You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]


Transcript

GONADS: FRONADS FINAL WEB TRANSCRIPT

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[RADIOLAB INTRO]

MOLLY WEBSTER: This is Gonads, episode two. I'm <PRESIDIO_ANONYMIZED_PERSON>.

MOLLY: Okay, my dashboard says it's 12 degrees outside. It's all ...

MOLLY: Okay. So in January, I went to Erie, Pennsylvania.

MOLLY: Second attempt at Erie. First attempt was snowed out but on the New York side. Thank you bomb cyclone.

MOLLY: It was like the Arctic winters of my youth.

MOLLY: There are ice fisherman out on the lake.

MOLLY: There was, like, some sort of record-setting snowfall in Erie that I'm sure is probably still melting up there. And I had landed in this -- in this frozen land to do a story about people freezing things.

JAD ABUMRAD: Oh.

MOLLY: But not -- not things that you would expect to be frozen. I don't know what you expect out of frozenness, but it's not that.

JAD: Tofutti Cuties. Ice cream. That's what I freeze.

MOLLY: Oh, my gosh.

JAD: Blueberries.

MOLLY: Not fruit, but actual body parts. Ooh!

JAD: Ooh. I like it.

MOLLY: It starts at this house. I'm going to -- we're going to the house.

MOLLY: And here we are. [CAR DOOR SLAMS]

[DOORBELL RINGS]

MOLLY: Hi!

ANNE DOWER: How are you?

MOLLY: And the people who were at the center of the freezing were this couple.

ANNE DOWER: My name is <PRESIDIO_ANONYMIZED_PERSON>.

MOLLY: That's one half.

GREG DOWER: My name is Greg. I'm Annie's husband. And ...

MOLLY: That's the other half.

GREG DOWER: I think that's it, right?

ANNE DOWER: Yeah.

GREG DOWER: Okay.

MOLLY: Let's start at the beginning.

GREG DOWER: So that's a crazy story. I think Shireen probably told you that, right?

MOLLY: What's your version?

GREG DOWER: Well ...

MOLLY: Fall, 1999.

ANNE DOWER: I was teaching high school phys-ed.

MOLLY: It was a Friday. She had just finished coaching volleyball. And her dad called and he said, "Hey, I'm leaving work early. I'm gonna go to this fish fry. I will swing by and pick you up. Let's go grab some dinner.

ANNE DOWER: And I'm like, "Sure." He goes, "I'll be over in about 15 minutes." I said, "Okay." And he goes, "Hey, it wouldn't hurt to look a little nice," and he puts the phone down and I'm like, "Ew," you know? Like, because I was literally in, like, a Nike outfit with my sneakers because I teach gym and I just finished coaching. So like, I'm like -- and that's how I would have gone to dinner with them, because it's dinner with my dad, whatever.

MOLLY: But her dad had ulterior motives.

ANNE DOWER: Oh, there's a guy that I work with gonna meet us, and I'm like, "Ah! You set me up." So we're driving over there and I'm like, "Dad, how old is this guy? Like 50, 60 years old? Like, your age? Like, how old is he?" You know, and he's like -- and he's just like, "Anne, honestly, he's not that old. He's maybe a little older than you."

MOLLY: So they get to the bar, grab a couple of beers and then this guy walks over.

ANNE DOWER: Oh, that guy's not bad-looking.

GREG DOWER: [laughs]

MOLLY: This, of course, was Greg.

ANNE DOWER: We sat down at a booth, ate dinner, and ...

MOLLY: By the end of dinner, Annie's thinking ...

ANNE DOWER: Yeah, he's pretty cool.

GREG DOWER: We just had a lot of fun together.

ANNE DOWER: And so one date leads to two, two leads to three. At that point, they ditch her dad because he had still been hanging out with them. And a year later, things had gotten pretty serious.

GREG DOWER: We still have that placemat. In fact, I was looking at it the other day.

ANNE DOWER: It's in the kitchen. Get it on the ...

MOLLY: What -- a placemat is coming out. Describe it to our listeners.

ANNE DOWER: White -- white, scalloped edges. Some yellow food stains, probably a little mustard.

MOLLY: This placemat is from a date that they went on around their one-year anniversary, which was almost 20 years ago.

