12. Should we grow babies in the lab? A talk on ectogenesis w/ MD Carlo Bulletti, Yale University.

Should we grow babies in the lab? A talk on ectogenesis w/ MD Carlo Bulletti, Yale University. === [00:00:00] MD Carlo Bulletti: The Ectogenesis means, to have the complete pregnancy outside from the human body of the mother. From the formation of the, embrio, from, uh, the sperm and ovocyte. And the growth of the, the embryo to fetus, and to fetus to baby until the end of the pregnancy. All the biological function of these embryo before and fetus later are under biochemical electromechanical controls of the machine. And even the growthness and the development of each part of the organs are under control. [00:01:00] Mizter Rad: Hello beautiful humans. Today I'm having a chat with Dr. Carlo Bulletti. He's a reproductive science specialist and a professor at Yale University. He's also a renowned fertility specialist with hundreds of papers written in Italian and English. I recently met Dr. Bulletti for a coffee in Berlin and we talked about population decline. The reproductive problems we'll face as a human race and how artificial womb technologies will allow us to grow babies outside of human bodies in the years to come. Carlo, come stai? How are you? [00:01:38] MD Carlo Bulletti: Well, very well. I, uh, we are working hardly as always. As everybody. [00:01:44] Mizter Rad: I would like to, let's, you know, jump straight away into the topic. Let me ask you something. Why do you think it is important for the human race to start thinking of gestating or growing human fetuses around, or sorry, outside the body? [00:02:01] MD Carlo Bulletti: I think that is not only an amenity such as a lot of people believe when they heard about it, but is a need for the 3 million babies that die because premature. for the 11 million of babies that , uh, uh, birth with, uh, uh, dramatic defects and for the thousand and thousand women that doesn't have the uterus. They born with, uh, ovaries, but not with the uterus. And also the woman that have, uh, hysterectomy very, very early because of cancer. But today, cancer is curable. So, uh, they, uh, have, uh, an expectant life without the, the, the happiness to have a family or at least to have a baby that they grow in the, in their own womb. And also there are a lot of other, uh, uh, groups of patients that cannot have a baby by themself. They have, uh, gamete, but they have not the possibility to have it. Now, today, they refer to To gestational carrier in in several country. But that is an issue that in several country is is debated. Because a lot of people does not accept the, you can do it by, uh, uh, For money. And uh, without money, just for love, uh, one to each other is not very common to find people to do it. And anyway that is something that could uh, block the the just the surrogate mother program and is something that provide for the health and the pregnancy and the motherhood for thousand and thousand of people. [00:03:53] Mizter Rad: I find it interesting that you touched the topic of surrogate mothers. Is this one of the ways, the problems you describe of maybe mothers not being able to have babies because they have no utero or the 3 million babies that die prematurely. Are surrogate mothers one of the solutions that the market is offering at the moment in order to have babies to these people that can't have babies?, or what are, how are we solving all these problems that you mentioned? [00:04:25] MD Carlo Bulletti: Yes. The problem for the premature babies are not resolved at all. Is limited from 20 years from From training else, by improving the capability to survive for premature after, uh, weeks 24. After weeks 24, you have half of the babies that survive. Some of them with the serious problem. In the future may be that they liquid to liquid instead they air pulmonary work for the baby, uh, could, uh, improve, uh, the capability to, uh, survive for the baby. But that is not, uh, the final solution. The final solution would be an artificial womb. One example of that for this kind of babies is what the, the guys from Philadelphia did a couple of years ago, uh, Patrick Coworker. They, uh, they, uh, Make the survival of, uh, sheep for four weeks during the pregnancy. And from the period of uh, premature to the mature. And, uh, and that means that, uh, if, uh, The, this experiment worked in the sheep, uh, maybe in the future it work also with, uh, uh, a woman, uh, that is one of, uh, the concrete, uh, possibility uh, to improve this, uh, kind of solution. There are a lot of people that have some, uh, biochemical situation, diabetics or, uh, hypertension, whatever that cannot permit them to have a baby. This could be the solution offered