Latest / Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss / Understanding Recurrent Pregnancy Loss, Infertility, and Hope: A Conversation with Dr. Melanie Ochalski of Shady Grove Fertility

Transcript

Understanding Recurrent Pregnancy Loss, Infertility, and Hope: A Conversation with Dr. Melanie Ochalski of Shady Grove Fertility · Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss

• 0:13
  Crying out loud a podcast by Chasing the Rainbows with your.
• 0:20
  Host. Bernice Quisenberry.
• 0:27
  Welcome back to Cried Out Loud, the podcast where no story is
• 0:30
  too heavy, no grief too small, and where every family
• 0:34
  navigating infertility, pregnancy, or infant loss has a
• 0:36
  voice. Today, we're honored to welcome
• 0:38
  a guest to Work literally changes lives, helping families
• 0:42
  who long for a child find answers, support, and hope.
• 0:45
  Doctor Melanie Ohowski is a board certified reproductive end
• 0:49
  chronologist at Shady Grove Fertility.
• 0:52
  She has decades of experience treating infertility,
• 0:55
  reoccurring pregnancy loss, and ovulatory disorders.
• 0:58
  Doctor O has published numerous peer reviewed scientific
• 1:02
  manuscripts, received multiple teaching awards, and is
• 1:05
  dedicated to combining medical expertise with compassionate
• 1:09
  care. In today's episode, we're going
• 1:11
  to explore infertility as a medical condition, debunk those
• 1:14
  myths that can unintentionally harm patients, and provide
• 1:18
  guidance on the questions everyone asks, from home
• 1:21
  ovulation kits to when to seek professional help.
• 1:25
  This episode is for anyone who has ever felt frustrated,
• 1:27
  confused, or alone on their own fertility journey.
• 1:31
  Doctor O, thank you so much for joining us today.
• 1:34
  It is an honor and thank you for reaching so many patients and
• 1:39
  being a beacon of hope and light when sometimes it feels like
• 1:44
  everything seems dark. So truly, thank you.
• 1:47
  Oh, thanks, Doctor O That means the world.
• 1:49
  And it's such an honor to have you here and to connect you, we
• 1:52
  know, with our listeners. And I would love for you, you
• 1:55
  know, to start from the beginning, you know, what got
• 1:58
  you into this field and what you do, you know, for your patients.
• 2:03
  Yeah, I initially was interested in the field because of the
• 2:09
  science behind it. Human reproduction is so cool.
• 2:14
  I mean, just female reproduction and the ovary, how this small
• 2:19
  little nugget has millions of eggs and effects our hormones
• 2:25
  that affect so many other aspects of female health.
• 2:29
  I mean, it's incredible. So I went into the field very
• 2:32
  interested in the science of it and the research.
• 2:37
  I performed some early research on preventing chemotherapy from
• 2:43
  affecting women's fertility in the future, but very quickly I
• 2:49
  realized what an amazing patient population the women who sought
• 2:55
  my care were. And so it started to feel like I
• 2:59
  was helping a friend rather than really like the medical part of
• 3:05
  it came second. And the impact of listening and
• 3:11
  being part of such an important journey really is the number one
• 3:15
  reason why I'm still doing this 20 years later.
• 3:18
  And I feel really blessed and honored that patients trust me
• 3:24
  with their care. And I think I'm so inspired by
• 3:29
  patients. So that was that's my journey.
• 3:32
  Yeah. Oh, that's so beautiful.
• 3:34
  And it's true. You know, when someone comes to
• 3:37
  you like their future and, you know, their family, planning is
• 3:40
  really in your hands with them as a partner and a true partner,
• 3:43
  you know, walking alongside them in this journey.
• 3:46
  So that just, you know, means the world to have that kind of
• 3:48
  compassionate level of care of someone who treats it so gently.
• 3:53
  It really is a relationship because when I'm first meeting a
• 3:57
  patient, I don't know if I'm going to know them for a month
• 4:00
  because they'll be very quickly successful, or if it's going to
• 4:05
  be a year or two because it's it's it's unpredictable.
• 4:10
  But I think knowing that they're not alone and that we're in it
• 4:14
  together till the end is is really an important part of the
• 4:19
  equation. Absolutely.
