On this episode, Griffin Jones and Giles Palmer, the executive director of a group called the International IVF Initiative, discuss what’s happening in the lab and why clinicians, managers, and other folks should pay attention. Giles holds webinars for embryologists and other fertility professionals, attracting over 800 people each session. Tune in to this episode to hear more on the shortage of embryologists and how automation could be one key to increasing your embryologists’ capacity and quality of life.
Listen to the full episode to hear:
Giles perspective on hiring young embryologists
How automation will affect lab efficiency
Giles viewpoint on corporate IVF
How Giles is able to attract large crowds of embryologists
Giles Palmer:
Company name: International IVF Initiative
LinkedIn Handle: https://www.linkedin.com/in/giles-palmer-52461531/
Twitter Handle: @IVFLIFE
Facebook: https://www.facebook.com/giles.a.palmer
Website URL: https://www.kosmogonia.net/
Want to make your company irresistible to new talent? Let’s start the conversation at fertilitybridge.com
Transcript
[00:00:00] Griffin Jones: So I think what I'm saying is the cycle of life is continuing, but yes, it seems to me that the trajectory of most things is consolidation and fragmentation happens with countries, happens with businesses. And so we're seeing consolidation right now, but I also think we're seeing fragmentation and, and niching as well.
[00:01:00] Griffin Jones: On today's episode and back in the lab and I'm across the pond. I haven't had too many guests from the UK or from Europe and on today's show, I have an embryologist, someone with lab experience, someone running an initiative, that they'll talk about from the UK who has also worked many years in Europe.
This is Giles Palmer. He is based in Cardiff Wales at the moment. And now he's the executive director of a group called the International IVF Initiative that he formed with some other lab folks in the start of the pandemic. And now they have audience. Like several hundred people, not just embryologist and lab staff, but also clinicians.
And in this episode, we talk about what clinicians, managers and other folks who aren't in the lab have to worry about what's happening in the lab because it's coming for them so enjoy this show with Giles.
Mr. Palmer Giles. Welcome the Insider Reproductive Health.
[00:01:57] Giles Palmer: Thank you very much. We meet at last, I think we occupied the same you know, virtual university, if you like, but it's good to see you, you know, So it's great to be on the show. Thank you very much.
[00:02:09] Griffin Jones: Well, I like to give you the ability to decipher some of my audience. I'd like some exposure to yours because I got to confess. I have not had too many guests from the UK on the show of 125. You might be number three, maybe number four. And so that's fine. We are having to recruit a, too many guests. And so I felt we need more representation across the Anglosphere and here you are.
[00:02:37] Giles Palmer: Well, thank you very much. I shouldn't be offended at all. I mean, I only moved to the UK only about six years ago. Yes. I was born in Britain, but I've worked most of my life in Europe. Okay. And I came back to the UK, you know, only a short time ago, so although we're out of your work. I still like to think of myself as European. But certainly from across the pond. So yeah, perhaps I can give a different perspective in things in the IVF world, in that respect.
[00:03:02] Griffin Jones: So having worked in Europe for a number of years now, working in the UK and the initiative that you're involved in that we'll talk about.
That sounds like you have a good exposure to both the UK and Europe. And I want you to give us just a little bit of state of the union of what's happening over there. So here in the US and Canada last year and a half is you're probably aware most centers have just been slammed. Some have not. If they're in competitive markets or they haven't updated their business in a long time, but I would say 75% centers have been slammed.
I might be starting to change now. We'll talk about that in a little bit, if that might be the case, but what's been happening in Europe and the UK post covid.
[00:03:43] Giles Palmer: Oh sure but what's the word you use slammed was that?
[00:03:47] Griffin Jones: Very busy. It means very busy.
[00:03:49] Giles Palmer: Very busy. Okay.
[00:03:49] Griffin Jones: To be at or exceeding capacity.