to these, uh, woman, uh, that otherwise they cannot have it. [00:06:12] Mizter Rad: So wait, I, I find it interesting what you said about the doctors in Philadelphia. So they basically accelerated the maturation of the baby. It was faster?. [00:06:23] MD Carlo Bulletti: No, no, they not do, not maturate, but they take the sheep, uh, the, the, the, the fetus from the sheep, um, off from the mother. They put inside to an envelope that repre an envelope, a special envelope with, uh, input and output. And, uh, uh, that simulate an artificial uterus. And, uh, they provide the survival for four weeks of this sheep. They take, uh, off the sheep, the fetus that were no mature and they, uh, mature the, uh, this fetus in, uh, outside for the, uh, body of the sheep. [00:07:04] Mizter Rad: So the fetus matured in an artificial, uh, womb, right? Basically. [00:07:09] MD Carlo Bulletti: Right. [00:07:09] Mizter Rad: And do you know what happened with that? What, what happened with the sheep? Is, is the sheep still alive or do, do you know? [00:07:15] MD Carlo Bulletti: They, they, yeah. They, yeah, they, they, they survive the sheep. Uh, and if you go to see the, the publication, they are also the video that represent, uh, uh, the experiment. There is a discre. Of, uh, all the experiment, all the artificial womb that they made and, uh, uh, the survival rate. [00:07:36] Mizter Rad: Oh, wow. Okay. So this is already... so basically artificial wo technologies are already being used, but they're not being used with humans. [00:07:46] MD Carlo Bulletti: No, uh, yeah, it is used, uh, and, uh, and not in humans. He, of course, uh, for a while is used only for the, uh, piece of the entire, uh, time of pregnancy, four weeks here, and, uh, in, in the mouse for half of, uh, entire pregnancy. There are also a group from, uh, uh, Israel that, uh, publish, uh, uh, on nature. Beautiful paper on developing after gastrulation of the, uh, uh, mouse, embryo to fetus. And they stop at a certain point, but when all the organ were, uh, differentiated. So, uh, they improve a lot of the experiment. Unfortunately, with the, uh, an animal the size of the mouse. And, uh, we have, uh, to do twice. Increase the timeline of, uh, uh, artificial womb work. And the second to increase the size, uh, of the animal, of the experiment, and then we, we will go versus the final point that could be in the future, the user for the humans. [00:08:52] Mizter Rad: And why, why is it important? Very basic question here. Why is it important the, the size of the animal? Because it is there more energy required, more processes require? A rat. A mouse is very small. I guess easier kind of to, to go through this process or no. [00:09:11] MD Carlo Bulletti: Because, uh, because, uh, uh, is, uh, is quite more complicated with, uh, with the size, the size of the animal, uh, require much more effort in, uh, in survival. For instance, I give you an example when you would do research on, uh, Embryo implantation in human uterus, the embryo implantation of humans are about, uh, 30 to 40% in, uh, per embryo, per good embryo. In, uh, in mouse is 80, 90% for good embryo. So... [00:09:44] Mizter Rad: okay. [00:09:44] MD Carlo Bulletti: The, the efficiency is much, much higher in the animals. So we have to be more carefully and to reach the human experiment when everything is done in the animals. [00:09:56] Mizter Rad: Okay. So talking about, um, in vitro fertilization, cause you're also very knowledgeable about the topic and, and you, if I'm not mistaken, you practice that also in your, uh, with your patients. Patients that, that can't have babies naturally. There is this concept called surrogacy where a host mother has a baby for another couple. Can you tell us a bit more about surrogacy and why do you think this may not be the answer to all the problems that you described? [00:10:32] MD Carlo Bulletti: No. I don't say that it is not the answer. What I said is that you have you have, uh, two way by which a woman can do the surrogacy for one another. And the first one is for money that not always is bad. And the other is that is for empathy. When they do for money, sometime they do for money because they wanted to resolve the problem of the future of their child though this function, the surrogate mother. Someone ethically doesn't accept this uh, protest, but, uh, it's something to debate. It's not, uh, completely one, one hand or to to the other, the reason. The second one is for empathy, but for, uh, empathy, uh, is uh, is not so a common phenomenon because it's very uh, uh, time consuming, uh, energy consuming and, and also cost expensive because, uh, a woman is pregnant for another, doesn't work, uh, for a, a certain period. So it is not, it is