• 4:21
  It really is and you know, another part of that is really
• 4:24
  educating others on, you know, infertility and and not being as
• 4:29
  easy as go take a vacation or just relax and it'll happen, you
• 4:33
  know, and that this is a true medical condition.
• 4:36
  I think understanding that too. And the earlier that I know
• 4:39
  we're talking pre show, you know, it's that early detection
• 4:43
  or you know, doing deeper. I would love to hear your
• 4:45
  opinion about that. Yeah, I think that in the US
• 4:50
  there's so much emphasis on preventing pregnancy when it's
• 4:53
  unwanted and we don't do enough education about how our
• 4:59
  fertility is time sensitive, especially women's fertility,
• 5:04
  and that we're most fertile in our early 20s.
• 5:08
  And, and I think that's, I think that's really important.
• 5:12
  And I, it's a take home message. I try to emphasize anyone that
• 5:17
  will listen. So my poor nieces in college
• 5:20
  have heard me say this very often.
• 5:25
  But I, I do think it's, it's, it's important, especially for
• 5:30
  women who are embarking on careers that may delay their
• 5:35
  fertility, knowing their, knowing their options and having
• 5:40
  a, a strategy is, is important. But one of my talk talking about
• 5:47
  kind of myths or, or things that are, are, are said, one of my
• 5:52
  pet peeves is that, you know, like, you just have to relax.
• 5:57
  It's if you're just too stressed.
• 5:59
  And when I think about it, like when would you ever go to a
• 6:03
  doctor and you know, you're diagnosed with strep throat and
• 6:06
  the doctor says, oh, you're stressed, you just got to relax.
• 6:09
  That'll do it. I mean, factor ability is a
• 6:12
  medical condition and it's no one's fault.
• 6:16
  And I, I, I completely understand that we don't want to
• 6:22
  medicalize something that should be natural too early, but it's
• 6:26
  really not about medicalizing anything.
• 6:28
  It's about picking up cues that can help a, a patient or a
• 6:34
  couple be successful and kind of streamline their journey.
• 6:39
  So whenever I hear someone say like, you just need a glass of
• 6:42
  wine or you just need to go away it, it makes me sad because it
• 6:48
  does a disservice. And it also kind of points the
• 6:51
  finger and puts the blame on the person, like they're doing
• 6:55
  something wrong, yes. It's very dismissive and also,
• 7:00
  you know, telling someone that then they're trying for let's
• 7:03
  say 3 or 4 years and they're not, and then they finally get
• 7:05
  back. Well, that might put them in
• 7:06
  their 30s then, you know, or, or whatever timeline that is
• 7:09
  because they felt like, oh, like, I just need to do this.
• 7:12
  Because as you know, time flies by and like when you're tracking
• 7:15
  all of that and it's like, or not knowing what to do and it is
• 7:19
  dismissive like that, you're, you then get in your own head.
• 7:21
  Am I just coming up with this? But as women, we know our bodies
• 7:24
  so well from a young age and, you know, know that.
• 7:27
  So we, if we feel like something's off or something
• 7:30
  isn't happening, it probably is, you know, just better to get.
• 7:33
  Looked at, I think women's intuition is very powerful and
• 7:39
  one of the, one of the points I always try to emphasize when I'm
• 7:42
  talking with a couple is here's, I'll give them my
• 7:45
  recommendations and then I'll say whatever you decide to do,
• 7:49
  you'll take this at your pace. However, put time limits, time
• 7:54
  stamps on it because it is so common that a year, 2 years goes
• 8:00
  by and we're still at the same point.
• 8:03
  We haven't made any progress. So if you put time points like
• 8:06
  OK, if next by 4th of July or by this date, if we haven't seen a
• 8:12
  difference, then we're going to execute on part of this plan
• 8:16
  because time goes by so fast. And unfortunately it is a really
• 8:21
  important factor when it comes to how successful we we are.
• 8:27
  Yeah, absolutely. And I love the time stamping
• 8:30
  because it almost feels like that's what you need to keep.
• 8:33
  And also, it kind of gives you hope and goals, so it doesn't
• 8:36
  feel as daunting as it can be when you're in the midst of it.