[00:03:52] Giles Palmer: Well, thank you very much to clarify that marvelous. Yes. It is incredibly busy.
Both in Europe and in the UK. And you can see this from the posts, you know, everyone is hiring, and that's from the countries that I've worked for and in the UK. But yeah. But why is that? It's not just that there's been like a bottleneck, you know, and people haven't been treated over there pandemic.
First of all from the patient point of view, I think that people have thought, you know, they're like reassess their live and they say, yes, I want to have IVF. So yes, there's been a small amount of people that couldn't be treated and now they're being treated, but there's a lot of people that are thinking, yes, you know, I want to start a family.
So I think there's been an increased demand. Also, you know, the life of the embryologist has changed dramatically over the past few years. I mean there's more free cycles. Okay. Which means you have to have a devoted person to do that in the lab, it's not so much, you know, like full rounded, like, in the IVF lab, you'll have an egg collection, you'll fertilize, and some days later you'll then have the transfer, you know a lot of people are freezing the embryos and transferring them in a further cycle.
So that means that there's a lot of you know, force to be done as well. Which means as well for like the dynamics of a clinic as well. And I don't know if you've touched on this in some of your programs, but you get a higher throughput through your theater. If people are just having egg collections, when people are having egg collections you know, egg retrievals, but also embryo transfers, then there's going to be some time that you've got to sort of a lot for that, but I think the dynamics have changed in the clinic. And even within the inner workings, people are working a lot more and continuing on for that, of course you know, PGT and biopsy. You know, other techniques are being used as well. So I just think in a way it's a great time to be an embryologist, but it's a very tiring time to be an embryologist.
[00:05:45] Griffin Jones: Is batching common in the UK and in Europe?
[00:05:51] Giles Palmer: Not so much, no in your Europe and especially where I was like in the Mediterranean which is quite shocking for people in the states. I know that like using summer, we wind down and there's a reason for that. Like, you know, for example, I was in Greece and there was no treatments in August, okay,, but that meant that, you know, the whole staff could be taken you know, could take a holiday.
You know, the clinic could be shut down. It could be just, you know, like maintenance done on that period of time. And then, you know, back up again after August or so that was like in that sense, patching, but in the UK, you know, there's no distinction between, you know, summer and winter there, mainly because of the weather, I think, but there's none of that that goes on, obviously in large air, you know, larger countries like India, there is a lot of batching just because it's such a wide expanse and the such a demand for embryologists that they cannot be treated in that sense.
So there'll be a clinic which will open in like a remote area for, you know, for a certain amount of weeks, but I wouldn't say batching has done. No, no. The only time it may be done, I think is in clinics that treat HIV patients. And then we sort of have a certain time where they'll treat HIV patients you know, for risk of contamination and whatever they like bachelor in that sense. But now it's, work all around the year. I think a few days of in holidays, but it's busier than ever.
[00:07:09] Griffin Jones: So what are people doing to meet the increased volume? You said everybody's hiring, which means that there are not enough people coming in and filling those positions as quickly as possible as it is here. And so what are people doing?
[00:07:23] Giles Palmer: I mean, the desperately trying to find staff, and it's not always the solution that you can find a trained staff, okay, there was effect, I was giving a talk in Arizona, that was the start of January this year. And I've talked about mental health, which was a study we did which was the international study. We did actually with the group that I worked with and we looked at burnout. So ita lot of embryologist who are suffering or on the verge of burnout.
There's so much work that's going on. But that said it's very difficult to recruit younger people that have the skills, now it takes investment to train people. And the ideal thing is of course, to find someone who's like pretty well-trained or at least knows the basics. Now there's a lot of masters courses all around the world going on teaching at various stages, some are treating practical aspects.
Some are treating just theoretical. So there is quite a large pool of young embryologists, but it's being accepted to sort of join a team because as I said, there is an investment that needs to be done plus, and we're sort of changing tack a little bit. There's a growing workforce, especially in the states.
