Infertile couples overestimate their chance of IVF success – BioNews

7 July 2020

Couples undergoing fertility treatment markedly overestimate their chance of IVF success, men to a greater extentthan women, according to new research.

The research presented at the virtual meeting of the European Society of Human Reproduction and Embryology 2020 came from a small, single-centre study at Leuven University fertility clinic in Belgium.

'Clinics do share average success rates on their websites, but these are often only relevant to a reference population of younger patients. And many patients do not think that average success rates apply to them. They expect greater success, thinking of their healthy lifestyle or their experienced doctors,' said study author embryologist Johanna Devroe.

Sixty-nine couples who were about to start at second or subsequent IVF cycles separately completed a questionnaire assessing their dispositional outlook and estimated their chances of IVF success. The data was then compared with the couples' personalised calculated chance of IVF live birth.

The mean calculation of live birth rate for participants in the study was 32 percent, however, the vast majority of both women and men greatly overestimated their chances of success. Women overestimated by a factor of 1.8, while men overestimated their chance of success by a factor of 2.3 with over halfof the men expecting their birth rate to be more than double their calculated prognosis.

'Partners didn't differ in their dispositional outlook so we cannot fully explain the higher expected live birth rate in men by a difference in optimism,' said Devroe. 'We are now investigating this, to see if disclosing an individual's predicted success rate rather than a clinic's average success rate helps to set realistic expectations.'

Sarah Norcross, director of fertility and genetics charity, the Progress Educational Trust, said: 'This interesting, though not surprising, single-centre study, shows just how much both men and women hoping to become parents overestimate their chances of success following fertility treatment. It sends an important message to fertility clinics about the need to manage patients' expectations and support them before, during and after fertility treatment. The dramatic mismatch shown by this study where the vast majority of both men and women estimated their chance of success to be double what it actually was shows just how shocking it can be for couples when IVF does not work which is, sadly, what happens two-thirds of the time.'

Dr Raj Mathur, consultant gynaecologist and fertility lead at St Mary's hospital, Manchester, told BioNews: 'The findings will resonate with members of the British Fertility Society, who aim to counsel patients properly about their individual chances, while at the same time recognising the innate human bias towards positivity and hope. We support clinics and the UK fertility regulator, the Human Fertilisation and Embryology Authority in displaying success rates in a uniform way that can be understood by patients, and we feel that the relationship between patients and their clinicians is of the utmost importance in making decisions about whether to start or continue complex fertility treatment.'

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Infertile couples overestimate their chance of IVF success - BioNews

New practical recommendations for the use of time-lapse technology in ART – ESHRE

New recommendations from ESHRE concentrate on the practicalities of introducing a time-lapse system into IVF labs, not on its use solely to improve delivery rates.

Despite such hopes and its widespread uptake, a lack of good practice guidelines for TLT in IVF has persisted. Now, the wait is over. Debbie Montjean, a member of the ESHREs SIG Embryology and one of 11 international contributors, presented details of the long awaited recommendations for TLT at this years virtual annual meeting. The collaborative effort has now produced a set of good-practice recommendations for the introduction and application of TLT, a comprehensive literature review and detailed time points for annotating development, whilst finely balancing both the pros and cons of this technology.(1)

The published recommendations, as Montjean emphasised, are not set out as a blueprint for improving embryo selection or delivery rates, but provide extensive support to IVF laboratories embarking on investment in TLT and standardisation and structure to those with the systems already in place. In addition, the publication emphasises the need for consistent nomenclature and annotations of morphokinetics, guidelines which were previously published but further summarised within this publication.(2)

For newcomers to the technology the recommendations are divided into a user-friendly 11-step guide to the best approach to introduction and application. The publication comprehensively reviews all versions of TLT currently available, comparing an extensive range of user requirement specifications in hardware, software and the on-going costs of technical support and maintenance.

