Everyone.
Welcome back to friends with fertility.
Today, we have Doctor.
Courtney Murphy.
Did I say that right? You did.
You nailed it.
Yep.
I don't know why it seemed off to me.
Um, she is a board certified obstetrician, obstetrician, and gynecologist with specialized training in reproductive endocrinology and infertility.
She joins Pinnacle Fertility in Chicago after completing her fellowship in reproductive endocrinology and infertility at Washington University School of Medicine in Saint Louis where she also served as a clinical fellow an active contributor to research on uterine function and reproductive health.
I'm going to continue on leaving her bio in our show notes because I wanna just also touch on this, and I'll put it in the show notes too.
Um, Courtney, that you you've studied in Ireland as well.
I did.
How did that happen? I know you're Canadian, you said.
Right? So you have the benefit of being able to be here and there and anywhere the commonwealth is.
I am assuming that's how you were able to be.
Well, yeah.
I know I don't necessarily, like, look like it, but I'm a Murphy, so my dad's Irish.
Okay.
So when I was, like, exploring, you know, I was an undergrad.
I was like, I wanna do medicine.
I knew I wanted to do medicine, but I've always grown up traveling and just loved traveling at the same time.
And my mom at the time was like, well, why don't you do both? Why don't you just, like, apply and go to Ireland? And I got my citizenship while I was there.
And so now, and my husband, when we met in med school and similarly his dad's Irish and we're both Canadian, and we both have our Irish citizenship, and it was the best five years of our life.
That's so fun.
Because we go to do it all.
We got to do medicine and travel and meet people from all over the world.
It was it was the best.
That is the best.
That's so awesome.
I feel like that's you know, it's rare that Americans, I feel like, we don't really, we don't get that opportunity.
Like, you can go study abroad, but that that's pretty much it.
Like, you can get a year at most.
And then That's it.
And I feel like the part of the commonwealth always has these different opportunities that I think young people should really take advantage of.
And, um, like you did, which is awesome, which also leads me to my next question.
Being there, compared to also being in school here, did you notice any big differences with fertility specifically other than the National Healthcare System and how that works? But, like, the the the way of care and the the way of medication, so to speak, that we're being used, etcetera.
Like, because we talk to people all over the world.
And for the most part, medications in relation to fertility are the same, you know, like, and the emotional journey for people going through fertility is essentially the same.
I will say there's differences in cultures where maybe religion is different or family culture is different that makes the expectations, um, a little unusual, but for the most part, like the protocols and the medications and stuff.
Now did you find that being across the pond so to speak for Tuesday in America? Completely honest.
When I was there during my five years, I was a medical student, so certainly not as involved deeply in the fertility space as I am now.
Of course, that being said, I had a little bit of insight in the sense that there is not necessarily fellowship training in Ireland itself.
So you would have to go outside of Ireland.
So I actually met a provider who was doing additional training in Toronto at the time, who was an endocrinologist in Ireland.
And went back to practice there and, um, did some infertility work.
Largely, the medication is the same, but there are differences in the way Europe practices versus the way The US does.
And that's often apparent when we go to national meetings like Assura that's held in Europe, the European society for human reproduction.
So we do see differences there.
Overall, generally, it's the same, but there is different advances in progesterone protocols for embryo transfers, simulation protocols, all that.
And then lab elements are different as well.
Um, there's a huge, huge, um, research facility out of Spain.
Spain produces a ton of fertility based research.
So I think we learn a lot from our European counterparts and vice versa.
So I think we're relatively on pace, but there are definitely differences amongst the different, uh, countries and, um, continents.
I'm thank you for pointing that out.
That is it's so well stated because if somebody is looking into going outside of The US, for example, Spain is a number one place that has things going on with fertility, but SRS specifically to look up studies that were published for that show.
It's basically a trade show, medical trade show, um, and conference that is in Europe, the equivalent of ASRM in The United States.
And the studies, as Doctor.
Murphy was pointing out, they are different.
And oftentimes because of the different regulations in the countries there, they have maybe sometimes advances that are happening that haven't quite made it here yet for FDA purposes or whatever the situation So I I always find it fascinating if you if you really wanna geek out on that or you're really interested in something specific, um, you know, check that route as well because there are different things happening in in that side of the world.
So to speak.
Yeah.
There will.
And I will point out something real quick just on that topic.