• 8:39
  Yeah, I, I, I think the only way to survive this is to think
• 8:44
  about the end goal. Like if you're thinking about,
• 8:47
  oh, I got to take this pill or I got to do this test, who would
• 8:50
  ever want to do that? But if, if you think, OK, this
• 8:53
  time next year, I want to have been successful, like that's the
• 8:57
  goal. And then that gets you up every
• 8:59
  morning and, and moving on. It's that hope for that.
• 9:03
  Absolutely, yeah. And I think it's so important to
• 9:06
  remember this isn't our fault and you know, anything, it's,
• 9:10
  you know, just evidence based medicine.
• 9:13
  It's so important, you know, running tests or doing more and
• 9:16
  would love to hear, you know, what you do with your patients
• 9:18
  doctor when they come to you, what that kind of looks like.
• 9:22
  Yeah, I, I'm so glad you said it's, it's not your fault
• 9:26
  because I think a lot of people, their brain knows that, but
• 9:30
  their heart feels like what, what, what am I doing or not
• 9:34
  doing? And when someone has been trying
• 9:41
  to get pregnant and hasn't been successful, and then they end up
• 9:46
  in my office, I think there's a little, they're grieving the
• 9:51
  fact that it hasn't been easy and everyone around them, you
• 9:55
  know, has an oopsie and, and you know, there's, that's a loss to,
• 10:00
  to know that that there, there's possibly some tests or some
• 10:05
  treatment needed. So I think just acknowledging
• 10:08
  that that that's normal and it's, it's not fair, but you
• 10:12
  know, we're going to get through it and, and we're going to get
• 10:15
  there. And so typically when a patient
• 10:21
  has been trying for 12 months or longer, we recommend an
• 10:26
  evaluation. And it's not as though at 12
• 10:29
  months something breaks and and it's all downhill after that.
• 10:34
  It's simply that at the 12 month mark, it is worth investigating
• 10:39
  some clues that can help identify what what might be
• 10:43
  helpful for the patient. And sometimes we would like to
• 10:49
  see a patient sooner. If there are some known issues
• 10:54
  that can affect fertility like PCOS or endometriosis or a known
• 10:59
  male issue, then no reason to delay, no reason to wait till
• 11:04
  that 12 month mark. Let's see you sooner.
• 11:07
  And then I think age of the female partner is really
• 11:10
  important. So 35 or older, we say give it
• 11:15
  six months and then let's just talk about maybe doing some
• 11:18
  tests. And then at 40, we say let's
• 11:22
  come in as soon as you're ready. No reason to delay just in case
• 11:25
  there's something a little off. Let's try to optimize it while
• 11:29
  time is still on our side. Absolutely.
• 11:32
  And I think you're, you know, that's so beautiful that you're
• 11:34
  recognizing to the innocence of the pregnancy kind of being
• 11:37
  taken from this couple. Not just like getting deprived
• 11:40
  of that, like, oh, I get to surprise my husband with a
• 11:43
  pregnancy announcement because I got to take a test and him not
• 11:45
  know about it, you know, or just unplanned and just like
• 11:50
  sporadically, like we're pregnant.
• 11:51
  Yeah. Like that, you know, isn't the
• 11:53
  case. And it, and it can, it's so
• 11:55
  heartbreaking in those moments because everything then does
• 11:59
  feel like it is planned out and it's not that, you know, and
• 12:02
  then we also are aware of complications and risks and HCG
• 12:07
  levels and all of these different things that the
• 12:09
  normal, you know, person who's getting pregnancy unexpectedly,
• 12:13
  you know, isn't experiencing like we are, you know, in this
• 12:16
  population. Yeah, I can, I, I will share
• 12:21
  with you that I, I having gone through a miscarriage, it is
• 12:25
  true that when you are mourning that loss, everyone around you
• 12:29
  has a big belly and is there's baby announcements everywhere.
• 12:33
  And it's like, seriously, is this, it's constant reminders
• 12:38
  and it can feel really isolating.
• 12:41
  So. Yeah.
• 12:43
  Especially around the holidays, I feel like, you know, I'm
• 12:46
  seeing again and again. But yeah, maybe it's just the
• 12:49
  season and reason we're in, but it's like, here is, you know,
• 12:52
  this person getting pregnant, Everybody wants to announce them
• 12:54
  around the holidays. It just feels almost like, like,
• 12:57
  when is it our turn, right? When's it gonna happen?
• 13:00
  Yeah, the the holidays can be particularly tough.