Acknowledging the initial excitement when TLT was first introduced, with obvious implications for the efficiency of ART treatment, the authors propose that these expectations are yet to be met; indeed, the integration of TLT within the ART laboratory has not yet increased IVF success rates as once hoped. Yet, added Montjean, clinical outcomes arent the only advantage to justify use. Significant importance to other laboratory activities should not be ignored, she said. Undisturbed and stable culture conditions combined with improvements in laboratory workflow, flexibility and efficiency are substantial benefits. Moreover, TLT has undoubtedly revealed further biological markers and development anomalies which are otherwise undetected in traditional culture and static embryo assessments. Thus, the recommendations summarise 20 atypical features in human embryo cleavage development, 13 of which are exclusively observed using TLT and the remaining seven better observed when assisted by TLT. Such observations of subtle embryo anomalies and early mitosis can assist in blastocyst prediction with higher sensitivity and accuracy. Montjean ended her online presentation noting that time-lapse will at least help you to prioritise embryos and ultimately shorten your time to pregnancy.

Until now the absence of good practice guidelines for TLT and a lack of standardisation might be a reason for the inconsistent results among global users of the technology. But the authors here recognise that TLT is here to stay in the IVF lab; perhaps a standardisation of practice may unify the data and point towards an improvement in IVF success rates.

1. ESHRE Working group on Time-Lapse technology. Good practice recommendations for the use of time-Lapse technology. Hum Reprod Open 2020; doi: 10.1093/hropen/hoaa008.2. Ciray HN, Campbell A, Agerholm AE, et al. Proposed guidelines on the nomenclature and annotation of dynamic human embryo monitoring by a time lapse user group. Human Reprod 2014; 29: 2650-2660.

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New practical recommendations for the use of time-lapse technology in ART - ESHRE

Risk of IVF babies being born with cerebral palsy halves due to decline in twins, study reveals – The Telegraph

The risk of IVF babies being born with cerebral palsy has fallen by 50 per cent due to the decline in twins, a study has found.

Fewer twins are being conceived using the method because doctors are reducing the practice of implanting multiple embryos into the woman's womb, according to scientists at Copenhagen University Hospital in Denmark.

Women who have just one embryo transferred during IVF treatment are five times more likely to give birth to a healthy baby as there is less risk the child will be born low-weight or delivered prematurely, researchers from the University of Aberdeen previously found.

IVF twin rates have declined from almost 25 per cent in the 1990s to less than 5 per cent today.

This latest study now indicates that the number of babies being born with cerebral palsy, a condition which affects movement and coordination, has more than halved in the past 20 years and the risk is now equal to those conceived naturally.

Using data from Denmark, Finland and Sweden, the researchers examined some 112,000 IVF children born over 24 years.

They found that the prevalence of cerebral palsy among single babies born from IVF decreased from 8.5 per 1,000 to the normal population rate of 2.8. For twins, the rate remained stable at 10.9.

Dr Anne Lrke Spangmose presented the findings at the online Annual Meeting of the European Society of Human Reproduction and Embryology.

"The inclusion of complete IVF and naturally conceived birth cohorts makes our data robust and has allowed assessment of the true risk of cerebral palsy in IVF and its decline over time," she said.

"Multiple embryo transfer is still standard care in many countries. Our findings emphasise that single embryo transfer and singleton births should be encouraged worldwide."

Large registry studies have shown that the risk of cerebral palsy has virtually disappeared in IVF children born in the Nordic countries after a policy of single embryo transfer was introduced in the early 2000s.

The NHS recommends that women aged 39 and under should have a single embryo transfer where possible, while women aged 40 and above can have a double embryo transfer.

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Risk of IVF babies being born with cerebral palsy halves due to decline in twins, study reveals - The Telegraph

"The global gold standard": Aussie startup Presagen launches its AI fertility app in the UK and Europe – SmartCompany.com.au

Co-founders Dr Jonathan Hall, Dr Michelle Perugini and Dr Don Perugini. Source: Matt Loxton.

An Australian company that uses artificial intelligence to increase the chance of pregnancy through IVF has launched its software application in the UK and Europe.

Life Whisperer, the fertility arm of AI healthcare company Presagen, commercialised its flagship product in Australia in late January and released it through a distributor into India, Sri Lanka and Bangladesh last month.

Approvals are also being sought to sell the South Australian-developed software tool in Japan, Southeast Asia and the US, where it has conducted a number of clinical trials.

Last weeks launch into the UK and Europe is a major step in the three-and-a-half-year journey for the product, which was forced into a COVID-19 hiatus from March to May when many of the worlds fertility clinics closed their doors.