Reproductive tourism is huge.
Right? I remember even, I we took a trip to Portugal.
We were on the Azore as a small island off the coast of Portugal.
We were at a restaurant, and On the restaurant, there was a QR code on the bottom of the menu saying interested in fertility treatment and you scan it and it brings you to their clinic.
And while that sounds alluring right hand, I'm gonna take a two week trip to The Azores, do my IVF cycle, Be very mindful of where you plan to have your embryo transfer because not all clinics will accept embryos meet internationally.
Right? So we need to make sure that especially if you're interested in third party and maybe are intending to transfer them to a gestational carrier.
There's rules in FDA testing that's highly regulated in The US that I think this sounds fun and a great option for people.
You need to see the whole picture, right, and what our plans are down the line for using those embryos.
So For sure.
Mindful of that.
Thank you for pointing that out.
As well as people will see the bottom line price tag of doing it in Portugal or wherever and think, oh, this is way cheaper, but they're not taking into consideration and the flights there, the housing there, like whatever you need to do in order to get there.
Sometimes it, it actually doesn't work out to being that much cheaper.
Um, I can't believe there was a QR code at a restaurant.
That's bananas.
It was shocking.
Yeah.
I worked with a a clinic and they in Los Angeles, and they're, like, doing a bunch of setting up services for people during the Olympics for people to, like, pick up their baby and go to the Olympics.
I'm, like, this is.
What a concept? It's so crazy.
It's 2025.
I know.
Anyway, um, so what do you see most in your practice for people that are listening right now? I mean, I know we run the gamut of talking about egg freezing, which I did seems like a million years ago, um, to just people starting their journey to not know where to begin.
Maybe they've just recently gotten married or they've just gotten divorced, which is what had happened to me when I went to go freeze my eggs, uh, way back, but when but what do you see as kind of common recurrent themes so to speak in your practice right now? Yeah.
I think egg freezing's a big one right now.
Right? I'm we're in Chicago.
It's a big metropolitan area with a lot of career driven individuals, um, people that are circling in the dating scenes.
Hard out there.
And we continue to age and we're like, okay.
Hold on.
We're doing all these things to preserve our beauty and preserve our looks and preserve our careers, but our ovaries are just continuing on at a pace that ignores all of those other things.
So we are seeing a lot of people looking to preserve that And I'm just so glad we continue to talk about it.
Right? Because I still get a 40 year old, a 44 year old saying that they wanna freeze eggs.
And can we do that? Absolutely.
But, oh, my goodness, come see me five, ten years sooner, and the conversation's completely different.
It's interesting because I think the people that are single that are early forties versus the people that are single in their twenties and thirties, it's a different conversation as far as those people are out at happy hour in their twenties and thirties, talking about egg freezing, like, no big thing.
It's just a regular part of the conversation, but yet the older ones, I think still are feeling like they've missed the boat on that, and it's too late.
And and there are some clinics that won't even, you know, talk about that at, at this point, over 40.
So what do you recommend for women who either just have never been in a relationship and or finding themselves now alone thinking is it too late to be going down this route? And where do you start from that point? Because I had somebody Last summer, she turned 51 just had her first baby granted it wasn't her own eggs, but she has the baby that she's always dreamed of.
You know? Right.
So I think we would I would love to get your opinion on where what are the options for people who are kind of on the older spectrum, so to speak, of kind of feeling like they still there's that yearning in them still, like, I still kinda wanna do this, even though society may say we're too old or whatever it may be.
Sure.
Sure.
I think the first part is having the conversation.
Right? Talk to somebody who understands what your options are, and the easiest point of contact is often an OB GYN, but do also go into that consult with you understanding that your OB GAN may not have all the answers or feel comfortable speaking in that space.
And the reason I say go to OB GYN first is that sometimes, depending on what your insurance policy is, if you have fertility benefit, they may require that the fertility consult is put in through your OB GYN.
The referral is put in.
But that doesn't apply all the time.
There's a lot of the times where fertility plans don't require a referral, and you could just speak to a fertility doctor upfront.
Right? And would you suggest though again, based on age that because I think a lot of OB GYNs right out the gate would say, oh, you're 41.
Talk how do you encourage your OB GYN to be open to pass you off to a fertility doctor, I guess, is the question.
I think the biggest thing is, like, we're, again, it's 2025.
We're not in the space of gatekeeping information about patients.