not so easy. So that is, uh, biologically a way to substitute, uh, the, uh, the mother in term of, uh, doing the, uh, uh, the baby. But in term of, uh, as a final, uh, solution, not because, uh, for instance, uh, in Italy, the debate is very aggressive and the people that is not legal in, in several countries, not legal. It was in India, but they now recently, Uh, do the possibility to have a surrogate mother only for Indian to Indian. Because a lot of people from outside of, uh, the country come to use this, uh, uh, procedure. And also, for instance, in, uh, some country in Europe is legal only for empathy, not, uh, with exchange of money. Uh, and that's, uh, is, uh, is, uh, I, I not agree or disagree is a point, is a point is uh, uh, a a point for a country. So with, uh, with, with, uh, with, uh, an artificial womb, uh, this debate is, is game over. Because you can use, uh, uh, the artificial womb instead to have a pregnancy with, uh, the help of another or the third person. [00:12:59] Mizter Rad: Yeah, so basically,. What's happening in in the world, just to, to put it in very simple words, is people that cannot have babies, they go to countries where surrogacy is legal. Let's say sometime ago in India. And they pay, I read, as low as 20, $30,000 to have some Indian woman um, Give birth and actually go through the whole pregnancy process of a couple, let's say, from the US. From the United States. And then that mother, of course, is just giving birth, that as soon as the baby is born, uh, the baby belongs to that American couple and the Indian woman gets the 20,000 or 30,000 or whatever dollars. And that happens in some countries. I also read that in Ukraine it happens. And in Canada it's actually like you said, not for financial means, but more as a favor. So women volunteer themselves with no economic contribution from the couple that wants to have the baby. So that is surrogacy, and that's the current let's say status in the world. Many countries ban it. It's not legal, but in some countries it is legal. And now what you're saying is that surrogacy, of course, don't, doesn't solve all the problems that pregnancy have. And artificial womb technology, ectogenesis, can solve the problem. Can you explain us a bit what Ectogenesis is? Like from the very beginning. Like how can we, because I mean people, people that are listening maybe are still a bit lost and don't understand what we're talking about. So maybe can you illustrate it in very simple words? [00:14:51] MD Carlo Bulletti: Yeah, yeah. The, the Ectogenesis means, uh, uh, to have the complete pregnancy outside from, uh, from the human body of the. mother I mean, uh, uh, then you have a partial Ectogenesis such as the experiment of, uh, Philadelphia that we mentioned about four weeks only on, uh, the entire period of pregnancy. But the Ectogenesis uh, is, uh, from the, uh, the formation of the, embrio from, uh, the sperm and ovocyte. The implantation in a plant that is, uh, simulating the endometrium. And that the growth of the, the embryo to fetus and to fetus to baby until the, uh, the end of the pregnancy. All, all the biological function of these embryo before and fetus later are under biochemical, electromechanical controls of the machine. And, uh, uh, and uh, it, and even the, the growthness and the rhythm of the growth, the growthness and the development of each part of the organs uh, are under control Uh, and, uh, uh, Ectogenesis is the complete formation of a baby from the beginning to the end. Uh, that, that is the, uh, Ectogenesis. [00:16:20] Mizter Rad: Okay, so I have, I have some points here. Can you actually do this for synthetic embryos? So no sperm, no egg, no fertilization. Everything comes out of a... [00:16:32] MD Carlo Bulletti: Yeah, I think that that is, uh, I think is far away. First of all, I, I wanted to say that for each uh, research, uh, the problem of a time requested to reach the objective of the research itself, is is correlated to the to the investment. The co the financial effort, uh, dedicated to this, uh, project. And, uh, of co Of course, the Ectogenesis until now, uh, was not in the priorities of research in the world. So, um, that is the reason why, uh, it is not, uh, uh, so fast. And it, it required at least, uh, more, 10 more years. Concerning the the possibility to not to transmit the life from, the, the sperm and ovocyte, but to create the, uh, that was the question, right? [00:17:26] Mizter Rad: Yeah. To create it out of the stem cell. [00:17:29] MD Carlo Bulletti: Uh, we, we have, uh, uh, a couple of information that are the US to, uh, to answer to this question. Uh, few years ago, uh, humans create, uh, uh, the smallest bacterium that never existed. Of, I think about, uh, 