Adelaide-based Presagen currently has 15 staff and small offices in San Francisco and London to drive the global expansion.

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Presagen co-founder and chief executive Dr Michelle Perugini said the company had strong connections in the UK and Europe and a number of clinics were already trialling the product in the region.

She said getting clinics on board as commercial customers was the next stage.

Regulatory approval in the UK and Europe represents a significant opportunity for Life Whisperer to expand its global presence, and we are very much looking forward to working with clinics and patients across the region, supported from our London offices, she said.

Its a secure web-based application that is completely scalable so we can set up new clinics within minutes anywhere in the world.

The Embryo Viability Application for IVF clinics uses artificial intelligence to analyse images of embryos to assist clinicians to identify which embryo will likely lead to a pregnancy.

By selecting the best embryo, Life Whisperer aims to shorten the time to pregnancy and improve outcomes for couples undergoing IVF treatment.

An international study recently published in the journal Human Reproduction involved blind evaluation of 1600 IVF embryos.

Life Whisperer was shown to perform 25% better than traditional manual methods of embryo assessment by highly experienced embryologists.

The technology was showcased on Tuesday night last week (Australian time) at the 36th Annual Meeting of the European Society of Human Reproduction and Embryology, which is being held online this year.

Internationally renowned fertility expert Matthew (Tex) VerMilyea from Ovation Fertility (US) will present Life Whisperers latest advances in AI for IVF at the event where Presagen will also have a virtual exhibition booth.

Dr Perugini said Presagen was planning a significant capital raise this year to drive growth.

She said the company was looking forward to working with IVF clinics across the globe to offer Life Whisperer to patients at a low cost, meaning more couples could gain more certainty in embryo selection and achieve success sooner, with fewer IVF cycles.

Life Whisperer is poised to become the global gold standard embryo pre-screening tool in IVF, supporting the clinical decision about which embryo is most viable.

This article was first published by The Lead.

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"The global gold standard": Aussie startup Presagen launches its AI fertility app in the UK and Europe - SmartCompany.com.au

I found sperm donor on Facebook as I was desperate for a baby, we first met when he came round to give me the – The Sun

A FIRST-TIME mum was so desperate to have a child with her female partner that she used aspermdonor - that she found on FACEBOOK.

Shannon, 20, turned to the social networking site in the hope of finding an affordable way to fall pregnant with her partner, Katie, 25.

6

The pair began to research their options, but didn't like the idea of picking an anonymous donor from a list and couldn't afford the 3k fertility clinic price tag.

Instead, they joined a Facebook group with other hopeful parents and willing donors.

They went on to select a donor from Facebook in April 2019, after being together for seven months, and within two months Shannon fell pregnant via artificial insemination (AI) - using a syringe bought from Amazon to conceive.

Artificial insemination is the process in which a donor'sspermis inserted into the female's body not via sex - but commonly with pipettes and even turkey basters.

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She gave birth to Ocean Mabel Rose onFebruary 13 this year, weighing a healthy 6lbs 2oz - their first baby together.

Ocean completes their new family of four - as Katie has another child also via a donor, two-year-old Jaycee-Rayne.

Stay-at-home mum Shannon said: "I'm adopted myself, and have never been surrounded by an actual biological family.

"Once Katie and I decided we wanted a baby together, I simply searched online 'Spermdonors UK'.

"I wasnt expecting much, perhaps to see a load of IVF clinics with all these huge prices that I knew I would never be able to afford.

I got lots of strange friend requests from men saying they would be my donor, but 8/10 looked like fake accounts.

"Instead, it linked me to a Facebook group where donors and recipients could find each other and get to know one another - establishing a proper relationship, not all anonymous like the clinics do things.

"I was shocked at first as I thought it was odd. But the more I looked into it, the more I warmed up to the idea.

"Everyone was friendly and we had so many donors messaging us and offering their services. If I was to have another child, this is the only way I'd do it."

New mum Shannon had always dreamed of having her own baby, but knew the costs atspermdonor clinics were out of her budget.

She said: "Ever since I was a kid I wanted to be a mum.

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"Having a female partner automatically made that process more difficult, but it was just another hurdle to overcome.

"I'd considered aspermdonor in December 2018 when I was single, but then Katie came into my life and things changed."

