Irene Souter, MD: Infertility & Environmental Impact on Reproductive Health

Q:   Infertility is much more common than some people might think. And yet, many women and men are hesitant to discuss their struggles and concerns. The Centers for Disease Control and Prevention estimate that about 10 percent of women in the US have difficulty getting pregnant. And in about 35 percent of couples with infertility, there are complications identified for both the man and the woman.   

Dr. Irene Souter understands these struggles and cares for couples with both female and male infertility. Irene grew up in a family of all women, and knew, at the young age of 15, that she wanted to dedicate her life to women's healthcare. The interest in infertility and reproductive care developed later, stemming from what Irene calls a pure love of life.  

Today, she works as a reproductive endocrinologist at the Mass General Fertility Center, and participates in many research areas, to better understand infertility outcomes. Recently, she collaborated with renowned scientists from the Harvard T.H. Chan School of Public Health, in the groundbreaking 20-year EARTH Study, which investigates the impact of environmental, nutritional, and lifestyle factors on fertility.  

So welcome, Irene. 

A:   Hi. It's great to be here with you today. 

Q:   It's great to have you. So if I could, I'd like to start right at the beginning. When did you know that you wanted to work in women's health?

A:   My decision to pursue a career in medicine was a really early one. I remember myself, on my fourth birthday, receiving as a birthday gift from my father, a stethoscope and a syringe. 

He handed those to me, and told me that, if I choose a career in medicine, I might one day end up in heaven. I guess what he meant to say was that, as a physician, I will have multiple opportunities to help those in need.  

By my teenage years, this idea had solidified. I also realized, I was attracted to the field of OB/GYN.  

So why did I come to this decision? I think part of it was the fact that,I grew up in a family of three girls, surrounded by many female figures. 

I grew up thinking I wanted to give back to those women. I also realized, very early, that I love life. Life is a miracle and a beautiful gift. Women give life. Women support and nourish life. Women embellish life. That's what my immediate family taught me.  

And that's why I wanted to go into a profession that would take care of these women, that would give back to them, that would empower them to take care of their reproductive health, and reproductive destiny, so that they can play the multiple roles, be mothers, sisters, friends, leaders, mentors, teachers, among the many other things they do.

Q:   And so you described having a lot of female influences in your life. Were there conversations that they would have with you around reproductive healthcare that kind of pushed you in that direction? 

A:   I think that, even more than that, it was in me the desire to show other women that we can do it all. I really wanted to be part of this advocacy, if you wish, which probably was part of what I was growing up with in the '70s and '80s, right.  

To be part of this, so that we as women can deal with the biologic challenges, and can eventually focus in our careers, and in our personal happiness, which, many times, includes building our families. 

Q:   That's beautiful. So the idea of doing it all, was that something you saw your grandmothers and your mother and your female influences doing themselves? Or something that they were talking about and wanted for you? 

A:   I think that they all were pushing me to, learn as much as I can, and be prepared for the world the best way I can. They all had faith in me. But I think, also, my father helped me, also, in that direction, in the sense that he was a forward thinker.  

And he's instilled in me the confidence that I can succeed despite the challenges associated with the traditional roles attributed to a female. When I was growing up in Greece in the '70s and early '80s, Greece was changing. But it was still a male-dominated society.  

So I would feel on occasion, that as a female, I might be deprived from some opportunities that might be available to my male friends. He, my father, though, taught me that opportunities are conquered and not handed over. So he never, ever allowed me to think that an opportunity will not be available to me, simply because I'm a woman. 

But, if I wanted other women to have these opportunities too, I had to be part of this force, that would allow women to control their reproductive destiny. Because the one thing that was forcing women to stay behind, in their professional life, for many, many years, was the fact that they did not have control of their reproductive destiny.  

And with that, there were a lot of biologic challenges that would come up, and force them to stay away from the workforce.  

Q:   So I'm curious to hear more about just your experience today, working as an infertility specialist. Can you talk about that, and also again, intrigued by that idea of advocacy, perhaps how your work intersects with advocating on behalf of women?  

A:   Being a infertility specialist has been an amazing and rewarding experience, that taught me, above all, that a healthy baby is not a given. A healthy baby is the biggest gift. And for some patients, the journey to that healthy baby, that fertility journey can be very long and very challenging.  