ANNE DOWER: Texas Roadhouse, right?

GREG DOWER: I think it was a Texas Roadhouse. Texas Roadhouse, yeah. Or Chili's. One of the two, because we used to go to Chili's.

ANNE DOWER: No, it was Texas Roadhouse.

GREG DOWER: Texas Roadhouse. Because they had peanuts, they had great peanuts there.

MOLLY: And they had only been dating for a year, but they were super into each other. So at a certain point, they're eating their peanuts or whatever, and the conversation turns to -- the future. It's like, "Say we're gonna be together. What do you want? Like, what do you imagine?

ANNE DOWER: And we just kind of were -- we were talking about all sorts of things. Like, kind of a little -- almost a goal-setting that we had.

MOLLY: Like, how much would you want to make?

ANNE DOWER: You know, just real casual.

MOLLY: Where do you want to live?

GREG DOWER: We both really like Florida. We like the climate. So we put on there I think something like, we wanted to be in Florida in 2005.

MOLLY: And then before you know it, they're -- they're jotting down ...

ANNE DOWER: Children.

MOLLY: Kids. Like, how many kids they'd want to have together.

ANNE DOWER: Two kids, at least.

GREG DOWER: We both agreed on that.

MOLLY: Greg had already expressed at some point that family was super important to him.

ANNE DOWER: He loved having brothers and sisters.

MOLLY: Annie felt the same way.

ANNE DOWER: Like, we went to Christmas Eve this past Christmas, and I think there was 45 people there. And it was all family.

MOLLY: But it's like, they don't write down that they just want to have kids. They start writing down ...

GREG DOWER: Like, names and stuff like that, you know?

ANNE DOWER: Jack Dower. Jimmy. Tyler. Jake. Joseph. Joey. These were all names were throwing around. Boys' names. And then we had for girls Taylor, Madeline, Bobbi with an 'i' because his dad's name was Robert.

MOLLY: And then they wrote their own names down on it.

ANNE DOWER: And he signed it and I signed it with the date.

MOLLY: But I just want to say guys, this doesn't seem casual.

ANNE DOWER: No! Pretty intense, right? Casual dinner. We covered it all.

MOLLY: Your definition of casual and mine are very different.

MOLLY: A few months after that date, they go on one of their first big trips together.

ANNE DOWER: To the Super Bowl.

[SPORTS CLIP: Good evening ladies and gentlemen and welcome to Super Bowl 35.]

ANNE DOWER: In Tampa Bay. And the morning of the Super Bowl, we were laying in the hotel room and I woke up and I felt like ...

MOLLY: She had this feeling of a weight on her chest.

ANNE DOWER: Like a hundred-pound weight sitting on my chest. Like I couldn't catch my breath. And I was like, "Something's wrong."

MOLLY: So they come back from the Super Bowl. They go to the doctor. The doctor runs a bunch of tests, and then a week later they go back.

ANNE DOWER: And they were like, "You want the good news or the bad news?" And I was like, "The bad news." And they were like, "It's cancer." And I was like, "Okay. Not good."

MOLLY: It turns out she had this pretty big tumor, like, right down her breastplate, like, where your ribcage meets. Like, right over your heart and lungs.

JAD: How big are we talking about?

MOLLY: Grapefruit-sized.

JAD: Whoa.

ANNE DOWER: You know, you think cancer and you immediately think you're dying, or you're gonna die.

MOLLY: But her doctor said ...

ANNE DOWER: Good news is that it's Hodgkin's lymphoma, and it has a cure rate of, like, 95 percent.

MOLLY: She said that the doctor literally was like, "It's fine."

ANNE DOWER: Called it a slam dunk.

MOLLY: But it's still super scary. Any cancer's scary. And at some point Annie finds herself sitting down with Greg and saying, "You don't have to do this."

ANNE DOWER: You didn't sign on for this.

MOLLY: Like, we haven't even been dating a year yet.

ANNE DOWER: You know, you're young. You're a good-looking guy. You can find another girl and you can be guaranteed like, you know, a good future and you know, I said, "Run."