There's a lot of embryologists who have worked in clinics for over 20 years or more. This again was a finding from our study and these people will be retiring soon. Okay. And leaving the workforce. So there is I think a crisis coming perhaps when we have to find the men, you know, the members of staff to actually fill in this space.
Again, you mentioned, what are people doing to alleviate this? Two things I'd like to mention one is that there seems to be more and more what I called locum, but you call per diem embryologist,. okay. And it's a supply in need. I mean there are many more that are coming out and they can actually move from clinic to clinic and give their skills to a clinic who for many reasons needs to have more staff.
Okay. They have to be mobile. They have to be very well trained to sort of go to another lab. In fact cook in another kitchen, if you like, okay. They have to know all the equipment, they have to know all the protocols and they have to assimilate very quickly into a lab. So there's many more per diems coming into the fray, if you like.
And one thing which is changing is that now that the clinics are sometimes in chains, you know, the corporate companies which are coming out the advantage of those is that they can in fact relocate or they can move around their staff. So now I'm terrible at the geography of the states.
But you know, let's say that it's spread across the nation. If there's a shortcoming in one of the clinics, okay. In some kind of conglomerate, then they can effect, you know, move around people to sort of care for that. So that I think answers, that's my long answer to your, the question, but there are ways around everything again it's a good time to be an embryologist because there are many jobs out there.
[00:10:15] Griffin Jones: That's right. It's a seller's market at the embryologist, the seller in this context, though, people are, they're recruiting, they're using per diem folks. Is there any acquiescence to the burnout in, from the side of the clinic and the lab in that? Okay. Well, we just can't hire enough per diem folks, or we can't replace the folks that are being burnt out.
Our current staff are telling us they're burns out and we're so afraid of we lose even one that will, our problem will be compounded that much more. Is anyone saying, okay, well, our waitlist for patients might be two months to start IVF. Well, sorry. We're going to have to make it three or two and a half because otherwise we're going to burn out our embryologist.
Is anyone acquiescing as far as you?
[00:11:02] Giles Palmer: I know of one example that slowed down there are treatments and that's a clinic in the UK actually who through staffing reasons they just had to. Okay. And. It's all power to them to be able to do that because you kind of went to clinic, you know, on a shoe string and you kind of when a clinic, you know if there's not an adequate number of staff.
So I think that has been the case. But it has been the case, even with the pandemic. If you think about it, the way that they've had to slow down in the UK, they couldn't have had to stop completely. I know in the states that wasn't the case. In every single state in North America. But you know, there has been this like management of staff just sort of keeps them furloughed if you like.
Okay. And sort of like gear them up again to be done. What has happened in the pandemic is that there's been a lot of like a, transfer's a bit like football. There's been a lot of you know, key players that have moved from clinic to clinic. And that's been the case, not just in the IVF world, but also in any kind of industry.
We've found people have reevaluated their values and their job. And if they haven't happened, if they haven't been happy in their in a particular job and feel a bit disgruntled with that company, then they had a great opportunity to change. We see a lot of fluidity over the last few months.
But then if you've noticed as well, there's been a lot of changes going on. And of course that goes fuels. Why people have been advertising so much. So there has been more change going on in that market, you said it's a sellers market. Well, I kind of took about salaries. You know there are clinics which are offering, like sign up bonuses for that, which I think is a great incentive.
But salary isn't everything and that's very easy for me to say, but you know, there are various things in your working life, you can look at as opposed to just salary being the reason why you leave. We know the embryologist are, are the greatest asset to a clinic, but if they're so good then you always have the danger that they're going to leave.
Now I was in lab management, I'm an embryologist, but I've been in lab management for, many years over 30 years. And some of your staff maybe like headhunted, you know, maybe taken away. Well, that's Inevitable, you have to be gracious when that happens. There are wheels within wheels.
