Ep 23: Embryology with Donna Dowling
Fertility Forward Episode 23:
The handling of eggs and sperm in the culturing of embryos is delicate and complex and is performed by highly-trained embryology and andrology specialists. RMA of New York has a large and experienced lab team that is committed to upholding the highest standards of safety and precision to achieve superior success rates and healthy pregnancy outcomes for our patients. In this episode we talk to Senior Embryologist at RMA of New York, Donna Dowling, about what exactly an embryologist does, the process of making an embryo, ICSI explained, and what happens to your eggs post-retrieval.
Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena:RMA of New York state of the art laboratory is one of the crucial components in our ability to achieve high success rates for our patients. Over the past decade, the majority of advances in assisted reproductive medicine have occurred at the laboratory and at the genomic level RMA New York has been at the forefront of these innovations and is a recognized leader in the scientific and technological advancements in the field. The handling of eggs and sperm and the culturing of embryos is delicate and complex and is performed by highly trained embryology and andrology specialists. RMA of New York has a large and experienced laboratory team that is committed to upholding the highest standards of safety and precision to achieve superior success rates and healthy pregnancy outcomes for our patients. In this episode, we talk with RMA embryologist, Donna Dowling-Lacey, about what exactly an embryologist does, the process of making an embryo, ICSI explained and what happens to your eggs post retrieval.
Rena: We are so excited to welcome to fertility forward today Donna Dowling from RMAs embryology lab. Thank you so much for coming on, Donna.
Donna: Oh, great. No problem.
Dara: Thanks for walking up two flights of stairs to see us.
Rena: And coming out of the lab.
Donna: It's always great to come out to the lab.
Dara: We were just saying that, um, you know, there's a bunch of levels at work at RMA and how we don't always cross paths so it's so nice that we finally get to see you.
Donna: It’s nice to be in the office area every so often. I sneak away.
Rena: Well, so tell us, where are you usually in a lab all day?
Donna: It depends on what I'm doing sometimes because the lab is like a long alley so sometimes I’m in front, in the middle, in the back. In the afternoons I'm usually all the way in the back.
Donna: Because in my mind, the embryologists are kind of standing in a line, looking at a microscope all day at things on a little slide. Is that the reality or that's just my picture?
Donna: It’s part of the time where we're staring at things, but it's a lot of moving around, like back and forth.
Rena: So I guess, so tell us really, what do you do all day?
Dara: What is an embryologist?
Donna: Well in the morning we focus more on doing thawing and checking the eggs that have been fertilized and retrievals and checking embryos for biopsies. So there's a lot of movement back and forth going from the incubator to a working station in the morning. It's very busy. And then in the afternoon, it's a little bit quieter. It's more freezing where you're in one place for a little bit more of a longer time. So it's not as much hustle and bustle and there's a lot of transfers. So usually that one person is doing transfers is doing a lot of back and forth because the transfers it's a very quick…
Dara: Time sensitive?
Donna: Very quick. So it’s that person that's usually the one that's going back and forth a lot, but usually in the afternoon I’m sitting in a corner and someone just feeds me dishes, sitting there.
Dara: So I’m so curious, my presumption is that a lot of the retrievals are done in the morning and is that why it's extra busy?
Dara: OK. Those are quick too.
Rena: So what happens to that? So they go in, they retrieve the eggs and then they come to you?
Donna: The OR staff brings us tubes with the fluid and the fluid has the eggs in them. And then they pour it out in a dish, the embryologist, and does the search for the eggs and puts it in another holding dish. And then at the end of that, you just kind of rinse them off and you put them in the a dish that goes in the incubator. So it's just takes about maybe 12 or 15 minutes per retrieval.
Rena: Wow. And then what happens in the incubator?
Donna: It just sits and it kind of gets happy. Like a little happy place just kind of gets used to its new environment because, you know, you just took it out of the human body.
Rena: And well are they separate or is it individual eggs on a dish or they're still together in a group at this point?
Donna: They're grouped at that time, they’re grouped. So there's like maybe three or four in a drop. We have like little drops along the edge of the dish. And so they could put in those and then they go into.
Rena: Ok and then what happens?
Donna: And then they sit for maybe about three, four hours and then they get two and a half or so. And then depending on what the procedure is, if it’s an ICSI then we take the eggs cause they're at the time of retrieval they’re trimmed of all the excess Cumulus cells around them. So they're like a little package, so they're easier to work with. And so we take that and then we do a hyaluronidase procedure where we strip the eggs of the Cumulus cells. But you want to keep the cells around the eggs during that little incubation time, just to kind of help the eggs if they're not mature at the time of retrieval, it kinda like talk to the eggs. It's like a little communication thing, kinda helps them get mature. So at the time of the hyaluronidase…
Rena: Wait I want to say, hyaluronidase?