Meeting on dating app Plenty of Fish, Shannon and full-time-mum Katie instantly clicked and discussed having their own children. Katie was already a mother to then 10-month-old Jaycee-Rayne.

Shannon said: "I expressed to Katie that I wanted to have a child but she wasnt ready at that time, considering how young her daughter was.

"By January 2019 I brought the subject back up and it nearly broke our relationship as she still wasn't ready.

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"Having a baby was my number one dream, but she had already had her daughter and just wasnt ready to take on another."

Two months later, the couple had another chat, and after some tears and a deep discussion, they decided that they were ready to have a baby of their own.

Unsure where to commence their search for aspermdonor, the pair searched online on a whim for options, and Facebook was the first result that popped up.

The link was to a private Facebook group of hopeful parents andspermdonors offering their services.

Shannon said: "There were hundreds of groups, but I wanted to make sure I wasnt rushing into joining any old one.

The donor really understood the process, and was patient with us without being overbearing or creepy.

"I worried about the motives of some of these donors, but once we saw their STD checks and genetic test results, my mind was put at ease.

"Looks weren't too important to us either, as the DNA pool would be 50/50 anyway. We were more concerned about having a healthy, happy baby over anything cosmetic.

"At first I got lots of strange friend requests from men saying they would be my donor, but 8/10 looked like fake accounts.

"But then I saw more and more posts from women who had been successful with their donors, and it gave me the hope that the right donor would eventually come to me."

In April 2019 Shannon and Katie received the message they had been waiting for - a donor who had previously fathered children through the page.

He provided them with up-to-date health check certificates, photos of himself, his job description and photos of his previous donor children -of which there were 11.

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Excited Katie said: "I practically jumped with excitement and thought to myself that he was perfect, and the one for us.

"Once we started talking, Shannon let him know the dates on which she would be ovulating, so he could come to our flat in that time-frame and provide hissperm.

"We bought a kit on Amazon which came with an ovulation test, a sterile cup for the donor to leave his sample in, and a syringe so I could insert Shannon with thespermonce the donor had completed his sample."

The donor then came to the pair's flat two times in May and June, taking his sample cup into the bathroom to fill withspermand return it to the couple.

Then, Katie would suck up thespermwith a syringe and insert it into Shannon, who lay down for at least half an hour to ensure thespermwas in her body.

Shannon said: "It was all a bit of a rush, as to maximise the chance of falling pregnant thespermshouldn't be outside of the body for too long. After about 20 minutes thespermcan die, so we couldn't afford to wait if we wanted it to be successful.

"The donor really understood the process, and was patient with us without being overbearing or creepy.

"He said he did it to help women or couples have children he just seemed like a nice man, and always did the job!"

The couple paid the donor's transport costs, and although DIY insemination is not officially unlawful, it is illegal to distributespermintended for human application without a licence issued by theHuman Fertilisation and Embryology Authority.

Donors on Facebook dont have the same rights as theofficial route theyre liable to pay child support if a contract isnt signed and could still see the child if thats what both parties want.

After two attempts, Shannon successfully became pregnant in June 2019."I had such severe morning sickness until week 25 of the pregnancy, but I was elated more than anything to have a safe and healthy baby," she said.

"Our little girl was born naturally at 38 weeks and it was the best day of my life."

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Shannon was in labour for 16 hours, and with Katie by her side she gave birth on 13th February 2020 to Ocean Mabel Rose.

Shannon said: As soon as I held my baby I knew Id made the right decision. Katie and I were both in tears, and I felt nothing but pure joy. She looked perfect."

There is no fathers name on Ocean's birth certificate and a man who providesspermas a donor gives up his legal rights over the biological child.

The donor will only meet the baby at the request of Shannon and Katie, but he has no legal grounds upon which to request visitation or custody.

Shannon said: "I feel like a new woman.

"We're all doing really well, and Ocean is the most content baby ever.

"The process was so easy and we were so lucky to fall pregnant so quickly.

"We now have the perfect family of four. Facebook gave me a baby, something I never thought I'd say."

How does sperm donation in the UK work?

Sperm donation can help couples struggling to have kids of their own or single women who want to start a family.

If you donate your sperm through a fertility clinic or a sperm bank, you wont have any responsibilities or rights towards a child conceived using your semen.