We're still a very small community embryologist. I don't know how many thousands we are worldwide, but we are quite sociable and we all meet up, you know, even more so virtually, so is to be gracious. And if they have to go, they have to go. But there are many ways that you can keep an embryologist and it can be an, and you refer to burnout.
It can be just a flat fact that you, you give more amicable working hours or flexible hours.
[00:13:36] Griffin Jones: I was having this conversation with Dr. Tony Anderson from Texas, and he was saying the exact same. You said, but I pushed back and said, well, how do you give people better working hours or fewer hours? When the queue of patients is figuratively around the corner and if you do that, then you're either pushing back treatment for people or you are putting the workload onto another embryologist. Say how do you do that when the demand is so high?
[00:14:09] Giles Palmer: Well, I'm sure there's no company that's going to give someone, you know, extra time off if that's at the detriment of their lab staff.
Okay. But it's all part of management, you know, it's all part of lab manager. You have to have redundancy anyway. Okay. that is a day-to-day thing that a lab manager has to cope with. There's always going to be, there's always going to be someone in your large chain of clinics that, you know, you're going to be ill for one day. I'm going to have to take time off for like personal reasons. So you should always find that you can fit people to their abilities. You have to have younger staff. I'm not saying you can't and you have to train them and you have to train them on the job. Like I said, there are many training colleges around.
Okay. Especially in North America that, you have someone who has the competencies to sort of start with a less learning curve. Okay. When they join the lab, it is a commitment to the lab manager to actually see that everyone is competent and everyone starts off. But you know, it has to be done in the UK in fact, there's a new sort of subset of embryologists. Think they're called lab practitioners. I could be wrong, but they just do egg collections and semen analysis. So they do, let's say You know, limited workload, but it can be like a job which would take an embryologist, you know, hours away from doing other work while the other more experienced people will do.
You know, the embryo biopsies, the ICSI, makeup the culture medium. So, you know, there are ways around that.
[00:15:33] Griffin Jones: What do you think should be eliminated Giles and in any workloads, there's priority is eliminate, automate, delegate. And when you're getting so busy, you have to be extra scrutinous. What do you think could be eliminated or automated readily that you still see many labs not doing?
[00:15:56] Giles Palmer: I think you know, a lot of it is the paperwork. Okay. Now you don't have to be paper free, but you can be paper light in a lot of the clinics. A cornerstone of clinical embryology is of course quality control. Okay. But you still see people walking around the lab with, you know, pieces of paper you know, with a little tick box.
Okay. There are now electronic means reflections where it's an outweighed and just electronically typing all these numbers you have to do. And they're forgotten about in a way until you want to actually retrieve them and reflect on them for any number of reasons. Okay. There's lots of things that can be done around the lab, which again, can be automated.
You do in fact, have these alarm systems on most of the critical pieces of equipment, but you still have to visually check them every day. Okay. I'm not saying that you shouldn't. But there's a lot of paperwork that goes on now, embryology as well. And we've spoken about this many times between the peers is there's a lot of admin work that is done with embryology.
Now that is a root of great concern because when an embryologist is trained, he doesn't realize that he's got to do another quality control assessments and he's got to do stocktaking and the, and the inventory to look after the, you know, quiet back. Okay. Even speak to patients. A lot of people are unaware that they have to do that when they train to be an embryologist.
And it could be that the embryologist wants to spend time on the bench work. So, you know, automating all this interaction with the patients, if you don't want to, or the admin, it could be done and there's not an efficient EMR at the moment, which can help with that. You've got to take yourself out of your working routine and type things in.
But you know, that will change. We often speak on our initiative about, you know, like smart devices now in the future, there'll be, you know, like perhaps smart dishes where you haven't got to use a sticky labels and there'll be voice to action certain ways that you can witness things in that sense.
But technology is coming just to take all the admin away from the embryologist. So that will be a good thing.