Right? There's a lot of hesitancy on ordering markers for ovarian reserve.
I think age is something that we can't work against.
Right? Our biology moves on without us, and age is the biggest predictor of egg quality.
Right? We've got no other test to tell us how good the quality of our eggs are the age.
There are tests we can do for a quantity that can be ordered by an OB GYN.
But I do think it's a very nuanced discussion in women in their forties wanting to freeze eggs because the conversation changes a little bit, so we'll maybe do the freeze embryos.
Okay? Cause we get a lot more information about what we have to potentially use in the future when we have embryos versus eggs.
And that conversation dialogue from egg freezing to embryo freezing and people who are single changes around the age of 38.
Right? Cause we know that the quality of eggs declines gradually over time.
It's it's a curve.
It's not a cliff that you fall off when you turn 35, but that gradual decline happens.
And we see it more pronounced over 38.
So when we freeze eggs over the age of 38, we just don't really actually have a sense of how many embryos we're gonna get at the end of the day because there's a huge attrition at baseline Right? Not all eggs survive the thaw.
We're really good at it now, but it's still about 90%, not a 100%.
Of the eggs that survive the thaw, seventy percent will fertilize.
And depending on your age, a fracture, those will make it to an embryo or blastocyst and If we're over the age 38, the chances of it being chromosomally abnormal are now higher than it being chromosomally normal.
So when we have patients that are not ready to build their family quite yet, but want to preserve that option in the future when we're over the age of 38, we say, okay, well, maybe the get eggs, and we can counsel you on how many eggs we think will get based on your reserve markers.
Right? So blood test and ultrasound to say roughly how many eggs do we have left at the bank.
But do we maybe make embryos because that gives us a better idea of what do we actually have to use and transfer in the future, because embryos actually give us a better prediction of live birth and frozen eggs.
Right.
And I'm a big proponent of frozen embryos.
Yeah.
In addition to frozen eggs, I understand that everybody, like, hopes and prays that they can use their eggs with the man of their dreams.
Right.
But at the same time, I've seen it far too often to know that might not happen.
And then when you're 43, 44, 45, even when you do meet that guy, your eggs might not thaw.
They Right.
Properly.
They may not fertilize well.
So it's it's like, would you rather have an embryo with a donor that you know is more likely to survive to a live birth Right.
Versus starting from an egg donor and a sperm donor, which that might be the the right decision for you and your family.
But just knowing all of those facts and knowing what's on the table for you and how to make the appropriate decision, I think, is really important because I've said time and time again.
I think that people don't understand that full attrition.
They don't understand the full process of what it means.
And I from what I understand and been told as well that the the egg thawing versus the embryo thawing, even though that Delta has gotten a lot closer, It This is such a fish.
In my again, having live in lived through it myself, seeing so many patients go through it.
Yeah.
I and just the biology of the makeup of an embryo versus an egg.
Right.
How can it not Right.
Again, this is my humble nonmedical doctor.
Yeah.
Nobody makes sense.
Right? One cell versus an embryo that's hundreds of cells.
Right? And we know that the blastocyst or embryo thaw success rate is ninety five, ninety seven percent.
Whereas eggs, we're still kinda sitting at that eighty five to ninety.
That being said much better than where we are from the early two thousands.
Right? Since we've introduced this vitrification, this snap freezing of eggs, we've gotten a lot better at thawing them.
Um, but it's it's not a guaranteed payout at the end of the day.
Right.
And so do you suggest that to your patients when they are so let's say they they were able to retrieve 20 eggs, which is a lot for the record.
Right.
And depending on your age.
But do you say, let's do, you know, five of those as embryos and and forget those fertilize with a donor and then freeze the rest Yeah.
Or do you do you not even introduce that into the conversation? I think it's important.
Right? My job is to give patients the information.
Right? That's all my job is, and they choose.
Right? So it's really a platter of options that we have.
And that conversation is nuanced because it really depends on age as we mentioned, but egg quantity as well.
Right? Are we really gonna get 20 eggs and one retrieval and we can get a sense of that based on ovarian reserve markers? But I think people have choices to be fertilize half the eggs, right, and create embryos with half and freeze the rest as eggs.
Do we do one cycle over freezing all eggs, but maybe we do a second cycle or we make embryos with that? Right? Because not everybody's gonna get to build however many embryos are eggs.