However, as of April 2005, children conceived through sperm donation do have the right to ask for certain information about their donor once they reach the age of 16.

When they turn 18 they can also request to know the name and last known address of their donor.

The main reason men choose to donate their sperm is to help couples who cant conceive naturally, or if they have a strong desire to pass on their genes to another generation.

In the UK, donation in exchange for payment is prohibited by law.

SUPERMARKET SWEEPMum shares meal planner which has saved her family 360 a month on food

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HINCH ITMy entire home is grey just like Mrs Hinch's - we even have the same dog

REPLI-KATELidl is selling a 9.99 dress which is identical to Kate Middletons 449 frock

HOME RUNMum beats empty nest syndrome by making daughter's room a MASSIVE walk-in wardrobe

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Meanwhile, super sperm donorMitch KennedybaffledThis Morning viewerswith his plan to prevent incestuous relationships among his expanding brood.

And 66 kids and counting... 'white van man sperm donor' Clive tells more about his remarkable storyhere.

Plus meet Charlotte who had a kid with Clive - one of the UK's most prolific sperm donors.

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I found sperm donor on Facebook as I was desperate for a baby, we first met when he came round to give me the - The Sun

Simple hair test ‘could tell women how many eggs they have left’ – Brinkwire

A simple test of a womans hair could tell women how many eggs they have left by judging levels of a key fertility hormone, scientists say.

US and Spanish researchers found biologically relevant levels of anti-Mllerian hormone (AMH) an indicator of ovarian reserves in womens hair samples.

AMH is a hormone produced by the cells within a womans ovaries and gives an indication of her egg reserves and subsequent fertility.

The hormone is incorporated into the matrix of hair before it reaches the surface of the skin.

Levels of AMH from the hair correlated with levels from blood samples, which is currently the most common method of measuring the hormone.

But taking AHM readings from the hair would be less invasive than a blood sample and a more appropriate representation of hormone levels, according to scientists.

Testing can be done without visiting a clinic, such as by sending a hair sample through the post, which makes this type of test cheaper and available to a broader range of women.

The role of AMH as a measure of ovarian reserve in predicting response to ovarian stimulation for IVF now seems beyond question, researchers add.

Hair is a medium that can accumulate biomarkers over several weeks, while serum is an acute matrix representing only current levels, said Sarthak Sawarkar at US health tech firm MedAnswers, who presented his research online at the 36th Annual Meeting of the European Society of Human Reproduction and Embryology.

While hormone levels in blood can fluctuate rapidly in response to stimuli, hormone levels measured in hair would represent an accumulation over several weeks.

A measurement using a hair sample is more likely to reflect the average hormone levels in an individual.

AMH has become a key marker in the assessment of how women may respond to fertility treatment.

The hormone is produced by small cells surrounding each egg as it develops in the ovary.

Studies have not correlated AMH levels to a reliable chance of live birth, nor to forecasting the time of menopause.

However, AMH measurement has become an intrinsic marker in assessing how a patient will respond to ovarian stimulation for IVF as a normal responder, poor responder (with few eggs), or over-responder (with many eggs and a risk of ovarian hyperstimulation syndrome).

Currently, AMH is presently measured in serum taken from a blood sample drawn intravenously, but readings taken this way represent just a snapshot of a moment in time and are relatively invasive to complete.

To learn more about the potential of AMH readings taken from the hair, researchers collected hair and blood samples 152 women from whom hair were during hospital visits.

AMH was also measured in blood samples from the same subjects, as well as an ultrasound count of developing follicles in the ovary a method known as antral follicle count (AFC).

Biologically relevant AMH levels were successfully detected in the hair samples, which declined with patient age, as expected by the team.

AMH levels from hair strongly correlated with levels as determined by both serum in the blood and AFC.

The hair test was also able to detect a wide range of AMH levels within individuals from a similar age cohort, suggesting a greater accuracy than from a single blood sample.

Hormones accumulate in hair shafts over a period of months, while hormone levels in serum can change over the course of hours, they found, meaning the hair test may be a more reliable measurement.

Hormone levels are also assessed non-invasively, which reduces testing stress and offers a less expensive assay.