150 amino acid. And that was the first, uh, Original new, uh, uh, invivo element, uh, that, uh, was created. Um, the geneticist from United States says that, to generate, uh, 30,000, uh, gene sequencing, uh, that is what we need for the, uh, humans, it may occur, uh, at least, uh, uh, from, from 10 to 20 years if, if, uh, a lot of front of researcher are focused on this goal. Of course it depends on how many people are dedicated to that. But when, when we use the same technique by that, that we use it for the, uh, the, the, the, the small, uh, microbe that we, uh, created to, uh, making sequence, uh, the humans amino acid, we then create the new, uh, uh, humans. And at that point, Medicine does not, uh, uh, uh, does not work to transmit life, but medicine work to create life. [00:19:03] Mizter Rad: Yeah. So we, we, we go from being sexual species in sexual in terms of reproduction to being maybe asexual, uh, uh, that basically to have new off offsprings or children, don't need to be coupled with someone else. Just as a single, as a single cell. As a single organism. [00:19:27] MD Carlo Bulletti: Yeah. Yeah. Because, uh, because the envelope of the ovocyte, for instance, could be the same, but you insert instead of the DNA of the mother, the new DNA that you generated. And that is, uh, today with the Crispr technique is always much, much easier. Even if the project for human is a big project. For instance we already mentioned the experiment that did a group of researchers from Portland, Oregon, that change, do not, do not discarded the embryo with myocardial atrophy. Uh, there was a mutation they, uh, identify changed this uh, mutation by creating a new embryo that was forever without this rare disease. [00:20:17] Mizter Rad: Okay. So let me go back to Ectogenesis, because we're off, off the tangent a bit here with synthetic embryos. So we went a bit too far in the future. That's that's not happening yet. But with the Ectogenesis basically for people to be on the same page. Instead of doing in vitro fertilization, for example, where you take a sperm from the man and put it in a, in a woman uterus, and then the woman grows, a fetus... an embryo, and then a fetus, and then a baby in her body. Now you're saying, no woman, you don't have to do that. We can all, we can do that all in a lab, and or in... in a safe environment, let's say. And in that safe environment, the embryo, the fetus, the baby will be able to grow healthy because we have all the mechanics, and chemicals, and nutrients, um, and environment that the baby needs to grow healthy. And on top of that, the woman, the mother that opts to go that way, will be able to control or to look at the baby remotely from the phone, for example. Is that correct? In theory. That's the vision. [00:21:34] MD Carlo Bulletti: Yeah. Yeah. The, first of all when we are talking about the future, uh, goal in research, we have, we have to, to say several times that what we are talking now does not exist. It will be exist, but does not exist because people can have some dream, uh, by themself. Unfortunately, it's not. For instance, people that have a law that, uh, doesn't allow to have a baby with another woman with a gestational carrier here, they dream to have this system now. But, uh, we don't have it yet. It's not because several women wrote me to, to ask for, for that, but it's not for the, that time. It's only, uh, a discussion for the future. Yes. [00:22:17] Mizter Rad: Right. [00:22:18] MD Carlo Bulletti: Coming. Coming to your question. What I figure out in my ideal plan would be, uh, uh, Exactly what you said. Now, when in 19 89 in Mount Sinai, New York, I uh, I preserved a human hysterectomized uterus in a cabinet by perfusing with uh, oxygenated fluid, for more than two days. At that time, I put one embryo, uh, in, uh, in, uh, not in New York, but when I came out, came back in, in Italy, I put, uh, one embryo inside to the uterus and the embryo implanted. Uh, was the first human pregnancy, beginning of human pregnancy outside of her human body. And it worked for two days. 52 hours. What we can do is tohave a fertilization in vitro. Okay. But then we may add a cabinet in which we have a platform, in which you can put an artificial endometrium that, uh, already exists with, uh, uh, stromal and epithelial cells. That are oxygenated and with the blood of the mother, you have a thin, uh, tube, uh, behind this platform that oxygenate the platform itself, uh, and give the nutrition of the mother to this platform. Here there is the implantation in vitro. We have several experiment on mouse that did that. So that, uh, you have the implantation outside of the human body, but uh, from the other species. Uh, and, and then it grows until, uh, and after gastrulation. Until now, there are a general worldwide ethical law that, uh, uh, do not allow research to go over 14 days of development in vitro. But, uh, several, uh, groups are asking to move uh, after this, uh, threshold. And, uh, and... then, [00:24:23] Mizter Rad: so wait, sorry, one second. 