Dara: I will not try and spell that.
Donna: It’s an enzyme and so the enzyme breaks down the cells around the eggs. So you can clearly see the polar body, which is the sign of maturity for the egg.
Dara: So basically in two and a half to three hours is the time that really helps those enzymes work on the eggs but after the two and a half, three hours, does that means there's not as much...
Donna: There's still potential that if they're immature at the time of cryo, that they will mature, but the Cumulus cells like really like with there's still like residual hormones and stuff like that.
Dara: So think of them as the helper cells.
Donna: Yeah they’re helper cells.
Rena: Okay. So then after two and a half three hours you do the hyaluronidase and then if you’re doing ICSI that’s when you would then inject the sperm in?
Donna: There's another incubation period after that, because…
Dara: It's complicated.
Donna: Yeah it’s, you want to keep the eggs happy so,
Rena: So you’re doing like a song and dance for them? Playing them some music?
Donna: Put them back in the incubator, you let them rest for a little bit. And then you do the injections.
Rena: Sounds like a nice life. Relax.
Dara: Have their buddies, the enzyme come in and help them.
Donna: There’s music playing in the lab. There's this everything's happy.
Dara: What, what type of music is it? Is it like the Beatles? Like is there,
Donna: Sometimes the Beatles. Sometimes some eighties, sometimes some eighties music. Sometimes it’s Lizzo.
Dara: It’d be so fun if you did research on the music at the time of the you know.
Rena: If it helps the eggs really?
Donna: Yeah. It just depends on who's in charge of the music.
Rena: Okay. Okay. So then, okay. So then after that, if they're doing ICSI, then can you explain what that is?
Donna: Well, there's a person, there’s an injection person and then there's an assistant and the assistant gets the dishes and puts, we have little dishes and
Dara: Like a Petri dish?
Donna: Yeah a little Petri dish. A little flat dish. And they have, there's a PVP dish in the middle. This is another big word. If I can remember it, PVP is perivillian pyruvate, or something like that.
Donna: PVP yeah let’s just call it that.
Donna: It slows the sperm down so we can catch it. So you kind of take the needles, there's needles on this inverted microscope. And you just kind of wack them and pick the sperm.
Rena: Like whack-a-mole?
Donna: It’s like whack-a-mole, yeah.
Dara: Wait you want to slow them down? Wouldn’t you, like, this is I guess my ignorance. You would want you would think that the ones that are fast would be the ones that you would want, because those would be the survival ones.
Dara: And why do we slow them down? Is it to make sure that they go nicely?
Donna: Well they move so fast that you can't catch them?
Rena: And for ICSI though, you're then injecting them into the egg, correct?
Donna: Individually, yeah. So that's what the assistant's job is to put the sperm into the drop. And then the eggs go into separate drops, like kind of like a little mini triangle like that. It’s like PVP and then the two micro manipulation drops, the eggs go in there and then hands the dish to me, or to whoever is doing the procedure and then the needles are used to hold the egg and inject the sperm.
Dara: And how long does that take? Where like, from the beginning from once the eggs are removed, it's about two and a half hours. And then from that time until the injection?
Donna: That's another, maybe hour, hour and a half after cryo?
Donna: And then the procedure takes I think about five minutes per dish?
Donna: So it’s like maybe 12 eggs per patient around about so it takes like maybe 15, 20 minutes per patient to do a full procedure.
Rena: OK so if you are going the route of making embryos, once you have embryos, then what happens?
Donna: The embryos fertilize overnight. And so we check those in the morning and then they get separated again into individual drops and they're numbered individually. And then on day three, they're checked to see their, I guess, cleavage stage. So they have to at least be a four cell to proceed to day 5 so it’s and either they're hatched or usually they're hatched because most of our patients are going to have biopsies done.
Dara: What’s hatched?
Donna: Hatched. We take the divided embryo like little cells and they have like little they're like little cells. They're like, look like a little cluster of grapes. And so there's little spaces in between the cells and you take a laser and you just put a little hole in that little space. And so when the embryo grows to the blastocyst stage, they kind of escape. Some of the trophectoderm cells will escape from that hole. And on the day of biopsy, just take the laser and you just cut off some of those cells and put them in a PCR tube who send it for testing.