Infertility also taught me that the instinct to reproduce, the instinct to pass on one's genes, is extremely strong. And it goes hand-in-hand with the instinct of survival. So when people face difficulties conceiving, they feel extremely threatened. The challenges they face are many, physical and emotional. And the feelings are overwhelming.  

So my job is to diagnose and treat, but to do that while I offer support, and without overlooking all of the complexities associated with the diagnosis of infertility. My experience has obviously been very rewarding for many reasons. But one important reason is the fact that people trust me. They trust me with their hopes. They trust me with their fears. They trust me with their emotions.  

And sometimes, more often than not, they can be upset. They can be angry. They can be disheartened by a failure, disappointed by the challenges. But the one thing I've learned is that this is part of the struggle with infertility. And I'm there to help them through it. I'm there to advocate for them. 

Q: Your patients coming in. In such an emotional, vulnerable time. What has been your approach to working with a new patient who might be feeling that way? How do you sort of create that safe space?

A:   The first thing I have to do, is to take a comprehensive and detailed history, and perform an exam. But I want to try to be human, warm, and compassionate when I do that, recognizing my limitations.  

No matter how hard I try to understand their feelings, I'm not the one suffering through it. And I don't want them to feel that. I want them to know that I'm there with them, that their failure is my failure. And their success is my success. 

So how do I learn about their feelings? To understand their fears, their emotions, the impact the agony of infertility has had on their relationship, not only with each other, but with themselves, and with the rest of the world.  

I have to try to understand the societal pressures they receive, their personal, cultural, religious, and other beliefs that shape their way of thinking, and their approach to treatment.  

So I have to understand who is the patient that is sitting across the room from me? What are the couple's needs? How can I offer them treatments that are acceptable to them? How do I make sure that they are comfortable with their decisions, right? 

Sometimes they might decide to postpone much-needed treatments, because they simply don't have the financial means, or because something unforeseen happens. Sometimes they might have to give up treatments, and decide that they are not going to build a family. 

They might decide to take advantage of third party reproductive options or adoption. 

I keep in mind the Dr. Seuss book that is titled Are You My Mother? And I want to make sure that the babies I will help bring to this world will feel loved, supported, and belonging to the families they were raised in.

These are deeply personal decisions. And people have to look inside themselves to find the power to make those decisions.

Q:   Yeah. It sounds incredibly challenging, especially taking into consideration everything you said, culture, societal pressure, family pressure. Is developing this skill, this compassion, this empathy, was that something that you found you had to develop over time? Or did it come quite naturally to you? 

A:   I absolutely think that this is something that I developed over time. I think naturally, you like what you do. You want to be there for your patient. But sometimes you don't know how to be there for your patient. Sometimes you're standing outside of the door, knowing you're going to go inside, and you're probably not going to have good news for your patient.  

This might not be a good pregnancy. How do I tell this patient that struggled  through infertility that this is not a good pregnancy? This is something I think that you learn by learning from their pain, by hearing what they have to say, and by also putting yourself in their situation.  

I want the patient to know that many times, I cannot change the outcome. 

But I'm there. I'm there with my patient. And I think that this is something that, yes, you do learn over the years. This is not something that it's easy to teach.  

Q:   Are there any particular experiences or patients that kind of stand out in your memory, as having taught you some of that, that you've carried forward and referenced, in current situations? 

I have had the privilege of helping many, many, many patients achieve their families through third party reproduction, through gamma donation, through egg donation.  

And people don't realize that almost 10 percent of what we do in infertility involves donor eggs. And this is not something that patients want to hear about when they first come to the office. Every single time, I will mention that word, the patients will shut me down and say, “This is not an option for us, doctor.”  

I spend a lot of time thinking, what does it feel like to a woman, to have to parent through outside donation? How do I help my patient understand that this is another opportunity, this is another privilege, this is— something to celebrate, right.  

So naturally, you know, people will ask, “Do you think your patient will love her baby as much as she would if it was her own egg?” And I will tell you, my experience is, yes. And I say this because I've seen my patients, how extremely happy they are when they see that little heart beating in their womb. There is no difference between a woman that used her own egg versus a woman that was blessed to have a child through egg donation. 

I had patients that were diagnosed with malignancies during their donor pregnancies. The first question that came out of their mouth wasn't, “What about me?” It was, “What's going to happen to my baby?” And this was extremely reassuring to me, because I knew that this patient had already bonded with her little baby. And she was already making that baby, and that baby's well-being, the center of her world.  