14 days is the, is the maximum that you can do in vitro. And is this like in a artificial womb also? [00:24:32] MD Carlo Bulletti: Yes, yes. That is, is something that is unethical. Uh, worldwide accepted, uh, deadline that we cannot, uh, pass to. Uh, but, but, uh, today for instance, the, the, the people, uh, the, the colleagues from, uh, Israel, they did, uh, in mouse, uh, this beautiful, uh, paper on natural. They, uh, go over very over. And they have, uh, after gastrulation, uh, so much over and, uh, uh, and demonstrated the, uh, differentiation in all the organs of the mouse. Uh, however, uh, that's may, uh, continue with the formation of placenta inside. And, uh, there is, uh, therorically the growth of this fetus inside to the, this cabinet that is a cabinet, uh, protected from the light, uh, with, uh, an an environment in fluid that is, controlled by, uh, an, uh, they were perfusated with, uh, a, an, uh, artificial heart, artificial lung. And, uh, artificial kidney that, uh, work for the fluid inside, outside of the baby. And, uh, from the fluid that, uh, uh, enter as a blood in, uh, in the baby itself, that is the, the blood of the mother. Uh, [00:25:58] Mizter Rad: This is fascinating. So basically like machine making sure the environment for the fetus, for the baby is perfect. [00:26:09] MD Carlo Bulletti: Yeah, because, uh, because, uh, is, is, uh, computer controlled, and now is quite easy... For instance, if you have, uh, outside in the fluid in which, uh, the baby is, uh, immerse, uh, if you have a variation in pH, you can easily by voice, say to the computer to change the pH of... of, uh, the immersion and, uh, and, and it's happening in second, not in... [00:26:36] Mizter Rad: Crazy, crazy, crazy, crazy. Absolutely fantastic. I mean, this, again, for the people that are listening, this is not happening yet. No. This may be the future. This may the future. [00:26:50] MD Carlo Bulletti: Absolutely. But, but as, the great artist, Kandinski says, used to say: what it, it'll come before you have to imagine it. [00:27:02] Mizter Rad: Yeah, absolutely. I agree. I mean, if we're able to imagine it, it's, yeah, it, it will become a reality at some point. As you say, it is not a priority right now. It's not a priority. In terms of funding and people working on this, there is still a lack. There is not much money put into this yet. Why do you think we should fund this? Is it because we wanna live longer? Uh, is it because we wanna have healthier babies and humans, and we, we have the power to control that in, in, or, or let's say from the very beginning of life, in a very controlled situation. [00:27:39] MD Carlo Bulletti: I think that the indication for amelioration, uh, the, uh, human being are, are obviously, are completely, uh, evident, uh, on the, as always happened also, the abuse of, uh, one. Uh, or one technique or the different use if you want it, uh, could be taken account. [00:28:04] Mizter Rad: So do you think that, let's say we start living longer and we start growing fetuses, babies in a more controlled environment, like in a lab. In general maybe in the future we'll be able to have more control over our population growth. So I would like to know, in your opinion, who should be taking this responsibility given that the world has limited resources? Should the government be the ones having the responsibility of controlling the population growth in, in, in a sense that they can monitor how many babies will be born, let's say in lab, or should be the companies, or should that be an individual right? Or how do you, I mean, I know it's a very complicated maybe question or thing to imagine because this is not happening yet, but as a, as a scientist, as a doctor, how do you see this, um, rolling up in the next decade? [00:29:04] MD Carlo Bulletti: Yeah, I think, uh, I think that, uh, this is an old question and, uh, is an interesting question for. As you know, uh, in, uh, in a populated and very populated country, uh, such as in China, they had, uh, and they, and they renounced later to the low, having only one baby per couple, uh. Because, uh, they, they were too many. But then, uh, after, uh, after a certain time, they observed that the population, uh, were decreasing in China too. And they removed the law that, uh, regulating one baby per one couple. What I think is, uh, that, uh. You right resources in the world are, uh, limited. Uh, are not infinite. So, uh, but