GREG DOWER: When we got diagnosed, it's just like, boom! Just like we got thrust from kind of this fast-track relationship and we're really having fun, enjoying each other and moving -- moving pretty quick. And then bam! We got hit with that. So you got to do one of two things. You gotta say, "Do I -- do I love this woman, and I am I ready to go on this -- kind of this tough journey that's going to be ahead? Or am I gonna get out?" It was gonna have to be one or the other, right? There's no gray in that scenario. So that's when I proposed to her.

JAD: Whoa! Okay.

MOLLY: She says yes. And so, like, newly-engaged they go through this cancer treatment, and about nine months later, after all the treatment's done, she goes in for another scan and all of the cancer is totally eradicated, except for this one thumbnail-sized tumor.

ANNE DOWER: The grapefruit tumor I had in my chest and my spleen dissipated, but it was still there.

MOLLY: Way smaller, but it was still there right in the middle of her chest.

ANNE DOWER: And at that point ...

MOLLY: The doctor looked scared.

ANNE DOWER: I saw terror in his eyes, like he was -- he was confused.

MOLLY: Because he was like, "I gave you the normal regimen. There must be something else going on. Like, that should be gone."

ANNE DOWER: He didn't know what else to do.

MOLLY: So Annie and Greg thought, "We need a different doctor."

GREG DOWER: But Anne's insurance wasn't gonna cover that.

MOLLY: But Greg's would. So they just decide, "Screw it. Let's just get married right now."

GREG DOWER: And so we had like this real kind of small, impromptu wedding at St. Gregory's. Just our immediate family. Brothers and sisters, mom and dad. and ...

ANNE DOWER: Literally, that was the only people invited. It was kind of somber.

MOLLY: Because it was like ...

ANNE DOWER: Will I be alive in a year? Like, it's a big "What-if?"

MOLLY: Six days later they're in New York City with a new doctor.

ANNE DOWER: Dr. Carol Portlock at Sloan-Kettering.

MOLLY: And they had sent all of their test results to this doctor. They have their first meeting. They go through another month of tests. And then ...

ANNE DOWER: She sits down, puts her glasses down.

MOLLY: Says ...

ANNE DOWER: "Okay."

MOLLY: "I've looked over your test results and ..."

ANNE DOWER: "You have stage-four non-Hodgkin's lymphoma." She goes, "It's very aggressive, and it's a 70% chance you're gonna die." I just remember feeling like -- kind of like with her words and how quick they were and kind of cold, it was kind of like, "Hmm. This might not turn out the way we both really, really want it to."

MOLLY: Annie asked the doctor, "How will you treat this?" Doctor says, "It's this super-intense chemotherapy and a stem cell transplant, which is a very intense procedure." And then ...

ANNE DOWER: I asked her, "What can I do about my fertility?" And she looked at me like I had three heads, you know? Like, she goes, "My darling, forget the fertility. You're fighting for your life."

MOLLY: And Annie says back to her like, "No ..."

ANNE DOWER: I want children.

MOLLY: Like, I don't think you get it. We have a plan. I put this on a placemat. I signed it.

ANNE DOWER: I'm going to beat this. You might not believe it, but I believe it.

MOLLY: I'm having kids, and I'm having kids with Greg. And when I asked her why she was so adamant about it, she just said it was a couple of things. One, she just always really wanted to be a mom.

ANNE DOWER: That's what I wanted. I wanted to be a mom, but ...

MOLLY: Two, she had just married Greg, just made this promise that they could have kids together. And she felt like if she couldn't do that, she was breaking that promise to him.

ANNE DOWER: Okay, so I get through it and then he's maybe not gonna want to be with me anymore? Like, you know, like once I get healthy, because he's got dreams of himself individually. Like, separate from mine, you know? Even though we're married, you know what I mean? Like ...

MOLLY: Kind of like a worry that, like, maybe if we can't have kids that, like, we might break up?

ANNE DOWER: Not really a worry, but a thought. Kind of, you know, as you lay there and you're taking ...

GREG DOWER: Well, I definitely wanted kids, you know? But I wasn't -- however this goes I'll be -- I'll be happy. And so, you know, our focus, my focus was on getting her healthy.