[00:18:01] Griffin Jones: Well, there are some life sciences companies out there now. With replace a lot of the manual systems and both with storage and managing if they're not cleaning up right now on the heels of labs needing to become more efficient because they can't fill enough embryologists, then they don't have a very good sales platform.
I think there are some solutions out there I'm not qualified necessarily to speak right now. The pros and cons of each, but are these, some of the things that you talk about in your initiative that you call Ifree, which is the international IVF initiative. Tell us more about that. What do you do there?
[00:18:41] Giles Palmer: Sure. Well to answer your question about, does it, does it fill the void? Well, it's certainly a space which has been filled up by many companies. So, obviously you know, there is work for everyone to do making things automated and one is with the, you know, like quite a storage. It's a no brainer just because why should we have to check ourselves visually every year that we've put something in the right place, if it can be done automatically, then it should be done. You know, once AI of course has perhaps been overused these past few years. I mean, you know, everything is AI at the moment. But it's like tangible benchtop AI, which is going to come out and actually help us.
It'll rank things first it'll help us choose embryos a little bit better, but we'll still have to have embryologists that will actually look over the results. You know, it's like, a driverless car, will we allow complete control over it? You know, like a driverless car, we'll still have to look at this you know, this data to help us. That will be an improvement because now, you know, you'll know about time-lapse and time-lapse imaging, which is a fantastic way forward is a better way to incubate, it's undisturbed, but to choose an embryo, an embryologist may spend, you know, a much longer time if they have time looking over these images and trying to choose, which is the best embryo, it may call over one of his colleagues and have a debate purely because you have the luxury of seeing the video of that sense. So all these new technologies we talk about in our initiative. But it, talks about so much more it's really addressed to clinic staff We have a slight majority of embryologists, but also clinicians and lab managers follow this initiative.
We usually have them once a week. It's become very popular, but we do the whole gamma of the IVF industry. So we do like the cutting science. Okay. What's happening with new articles and practices. We can then do about new innovations. So again, we do about what's new on the market, but we've also touched on the field of embryology and looked at things that concern them, like quiet governance which is of course affecting everyone with a recent or failures, which are happening, everyone's paranoid to say the least about getting things right. We've looked at staffing levels. We've done a survey which was awarded which has been awarded at the fertility 2022 for its work.
We looked at mental health in an international survey, which I think I sort of touched on beforehand, but there's a lot of data in there. There's a lot of data that we know now about the psyche of the clinical embryologist. And then of course we've done a few webinars as well, which have looked at animal reproduction.
Okay, cloning stuff, which you know, is interested people. I think they do our job, which can, if can add that to your daily speaking with the patient, giving you a weird and wonderful, explanations from nature, then that's quite good, really. And we've even gone off piece and had people from NASA that had spoken to us because as you know, every five minutes people are popping into space nowadays and there will be productive houses with that.
There's micro gravity. There's a radiation problems and it's not been discussed. So people are doing experiments on sperm and embryogenesis in space which I think are interesting, not just as an embryologist, but the lessons they learn can she help some of the medicine here on earth as well.
So we've done about everything cause you can see.
[00:22:02] Griffin Jones: When did you start?
[00:22:04] Giles Palmer: We started just as the pandemic hit, actually the start of 2020. And it was Dr. JacquesCohen who got us all together. He felt, you know, and is a great visionary. So he thought that embryologist would need someone to talk and and to discuss things, especially as you know, there were like furloughed in, at home and in this uncertainty.
And he got together with Thomas Elliot of ivf.net. Who's a bit of a it wizard and he set up a website and they had the idea to have these like webinars. And of course, everyone has been doing webinars, but I think we've done something a little bit special. They've been very popular and to go with those two, Dr. Zsolt Peter Nagy.
Okay. And they look at like the scientific content of everything. And then we've had Mary Ann who's been with us in the IVF industry for a long time. Shaista Sadruddin as well. She helps out and Colin Howles, of course, who's quite a well-known figure in the pharmacy world.