They want the bait with one cycle.
It might take one to two, sometimes three.
So there's different ways of slicing it, if you will, to make people feel comfortable with what they have to use in the future.
Because I think that that idea of Well, I was prepared to freeze my eggs, but I wasn't prepared to pick a sperm donor, like, hold up.
Like, what is that's a whole another conversation, you know? Right.
But again, I think because I have seen it so often, more often than I would like to say, It's it's worse to have in the back pocket, um, some embryos and things.
Yeah.
Yeah.
Yeah.
It it's our job, and I think that's where a fertility consults will give you that information.
Right? We will go over the numbers with you and show you that attrition.
And that's an average.
Right? People fall on one hand where they have great fertilization, they have great blast rate, and there's people that fall on the other end of that spectrum.
Where they don't get the numbers that we anticipate, but we only know that when we go to try to create embryos.
Right? And also, that being said, there's embryos that have, you know, super amazing grades and are tested normal and the the transfers don't take and or they miscarry or whatever.
So I always say that not to put a negative spin on it all of it, but, like, as much as we can plan and know what we're doing and have all the numbers and the data, it still can end up a way that we we don't want.
Absolutely.
Absolutely.
Technology is great, but biology is the driver at the end of the day.
And There's so much that we've learned over this short career of fertility medicine, but there's still so much that we've yet to learn.
And no doctor is ever going to give you a 100% guarantee rate of anything.
Right? Even with standard non embryo.
I have heard radio commercials that say, like, we guarantee, and I'm like, do not ever trust anybody who says anything around fertility that's telling you they're guaranteeing you anything because it's not possible.
Right.
So you're known for your compassionate and your patient care and that sense patient care centered approach.
How do you see the mental strain on your patients coming in? And I of course, it's different for somebody who's just freezing eggs versus, you know, having tried for a while.
But how do you deal with that? Cause I know at least in The United States and medical school, they don't teach you anything about that.
Um, but there's lots of science now that does show that the mental state impacts the physical state.
So how do you approach that with your patients? Yeah.
I I got the chills when you first mentioned it because I think it's a huge part of our jobs.
At the end of the day.
Right? Where you see our patients for thirty minutes to an hour at the visit, but they go they hop off that visit and have so many things going through their mind after conversations at the dinner table with their partner, or maybe without a partner, with their family around the holidays, the holidays are coming up, and that's a really, really hard time.
And we're a safe space for them, right, where somebody that understands their journey and they've already opened up so much to us meeting more than they have anyone else.
And I would be doing a disservice to my patients if I didn't ask how we're coping with this, and it just starts with asking.
That's all it takes.
And often, they'll open up, and we have resources.
Right? We have resources that we can help connect.
And if we don't know where the resources are off the top of our hands, we can ask colleagues, and we can ask somebody, hey, do you know someone who has a group or support group or whatever the case may be? The company I work with Pinnacle Fertility, we have a wonderful support group.
Um, but that may not be what's right for a patient.
So we'll look out for others.
So just asking the question.
How are you? Put the medicine aside.
How's your relationship doing? How's your self identity doing with all of this? It's a huge, huge space in our field.
Even they get aside from the medicine and the surgery of it all, it can't be ignored.
And I just having been in this realm for a long time starting from family history stuff, I I feel like the the younger generation of doctors that are coming out are much more aware of the impact that this has on patients.
No offense to the older generation that came before us and pioneered this industry.
Like, we need them.
We're grateful for them a 100%, but there was never the conversation of how are you doing with this? It was like, this isn't your fault and ushered out the back door after a loss or whatever.
And, um, I hope that you, you know, resolve was the only option really when I was going through it.
And some people just are not comfortable in group settings because you're comparing yourself or you see other nuances that that might be triggering for you because of what you're going through or not going through, whatever it may be.
And I think, again, this new younger generation I like to say of the doctors is amazing because they get it on such a bigger macro level of how it all interplays together.
And so I would encourage anybody who's going through it to pay attention to their doctor, are they caring about their whole well-being, right, their mental health, their physical health, and all the things intertwined? Because it does make a difference.
It does.
And ask for the resources.
If you're struggling say so and ask for the resources because if your doctor is not going to ask, you have to be the one to ask.
Right? And like you mentioned, some people may not be ready to talk about it in a group setting, but there are so many other resources that you can use in your own time.