MOLLY: It was interesting, because whenever they talked about, like, kids or when they're -- them at that time, like, trying to get through stuff, they kept throwing their hands kind of forward where they just kept saying, like -- like, they were, like, tossing something in front of them.

JAD: Oh, they would make that gesture?

MOLLY: They would make the gesture of like -- of like, I'm gonna -- I'm, like, throwing a ball out.

MOLLY: Like, your hand gestures are interesting, because every time you talk about kids you're, like, shooting your hands out away from your body and, like, putting something out there in front of you that then you can, like, heave yourself towards.

ANNE DOWER: I know, right? I mean, it's just kind of like -- Yeah, like you, like, reel it in, you know? It's out there and it's circulating so you can see it. I don't know, I just felt like it was hope of: there's the goal go get it.

MOLLY: So Portlock is like, "No, I don't think you understand. Like, we need to get you in treatment right away. Like, within maybe a week." And any fertility treatment would take too long. Like, egg freezing takes too long, IVF that would take weeks. But Annie is just like, "Come on."

ANNE DOWER: Anything. Give me a shot. And she just paused for about 30 seconds.

MOLLY: And then ...

ANNE DOWER: She goes, "There is a doctor across the street at Weill Cornell. He is a fertility specialist. He's doing a study right now. I don't know much about it, but I will make sure you have an appointment tomorrow morning."

MOLLY: So the next morning Annie is in the doctor's office across the street and in walks this mystery doctor.

KUTLUK OKTAY: All right, the duck is in the house.

ANNE DOWER: He had crazy, curly black hair and he had a white lab coat on. I mean, he looked like a Nutty Professor. And I'm like, "I kind of like this guy. I don't know why I like this guy, but I kind of like this guy."

MOLLY: Do you remember when you met her?

KUTLUK OKTAY: Yeah, Anne was one of the first few patients that we did the freezing for.

JAD: Oh, this is our guy from episode one. Mister Magical Gonads.

KUTLUK OKTAY: Gonads are magical organs. [laughs]

MOLLY: Yeah.

JAD: Okay.

MOLLY: We're back with the magic of the gonads. We're about to re-enter the magic land, and he's also the guy that brings us to freezing. But first a little context. If you think about all of human history, creating more of us required an egg and a sperm and sex, and then some magic happened and a baby popped out.

JAD: Yeah.

MOLLY: But at a certain point we started trying to figure out how to control that process. And so what starts is the freezing of reproductive parts. It all started with sperm.

JAD: Okay.

MOLLY: In the 1700s, they realized that sperm slowed down and became really sleepy when it got cold. I don't know, some sperm ended up in some snow. I'm not sure what the story is, but that's what they saw. It wasn't until the 1950s when they actually figured out how to freeze sperm, thaw sperm and then use that to make a real baby. And then it's like, "Okay. Well, if we've figured out sperm that's like half the population. So what about eggs?"

MOLLY: And so they start trying to freeze eggs, but that turns out to be a lot harder because eggs are so full of liquid. So when you try and freeze them, ice crystals form and it just -- phoosh -- pierces the egg. And it's at this point sort of in the '90s that Oktay walks into the room. He was studying kind of eggs in general and fertility, and he ends up in a lab that is saying, you know, if we can't freeze eggs, maybe what we should actually do is just freeze the ovary. Which is a totally different ballgame, because an ovary is an entire organ.

JAD: Yeah. Isn't an ovary kind of a big -- well, how big is an ovary?

MOLLY: I mean, it's the size of, like, a -- I don't know, a walnut? But yeah, it's not a small task. It is still a whole organ. And that is actually what is cool about this whole thing, because it is the egg factory. So if you can figure out how to freeze an ovary, you can potentially freeze thousands of eggs. And so when Annie shows up onto the scene, this was just an idea. It had never been done before, except for in animals. But the idea that a handful of doctors including Oktay had was for women in Annie's situation, you know, let's freeze some of your ovarian tissue, and then maybe one day the technology will catch up and we can do something with it.

MOLLY: So when Annie walked in the door, how experimental was what you were doing?

KUTLUK OKTAY: No, it was highly experimental, because she was one of the first few patients.

MOLLY: Annie comes in and he says, "There's this thing. It's ovarian freezing."