So that's the core band, if you like, but we've been helped with, you know, so many people in the IVF industry, so many people have wanted to help us.Dr. Liesl Nel-Themaat has helped us out, Dara Berger, Alison Campbell, another person from the UK. And two others, Alison Bartolucci and Kelly Ketterson have all sort of helped behind the scenes to make these things a success.
[00:23:24] Griffin Jones: You mentioned that you have it's embryologist heavy, but you have a number of clinicians and physicians and lab managers, what kind of crowds are you? Are you getting now that the pandemic is now that people are on zoom every second of the day, like they were in March and April of 2020 about what's a average crowd for you?
[00:23:45] Giles Palmer: Well, we got about an average 600 to 800 people, every webinar I'm told is pretty good, especially as like companies that hold webinars you know, don't do very well at all, but it's because it's because it entertaining, you know, yourself and then your interview skills are fantastic.
You have to make people buy into the time that you want to give them, you know, they're working hard, it's their own personal time. Okay. You know, it's gotta be something that they want to listen to. And you know, and we have topics where I think people want to listen to, you know it's got the scientific core but it's also entertaining as well.
You know, no one wants to finish you know, like a long day and listen to like a commercial yeah. You know, on a certain project, you know at the start of the pandemic, of course it wasn't much higher. We were having over a thousand people attend but it's like leveled off to the numbers, which I've said.
And then of course it's put on the website afterwards and then many thousands watch it on demand as they say. Yeah.
[00:24:40] Griffin Jones: Are they mostly coming from the UK and Europe? What's your distribution?
[00:24:45] Giles Palmer: I'd say it's over half from North America. Okay. And then after that it sort of pretty similar numbers, but I wouldn't say that you know, too many people from the UK, watch it shame on them, but I say it's like north America and then the rest are all very similar.
You know, we've got UK as well, obviously. We've got a great following from. And now in India, usually the tone that we show these webinars, it's like 11, 12 o'clock at night, but thankfully that, you know, they stay up to listen to it as well. We do have them on other times if you never time to time, but the time we usually have them, which is 3:00 PM Eastern it's sort of our slot.
So we're quite pleased that we've got, you know, like a global following.
[00:25:24] Griffin Jones: So, what are some of the insights that you've gleaned in the last few months? Because on this show, I talk about the business side of the field. And when I have lab folks on and talk about the business side of the lab, but I'm not having any sort of topics on about the latest techniques on ongoing to date by her beyond glasses.
And I'm not, you know, I'm not covering hatching.
[00:25:47] Giles Palmer: Yeah, I'm not sure, but you know what it is though, but you know what it is you see, and that's the thing. And we'd still have people who own a clinic who we may want to dip into you know, webinars, just because it's much more practical experience. So you'd have someone talking perhaps about hatching blastocysts isn't it, you know, as you said, but it will say, it may be in a. terrible discussion where you've got people from, you know, leading clinics all over the world and they're talking about, well, I do like this and I do like that. So it'll perhaps, you know, help them sort of manage either their workload or their sort of plan about how they want their clinic to go.
So that's what they gleaned from it, you know, that, you know and we have a large, we have a very large, let's say following, we have over 18,000 members, but that doesn't mean that they watch it every week. Of course, you're going to have like a subset of people that are going to be interested in, you know sperm and similarities.
Now, even if. 20% of those watching it, then that's a very, that's a really big number. You know, other people who are interested in like the tech side of it are going to be that and other people, which are medicine are going to fall from that field. So, you know, by having a large net, if you like and being global, we can get the numbers, which are quite envious in anyone's book I think.
[00:27:00] Griffin Jones: Especially for people that want to talk to embryologists right now. So who can join? Is this, is this a membership that people have to sign up for?
[00:27:08] Giles Palmer: Anyone can join. It's completely free and heal and it will always be free. We have an electronic membership card, which is quite good that you can put it on your phone.