So that's something I learned, as I saw more and more patients dealing with infertility. So definitely, there are moments that I remember. I also very fondly remember the times that I was wrong, meaning, sometimes I thought this is never going to happen.  

I've learned over the years, that I cannot predict. And every now and then, a little miracle happens that is there to remind me that I should never, ever take away hope from my patients.  

Q:   And you mentioned some of the questions that you find your patients asking you. When I think, you know, just from a lay-woman's perspective, when I think of fertility, it seems like a topic that probably carries some myths or misconceptions, so to speak. What are some of the other questions that you find patients routinely asking when they're coming in for care? 

A:   First of all, there are clearly misconceptions and unrealistic expectations. And I think instead of putting the blame on the patient, we should put the blame on ourselves. Because it is our job to educate the public and help them set the realistic expectations. 

I think the most pressing question they want an answer on is, “In your honest opinion, Dr. Souter, will we succeed?”   

Deep in their heart, they're fearful that I might actually take away hope from them.  

And, you know, this is not a good feeling for me, either, right, to know that the patients fear my answer. So I want to be able to give them good advice, while at the same time, I help them feel supported.  

But many of them question their ability to get through it. They're asking questions, “Are we up for the challenge? What does this mean for us? Will we get through it? Will our baby be healthy and normal if we employ all these technologies?”  

People have this unspoken fear that they challenge nature by utilizing fancy technologies. And they're afraid of the consequences. They're afraid that if they do IVF and ICSI, if they do a biopsy to, diagnose abnormalities in their embryos, this is challenging nature, challenging fate, something bad is going to happen, right. 

So I'm there to help them understand, you know, what their options are, what their real risks are, what literature shows, and help them make informed decisions. 

And many of them will look at me and say, “Why me, Doctor? I have a healthy lifestyle. It's so easy for others. Why is it so hard for us?” These are all very, very personal and heartfelt questions that people ask me.

Q:   And what are some of the causes of infertility? 

A:  A good percentage of people have infertility because they have what we call decreased ovarian reserve. In other words, their ovaries are weak because the patients are approaching the upper limits of their reproductive years.  

Or they're weak because of other factors, sometimes genetic, environmental, autoimmune, exposures, you know, people might have had to face strong treatments in the past that potentially had a negative impact on their ovaries or on their testicles A good percentage of people have male factor infertility.  

So it could be that the sperm is weaker, the numbers are low. The sperm materials are not swimming as fast or as powerful as they should. Sometimes they don't have the right shape to achieve fertilization. Many times people have combined factors. You know, somebody can have endometriosis, and at the same time have low ovarian reserve.  

Some people can have ovulatory dysfunction, like, you know, that caused by polycystic ovarian syndrome. But, at the same time, they might have a uterine abnormality as well. 

But, in many, many cases, infertility is unexplained. It's what we call idiopathic And that's a challenging diagnosis, because the patients always perceive the diagnosis of idiopathic infertility as nothing is wrong. And I always tell people, idiopathic, unexplained infertility, does not mean there is no infertility. It means that I don't have an explanation for it. 

At least if you provide somebody with a diagnosis, they can understand it. But if you tell them it's unexplained, they feel helpless. My doctor doesn't know what's wrong with me. Is that because my doctor doesn't know enough? Or is that because science hasn't reached that point? 

Q:   And does that come up quite often, that kind of diagnosis? 

A:   Yes. Idiopathic infertility is very common, yes.  

Q:   Why is that? Is there a reason for some of that gap in understanding? 

A:   Great question. And I will say that we tend to think of fertility in a very simplistic way. The sperm meets the egg, and the fertilized embryo will travel down the Fallopian tubes, get into the uterus, and implant. And it's not as simple as it sounds. 

There is an enzyme that controls every function in our body, and a gene that controls the function of every enzyme. And a change can happen in every single gene in our body, every single enzyme, every single interaction. And a lot of those interactions are not known to us, or we've witnessed them in the laboratory but we don't know what they mean. And certainly, we don't know what can make them go wrong. 

So sometimes people have unexplained infertility, and they end up requiring in vitro fertilization. And the day that we put the sperm with the egg in the Petri dish, we realize that there is no fertilization. So, although up to that point, I had no answer for that couple, now I do. Yes, the sperm is healthy. Yes, the egg appears to be healthy too. But for some reason, that sperm and that egg don't get along, right. 

So fortunately for situations like that, we have ways to overcome it. There are other situations where, you know, people have good fertilization. They have great production of eggs. But embryonic development suffers. And we don't have an explanation for that. You watch them grow in the laboratory, and they really, really fall apart.  

And unfortunately, quite often, we don't have an explanation for it. And yes, yes, absolutely, people are putting efforts in research to be able to answer those questions. And one of those questions is,  

 Could it be that the environment or what we do or what gets through our system, through our food, the air we breathe, affecting somehow what we see in the laboratory? 

Q:  I know you're involved in sort of a lot of different areas of research in infertility, and one of which being the EARTH Study. Can you talk a little bit about what that is, and its significance? 

A:  The EARTH Study is a monumental study. The efforts to put together the EARTH Study started in the late '90s. And the person that led all these efforts and is responsible for most of the success of this study is Dr. Russ Hauser, who is a professor at the Harvard School of Public Health, and also a professor of OB/GYN at Harvard Medical School.  

We started recruiting patients in 2004. And the study went on for approximately 14 years, almost 15 years. The major question of the study was whether environment can affect one's fertility.  

And the term “environment” included a lot of things: commonly found chemicals, like those found in plastics, in cosmetics, in the air, in our food packaging. Chemicals that we all get exposed to, on a daily basis, repetitively, and at small amounts.  

We perceive our environment as safe. And all we have to do is just take a look around us, and question everything that is around us.  

Is the computer I'm sitting in front of right now safe? Is the bottle of water that I'm drinking my water from safe? How about that cup of coffee? Right. How about the clothes I'm putting on, on my body? Soaps we use, the cosmetics, the—just name it, you know. So many things in our surroundings are being perceived as safe. But do we have the evidence that they are safe, right?  

If you think about it, medications, before they get approval, they undergo a very, very strict and complicated process to be approved. But thousands of chemicals get approved all the time, in a way that is a lot more abbreviated, because we make the assumption that they don't find their way into our systems. They don't find their way into our food chain, right. 

And as we all know, they do. In the EARTH Study, the term “environment” became broader after a certain point, to include nutrition as well. Is it better to have a high fat diet or a low fat diet? Is it okay to eat dairy?  

Should we be taking vitamins? Should we be taking antioxidants? How about other supplements? Is organic better than non-organic, right? The huge thing about the EARTH Study is that it was designed in a way to answer many of those questions.  

And also, I would say that the people involved have really dedicated a tremendous amount of energy and expertise to address any possible confounding factor. Being part of it, I felt very privileged, very lucky. I never had so much support to do a study.   

Q:   And what have been some of the takeaways from that 20-year study so far? 

A:   So, yeah. Like you said, this is as study that has gone on for a long time. People were monitored prior to conception, around the time of conception. And quite a few of them were also monitored in pregnancy, and some of their babies are followed as well. 

So we, on our part, collected a lot of data, a lot of samples, in the pre- and peri-conception period. And what we've learned, and there is, I believe, a lot more than over 100 publications from their study at this point. We have seen that quite a few chemicals, and certain lifestyle habits play a role in affecting male or female fertility, or both.  

But we also always have to be careful when we translate the results, because we have to think, for example, is it the nutrient? Or is it the way the nutrient was processed, right? 

So when people talk often about dairy, we have to ask the question, is it the dairy that has a positive or negative impact? Or is it the hormones that are found in the dairy, or the growth factors that are found in the dairy, or the way this animal was fed, or raised prior to producing the product that finds its way to our food chain, right.  

So these are complex answers. And also, one of the strengths of the EARTH Study is also the fact that it looks at the fact that mixtures of chemicals have on the outcomes.  

And there are not that many studies that have looked at that. And the samples of the EARTH Study have been processed for a very large number of chemicals, if I'm not mistaken, probably close to 40 chemicals, that are found very commonly in our environment. And the group of the collaborators has really developed some fancy, if you wish, bio-statistical ways to address the effects of these synergies. 

So I think that we have learned a lot of things from the EARTH Study. But there is still a lot more that is being processed, that is going to answer many questions in the future as well. 