Your podcast.
There are so many other fertility podcasts out there as well.
There's books and we have more books now than we ever had before talking about this.
Social media, oh my goodness.
You can get lost in TikTok and Reddit, which isn't always necessarily the best resource, and I don't necessarily tell patients to go there because there can be a lot of doom scrolling.
Um, but resources that uplift you and educate and give factual information are the way that we point our patients.
And there's so many people from the everyone in the clinic that is rooting for you on this journey that finding, I always say your fertility team, like, who are those people that you know are on your side? Regardless of your age, Young, young as well.
Right? Because a lot of times, the younger women get blown off because they're like, oh, you're too young.
Come back later, or whatever it may be in my opinion is it doesn't matter if you're 25 or 45.
If you wanna that baby, you want it yesterday, really, usually.
And so you have a right to find that fertility team that's gonna help be on your side and be with you going through it because navigating this process isn't like anything that you ever expect in your life.
We talk about cancer in our families.
We talk about heart attacks.
We talk about divorce in our families.
We don't really talk about fertility issues and what that might look like.
And or miscarriage loss or anything of that nature.
And unfortunately, a lot of these issues can result in relationship issues with their partner.
So how do you also I see a lot of this in my own situation with clients, but how how do you navigate when one person in the partnership is wanting it more than the other? Like, I this is what I see, and I and tell me if you ever see this.
But the women, they'll say, okay, we're finally gonna do IVF.
We've made this big decision.
We're gonna invest in doing this.
We're gonna hope we're gonna have our family in ten months from now.
And the guy's like, I'm on board.
And then the the retrieval doesn't go as planned.
And she's like, okay, we're ready round two.
And he's like, what do you mean round two? We just I thought we just did it.
Like, is that not what we're set what we signed up for? And so I think both people don't quite understand the full gamut of what this could potentially look like.
And then it's she's on the quest of, like, I need to get the baby.
I need to get the baby.
He just really wants her to be happy, but is also, like, this is draining on my relationship on our finances, on our social calendar because we're not traveling, we're not going anywhere.
Like, how does that play into from your perspective? Because that's not really your dojo.
Right? You're you Sure.
You've trained in a very different area, but yet they're coming to see you every other day.
Sometimes, you know, while this is like going in the background of this couple that's sitting there.
Like, are you able to clue into that sometimes of like, okay, I don't think we're on the same page here.
And what should we do about that? Yeah.
I think this really comes back to that initial consult of setting expectations.
Right? I think we have a lot of work to continue to do in allowing patients to understand the real timeline and acknowledging the strain early.
Right? Even earlier, like, say before someone gets to IVF when we're doing IUIs, I always get asked, well, should we have sex at home too? And you know, we're like, we're like, more is more.
Right? We'll take more sperm, but no pressure.
Right? If it's becoming a chore and we're not having sex for fun, we're having sex for baby.
It's no longer fun.
And if that's removing the spark and the joy, it's okay.
We don't need it.
We're doing the intervention.
Right? We're helping you get there.
So don't feel pressure to do it.
So it's acknowledging that at the very beginning and kind of making sure that are we on the same page.
Again, you're only seeing a snapshot of your patient's life, right, for that twenty minute, thirty minute hour consult, and then you see them for a short period of time during a retrieval.
So A lot of that can get missed and you don't know the nuances of what goes on at home.
So I think my workaround of that is addressing it at the beginning.
Right? And Which I think that's great because as the patient's sitting there from the reverse of where you are, Your mind is just like, oh my god.
It did we ask all the questions we need? Did we we're not even thinking about our relationship.
We're just thinking about, like, how much is this gonna cost when are we gonna be pregnant? What is that three day to a five day blast me.
You know, like, all this information is coming at you.
Right.
You're not even thinking about the other side of things.
And, you know, for the doctors on your side of it, it it's like the consult is the consult.
Right? You've been through this so many times.
You know what to say and and all of that, but I do think that relationship perspective is something that, at least in the consult that I ever had with my husband and or as a single person for that matter too, they didn't talk about the potential of multiple rounds and what that would look like.
It was just like, this is a process.
This is how it goes.
And that was it.
And then if you wanna go through it again, we'll it was addressed when it was time to go through that again.
So I just think that that's one of the things that, again, these the doctors that are just much more self aware of the whole person can see that it there's a lot going on in the background.