maybe that is the rule of the resources. To limit the, our possibility to reproduct. So for instance, uh, in the world population starting from, uh, uh, 90, I don't remember, 17 something, something else. It, uh, it, it start to decrease. Uh, despite, we have 8 billion people right now, differently from 1950 that we have two, 2 billion and a half. Now it, it start to decrease. Uh, with, uh, with several differences in country. But for instance, China and India that are our nightmare right now, uh, are decreasing, are decreasing. The, the only country that is increasing the is Africa. That we have the mo that we lack the most populated, uh, count, uh, city, uh, in, uh, in 30 years right now. I think answer, to answer to your question, I think that is very difficult to have a law regulating the number of child that the family can can have. But I think that resources automatically regulate the possibility to happen and to maintain, uh, a baby, uh, with the increasing the level, uh, of economy, uh, uh, as the economy increase with the globalization correspondently uh, the, uh, the child, the number of child per family decreases. Uh, and that's because, uh, uh, people doesn't want anymore to have baby at all. They wanted to have a baby, a gift to them, the possibility of the future. And, uh, without resources, this possibility that they're not. [00:31:37] Mizter Rad: So what you're saying is that richer nations tend to have less babies and, and poorer nations less tend to have more babies. And the reason why that is, is because richer families, at some point they, they say, I don't wanna have more babies and maybe I wanna spend my time learning, traveling, taking care of myself. And at the same time, I know that the, I'm, I'm educated enough, or knowledgeable enough, or aware enough that the world has limited resources and I'm not gonna have more babies. And then let's say the lower income countries don't think about that. They have more day-to-day issues to take care of and they have not that long-term planning that maybe richer nations have. Is that correct? [00:32:24] MD Carlo Bulletti: Yeah. Or. No, I, I, I, yeah, I, I think, I think that, uh, the control of population would be, uh, uh, uh, would be generated, but by the, uh, this, the possibility of resources as soon as resources decrease you cannot have more babies. So there is a sort of automatic regulation in humans. Um, I don't know if you, if you know the story of, uh, uh, the, the, the, it is not the rat similar to rat that was described in north of Europe, in which, uh, when, uh, The population of a certain rat increase so much they go and put themselves in the water and they suicide. [00:33:12] Mizter Rad: Ok. I don't, I dunno, this story. Okay. Is this like a real story? Is this like a real rat? [00:33:16] MD Carlo Bulletti: Yeah, it is something that, uh, is in, in, in all the talk that, uh, you can reach when you have, uh, uh, uh, reading about population increase of population. Uh, but, uh, even, even, uh, if, uh, is a metaphor. Uh, now, uh, what we see is that when the population increase so much, there is, too much poverty, not enough food, and the people, uh, doesn't want to leave, uh, like that. And, and as soon as they have more, uh, resources, they decrease the population because, uh, that was happen with the globalization right now. [00:33:54] Mizter Rad: And how, like, I always, while I was having a conversation with you today and also some weeks ago in Berlin, I always wonder what kind of pushback do you get for the work you do? Because living in a country that, you know where the Catholic Church headquarters is, I imagine that is not very Catholic of you, what you do for some people. Um, do you, do you get any kind of pushback or any criticism on, um, the kind of job or the kind of thoughts you have in terms of Ectogenesis and Artificial Womb Technologies and all this stuff? [00:34:31] MD Carlo Bulletti: Oh, well, there, there, there is, uh, uh, a stronger criticism, but, I respect, uh, the point of view of everybody. But I consider also that the way by which they consider family, uh, uh, is an old, an older system. The, the child, they consider the child only if you generate with a woman, man, woman, and and, uh, the classic pregnancy. Otherwise they don't consider family. But the family today are very different. Uh, you may have the family because you consider someone your child and you take care of him until he died. Uh, so, uh, they, they, he is not a biological phenomenal to be parent to, uh, the, the, to be parent today is, uh, the promise that you do, uh, to take care of someone forever and love it. That is the only criteria to distinguish a parents. Nothing else. And that is not in the, in