ANNE DOWER: He goes, "This is brand-new."

MOLLY: I've never successfully done this in a human.

KUTLUK OKTAY: There were no pregnancies or anything.

MOLLY: He told Annie ...

ANNE DOWER: What I'm doing here is a shot in the dark.

MOLLY: This is like the basketball shot all the way across the court at the buzzer.

KUTLUK OKTAY: But unfortunately, this is your only option.

MOLLY: And then she said she was basically like, "Okay."

ANNE DOWER: He explained the process. Said, you know, this is what we will try to do, you know, we'll ...

MOLLY: We can take out one of your ovaries ...

ANNE DOWER: Freeze it in liquid nitrogen.

MOLLY: And then if you survive your cancer -- which is a big "if" at this point -- and if you make it to the two-year mark, which is a big landmark for cancer survivors, we can look at re-implanting it.

ANNE DOWER: He just handed us these papers. He's like, "Sign away." So I must have signed my name. Like ...

MOLLY: Do you remember what any of the waivers were?

ANNE DOWER: No. I just signed everything. Didn't read it. Just signed it. Like, he could have -- and we're sending it to China, and we're gonna make babies with, like, your ovary over there. I did not, like -- literally, I did not, like, pay any attention. I just wanted a chance.

MOLLY: Coming up, she gets that chance. And things get weird. I'm <PRESIDIO_ANONYMIZED_PERSON>. This is Gonads on Radiolab. Stay tuned.

[KELLY POWERS: This is <PRESIDIO_ANONYMIZED_PERSON> in El Cerrito, California. Radiolab Presents: Gonads is supported in part by Science Sandbox, a Simons Foundation initiative dedicated to engaging everyone with the process of science. Additional support for Radiolab is provided by the Alfred P. Sloan Foundation.]

[PAT WALTERS: Hey, everybody. Pat Walters here. I'm a producer at Radiolab, and I'm here because I need your help. This summer, I'm hosting a series of stories on the show and I have requests for those of you who spend a lot of time with kids: parents, aunts and uncles, teachers. We're looking for stories about what we're calling tiny moments of childhood brilliance.

PAT: Basically, I want to hear about those times when a kid you know did something that just made you lean back and say, "Whoa, how did they do that?" Maybe it was the moment that a kid you'd been reading to for months started reading back to you. Or maybe the kid was at piano lessons and you suddenly notice they were doing advanced math on the margin of their musical score. Or maybe the kid was in math class and you noticed they were writing music in the margin of their geometry homework. We're interested in those small, specific moments where a kid does something super-smart, but it doesn't have anything to do with a test. If you have a story, please share it with us and go to Radiolab.org/brilliance and record a short audio message for us. Again, that's Radiolab.org/brilliance. Thank you so much.]

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MOLLY: It's Molly. We're back. Picking up where we left off. It's right after getting this terrible cancer diagnosis. And Annie is in the OR and Dr. Oktay takes out one of her ovaries.

JAD: Walk me through that operation. What's involved?

MOLLY: As far as surgeries go, it's -- it's super simple.

KUTLUK OKTAY: Easy, painless.

MOLLY: He puts her under anesthesia, and then he makes an incision in her abdomen.

KUTLUK OKTAY: We go through patient's belly button with a camera, and then two little punctures along the bikini line, and we can pull the ovary out through that incision in the belly button.

MOLLY: And then they drop it in a freezer.

KUTLUK OKTAY: This is like a 45-minute outpatient procedure.

JAD: Is it the kind of thing that, like, once it's done, you just walk home?

MOLLY: Yeah.

KUTLUK OKTAY: Oh, yeah.

MOLLY: A week later, she's at Memorial Sloan-Kettering getting chemo. And the treatment is, like, insane. She goes through rounds of chemotherapy where she gets chemo all weekend.

ANNE DOWER: You know, like, the big zip locks, like the freezer bags, like the gallon? That's what they were hanging up. Filled with chemo. Non-stop. Down one? Ah, time for another one. Down one? Ah, time for another one. Time for another one. Constant.

MOLLY: In this kind of chemo, they kill a lot of the cells in your body. Good cells, your bad cells, your immune cells, your stem cells, they kill everything.