• 13:06
  Yes, that's a one thing that you mentioned reminded me that when
• 13:15
  a couple is successful having gone through an infertility
• 13:20
  diagnosis and possibly treatment, there are ways of
• 13:24
  still holding on to some of the like spontaneity and excitement
• 13:29
  that that we see patients who may not have had that same
• 13:34
  struggle have. So, for example, calling with a
• 13:38
  positive pregnancy test when both partners can listen in or
• 13:43
  like doing, still doing gender reveals, even if it was an IVF
• 13:47
  genetically tested pregnancy, we still like can put the, the
• 13:52
  gender on a on in a sealed envelope.
• 13:55
  And, and, and I think those little things really can make a
• 14:00
  difference. And, and it really, I mean, it's
• 14:03
  even more meaningful when it's been a little more difficult to
• 14:07
  to get to. Absolutely.
• 14:09
  But it's our favorite thing is when we get the gender reveal
• 14:13
  videos or like we hear the stories and it's such a what a
• 14:18
  celebration. Oh, Doctor.
• 14:20
  Oh. And that's so great that, you
• 14:21
  know, still. Yeah.
• 14:22
  Like finding those celebratory moments, especially in the midst
• 14:26
  of all of it, is so important. Oh, that's so beautiful.
• 14:30
  Yeah, oh, so yeah, you know, going from doing like at home
• 14:37
  ovulation kits, how, you know, reliable?
• 14:39
  Are they like in any of the testing at home?
• 14:43
  I have to admit, I was guilty of buying different teas, lozenges.
• 14:49
  I mean, you know, we got to the point of like progesterone and
• 14:52
  corrective surgeries, but what's interesting is, you know, it,
• 14:56
  it's not as easy, you know, like just you read all these things
• 14:59
  and you just can't help it. Like I will try anything to try
• 15:02
  to get pregnant at that point, so.
• 15:04
  Oh, yeah. And I think nowadays more than
• 15:07
  ever, when there's so much information available to
• 15:11
  patients and there is a movement and I think it's a good movement
• 15:15
  to think about holistic remedies and making sure that we're we're
• 15:21
  as optimal, like we're as healthy as possible.
• 15:24
  And so it's very common when patients come to see me that
• 15:28
  they've already like tried out different supplements and how
• 15:31
  are using home devices. And I think that can be helpful,
• 15:38
  but I always caution to like continually evaluate whether
• 15:43
  those things are serving you and at any point that you're like
• 15:48
  starting to hate on the, the kit or the the wearable device, then
• 15:53
  that's just that the stress that that's causing isn't worth it.
• 15:58
  Like when I, when I see patients coming in having done some of
• 16:03
  their home initial evaluation, very often they're either using
• 16:07
  ovulation kits, which are the urine kits that can predict
• 16:11
  ovulation, basal body temping. And and then like more recently,
• 16:18
  the wearable devices that, that can tracks your cycles and then
• 16:22
  start to give predictions on your, your fertile window and
• 16:26
  when to expect your cycle. And so I think the merits of
• 16:31
  those things are that number one, they help you have insight
• 16:35
  into your body. And you know, up until these
• 16:39
  things existed, we were going off of symptoms like breast
• 16:43
  tenderness or cervical mucus and and now these these products can
• 16:48
  give you a little more objective data.
• 16:50
  So that's good. And I think it also helps a
• 16:55
  situation that feels so out of control, like, you know, if
• 17:01
  you're, if you're someone who you work hard, you set a goal
• 17:05
  and then you you get it. And now suddenly you're doing
• 17:08
  all the right things and this is not happening.
• 17:10
  Sometimes the devices and the products can help you feel like,
• 17:14
  I'll let like you're taking back the reins a little bit.
• 17:17
  The, the thing to caution listeners about are that any
• 17:22
  test, especially some of these at home tests are not always
• 17:26
  reliable. So you always want to take it
• 17:27
  with a grain of salt. And I they can be influenced by
• 17:35
  other things going on in your life.
• 17:37
  So like particularly the basal body temping and the, the
• 17:41
  wearables, those algorithms can be affected if you were sick or
• 17:47
  you were super stressed or didn't get a good night's sleep.
• 17:50
  And so you just want to like not let that be the end all be all.