the, in the mind of my country general opinion. But I don't care is, uh. I think it's the better of another era. I, I, I will, I, I prefer to look, to look, uh, in, uh, in front of me rather than, uh, behind me. [00:35:53] Mizter Rad: I, I see what you mean. There is also this belief that , there is this power of the communication between the mother and the child while, while the baby is in the mother's belly, and of course with Ectogenesis or growing a fetus outside of of a human body, this would not exist, in theory. What do you think about this? People that think about this? [00:36:16] MD Carlo Bulletti: Yeah. Yeah. It is a romantic idea that's came out, uh, several times since a long time. For sure the baby starting from a certain period of, uh, pregnancy, they can hear the rumors and whatever. The problem is that romantic people believe that are specific of their mother, their father, and they said with a very funny uh, talk on the, on the belly of the mother. But, uh, the problem is that, uh, is not specific. They can hear and they can react to the, uh, rumor. But not react to the specific rumor that are not specific. If you, if you do that, uh, in a, uh, with a disco, with the music, with, uh, other thing, is the same, uh, that the voice of the mother. So, you can have the connection even in, uh, an artificial womb. You can, uh, you can put, uh, the talking or if you prefer Frank Sinatra. Uh, but, uh, uh, it is not a question of the mother. [00:37:17] Mizter Rad: Okay. It is not a question of the mother. And for you, this is more like a part of what the culture taught us. The, that's the kind of the relationship with the mother and son? [00:37:29] MD Carlo Bulletti: That, that, that are stimuli are come, uh, uh, audio stimuli that can, uh, can produce a reaction. That's true, but, uh, uh, are not specific. [00:37:40] Mizter Rad: And I was thinking, and when I was talking to friends of mine before talking to you, uh, for many of us, you know, human bodies seem to be an incredible machine. Capable of to compute hundreds of thousands of microprocesses every second. Each organ, each hormone, each cell, with its own function. The body is almost like the most, you can see it as the most perfectly synchronized army in the world. And this obviously includes the processes that happen during, during the fertilization of an egg, the formation of the embryo, and then the development of the fetus and all the things that we talked about that happened in the womb. Yet we are here trying to fix and improve the process that to many, to many in our culture, in our days seem perfect. But of course, throughout many years of experience that you have , you've seen a lot of things of why you may think that this process is not perfect. What, in your opinion, are the main challenges that human bodies of the 21st century have that cannot or don't, don't allow them to get pregnant and have babies? So just to mention maybe 3, 4, 5 things that you say, because of these five things, women nowadays in the 21st century are not being able to have babies. [00:39:04] MD Carlo Bulletti: The reason the first one is, uh, for sure the age. People, people, uh, start, to study uh, and then they plan to have a family after this two study. But then when they finish the study, they, uh, plan to have a baby after the beginning of the work. After the beginning of the work, they plan to have a baby after they have house, but after the the partner is not good anymore. So they changed the partner. [00:39:38] Mizter Rad: What do you mean the partner is not good anymore? [00:39:40] MD Carlo Bulletti: Yeah, so that, uh, is exactly as they in, uh, in the famous, uh, song of, of Talking Heads. This is not a beautiful house. This is not my beautiful ma uh, uh, um, uh, spouse. I mean, Yeah, I think it is the time, uh, because, uh, uh, we believe, uh, uh, uh, earning and, uh, and reading the uh medicine of triumph we believe to be able to, to do baby whatever we want to have it. Uh, we can see in the, in the newspaper, uh, actress or whatever, that baby, a 45 or whatever. They cannot say that our donor of ovocytes. They believe that, uh, it is possible just with the, with the natural way or by you, by the help of medicine, you can. And, but that is not true. So the first reason is the false message that, uh, everybody of us give to the young people. The second one is, uh, is more technically, uh, is, uh, Uh, uh, and the, the age is related to the ture, the quality of the ovocyte. A woman, uh, born with a certain amount of ovocytes that decreased during the life. But also, the quality of the ovocyte decrease in the life. There are half until 35 that are good to have a baby. Half that are not good to have a baby. Uh, and