So we've noticed that you know, that Evan has email overload and sometimes, especially with webinars. So we have a lucky little app if you like, but it's, but it's a membership card which will tell you where the next session is coming up and there'll be various offers on. And you'll be first to know about certain things.
So that's what we do and that's how they hear about it. We've got the website, which is IVFmeeting.com, which has the back lobby of all the talks. And we don't just have the, like the whole webinar. We also have them sort of cut up into each single lecture. So we're finding that even like master's students or I should say in a master's course, the teachers is telling the master's students to actually, you know, go and watch session 66 or go and watch you know, the topic on this.
So, you know, it's quite an archive of like, current topics there. And we do delve into, you know, the, you know, the business side of things sometimes, you know, the management side, as you said, within a very successful.
[00:28:14] Griffin Jones: Yeah, but session coming up it by the time this episode is out, your session may have aren't fast, but I see you have a session coming up on corporate IVF.
[00:28:23] Giles Palmer: Yeah, I think it's very exciting. It's a very exciting time that we live in and you know, the clinics are just the preserve of like a single doctor or a group of doctors anymore. You know, these, you know, this is big business and to be quite honest, I think it does need to go into the biotech arena.
So we're getting these large companies more so in North America, but most centers in the UK now are, there's only about three or four, you know, like groups, if you like small in comparison, perhaps to ones in the states.
[00:28:52] Griffin Jones: Is that across the board of Giles? Now there's three or four major groups, but are there still boutique centers in different markets or it's almost everyone owned by those three or four groups?
[00:29:04] Giles Palmer: There's still a boutique. There's still boutique in Europe. There are very much boutique markets now. Okay. Save a few, you know, like IVI, and Eugin still, they are the, you know, the end of the preserve of like a group of doctors. But I think the writing on the wall, you know, I think it's a good model.
It's a good business model. It's good for quality. It's good for results. It's also good because you know, all the research nowadays is going to come from private companies in the states. There's no money, which is given to embryo research at all. Okay. Although there is funding, you know, for other forms of medicine.
So it's going to be the antidote is going to be the conglomerates that are going to have the mic to do this, you know, and that again is going to be like a coward that is going to attract, you know, like embryologists that want to do that work, big data, large number of patients. That's where the, you know, that's where the research is going to come from now a days.
[00:30:03] Griffin Jones: That's the argument for corporate IVF. There's also arguments against it. And I have both perspectives come on my show. are you going to have a debate in your topic on corporate IVF or what are you going to cover?
[00:30:18] Giles Palmer: We don't usually have the format of a debate now, you know, there were many other webinars and even, you know, the courses conferences, which do have like a debate.
[00:30:28] Griffin Jones: Neither do I, by the way sorry to interrupt because I want to sidetrack on this because so many, I would love to have a debate on my show because so many people will email me after a certain topic. And they'll say, I can't believe so-and-so said that when I think they're full of it. And I said, well, why don't you come on and share your perspective. No, you know, I can't, well, it would be great if people would.
[00:30:55] Giles Palmer: Well, I mean, I want to hear the, what are the arguments against it now? I'm sure they are, and I can guess that, you know, people think it's not gonna be personalized and whatever. But I just see the writings on the wall, you know, That's the way it's going to be.
[00:31:09] Griffin Jones: So this is the way it's happening over here. And I actually don't know if these metaphors work. Europe or the UK, but in the United States for a hundred years ago, you have a brewery in every city, in town, in America. There was Goebbels in Detroit, there's Genesee and Rochester. There's old style in Chicago and, and some of them are still around and some of them aren't, but every city had its own brewery or a couple.
And then as the century progressed, you had MillerCoors Anheuser-Busch merges the three conglomerates. Then you had south African brewing by Miller and then they walked coolers together. And then, so then you have SAB MillerCoors. Actually, I do think this analogy works in Europe because InBev comes from Europe and then merged with Anheuser-Busch. So now you've really just got two conglomerates that control most of the group, but what did we start seeing in the mid two thousands? The emergence of craft breweries, again in just about every city in America, and then some of them grow and they get bought by the bigger guys and then the middle of the new middle guys are buying the smaller guy.