Q:   And has any of this impacted your clinical work at all?  

A:   Yes. It has helped me answer many of the questions of my patients. The patients often want to know what should they eat? What should they not eat? The population of the United States is not setting the example of a good diet, for many, many reasons. So I always encourage my patients to prepare their own food as much as they can, cook their own food, eat more fresh food, have a balanced diet.  

And I don't necessarily know that going to extremes is a good thing, unless there is evidence, scientific evidence to support it. Make sure you receive all the nutrients that are needed by your body, right. And certainly, I'm sure it's better to probably take vitamins and antioxidants from fresh food. But we all know that many times, this is not always possible So if not possible, I'm sure that you know, supplementation might be better than deficiency.   

Q:  Are there big things that you would recommend listeners or patients to stay away from, materials, certain ingredients, anything specific that's come out of the study that you would want to share?  

A:   I think that the biggest thing that has come out of the study, is that you cannot bring big change, just simply on the individual level. Were swimming in an ocean of chemicals. I think that educating the public, educating the stakeholders is important, in order to bring significant change.  

And there is plenty of great scientists out there in those fields that are working and are listening to what we're saying. 

Q:  When reading about this particular study, there were a couple of things that I found particularly interesting. And I'm curious to know if this has been done in studies in the past. But the inclusion of both men and women in this research, is that sort of a differentiator? 

A:   Definitely. I think that this is definitely a differentiator. And it is something that it's so easy to see, but so difficult to do, right. I mean it takes two, to have a baby. So why do we always focus on the woman? Because we always focused on the prenatal exposures. The exposure happened during pregnancy. 

So what happens in the time period leading up to pregnancy? You asked me earlier about decreased ovarian reserve, right. Well, you don't wake up one day and just simply have low ovarian reserve, right. That's a process. We know if women are smoking, for example, they might go into menopause a little younger. Or they might have low ovarian reserve a little earlier, right. Why? Because that potentially could be an effect of toxins on the environment of the ovary.  

But that can also be applicable to other chemicals or nutrients or exposures, if you wish, in our environment, right. And we evaluated the peri and pre-conception period. But in reality, some of those things might be going back even longer than that, right.  

So as the fact that we are now able to combine the information for men and women, is a very important step in addressing those questions.  

Because we suspect that there is potentially an epigenetic change, right, something that can happen after fertilization occurs in the very early stages, or some alterations might even happen before that.  

And that's the beauty of the EARTH Study, that it allows us to go and look in this early event, not just the prenatal, but what leads after that. 

Q: I imagine a lot of the patients you get are already in that position of wanting to conceive, or have been trying to conceive. How can people preemptively think about their reproductive health, both men and women? 

A:   I think this is a great question. And I think this is something we probably began to put our efforts in, probably around 15 years ago. I remember me being a Fellow in reproduction, technology, and infertility, seeing the advertisements from the American Society for Reproductive Medicine.  

That was putting an effort to educate the public that fertility is not a given. It's a gift. And it has an expiration date on it. There was a lot of negative reaction. 

But we have to be realistic. In  other words, we can be angry at certain biologic limitations. But they're there. And the earlier we acknowledge them, then more successfully we will deal with them, right.  

So I think that was the time I would see 42, 43, 44 year old women that would come to the office and hear, for the first time ever, that despite all their efforts to lead a healthy lifestyle, ovarian aging might have already happened, right. 

So I think that was a painful realization for a lot of the patients, because the opportunity was taken away from them. They were diagnosed with diminished ovarian reserve to the point of no return, if you wish, before they even had a chance to take action on it.  

And I think we are doing better over the years. We are definitely trying to educate the younger women, and not just the younger women, men and women. Because if we only educate women, we will have anxious women that are trying to convince their male partners that there is a biologic clock, and it is ticking.  

So if we want to be successful. We have to educate male, females, anybody and everybody that is hoping to build a family, about what options are available to them, and what limitations are attached to those treatments. 

So I think we have to start early, just like we do with sexual education, right. We fought for years to put that in schools, to educate teenagers, how to get control of their reproductive destiny. And for a while, we thought that control of reproductive destiny means just avoiding an unwanted pregnancy. 

Well, control of reproductive destiny means to achieve the pregnancy when you want it, when it's the right time for you, and to hopefully know what's available to you, to increase the chances that this will have a healthy outcome. 