Rena: So Is that, so you're doing that process so you can then send that for testing?
Dara: Is this done for all embryos?
Donna: Just for the ones that are requesting a biopsy,a PGD testing.
Rena: Ok so that's how you prep them?
Dara: For the genetic testing?
Rena: So then I guess a lot of people also, you know, often have questions about what’s a day three versus day five, day six, day seven and the grading system. Can you, can you tell us about that?
Dara: And what's preferred and what we typically do here?
Donna: Right. The best embryo on day three, would be a six to an eight cell. And then on day five, you want it to at least be a blast three.
Rena: What does that mean?
Donna: It is the expansion of the embryo. So as it grows, the inner cell mass starts to grow and then trophectoderm cells on the outside part of the blastocyst, excuse me, they start to expand. So the blastoseal grows, it becomes filled with fluid. And so you have the inner cell mass, you have the dome. And so as it grows, it starts to expand. It gets bigger and bigger and bigger. And so eventually it will escape from the zonal pellucida, which is the protective, like an eggshell. And so it will break that open and it will escape. That's what it does normally. And that's the normal process, but because we put the hole in, it will escape through that little hole and then we just kind of cut.
Dara: So, Donna, for the lay person, um, I believe does that mean that you not only want the cells to divide? You also want each cell to have more mass as time goes on.
Dara: So those two components are critical for good quality embryos?
Donna: Right, yes.
Rena: And then if someone comes because you know, a lot of times people get a picture of their blastocyst and they say, okay, you know, mine was, it was all kind of compact in the zone pellucida, right, the circle? Or the picture could show a lot of cells escaping now is one better or worse in that scenario?
Donna: The more compaction the early the stage of the embryo is doesn't mean it's bad. It just means it's early. And sometimes they take a little bit longer to get to that fully expanded blastocyst stage. But it doesn't mean that it's poor cause we wouldn't transfer it if it was poor.
Dara: So, in terms of, so there's day three day five, do we hold off further than that now? Or is it usually a day five transfer? What's the typical or is there a typical I know back way back in 2009 time whenI was a patient here day threes were somewhat more typical, but I thought, and I could be wrong that day five is something that we want to strive towards?
Donna: Day five day six
Dara: Day six now.
Donna: It’s more optimal days for transfer and freezing.
Dara: And is there a reason not waiting any longer is because longer just because it's divided doesn't necessarily mean the quality will stay intact?
Donna: No, it's just the longer that it stays in culture, the longer it needs to be in the human body because that's what it's supposed to be. That's because it's human cells. But the longer it stays in culture, the longer it's the more likely it's going to lose its I guess integrity.
Dara: Okay, grade a little bit.
Donna: Yeah. So day seven is like the maximum time that we keep the embryos in culture and it's not necessarily day seven is not an ideal day, but it's, that's our cut off time.
Dara: That’s the max.
Rena: And then also, I guess, can you explain so say someone goes through a transfer of an embryo and then, you know, they walk out and your pregnancy test is approximately nine, 10 days after that, but then you think, okay, well I was only pregnant since my transfer, but really your timeline is actually longer. Is that because the embryo was in the dish for a certain amount of time before growing?
Dara: That’s a good question.
Donna: I think with the transfers, because they don't have the transfers right after their retrieval. It's more like if they have them frozen and then they come back. So everything is kind of timed so according to the day of the embryo, the uterus is prepped for the embryo so it’s in the ideal environment for the embryo.
Dara: And do we freeze most of them nowadays because I don't, again, back in 2009, none of them, like mine were not frozen. Both of my cycles, 2009, 2011. And I believe now they all are frozen prior to the transfer?
Donna: Majority of our embryos are frozen.
Dara: Is that to help a woman's body kind of normalize post transfer?
Donna: Yes exactly.
Dara: Post-retrieval I mean?
Donna: And also we're waiting for the test results from the biopsy. So everything that's biopsied gets frozen.
Dara: No matter what? So if you do choose to have a biopsy, it's frozen. OK.
Rena: So what are the school of thought now in a fresh versus frozen transfer, a different than an embryo with either?
Donna: Fresh it just depends on the patient's genetic history, how young they are. And also if the patient wants to have the genetic testing, if they don't want it, they prefer to have a fresh transfer, that's their prerogative.
Dara: But you don't see that too often anymore?
Donna: No, not really.
Rena: Cause most people are doing genetic testing?
Donna: Maybe 10%, 10, 15%.
