm going to call this work surveillance. Remember we did that one? Yeah.

Thought people, employees spying on you? Yeah. Employers spying? Which is true. Hey, guys. I work for Blank Company, a large shipping corporation. Let's call. Shipco.

Yeah, Shipco, for seven years. When I started, I loved the company and the job. As things shifted more towards a bottom line oriented attitude with the company, I started to get pretty burnt out, began looking for something else to do with my life. I'd always had an intense, I'm sorry, an interest. We'll say an intense interest. In electric guitars, not just as a player,

but as something I studied from a historical standpoint, I would always enjoy taking apart and messing with my guitars. At some point, I became interested in luthiery and decided to become a guitar maker. So what I ended up doing. Wait, luthiery? Yeah, like a luthier is a guitar maker. Like Cooper makes the barrels?

Yeah, wine barrels, I think. Yeah, a luthier makes a guitar. I did not know that. L-U-T-H-I-E-R. What ended up happening, I would finish up my workload for the day and tidy up the store. If there were no customers, I would work on my guitar designs at work. For a while, the management didn't care,

but as the pressure started being put on them, they had to tell me to stop. But I didn't, because I'd found my passion. Finally, one day, I was pulled into the office and handed screenshots that I hadn't taken of my guitar design work that I was doing on the clock. So they had a program that wasn't just sending keystroke information to their security team,

sending actual screens of everything going on on it. Yeah, we talked about that one. Yeah. I don't remember what it was called. I would freak out if someone handed me screenshots. Needless to say, I was put on disciplinary probation, didn't make it to the end of that, because I quit to pursue my dream.

And I'm happy to say that I've been a full-time professional luthier ever since. That's awesome. One of my guitars is even on the cover of a recent issue of Premier Guitar Magazine. Wow, that's like the Premier Guitar Magazine. There's a second story about a robbery that happened while I was on that probation period.

But I'll leave that for anyone curious enough to Google my name. Tandalizing. All right, that is from Paul Roney, R-H-O-N-E-Y. And he says, if either one of you guys wants a handmade USA electric guitar by a company that doesn't spy on its employees and hit me up, I will hook you up.

Wow. And I checked them out and they're sweet. Yeah? Yeah, I'm gonna see what hook you up means. And then talk to them. 10% off when you use coupon code stuff. Yeah, we'll see. But yeah, that is from Paul Roney.

And good for you for fighting shipco. Yeah, and pursuing your dreams, Mr. Roney. Yeah. Congratulations. And you're doing a good job. This thing's beautiful. Yeah. So if you wanna let us know about how you stuck it

to the man, you can tell us via Twitter at S-Y-S-K podcast on facebook.com slash stuff you should know through email at stuffpodcast at howstuffworks.com and check out our website while you're at it, stuffyoushouldknow.com. Yeah. For more on this and thousands of other topics, visit howstuffworks.com.

Attention, Bachelor Nation. He's back. The host of some of America's most dramatic TV moments returns with the most dramatic podcast ever with Chris Harrison. During two decades in reality TV, Chris saw it all and now he's telling all. It's gonna be difficult at times.

It'll be funny. We'll push the envelope. We have a lot to talk about. Listen to the most dramatic podcast ever with Chris Harrison on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor,

stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it.

Listen to Hey Dude, the 90s called on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts.