Nucleus Launches First Genetically Optimized Embryo

0:00Nucleus embryo is a genetic optimization software. So usually parents have a couple viable embryos and now they can actually take the raw DNA files of them, upload to nucleus, and we'll give you analysis on everything from cancers to IQ to eye color to hair color to schizophrenia risk. And so what really we're doing is we're completely empowering the patient with the full genetic profile of their embryos so they can genetically optimize their children. Sometimes people think DNA is everything and that's why they're scared of it. DNA is not destiny and DNA will never be destiny. It's one of many tools that parents use to give their child the best start in life.

0:34And I think Nucleus Embryo is going to really bring that technology to everyone. Keon, welcome to Sorcery. Thanks, Molly. Thanks for having me. I love that we're both matching in our... I mean, wow. Cream knits. I mean, I have to say, we coordinated this, didn't we? Clearly. Clearly did. Well, more importantly, congratulations on the big launch of Nucleus Embryo. What is Nucleus Embryo and why is this moment so significant? Yeah, Nucleus Embryo is a genetic optimization software. So we help parents give their child the best start in life. So usually parents have a couple viable embryos, and now they can actually take the raw DNA files of them, upload it to Nucleus, and we'll give you analysis on everything from cancers to IQ to eye color to hair color to schizophrenia risk.

1:17In other words, we give you the full genetic profile of every one of your embryos. With that, we're excited to announce a couple of things. One is we've partnered with Genomic Prediction. So Genomic Prediction was one of the first startups that ever actually did genome-wide testing in embryos. We are basically enabling old genomic prediction customers to access our embryo software, our genetic optimization software, so they can basically make more thoughtful choices. And also we're excited to announce this is the first time a couple has partnered, excuse me, this is the first time a company has partnered with a couple who have optimized their embryos on the basis of intelligence.

1:52So we have multiple massive announcements today. There was a Wall Street Journal exclusive article that came out. And all around, I think the company is just feeling so, so excited. Well, there's a lot to break down there and so much to get into, especially the couple optimizing for IQ. First, I want to get into the genetic optimization software for embryos. What does this actually mean? What this means is, you know, parents for the first time ever can give their children the best start in life. So often, you know, the first thing parents think about when they're having healthy children is, how do I not pass down like a rare disease, right?

2:28Something like maybe someone's a carrier for cystic fibrosis or something like Huntington's, for example. And they might think, okay, how do I not pass this down to the child? Then they think about maybe other diseases like common diseases, like breast cancer, like heart disease, right? These are conditions that generally speaking are just simply not tested in the clinic today. So let's say you're a couple doing IVF. The first thing that's very well accepted in the IVF context is making sure your child doesn't have any chromosomal abnormalities like Down syndrome, for example. Okay, so that's the first thing.

2:58Then they might test for rare hereditary diseases, as mentioned, like cystic fibrosis. But then that's it. They don't test for common diseases like cancers or heart disease or schizophrenia. They don't run any more sophisticated modeling of genetic prediction on things like IQ or height, for example. And so what really we're doing is we're completely empowering the patient with the full genetic profile of their embryos so they can genetically optimize their children. To put some numbers against that, what does that mean in terms of like how many embryos you can optimize at once or how many actual conditions there are?

3:36Usually couples have, you know, three to five viable embryos. So they would take these viable embryos that go to their IVF clinic. Maybe they use genomic predictions and PGTP test, and they basically request the files from the clinic. They get these three to five files. They upload it to Nucleus and then Nucleus will analyze these files across literally everything, across diseases and traits as mentioned. And then basically parents have to choose. You actually, it's very easy to, we analyze the embryos and then you can very easily sort them. You can compare them. You do all these things and then yeah, and then you can pick the one you want to implant.

4:10I guess more seriously, like why now and why you? Like, why do you think that it's capable now that you're able to do all this technological advancement versus, let's say, like five years ago? One of the big things about nucleus is preventative medicine. If you think about it, this is the greatest manifestation of preventative medicine. It is, you know, the genome is the foundation of health. We always say that. It's the foundation of life. It's the inception. If you go back and think, what is the single greatest way to reduce disease incidence? What is the single greatest way for a baby to live a long and healthy life is to go back to their DNA.

4:45And so I really see the launch of our embryo analysis product as an expansion and greater manifestation of our vision of a more preventative based medical system, one where people are empowered to live longer. We really champion at Nucleus something called generational health. Generational health is this idea that you do a genetic test, not just for yourself and your own health, right? But for your parents, for your children and their children. And I think you're seeing the rise of this kind of reproductive genetic stack forming, right? Parents came to Nucleus to do preconception testing to see if they're a carrier for anything.

5:19And then if they were and they weren't a genetic match, or even if they, you know, whether they're genetic match or not, they said, okay, maybe I want to do IVF now. And I want to now test my embryos, right? In other words, you can kind of see how adult testing, you know, genetic matching, which we launched a couple months ago, led naturally to then embryonic analysis. And so you see this testing from preconception to conception. And now even after birth, we're going to be exploring as well. And this reproductive stack is all genetically based. It's all genetically informed. And the embryo's DNA file is the same as an adult DNA's file.

5:53So we're taking the most cutting edge analysis and models that exist and applying it to embryos. And so when you think about it, this made perfect sense, not just technologically speaking, but fitting the ethos of our business of building a dramatically new preventative-based medical system. I think it's important to take a step back and actually understand how important this moment is in the grand scheme of fertility. There are significant shifts in the US for fertility. It seems commonplace now that couples are freezing eggs, that they're using IVF. And even broader than that, there's declining birth rates worldwide.

6:34Could you put some data behind all this? What is the current state of fertility? Well, you make a great point. First off, birth rates are declining. IVF is becoming much more commonplace. I mean, I think the statistic is that one in 50 babies today are born via IVF. That would be crazy to say a couple of decades ago. I mean, at some point, IVF babies were, you know, test tube babies, right? Now it's just how people have children. And you can imagine as it becomes easier and easier, maybe you take stem cells and make an egg or sperm, as it becomes easier and easier and less invasive to make an embryo, you can imagine that IVF is going to become more and more ubiquitous.

7:10And it's interesting because, you know, I always talk about the decreasing cost of whole genome sequencing. What used to be a billion dollars is now a couple hundred dollars. That obviously DNA being the generational health tool that it is, doesn't just impact adults and longevity, but also impacts fertility. And so you're going to see the rapid decrease in cost of IVF combined with the rapid decrease in cost of sequencing a genome. These things are going to converge together to enable this just this massive, massive new generation of parents having genetically optimized children. Sorcery is brought to you by Brex, the financial stack trusted by more than 30 ,000 companies, including one in three venture-backed startups in the US.

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8:38Start today at brex.com slash sorcery. That's B-R-E-X dot com slash sorcery. Could you draw that out a little bit further? Yeah, so a couple of things are happening in the context of the broader kind of reproductive world. So one is people are having births later. As you know, I mean, intuitively kind of people already know this. Women are having children much later on in life. And that means more and more women are opting for IVF. IVF is very expensive. I think the statistic is that's around$25 ,000 per cycle, which is pretty crazy. And with that, I think it's 2.8 million people, 2.8 million people in the United States have genetic disease.

9:20So think about that. all the pain, all the suffering that exists because of genetics. And we have the tools today. We have the tools today, combining preconception screening, and it can be with or without IVF, to actually basically help millions, literally millions of lives to prevent genetic disease. And so when I think about the kind of broader reproductive transformation, you're seeing basically the rise of IVF, you're seeing the cost coming down, you're seeing sequencing costs coming down, and you're seeing women especially who want to have children later on in life. And so this technology, and also on that point too, there was actually a really good study that was done asking couples about genetic optimization, which is, you know, what's their perspective on it?

10:06And in the study, it said over 50 % of people said genetic optimization for something like IQ is fine. And And then I think four of 10 people said if they could genetically optimize their children to get into a better college, they would do so. Wow. Yeah. Isn't that crazy? And I think it's interesting because genetics is another tool, right? Sometimes people think DNA is everything and that's why they're scared of it. DNA is not destiny and DNA will never be destiny. It's one of many tools that parents use to give their child the best start in life. It should be thought of as another medical intervention, right?

10:37A vaccine, right? Sending your kid to the best school, right? It's just another tool in the toolkit. and I think Nucleus Embryo is going to really bring that technology to everyone. It's still like a very early category. Like this was something seen as sci-fi and many of your announcements always seem like sci-fi, but it is reality now and it's something that people haven't actually considered. And so maybe the education on it might be limited, but I'm just curious, how does Nucleus fit into this broader fertility crisis and how are you educating people that these tools do exist? One of the core pillars we have is customer obsession.

11:16So I think what makes us different than a lot of other IVF genetic testing companies is there's a lot of technical improvements. But even beyond that, we're for you. We build software for you. Doctors and physicians, unfortunately, they have the key today on people's embryos. If you go and talk to fertility clinics, if you go talk to doctors, right now the doctor is the one that basically gatekeeps and controls what information couples can access about their own children. And so going back and kind of paralyzing this to the adult testing world, which today Nucleus is known for, in the same way often doctors will gatekeep genetic tests for adults, it's even to a more extreme extent in the context of embryos because other people will make value judgments for couples on what information they should and shouldn't get.

12:03We completely reject that. We believe that every piece of information from cancer to IQ to schizophrenia belongs very thoughtfully in the hands of the patient. And the patient is the one, not the doctor, that the patient is the one that should pick their embryo. Why do you think that parents still feel like having children is hitting a lottery ticket? Well, look, I think people are having children much later on, right? And IVF is a hard process. I mean, I think IVF takes a big toll on the woman's body and it's expensive. It can be demoralizing, right? If you have a miscarriage or the like. And so it's totally understandable that by the time you have a couple viable embryos, you would want to get any amount of information you can possibly get to basically pick your baby.

12:53I think that IVF is something that it's going to eventually get less invasive, but today it is still pretty invasive and it's still pretty expensive. And so I really think a technology like nucleus embryo will help couples have even more confidence when they're making that choice that they're giving their child the best possible start in life. A part of your announcement was on your partnership with Genomic Prediction. So what does this mean for the industry and how did you guys start working together? I think this is a defining moment for the genetics industry. And the reason for that is because of what you said.

13:27We're going full stack, baby. Everything from adults all the way to conception, all the way to beyond to birth. The genetic stack is forming. The reproductive stack is forming. One of my visions I had five years ago is I realized that, you know, sometimes people think of the genetics industry. It's like, oh, there's 23andMe and Ancestry, which are kind of like gimmicks. They do genealogy. Then there's like clinical testing companies like Natera or Myriad Genetics that are like very serious and will test your risk for, you know, cancers. And then there's pharmacogenomics companies, which will tell you how your DNA affects your metabolites and different drugs.

14:02And then there's also IVF genetic testing companies. And these things today are viewed as all separate. Here's the thing, and we will show this to be true. They are all the same. Because fundamentally, through the rise of the whole genome test, you can actually combine every single one of these applications. You can combine, you know, kind of Ancestry, Natera, Myriad, IVF genetic testing companies, pgx companies all into one roof into one house because again principally the the we're an adult dna testing company today but it's the same models that you use to analyze adult dna than embryo dna because obviously embryos grow up to be adults right it's the same dna dna is the you know language of life and so i think what what the genomic prediction partnership is showing is this full stack and with that also i think you know what it means to be a genetics company is being redefined, which I find I take great joy in, right?

14:53There's nothing more satisfying to me as an entrepreneur than the bearishness today on the DTC market. Because they go, oh, 23andMe failed. Oh, 23andMe failed. What do you think about it? What do you think about it? I think, you know, you're asking me, why did the horse carriage company fail? It failed because it's run by horses. You know, I have a Bugatti on the road, you know? And eventually the world's going to see that. And I think with this announcement, people are going to start seeing that because generally people don't associate a company like 23andMe with an IVF genetic testing company.

15:19I mean, what do these things have to do? But now the technology is powerful enough that these things are one of the same. And we couldn't be more excited to partner with genomic prediction. We couldn't be more excited to send and recommend our patients to do IVF with GP. They're the oldest player in the space. They have by far the best technology in terms of testing embryos. And so we're just so excited to continue to grow that stack and provide what we really see as generational health. And what does that mean for users and their onboarding experience? Yeah, so it means a couple things. So there's kind of a couple paths here.

15:53Often what happens is someone will come and do nucleus family. So nucleus family is our preconception test. We can see if you're a genetic match with your partner. Once you do that, and let's say you're not a match, you can actually then do IVF to actually make sure you don't pass down that rare condition to your future child. So I get the question a lot, which is, oh, well, Kian, what do I do if, you know, I'm a carrier for cystic fibrosis and so is my partner? Then like, am I screwed? Like, what can I do? Like, that's why maybe you don't even want to do the test. That's actually the beginning of solving that problem, right?

16:22You love your partner, turns out you're both a carrier for cystic fibrosis, no problem. Now we can refer you to our partner at Genomic Prediction, and then you can use the analysis technology to actually then pick the embryo without that condition. Then you can take those embryo files and actually run them back on Nucleus and then pick the one that is optimized to your preferences. So you can see, Molly, how this stack is forming where people come to Nucleus and then we actually send them to Genomic Prediction. Similarly, someone will go to genomic prediction, and the first step of any IVF process is preconception testing.

16:53Preconception just means before, you know, conceiving before there's an embryo, where you just get mom and dad. It's basically nucleus family, right? So genomic prediction will actually send those patients to us. And so now you can see, again, this stack forming. And I really think in the history of genetics, I really believe this, it's going to be one of the most defining partnerships that existed. Because eventually, you're not just going to be sequencing and analyzing DNA. You'll also probably be editing it as well. And it's funny because in the Wall Street Journal article, I'm not sure how many people saw that, but I was doing gene editing eight years ago in a do-it-yourself gene editing laboratory.

17:30And there's a lot of parallels with that as well. When I was doing that gene editing work, a lot of people said, oh, it's controversial. Oh, you shouldn't have access to technology. But what I learned is when I use that technology, when I use CRISPR, it taught me more about the technology than any reading I could have possibly done. And in using that technology, the laboratory set up the ethical frameworks that then I could operate within. So with Nucleus, I intend to do the same thing. The best way to educate parents about genetics and what genetics means and what genetic analysis means is by putting it in their hands.

18:00And that is exactly what we're going to do and doing it in a very thoughtful, careful, and deliberate way. DNA is not destiny. It's one piece of the puzzle. And that's exactly what we tell the patient. What are the specific categories of traits and conditions that you're analyzing? How accurate are these predictions? Yeah, so the different categories ranges from cancers to heart conditions to mental health conditions to something like physical characteristics like height or eye color or hair color. And regarding the predictability of the models, there's a large range depending on how genetic something is.

18:36For example, people might intuitively guess that something like height, right? Height, you would probably guess, you probably guess that's pretty genetic, right? You look at mom and dad, you're like, okay, this thing is like pretty genetic, which it is, right? And so that model tends to be a very good, strong model. Let's say something like depression. Depression's dramatically more environmentally driven, right? Than height. And with that, you would expect that model to be dramatically worse. And so DNA isn't deterministic. And that's actually not a bug. That's a feature, right? Obviously DNA, if it could predict everything, that there would be no free will, right?

19:09But it can't. And so one of the things that we're really careful in doing is we actually tell patients when they're using our services, which models are better, which models are worse. And the way we present results to patients always takes this into account in that if a model has lower genetic predictability, you would basically see the deviation or the prediction of the model to be mostly driven by non-genetic pieces of information. That might be a little bit too technical, but what I'm basically principally saying here is that genetic models are highly useful today and there's a range of them and different phenotypes or different traits or different diseases are driven to a different degree by genetics.

19:47And we communicate that to the patient. We express the limitations of the results of the patient and the patient can take the results and make the choice that they find best for their family. How far can you take picking out traits though? Like can you make an Elon Musk baby or a kylie denner baby no you can't um you can so one of the most important things to understand is that when you are doing embryo selection right the possible memories you have is based off your partner okay so the most important decision actually is who's your partner right like if you want like a really smart baby you should probably marry someone that's really smart right if you want a really tall baby you should probably marry someone that's really tall because the embryo selection will always be a relative optimization right iq can explain a couple IQ points, right?

20:33Height, you can, you know, explain a couple inches, but principally, if you, the most important kind of, the ingredients for your embryos comes from mom and dad, right? So that's like by far the most important decision. Embryo selection is always a relative optimization, but even though it's a relative optimization, it can still be a highly useful relative optimization, right? You can still dramatically reduce a baby's risk, for example, for something like Alzheimer's, which is then strongly associated with longevity or breast cancer or coronary disease, which are the top killers in the United States today.

20:58And so all this to be said is that, you know, you can't make Elon, which I don't even know if you want to make Elon. You can't make Elon, but you can give your baby the best star in life. It's an important tool and it's going to become only more prevalent. And how does nucleus embryo differ from what fertility clinics are already offering? Yeah, there's a lot of things. So fertility clinics, generally speaking, they're focused on really, really severe genetic diseases. So like Down syndrome, for example, or like a rare hereditary disease like cystic fibrosis or Tay-Sachs or Huntington's, they don't venture into the world of what kills most people, which is chronic conditions, things like cancers, things like Alzheimer's, things like Parkinson's, things like heart disease.

21:39They also do not veer into the land of traits. From our perspective as a company, there's really no difference between diseases and traits. It's a false line in the sand that was drawn. What do I mean by that? Think about height. right? The extreme enough version of height is, you know, Marfan syndrome. It's a disease. On the other end of height is dwarfism, also a disease. In other words, you know, trying to kind of say, oh, this is a, this is disease and this is trait and this is allowed, this isn't, it's completely arbitrary. The most important thing for us is that we do everything above board.

22:09Sunlight is the best disinfectant. We operate by transparency. Everyone has access to all the information, all the limitations are there, all the probabilities are there. And then patients can basically go from very kind of rigid and I would say very limited set of really, really bad-hearted diseases to everything, to diseases, to traits. And maybe there's a family who has a family history of schizophrenia. Today, they can't weed that out or attempt to contribute to weed that out of their future child. Tomorrow with nucleus embryo, they can't. And so I really think that this is just a natural evolution for the industry in moving away from kind of arbitrary lines and saying what people should have access to and shouldn't have access to.

22:52And that's one of the reasons why we're so patient centric, because we don't believe the doctor should hold the keys to your embryos. I mean, it still is very quiet. I mean, not to pull like too far of a comparison, but most people know about genetically modified agriculture or like dog breeding and that sort of kind of selection but how do you think about this in terms of quote unquote like designer babies and the controversy that surrounds it i think that you know embryonic selection today if you look at what's actually going on is you have a couple viable embryos and basically parents will pick the embryos completely randomly um and i find that um like kind of crazy like it's the most arguably one of the most important decisions of your entire life, what a baby you're going to implant your future child, and you pick randomly.

23:42And so I think what we're really doing is giving people more information to then be able to say, okay, I actually prefer this embryo over this one, maybe because it has dramatically less Alzheimer's risk. That's what this is really about. It's about just people having healthy children and, you know, picking the best baby in their mind, whatever that means to them, of the options they had. I do think that, you know, over time, this is really powerful technology. I think genetic testing technology and analysis technology, genome technology, if you will, is going to be as powerful as artificial intelligence.

24:12Artificial intelligence is ultimately a tool. And it's a tool that's going to, I think, be most consequential in the field of human genomics, right? Because DNA is life. It explains everything. It's how we all begin. I think part of our job is to be really responsible stewards of this power of technology. And the best way in our mind of doing that is by actually not hiding in the ivory tower, by putting in everyday people's hands. So what would you say to the critics? Like there's definitely going to be some misconceptions around this. It is newer science that's out in the public. And I'm sure there's going to be some heat.