Dara: It's just great that there's that option now. And then for me, this is the other component, which I wasn't so familiar with. I didn't know. I know a little bit more but, can we talk a little bit about grading and I believe there's different types of grading depending on what place you go to. And everyone does it a little bit differently, but we do here at RMA?
Donna: We use the gardener system where each stage of the embryo, the expansion that determines whether it's a one, two, three, four, five, or six. So one is when it's just starting to form like a little cavity, and then two is a little bit more expansion, but you can't really tell the differentiation between the blastocyst, the trophectoderm and the inner cell mass. And then three is when you have a full, like, almost more of an expansion of the blastocyst and you can see the inner cell mass and trophectoderm cells.
Dara: Which you don't want to see?
Donna: You do want to see it.
Dara: So the higher the number, the better. So you want to see a higher number?
Donna: Right. The higher the number, the more the state of the inner cell mass and the trophectoderm are in.
Dara: Cause I always thought…
Donna: And the more expanded it is.
Dara: I wonder if they changed it. It used to be graded again when I was a patient it was like a AA, AB, BA - is that still used? But that's different. That's a different type of grading?
Donna: No. The first A is the grade for the inner cell mass. And the second letter, the ABCD is for the trophectoderm.
Dara: So you want them ideally both to be AA, but in a higher number?
Donna: Right. Like a four AA.
Dara: Oh ok. I never paid attention to the number, but I was like, who doesn't want an A+ or an AA a double A? But it's more complex than that. It's the grade and the number are two important factors. So it could be a 4A, but a
Rena: It could be a four AC.
Dara: Wow. Super complicated.
Dara: But interesting.
Rena: So what would you say if you're a patient kind of the ideal embryo grading is?
Donna: We love 4AAs.
Donna: Yeah. I like the 4 AAs because they have that the best potential as far as implantation. And even though it appears that a 5AB or a 6AB, 6AA would be better because it's more expanded and that the 4AAs are have more potential, they have more better implantation and pregnancy rates because I guess maybe the zona protects it during the freezing process. So and it's more, more of the cells are inside of the zona when it's frozen.
Rena: Okay. So then, so you have the grading system, which I find a lot of patients put so much stock into that, you know, so, you know, say a patient comes back and they don't get a positive pregnancy result. And they say, well, I don't understand, you know, I had a 4AA, you know, embryo, this should have worked. And I always say, well, you know, there are other factors besides that, you know, the embryo is just one part of getting pregnant, you know? So what could be other reasons? If you have a 4AA embryo or whatever great graded embryo that it doesn't take?
Donna: It could depend on what day it’s a 4AA. It could be 4AA on day seven, day 5, day 6, day 7, depending on what day it is. It could also depend on the patient's lining if it's not properly prepared or if it's not an ideal place for implantation then it might not happen.
Rena: Well, so once you implant the embryo, what has to happen for a pregnancy to occur?
Donna: The embryo has to find that ideal spot so it can implant, but there also could be an abnormality in the embryo that it grows to a certain point and then it will just kinda…
Dara: Not grow anymore.
Donna: Not grow anymore. Yeah.
Dara: So, and also I'm assuming also the a woman's environment probably plays a role. The hormones perhaps at that time. So it's much more complex and I think it’s great that Rena mentioned that that we, we shouldn't necessarily focus just on that number. There could be so much more to it.
Rena: I think it's confusing for people they think you know I have this perfect on paper embryo. And I say, well, that's only one part of this. You know, there's so many other things that have to happen in your body.
Donna: Right and even though you do everything absolutely perfect and you follow all instructions. It's all about how your body accepts everything. So
Rena: Right it's very complicated.
Donna: All these different factors.
Dara: And you have, you wear a lot of hats. You do a lot of different things during the day. I didn't realize that it's, there's so many different stages. You have to work with the team, which is probably nice that you get to probably do different things on different days so it doesn't become as routine and boring?
Donna: I do a lot of different things every day. It's just, I have like a little schedule. I look at the different colors each, it's like a little hourly block. And I look for the colors to see exactly what I'm supposed to be doing. So everybody has their tasks for the day. So depending on the caseload, I could be doing one thing all morning and one thing all afternoon, or I could be doing like five different things in the morning and six different things in the afternoon. It just depends on what's going on.
Rena: And do you ever see your patients or you really only know them through their embryos?
Donna: Only transfers and retrievals, that's usually the only time I see them.
Dara: If the door’s wide open, that's the only time I saw any embryologist is when I was…
Donna: I feel that the embryologists don't see anybody if they’re not….