This study is very interesting as it suggests AMH can be reliably measured from hair samples as opposed to the standard approach of a blood test, Tim Child, medical director at Oxford Fertility, told the Times.

The AMH level in hair is more likely to be averaged-out over a time period rather than the more instant level in a blood sample.

The question is whether the hair AMH levels correlate to the ovarian response and therefore numbers of eggs collected during an IVF cycle this is not examined in this study.

If the correlation is poor then hair samples will be of no benefit.

If the correlation is as good as, or perhaps even better than with blood AMH, then this technique promises to further simplify the fertility treatment process for women and will be an exciting development.

The results have been presented by PhD student Sarthak Sawarkar, working in the laboratory of Professor Manel Lopez-Bejar in Barcelona, with collaborators from MedAnswers.

See more here:
Simple hair test 'could tell women how many eggs they have left' - Brinkwire

Comparative Anatomy and Histology | ScienceDirect

Comparative Anatomy and Histology: A Mouse and Human Atlas is aimed atthe new mouse investigator as well asmedical and veterinarypathologists who need to expand their knowledge base into comparative anatomy and histology. It guides the reader through normal mouse anatomy and histology using direct comparison to the human. The side by side comparison of mouse and human tissues highlight the unique biology of the mouse, which has great impact on thevalidation of mouse modelsof human disease.

Link:
Comparative Anatomy and Histology | ScienceDirect

When the Facts Change, We Change Our Minds (Anatomy of a Sale) – Yahoo Finance

Even before the coronavirus, we were not big fans of the airlines business. Planes are expensive. Airlines have to pay for them whether they are fully occupied during normal economic times or when they are half-loaded during recessions. Their other big cost is fuel - airlines have little control over it. If they hedge the oil price and it goes up, they are heroes. If they hedge oil and it declines, their unhedged competition will have an economic advantage. It is very difficult to develop competitive advantage; customers usually have very little loyalty and price is the deciding factor for most buying decisions.

Warren Buffett (Trades, Portfolio) invested in the airlines industry in the '80s, lost money, and swore he'd never invest in it again. However, after the Great Financial Crisis the industry went through significant consolidation by mergers and attrition, leaving four carriers controlling the bulk of the market. Fewer competitors made competition more rational and turned these airlines into much better businesses. So Buffett changed his mind and bought a 10% stake in all four of the largest U.S. airlines. For a few years it seemed that he was finally right about the airlines.

Airlines were never our cup of tea. The high fixed-cost structure of the industry and its past history of going bankrupt every other recession made our EQ when it comes to airlines very low. When Buffett bought them, for some value investors, the airlines had been blessed by the high priest. We are agnostic (growing up in Soviet Russia has its rare benefits) and have to own our decisions, so we passed on the airlines without spending much time thinking about them.

Typically, when you go into recession you can look at the rear-view mirror earnings for a cyclical company and that becomes your goalpost for future earnings power within a year or two, max. We don't know how long it will take until we'll again see the 2019 earnings power of airlines and the travel industry in general. Here is what we know. Though it is hard to imagine this today, the fear of COVID-19 will eventually go away, either because there is a vaccine or a cure, or because the virus is gone, or because we will simply adapt to its existence.

But even in absence of a vaccine or cure, we'll change our behavior, and that will happen slowly on the margin. After being locked up for a few months, not seeing friends and relatives except on Zoom or Facetime, we'll timidly visit their houses and sit six feet apart on their porches. (My family did this on Mother's Day.) Then we'll invite very close friends - the ones who stuck religiously to social distancing- to our homes for dinner. Then we might chance visiting a restaurant with outdoor seating. Then, on a rainy day, we'll go inside the restaurant and find that it now has huge spacing between the tables. We'll make a lot of small incremental decisions; each will be a tiny compromise that will nudge us out of our fear.

Of course, each time we read about serious virus flareups, we'll take one step back.

Flying is at one extreme in the spectrum of social distancing. It requires finding your way through airports packed with people and then getting on a plane that, even after the middle seats are removed will still have a higher density than a packed bar on Friday night in Manhattan. Thus flying will require a great many little, incremental, marginal decisions before we overcome the fear of boarding a plane.

Vaccine availability would instantly vanquish fear, and our behavior would come back to normal. Well, almost. There will be scar tissue on the economy - trillions in government debt and persistently high unemployment - that will take time to clear up. People are not flying today because we are in lockdown; they'll be flying less than they used to after lockdown is over because they are still afraid; and after their fear is gone they'll still be flying less because they cannot afford the flights.

We imagine that when Buffett bought airlines in 2015, he thought the worst case would be a significant recession where plane occupancy would fall from the usual 80-90% to 50-60% (according to the FT, only four airlines out of a few hundred are profitable at 62% occupancy). His thinking was that the airlines would lose some money for a few quarters, but the recession would be anything but an existential crisis for them. Recessions last months and expansion years, and he thought he had bought them cheap on full-cycle (both recession and expansion) earnings.

Story continues

Despite being the Oracle of Omaha, he did not foresee that one day we might have a different type of recession where 95% of the planes would be grounded, not because people couldn't afford to buy a tickets but because they would be required to stay home by their governments, or would be afraid that close proximity to others would make them sick or even kill them.

Very few businesses can survive when 95% of their revenue goes away for an extended period of time. Even fewer can survive when they have a large fixed-asset base that needs to be paid for whether they are using it or not.

The sad reality is that unless airlines raise new capital, they will go bankrupt. This capital, though it might save them, will reduce the value of their businesses. Equity issuances, especially at today's depressed stock prices, would permanently dilute shareholders, as future earnings will be shared with a much-increased shareholder base.

If the airlines issue debt, it will not be cheap capital, either, and will burden these companies, which already have a lot of fixed costs, with another cost - significant interest payments that will substantially reduce their future earnings power. The longer the fear of the virus lingers on, the more money these companies will lose and the greater the damage that will be done to their balance sheets and thus their future earnings power.

In our thinking about the virus we have three timelines, or eras: BC - before coronavirus, DC - during coronavirus (now), and AC - after coronavirus (the virus is completely gone, or there is a vaccine or effective treatment. The longer the DC era lasts the more impact it has on the AC era. The DC era comes with high unemployment and enormous government spending - larger deficits and an ever-growing debt pile that is no longer counted in billions but in trillions.

The future of the airlines is path-dependent, and they have little control over that path; it is controlled by the virus (or the fear of the virus).

We don't own airlines, so why am I spending so much time talking about them? There are several reasons. First, because they are companies that are antithetical to our portfolio philosophy. Charlie Munger (Trades, Portfolio) says, "Tell me where I am going to die so I won't go there." So it's worth having a clear picture of the types of businesses you don't want to own.

Second, we wanted to point out Buffett's ability to change his mind. Interestingly, Buffett, who was already the largest shareholder of U.S. airlines, bought more airline stocks a few weeks before he sold them. We did something similar this quarter, too: We increased our position in Melrose Industries, just to sell the full position two weeks later. (More about Melrose to follow).

Third, like Buffett, we were playing traditional chess, not realizing that the game had changed to Fischer random chess. We were following the normal recession handbook (mental models) but then realized that this is anything but a normal recession. We have to be incredibly careful about using our past mental models today; they were built in a very different environment. Today, past experience is not useless, but if relied on blindly it can be dangerous. Some things will play out in the future as they have in the past, but many won't.

We needed to start using a first-principles approach - a concept we shamelessly borrowed from physics. We took out a blank piece of paper, assumed we knew nothing, and instead of continuing to think by analogy, started questioning every assumption we make in our analysis.

Our decision to sell Melrose Industries (LSE:MRO) is very similar to Buffett's sale of the airlines. We sold Melrose before the Berkshire Hathaway (NYSE:BRK.A)(NYSE:BRK.B) annual meeting. It was a difficult decision, not because we cemented a loss but because we parted with a business we really liked, that was run by good management, and that was significantly undervalued when we bought it.

When we were buying Melrose we stress-tested it for a severe recession; however, the decline that Melrose is probably experiencing today did not occur to us in our wildest imagination. Melrose is a very strong player in two industries that have been impacted tremendously: the airlines space (it makes parts that go into planes and engines) and car parts (it is one of the largest makers of transmissions for cars). We talked to the company. It has credit lines and cash to give it immediate liquidity, but we are not sure if it will be enough.

We had applied the traditional recession mental model to our analysis, and we were wrong. Given the world we are looking at now, we should have sold it sooner.