• 17:56
  But I, I think it can be helpful.
• 17:58
  But when someone's coming in and I can tell like it's stressing
• 18:01
  them out, I say just like, let's, let's put that aside
• 18:05
  because right now it's this daily reminder about you needing
• 18:10
  to do it and it hasn't happened yet.
• 18:12
  Why hasn't happened yet. And it, it's, it's not worth it.
• 18:18
  Ovulation kits can be helpful when like couples are apart and
• 18:23
  they need to time things a little bit better.
• 18:27
  I think of the ovulation kits as like your turn signal, it's
• 18:32
  going to tell you what you're about to do, whereas basal body
• 18:35
  temping is your rear view mirror to say, oh, Yep, I did ovulate.
• 18:40
  So can be helpful, but you know, keep it.
• 18:44
  I I think keeping the perspective that it's not, you
• 18:47
  know, you don't have to do it. No, no fertility Dr. will say
• 18:51
  what you're not doing this already that because it's.
• 18:58
  Yeah. Oh, I know, I know, I as you're
• 19:01
  talking, doctor, I was like I was guilty of that, you know,
• 19:03
  doing all of the charts, checking everything daily, you
• 19:06
  know, especially first thing in the morning and like tracking it
• 19:10
  all and it was almost obsessive. It takes away from even the joy
• 19:14
  of the journey or any part of it, right?
• 19:17
  And it just makes it almost like AI mean loving the control over
• 19:20
  a feeling like you know, I have a sense of control over it.
• 19:23
  But then it is, it can be and I know you know it.
• 19:27
  It almost felt like a job after a while.
• 19:30
  Yeah, and I think there's many reasons why intimacy can be
• 19:34
  affected during the fertility journey.
• 19:36
  But it when when you're looking at your your kit or your chart
• 19:42
  and then you're saying, come on, honey, we need, we need to be
• 19:44
  intimate today. That kind of takes some of the
• 19:47
  excitement out of it also. But you get to that point like,
• 19:52
  you know, like you try the easy way and that doesn't work.
• 19:55
  So you want to do something different.
• 19:57
  And I think that's that's fine, but not for a year's worth.
• 20:03
  And I would say the same thing about supplements.
• 20:05
  So there's so much out there. It's overwhelming for me as a a
• 20:10
  doctor to vet what products are needed or helpful.
• 20:15
  So I could only imagine how overwhelming it is when you're
• 20:19
  the patient trying to navigate these supplements and and
• 20:23
  devices. But when someone comes to see me
• 20:28
  and they ask my advice about supplements, as long as it's not
• 20:32
  harmful, I'll say that's fine if you want to give it a try.
• 20:37
  But if you've given it 3-6 months and it really hasn't made
• 20:40
  a difference then probably not necessary.
• 20:45
  And also seeing how it makes you feel.
• 20:48
  Some supplements can cause side effects and not worth toughing
• 20:52
  it out if if that's the case. No.
• 20:56
  And it and get expensive. I mean, all of these products
• 20:59
  will be really, really expensive.
• 21:03
  So, you know, I think it's great that people, patients are
• 21:08
  empowered to try, like to do their research and try these
• 21:11
  things. And I always welcome patients to
• 21:15
  share with me what they're doing so that I can give my $0.02 on a
• 21:20
  supplement or a product. But most of the time, if it's
• 21:23
  making you healthier, that's a good thing.
• 21:29
  I caution patients, my, my male and female patients to avoid the
• 21:35
  supplements or products that claim to like enhance your
• 21:40
  vitality or like that that's more of a, a, a men's supplement
• 21:45
  thing. But it what if they're claiming
• 21:48
  that it's increasing your libido or increasing your, your
• 21:52
  vitality? I, it makes me wonder, is there
• 21:55
  a plant based type of male hormone in there that actually
• 21:58
  can be working against us? And then for female patients,
• 22:03
  any supplement that claims to regulate your cycle, I would, I
• 22:10
  would caution because birth control regulates your cycle
• 22:13
  because it totally takes over. So you just, you know, sometimes
• 22:18
  in an effort to try to make everything perfect, we can, you
• 22:22
  know, do a little, you know, more harm than good.
• 22:25
  But that's why you're never meant to do it alone.
• 22:28
  Like there is, there are people out there who can, can help you.