Rena: Yeah I wish I could know my embryologist who made, you know, my daughter and say thanks, thanks.
Donna: Every so often we see pictures and sometimes we'll see a baby in the elevator.
Rena: I remember that one in the dish. You look exactly like that. Zona pellucida.
Dara: So of all the things that you do, which seems like a lot, do you have a favorite part of your job?
Donna: I like doing thaws because it's just so really quick. And I get that, that little instant kind of satisfaction seeing an embryo like the life that's going to go into the patient. It's like, Oh, I did that. I thawed that, Oh, it's great. So it’s very exciting.
Dara: I think a thaw, I think if I could put it in, you know, I watch a lot of baking shows and you know, you're cooking you’re short for time. Okay. I want to put it in the freezer for a couple of minutes just to like harden and set. I mean, that's what I picture. And then it comes out, it thaws a little bit and you…
Rena: Well, yeah, a thaw, what do you do? Put on the microwave on the defrost setting? How do you thaw an embryo?
Donna: It’s a little small little dish and we have it at 37 degrees Celsius, which is body temperature. And then we just kind of take the little device that the embryo’s on and just kind of skydive right into it.
Dara: I love that you use celsius. I'm Canadian. So I appreciate….I wonder why? Are all the…
Donna: I think it's just the international scientific.
Dara: Ok because I think your thermometer just happens to be Canadian or British. And then anything in terms of work wise that you find the most challenging? You don't have to dislike it, but challenging.
Donna: Challenging usually are the sperm samples, the difficult ones, the TESEs, the segmentations, and that can take sometimes hours to do searches. It’s very tedious work. So that's, that’s not the worst thing, but it's not my favorite thing. It’s like you sit there and you have to be very dedicated to find that sperm.
Dara: You have to be in the right mental place.
Donna: You have to be in a mental place.
Dara: Maybe meditate beforehand.
Donna: Yeah, prayer.
Dara: Get in the zone.
Donna: You just go in and just get it done.
Rena: And how do you become an embryologist? How did you get into the field?
Donna: This was really random. I applied for a research assistant position. I didn't get it and they put my resume on file and then something popped up, another research position in a gamete/embryo research lab with Dr. Susan Lanzendorf at Eastern Virginia Medical School. She gave me my first job.
Rena: Thanks, Dr. Susan.
Donna: Thanks, Dr. Susan. And I worked there for maybe about three years and a position opened in the Jones Institute, which was basically like downstairs and across the quad in the hospital. And they offered me a position. And then I just jumped at the chance. I didn’t know what I was doing. The research lab prepped me because I was doing the research end of the clinical and I learned a lot working with like basic media and hatching and how to make my own pipettes, dissecting and it just was very cool. I could just do whatever I wanted. And then I went to the lab and it was just so structured. And this is like, what?
Dara: This is totally different!
Donna: But it was fun. Then I, you know, I got to meet all the people in the lab because she was their advisor. They were all getting a PhD or masters. So I got kind of wandered in like, Oh, Hey, Donna, why don't you come over here and work? It's like, Oh, okay, cool. I'll come over. I loved it. Been doing it for 12 years...what year is this? 19 years.
Rena: I ask that every day because I have to put a date on something.18, 19, 20. It’s all the same.
Dara: So do you do any research now cause I know that sounds like that was kind of your heart in the beginning.
Donna: I took a break because it was a lot. Because it was part of my job was doing research. So I was writing grants and papers and I was collecting data, not just for myself, but for the research fellows. And it became like almost consumed my life. So I just needed to just breathe and then when I took the position here, they told me I didn't have to do that unless I wanted to and I said oh.
Dara: It’s nice to have flexibility.
Donna: It’s like, I could do it if I want to so eventually I'll get back to it. I’m trying to like wiggle my way back into research, but it was a lot. That whole twelve years doing research.
Dara: And this way you're dealing with more people and…
Donna: Yeah but I don't have a lot of time to do research because there's so many other things that I have to do because I also not just the lab, but I deal with the discard for the embryos, where I help patients clear their accounts. So I have a lot of emails
Dara: What does that mean?
Donna: If they don't want their embryos anymore they have to sign a consent.
Dara: OK so there’s paperwork.
Donna: I have to create the consent and send it to them. And then I have to keep that paperwork organized. And we also have to keep track of our inventory of our embryos. So it's like when the test results come in, some of them are abnormal and because they signed the consent that says that we can automatically discard those have to keep track of all those embryos. And it's a lot of paperwork.