And then people are starting brand new breweries. And it happens with breweries that happens with local and regional banks. And we also see some of it with fertility centers that this doc was a partner over here, or they worked in an REI division and they got bought and then they went off and they started their own thing.
And now they're growing again. It gobbled up.
[00:32:33] Giles Palmer: So what's the answer. Yeah. So, yeah. So what's the answer, no, I mean you know, you could say if there are these conglomerates. And with your beer analogy, you know, is their choice. But of course there's choice because there's market forces. That's what I think.
And you know, someone's going to offer these things. And you mentioned about like the emergence of these microbreweries. Well, you know, that'll happen again, maybe with IVF, so, you know, all that we are seeing.
[00:32:57] Griffin Jones: We are seeingg it. So I think what I'm saying is the cycle of life is continuing, but yes, it seems to me that the trajectory of most things is consolidation and fragmentation happens with countries, happens with businesses. And so we're seeing consolidation right now, but I also think we're seeing fragmentation and, and niching as well.
[00:33:18] Giles Palmer: Yeah. But like, while these companies are big, then they get super efficient and they get this big data and that can help the smaller ones in the long run afterwards, you know, it gives them the opportunity to faction out if you like.
[00:33:29] Griffin Jones: If they provide efficiencies. And so come on my show and say, they're not so good at biting efficiency. I've gotten accused of being both. I'm neither. I do think there are pros and cons and I let people say which they think is.
So we've covered a lot. How would you like to conclude most of our audience right now comes from North America, about 75%. But there are some folks outside, I think after the US and Canada, India is our biggest listenership, but we've had listeners from Australia and central Europe.
You speak far more to the lab side, whereas our audience has some lab folks reach out I, how we got connected. But a lot more on the clinician side and the business side. How would you want to conclude with our audience either about what you see happening in the field and what like see, or what you'd like people to know about?
[00:34:22] Giles Palmer: I have to take a moment to think about that. I would just think about saying that what you've said to me now is you know, that you think that you are catering for an audience, which is just mainly north America, perhaps, and many conditions. And I think that we cater for people from the lab side of things, but as our hashtag is, it's like hashtag share the knowledge.
And that's what we did. You know, first of all, and people are watching it because whether it's legal aspects or it's business aspects, as you mentioned yourself, it is coming their way. And you know, we've got 180 countries that follow us and I'm sure you have as well, because they're going to learn something from what you're saying, and they're going to learn something from what we say as well now, maybe they've got different laws and a thing that we have seen. Not just with my, with my day juggles with is that every clinic works differently. Okay. They may have similar protocols, but every clinic works slightly differently, but they have these common problems in each country and each region has a way to solve that.
But you know, the issue of, you know, quiet governance. So what are you going to do with your non-compliant embryos, for example, what are you gonna do about safety? What you know about quality control, what are the legal aspects? What are you going to do about staffing levels? As we mentioned whatever it is, it's coming their way.
We've had some sessions on Treatment of same-sex couples. We've had successes on trans folk, which applies to perhaps my country, UK and yours, more where it is more open and it's more accepted, but as a service towards that many other countries in the world that's an opportunity for many of these people, but it's coming their way.
You know, this globalization is happening and they can learn from you know, like reaching out and having programs like yours, like mine and like others, where they can just see the writing that is on the wall and what is coming up in the future.
[00:36:11] Griffin Jones: Well, I thank you for coming on to share some of that with this audience.
I hope our audience will come and check out your initiative the international IVF initiative at IVFmeeting.com and we'll link to that in the show notes and hope that they benefit from the insights of the things that are coming their way. Thank you very much for coming on the show, Giles.
[00:36:35] Giles Palmer: Thank you very much.