Buying new planes is the last thing on airlines' minds today. Also, only 20% of Melrose's business comes from replacement parts. Melrose's auto parts business (ironically, the business we worried about the most when we bought the stock) may be okay; it may even generate some profit; but we are not sure it will be able to sustain the company. We simply don't know what the losses are going to be in the airlines space and for how long. We have a tremendous respect for the Melrose management team - they're a big reason why we bought the stock - but at this point the problem that Melrose is facing is bigger than them.

If you look carefully through your portfolio, you'll see that we've positioned it to the opposite side of spectrum from the airlines. Most of our holdings are concentrated in four industries: defense, healthcare, tobacco (where we are permitted by clients), and telecommunications. These industries have one thing in common: They will not be structurally impacted by the virus.

Consumption of goods and services in the four industries is completely insensitive to the virus. These companies all have very stable cash flows and pricing power - in the event of deflation they'll maintain their prices, while during inflation they'll raise them.

And one more thing...

I am not a journalist or reporter; I am an investor who thinks through writing. This and other investment articles are just my thinking at the point they were written. However, investment research is not static, it is fluid. New information comes our way and we continue to do research, which may lead us to tweak and modify assumptions and thus to change our minds.

We are long-term investors and often hold stocks for years, but as luck may or may not have it, by the time you read this article we may have already sold the stock. I may or may not write about this company ever again. Think of this and other articles as learning and thinking frameworks. But they are not investment recommendations. The bottom line is this. If this article piques your interest in the company I've mentioned, great. This should be the beginning, not the end, of your research.

Vitaliy Katsenelson, CFA

Student of Life

I am the CEO at IMA, which is anything but your average investment firm. (Why? Get our company brochure in your inbox here, or simply visit our website.)

In a brief moment of senility, Forbes magazine called me "the new Benjamin Graham."

I've written two books on investing, which were published by John Wiley & Sons and have been translated into eight languages. (I'm working on a third - you can read a chapter from it, titled "The 6 Commandments of Value Investing" here.)

And if you prefer listening, audio versions of my articles are published weekly at investor.fm.

This article first appeared on GuruFocus.

Read more:
When the Facts Change, We Change Our Minds (Anatomy of a Sale) - Yahoo Finance

Greys Anatomy Season 17: Greys Anatomy : Official Journal On The Start ? – Auto Freak

Season 17 of Greys Anatomy is in complete preparation. Everybody wonders what will happen to Oj following the passing of Alex.

In a month or two, fans of Greys Anatomy will have the ability to observe the year 17. But we are asked whatll happen to Oj following the departure of Alex. Beware; the report contains spoilers.

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Fans of Greys Anatomy havent been able to see all of the episodes of season 16. In reality, because of the Covid-19, the series runners havent released the previous four episodes of this year.

That the fans have frustrated since the last episode gave a play. Nonetheless, the season has not been without turns and twists, and fans have had to confront the departure of a personality flagship.

In fact, Alex played with Justin Chambers has selected to depart Seattle in order to help his unwell mom. The latter wanted to become present for his family, and hes left behind him, his wife.

It will not seem like Alex when we know that he loves Jo, and they had just gotten married. As well, the fans are disappointed, and everybody is wondering what will happen to Jo from the year 17 of Greys Anatomy.

Jo has created a big depression, and she recovered just out of his trauma from the sequence. Therefore, the departure of Alex could well mark the conclusion of the narrative of the physician. This last one may choose to leave for Greys Anatomy.

Chris Carmack that plays Lincoln, ensures that the character of Jo is strong. Thus, according to him, the woman Karev should recuperate. I do not believe that you can get rid of it easily; shes really tough skin. And she has a great deal to give to the planet and to his patients at Grey Sloan, he explained.

Hence, Oj should be present in Greys Anatomys season 17. Shell be able to rely upon the existence of his family to create a cross on his history with Alex. Additionally, it will be a little nearer to Lincoln.

In fact, Jo is very familiar with Lincoln, and they wish to be accomplices. One may even believe that they may end up going out together from the new season. But until now, Lincoln is in a relationship with Amelia, and they come just to get a child

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Greys Anatomy Season 17: Greys Anatomy : Official Journal On The Start ? - Auto Freak