Rena: Well that’s actually a question my patients ask a lot. Okay. Because they get, they want to know the nuances. Okay. So say you elect to discard your embryos. What does that mean? Where do they go? How is it done?
Donna: Well, it depends on what they want us to do with them. We can just...
Rena: But where do they go? I’ve had patients ask me, but where?
Donna: The biohazard.
Dara: Biohazard like the red box.
Rena: Well, no, my patients want to know. They say, well, is it, where is it going? They really, they would like to know. So it goes into the red biohazard?
Donna: Goes into embryo heaven. That's where they go. They can donate them to research.
Rena: It's definitely difficult to figure out, right?
Donna: Most of them go into the biohazard
Dara: And I'm assuming that the, um, you know, when you freeze embryos, longterm, is it a different freezing area? Is it in our office? Is it somewhere else?
Donna: All of our embryos are stored in one place. They just, we have these huge tanks and we put them at the bottom of the tanks because we're not really going down in there.
Dara: So those are for the longterm storage?
Donna: Longer term.
Dara: Longer term yeah.
Donna: Or they can opt to have them sent to another longterm facility.
Dara: Ok so there's many options.
Donna: Yeah they have options.
Rena: That’s a lot.
Donna: And that’s what we're here. And then there’s a whole nother team that takes care of transferring stuff out. They're busy too.
Dara: It’s a well-oiled machine here and it's a lot more complex than even the people that have been working here at Rena, myself than we even realize.
Rena: Oh sure.
Dara: Anything else that you want to add in terms of what you do or comments?
Donna: I just love to make people happy. And I like making people happy their joy is just to have children. So this is just a pleasure to help so many families and, you know, I’ve helped make a lot of babies for almost 20 years. A lot of babies. You know I’ve helped friends, relatives, neighbors so it's just a pleasure to be able to do that. You know, they see them and I don't, you know, I don’t want them. I’m not a babysitter. I’m just trying to slip into the darkness and enjoy your children.
Dara: It's so interesting to hear that. Cause I bet, Oh, my OB GYN loved, you know, working with me when I was pregnant. But as soon as I had my baby and I brought my daughter to see him, he was kind of awkward. Didn't really know what to do. It's like, it's so funny with, depending on each stage, that's what you're the expert in. It doesn't necessarily mean that you’re looking after them.
Donna: Show me your baby. I love to see the joy, the happiness of these. When I do the transfers, I get the tears, I get the smiles. And it's just great.
Rena: That is so nice.
Donna: A little reward.
Rena: Well you have such an important job. I mean, you're doing such important work. I mean, you're changing people's lives.
Donna: It’s very rewarding. It’s a gift and sometimes you have the heartbreak but we try to give the gift.
Dara: You do.
Donna: That's the most important thing.
Rena: Well, thank you so much for taking the time out of the lab to come here.
Donna: No problem. THank you for giving me a little escape.
Dara: We finally meet you. You’re not just a name. We need to come down to your floor now and say hi.
Donna: I know I’m like a little unicorn running around. No one really sees me.
Rena: I know. Well, we like to end our sessions by talking about one thing we're grateful for. So gratitude. So what is your gratitude for today?
Donna: My gratitude? It’s hust being helpful, trying my best, being helpful, being patient, looking forward to the final result. Babies. Lots and lots of babies.
Dara: You're in the right field.
Donna: I know. It's like, where else am I going to go to make people happy like this? It’s just very rewarding.
Rena: I love that. Dara? What’s your gratitude?
Dara: Lots to be grateful for, but I'm actually grateful for you, Donna, and for the embryology team, really, I feel like you guys are, you help so much and we don't really get to see you. I feel like we need to put you guys in the forefront pictures when you walk in. Really you are a big part of...but I’ll tell you it’s funny, Dr. Sandler was my doctor here. And like, I go to him all the time, like thanks for helping me make my baby. But really you guys are also a huge part of it. And you know, this is one opportunity to acknowledge the great work that you do, but so much gratitude for that. Rena?
Rena: Yeah, I’m gonna say of course I'm grateful for people like Donna and embryology, they're doing such important work. And you know, I wish, like I said, I wish I knew who made my daughter's embryo so I could say thank you. I mean, what an amazing thing. They that's my life right there. So, you know, I wish I knew who it was. So, you know, I'm so grateful for you for all the work you do, you know, for helping the patients and doing such important work.
Dara: Thanks for being here. Come visit us whenever you have a break. Thanks.
Dara: Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram @fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.