then that decrease. [00:41:11] Mizter Rad: What is that? Is that the eggs or what is that? Sorry. [00:41:14] MD Carlo Bulletti: The eggs. The eggs, yes. Uh, half of the eggs that are in the ovary until 35 are good for to have a baby. But the other half are not good to have a baby. And, uh, after 35 it come, it, uh, decrease, uh, slowly. But after 39 it decrease rapidly. So, the ovocyte good for having a baby uh, are around 12% after 40. So, uh, is, is not, uh, so much. So that is the first reason. Then we have the reason of, uh, Some disease inside to the, to the pelvis, to the abdominal, uh, such as, uh, sexual transmitted disease that produce, uh, other s that are blocking the, uh, uh, encounter of sperm with ovocyte. And then we have also endometriosis that is a specific disease of woman that produce pain and infertility. And then, Some other conditions such as, uh, uh, fibroids, uh, polyps and whatever that are, uh, resolved, uh. That is the, the major reason why. But the most important one, uh, is the age. If people become to have a baby around, uh, around 23, 27, uh, everything, uh, the, the percentage fertility, uh, should, uh, decrease at least of a half. [00:42:39] Mizter Rad: Okay. And do you think that the growth of processed food consumptions and the, the, the kind of lifestyles that we have nowadays in, in, in our times, contributes to this maybe unhealthy bodies, like you mentioned, uh, having maybe endometriosis or polyps or, um, other things that don't allow women to have babies nowadays? [00:43:06] MD Carlo Bulletti: You think? Do you think the habits? [00:43:08] Mizter Rad: Yeah, the habits. The, the processed foods. Yeah. The kinda lifestyles that we have. [00:43:15] MD Carlo Bulletti: Yeah. Yeah. There, there several, several, uh, Several papers that, uh, are reporting, uh, uh, in not in a clear manner, not in a strong evidence for, uh, smoking, for, uh, abuse of alcohol, for, uh, uh, the, but uh, also for body mass index when you are obese or, uh, big obese and, uh, and, uh, that may, uh, add a role in infertility. Unfortunately, what, uh, we need is, is not very clear, is the reversal. Uh, I mean, if you are smoking and you stop, uh, you don't have the demonstration that you revert your, uh, previous fertility, such as, With the alcohol and, uh, mostly for the body mass index, that is more, uh, one of the most important. Uh, if you reduce the weight, you don't increase the fertility, that is the, the bad thing. But if you increase the weight, you lose a little bit of fertility. [00:44:23] Mizter Rad: Okay, I see. That's a complex situation then. [00:44:26] MD Carlo Bulletti: Yeah. Yeah. [00:44:28] Mizter Rad: How do you want to be remembered Doctor Carlo Bulletti. In, you know, a hundred years from now? How would you like to be remembered if you would like to be remembered as anything? [00:44:40] MD Carlo Bulletti: Oh, uh, I think, I, I think that, is pretentious to be re to be reminded from the... in the future because, uh... [00:44:50] Mizter Rad: we we're all somehow pretentious, aren't we? [00:44:53] MD Carlo Bulletti: Yeah. Because after 10 years, nobody can, uh, remember you. But, uh, I think, uh, I would like for a short period of time to be remember as a good person. Not, not, uh, as a scientist, but as a human. [00:45:08] Mizter Rad: That's a beautiful answer. Is there anything else that you would like to share with my audience? There's a lot of young people that listen to this recording and that maybe are interested in the science or in medicine. Or in general, in the future of humanity. What do you want to tell them, based on your life experience and based on your field of expertise? How do you think humanity will evolve? And should we have hope, uh, sh should we not be scared of what these technologies might bring or contribute in our lives? And instead, should we be more positive and hopeful? What, what is your general message for this young generation? [00:45:54] MD Carlo Bulletti: 2, 2, 2 messages. First one uh, do not think that the star has something, uh, too much, uh, uh, distant from us, otherwise, you are not, you will be not, never be a good astrologist. And the second one is, uh, uh, To try to do in the life what, what you like to do, otherwise, people, uh, doesn't permit uh, uh, that, uh, the people constrict you to do what they do wanted to do. Hmm. [00:46:27] Mizter Rad: excellent. Carlo, thank you so much for your time. I appreciate this conversation. It's the second time that we talk and I hope this is not the last one. And I wish you a beautiful week and I hope to see you soon again. [00:46:41] MD Carlo Bulletti: Okay. Have a have a good, have a good week. Bye-bye. [00:46:44] Mizter Rad: Thank you. Thank you everyone. Bye-Bye.