• 22:31
  So always I think remembering that is important.
• 22:35
  Yes, and I think too like understanding when is it
• 22:38
  important to make the change over from a clinician, you know,
• 22:43
  AGP or OBGYNII know we get this a lot, you know, in support
• 22:48
  groups or different support services.
• 22:49
  We have infertility loss parents coming to us and you know, they
• 22:54
  go to their doctor. It's kind of, you know,
• 22:56
  dismissed, like we said about, you know, go home, relax kind of
• 22:59
  thing or not doing further testing or they had ADNC or a
• 23:03
  procedure from, you know, a pregnancy loss or, you know,
• 23:08
  have experienced endometriosis and PCOS.
• 23:10
  And maybe, you know, it's something that a surgery can go
• 23:13
  in. And I mean, I needed that.
• 23:17
  And you know when you would seek an RE doc to talk through all of
• 23:21
  these different things compared to staying with an OBGYN or
• 23:26
  feeling like your answers aren't being heard by a clinician?
• 23:29
  That's a great question. I think it's never wrong to
• 23:33
  start with your GYN or your PCP and share your your your current
• 23:39
  situation and get their advice. But if you feel as though
• 23:44
  there's kind of this like stall out and not much is happening,
• 23:50
  anyone can self refer to an RE I I would say at least at Shady
• 23:54
  Grove. I would, you know, at my
• 23:56
  practice, anyone can self refer and I it's not unusual.
• 24:00
  I have someone who hasn't been trying, you know, probably
• 24:04
  doesn't need to be here, but she needs to be here.
• 24:06
  If she needs to hear from me that everything sounds OK and we
• 24:10
  can do these tests to reassure you.
• 24:12
  But like that, that's OK. That's I, I think there's,
• 24:19
  that's why we're here to, to, you know, hopefully reassure
• 24:22
  patients. But if something is up, the
• 24:26
  sooner we know the better, right?
• 24:29
  We're just trying to come up with putting clues together and
• 24:32
  coming up with a road map. So I would say if, if, if ever
• 24:36
  someone is feeling like they need just a little bit more
• 24:41
  evaluation or listening to then then that either ask for a
• 24:46
  referral or just self refer. And I will also say that your
• 24:53
  intuition, whether you are a male or female, your intuition
• 24:59
  is important. And so if you, if your primary
• 25:03
  or your gynecology says now you're fine, you know, you're
• 25:06
  young, you're healthy, relax and that doesn't sit well with you,
• 25:10
  then, then, then. Seek.
• 25:13
  The expert care because no one knows you as well as you know
• 25:18
  you and and so. Absolutely, Doctor.
• 25:22
  Oh, no, that's fantastic. You know, if someone is
• 25:26
  listening today, you know takeaways, you know from our
• 25:30
  conversation, what would be the main ones that you would like
• 25:34
  them to take away? You're not alone.
• 25:39
  It feels like you may be the only one going through this, but
• 25:45
  that's not true. There are resources and people
• 25:50
  around to help you. And I really do believe there's
• 25:56
  a light at the end of every tunnel.
• 25:58
  And sometimes the tunnel's longer than we think or there's
• 26:03
  a little more, you know, scary parts of that journey.
• 26:07
  But I think that that getting to that that end of that tunnel is
• 26:13
  so amazing. And so like keeping your sights
• 26:15
  on that is, I think, the only way we all get through it.
• 26:21
  Yes. Oh, doctor, that was so
• 26:23
  beautiful. Thank you.
• 26:26
  It it just means so much. Thank you for sharing your
• 26:28
  expertise with such heart and clarity today.
• 26:31
  It means the world to have you here.
• 26:33
  It's I thank you for having me and for everything you do.
• 26:37
  Thanks Doctor. Oh yeah, For anyone listening,
• 26:40
  remember that infertility is not your fault, your questions are
• 26:43
  valid and seeking help is a sign of strength.
• 26:46
  If you need support, guidance, or simply a community that
• 26:48
  understands, Chasing the Rainbows offers a bunch of
• 26:51
  different daily support services and we're here for you to walk
• 26:54
  alongside navigate this journey with you.
• 26:56
  Until next time, be gentle with yourself and remember that hope
• 26:59
  is always possible. Thank you again, Doctor O.
• 27:02
  Thank you.