We really have to educate people better on the limitations that nature is putting on us, about the limits of their available treatments We can get older women pregnant, no doubt about it.  

But older women that get pregnant have to employ the help of others as well. 

And there's nothing wrong with that. I always tell people, traditionally, it took two people to make a baby. Well, science has evolved. Three people can make a baby. Four people can make a baby. Five people can make a baby. That does not make this baby any less of a precious human than a baby that was created to two people.   

So I  think that we experience a huge change in societal beliefs. And I'm proud to be part of this change. 

Q:  Just as far as the conversation around fertility. How have men shown up differently in that? How have women shown up differently? What's caused that to change? 

A:  For thousands of years, infertility was a curse. I mentioned earlier my great-aunt.  

Whenever I asked her why she did not have children, the poor woman answered to me, “I was cursed.” And for somebody to experience infertility as a curse, it's—it's a huge pain and a huge challenge.

So I think that this has changed. People felt that their own value was being questioned, their own sexuality was being questioned. There was no easy way to deal with that, right.  

There are cultures that the male was allowed to divorce the female, or take another spouse in order to have children, right. So I find that the ones that were blessed with easy fertility, were also easy to pass on judgment to the ones that were struggling. And this is and has been deeply unfair to the infertility patients.  

Nobody chooses to be in that position. So fortunately, with the advent of assisted reproductive technologies, and IVF, and the publicity around it, and the test tube baby, and this and that and the other thing, that sounded like science fiction to a lot of people, people found it easier to talk about fertility. 

After all, at the end of the day, the reproductive system is the same with every other system in the body. I don't know why humanity opted to address it differently.   

But I think one thing that made a dramatic difference was the internet.  

People that have been isolated, all of a sudden can find ways to connect with each other. They realize they're not alone in this struggle. There are thousands of other people that have lived through what they are living. So they find companionship. They find friendship. They find support from their own. And it makes a huge difference.  

At the end of the day, the patient wants to hear the good stories. The other patient that was, yes, in the exact same situation two, three, four years ago, and hey, she's blessed with a great outcome, whatever a great outcome might be for many patients. I think it's also important for patients to hear from other patients that opted for alternative means of conception, right. 

But I also think it offers them an opportunity to organize, to get together, to find better ways to address their needs, to provide education that is written in their own language, right, resources, access to resources. But, more than anything, also, access to advocacy. Because I think one thing that came with the change in the discussion about fertility, is also the understanding that infertility is a disease.  

People are in that state because something in their reproductive system is not working the way it should.

So I don't think that these challenges were obvious to the public, until people started going through them, and started talking about them. 

Q:   Thank you so much, Irene. This has just been really fascinating. And I really appreciate you being on the podcast. I have a few questions that I like to ask every guest. The first being, what's the best advice you've ever gotten?  

A:   What's the best advice I ever got? That sometimes, you might find yourself in a rough sea. You are the captain of the ship. And failure is not an option. You've got to steer the ship into a safe harbor. And I have reminded this to myself, in situations that were tough for me. Failure is not an option. 

And I got that advice from my father.  

Q:   If you weren't a doctor, what would you be? 

A:  I love creating things out of nothing, I think I have some artistic capabilities in general. And the only way I would combine this would be probably in architecture.  

Because I just kind of felt like, you absorb the beauty that you see around you. And somehow, this beauty finds a way to synthesize itself to something beautiful inside of you. 

So I think if I wasn't a physician, I might have pursued a career into something like this.  

Q:   What advice would you give your younger self? 

A:   To cross that bridge when I get there, if I ever get there. Because one thing I learned is that many things I feared, that would come, never, ever came. And I wasted so much energy trying to prepare, to cross that bridge, just to find out that something that I never, ever thought that would happen to me, happened  

Q:   Do you have any guilty pleasures?  

A:   Any guilty pleasures? Absolutely. Chocolate. [laughter] I have a big sign in my office that says,“Fall in love? I'd rather fall in chocolate.” [laughter] Absolutely.  

Q:  What do you consider your super power to be? 

A:   My persistence. I don't think that I give up easily.

Q:   That's great. 

Q:   That's great. Thank you again so much, Irene. It was so great to talk to you. I really appreciate you being here. 

A:   Thank you. I really enjoyed talking about, what my passion in life is. Thank you for giving me that opportunity.