Right.
Right.
And that's why that initial consult is for, like, information gathering.
Right? How many kids do we want? Cause if we want one more child versus four more children, the conversation's gonna be a bit different.
But then, again, explaining, you know, sometimes we get there quickly, and sometimes this journey is a long journey.
And I think calling that out from the beginning puts things into perspective.
Everybody wants to be the quick journey.
Right? And we hope that for everyone, but it's just on everyone's reality.
So it's setting the stage that this may be you, and if it is you hang in tight.
Right? We're gonna be there with you the whole time, but it might be a bit of a long ride to get there.
Right.
And an intimate one, you know, this, I will say, your clinic, your doctor, Again, the phlebotomist, everybody that's there is the people that you're gonna see a lot.
Yeah.
And you want those people to feel good for you when you walk in the door and that it's a safe good place for you to be and you feel positive about your journey because it's gonna be a lot of ups and downs.
It's gonna be a waiting game in a lot of ways.
And knowing that those people can make or break your day really is a huge deal.
And so I often tell people verbalize that to someone.
Like, oh my gosh.
Thank you for saying that, or thank you for the hug.
That made me feel so good because you you need that.
They're human too.
They're going through this process with other patients throughout the day.
It's an emotional roller coaster for them too, even though it's just another day in the office.
It's not easy to do the job that you guys do.
Yeah.
We're we're rooting for everyone.
Right? Their wins are our wins.
Their losses are our losses.
So Um, everyone in the clinic is here because we love what we do.
Right? And we value what we do.
It's important.
And, again, we're we're rooting for you.
So just like you said earlier, you really have to build your own village even within your fertility practice.
And what an amazing job to have when everything goes as planned and, like, the best calls to make and seeing the ultrasound and stuff.
I get goosebumps every time just from my when I get the pictures and everything from people, like there's nothing better.
It's it really is an amazing miracle that you are able to do what you do.
So that's Yeah.
So fun.
What's the where can people find you? Where can they work for with you.
And what advice would you lead somebody with who is on this journey? Absolutely.
So, again, my name is Doctor.
Courtney Murphy.
I am with Pinnacle Fertility, Illinois.
We have a wonderful network across the country.
Where we really treat every patient as an individual patient walking into our office.
You have a navigator that knows your ins and outs.
Your provider will review all of your labs.
Hope you with you every single step of the way.
And I really, really think that's a a special feature of our practice is that you're never left in the dark.
You understand every step of this journey because it's confusing.
Right? It can be confusing to anyone, even medical providers who come see us.
It's it's a hard road to follow and stay on top of.
So We make sure you're not left in the dark.
Um, just heading to our website, Pinnacle fertility, you can easily book a consultation.
I'm also on Instagram as Doctor Courtney Murphy, where I hope to continue sharing educational videos to make this process seem more tangible and accessible for people and less scary.
So you come in equipped with the knowledge and what to expect in a visit.
Um, and then I chose really the takeaway from all that says knowledge is power.
Right? Our job as a fertility doctor isn't to prescribe what to do to you.
Of course, we're gonna give our input on based on our knowledge and our success rate, what's the best thing to get you a baby the quickest or what makes sense for you.
But our job is to educate you, right, educate you about your menstrual cycles.
What's normal? What's abnormal? How do we optimize things? And what are your options for building your family? So again, knowledge is power, and I want everybody to have that even maybe before they even start thinking about building your family.
Right? Which would be awesome? I know.
Absolutely.
That would be awesome.
Well, thank you again for being here.
I do wanna also state, even though she's in Illinois, it's not uncommon to travel to a doctor for your fertility treatments if it's somebody that you feel aligned with and that you, you know, just feel good about because this is a huge time money, lifelong investment in who you partner with on this.
So If you feel alignment with doctor Murphy and you're not in Illinois, you can still have a consult with her and or go to Chicago.
Chicago's a great city.
It fun lots of good food and shopping and all the good stuff.
So Um, don't feel that just because she's in Chicago and you're not doesn't mean you're not able to work with her.
I just wanna make that clear as well.
I appreciate that.
Yeah.
We're happy to see patients wherever our outreach is far.
Like you mentioned, we have patients that come from all over the country, even sometimes out side of the country.
So Right.
Well, thank you for your time today, and until we meet again.
Thank you so much for all the work you do too, Elizabeth.
Thank you