ANNE DOWER: You're basically dead for all intents and purposes. I mean, the blood counts are all bottomed out. There's no -- there's nothing. Zero white, zero red, zero platelets. Your ...

MOLLY: From there, she gets a stem cell transplant, which is taking your blood out and putting stem cells back in. The idea is that then she would regrow her immune system, hopefully without cancer.

ANNE DOWER: May 26, I walked out of the hospital.

MOLLY: Annie is bald.

ANNE DOWER: No eyelashes, no eyebrows.

MOLLY: Super skinny.

ANNE DOWER: Mouth sores. It sucks.

MOLLY: But according to the doctors ...

ANNE DOWER: They were like, "You're good."

MOLLY: She's cancer-free.

ANNE DOWER: You're clear. So when we got out, we walked to the park.

MOLLY: Got a slice.

ANNE DOWER: Park Pizza, which is the greatest pizza ever. The sun was shining and horns honking, and it was New York. Like, it was like I stepped outside and I was like, "I'm alive again. Like, this is life."

MOLLY: But there was a pretty good chance that the cancer could come back. So she and Greg go home and wait. One month goes by, two.

ANNE DOWER: That placemat was just, like, you know, hanging, like, on the fridge, front and center. Like, floating there.

MOLLY: Three months. Four.

ANNE DOWER: I would think about the cancer most of the day. Where it was like, "Is it gonna come back? Where is it?"

MOLLY: Five, six. A year goes by, then 18 months. Still no cancer.

MOLLY: When did you first have the ovary re-enter your mind?

ANNE DOWER: Well, it started to -- I went May 13 of '04, you know the two-year mark. And they did a PET scan, bloodwork, all that, and I was clear. And that day, I went and saw Oktay.

MOLLY: You just walked across the street.

ANNE DOWER: I did! I was like, I told him I was gonna be there.

MOLLY: And what you'll remember is the last time she talked to Oktay, the deal was: get to the two-year mark. If you get to the two-year mark, give me a call. I have no idea where we'll be at with this technology then. No idea if I'm gonna be able to give you a baby, but we'll see. Now in that interim period, in those two years, Oktay had been continuing to experiment, working with other patients, taking thawed tissue and putting it back in them. But not where you'd expect.

KUTLUK OKTAY: Yeah, my -- originally we did this in the forearm.

MOLLY: What? Like, right under my watch? Like, on my forearm?

KUTLUK OKTAY: Yes, correct. We would take it and stick it in the muscle in the forearm.

JAD: An ovary in the forearm?

KUTLUK OKTAY: Yeah.

JAD: How does that even make sense?

MOLLY: Well, it makes sense, because this is how crazy weird, like, an ovary is. You can put it literally anywhere in the body that has good blood supply ...

KUTLUK OKTAY: And in the next three to ten days, new blood vessels form. And then ...

MOLLY: So it just -- it just pops on?

KUTLUK OKTAY: Correct.

JAD: But then how do you get a baby out of an ovary that's in your forearm?

MOLLY: Oh, so the idea is that you could just, you know, sort of pluck the mature eggs out from just underneath the skin, and then you could combine them with the sperm in a Petri dish and just do normal IVF, where you'd make an embryo in a Petri dish and then implant it.

JAD: Gotcha.

MOLLY: But by the time Annie walked in, no one had done this and gotten it to work. There had yet to be a baby born from an ovarian transplant. When Annie showed up though, Oktay was ready.

ANNE DOWER: He said, "I'm gonna take the 21-inch strips ...

MOLLY: These little bits of her ovary that had been frozen for two years.

ANNE DOWER: And we're gonna suture them right underneath your belly button in your stomach.

MOLLY: Wow! Wait, why there?

ANNE DOWER: Well, he has -- he put -- prior to me, he had put a few in a woman's rear end.

JAD: No, really?

MOLLY: It actually wasn't him that did that, but rumor on the street is that there's an ovary in a butt somewhere.

ANNE DOWER: But he felt that putting it closest to where the other ovary is, and where its original spot was, was probably the most beneficial. And he goes, "Hopefully within two months, you'll get a menstruation cycle." And he goes, "And then you'll come out of menopause."

MOLLY: Because remember, that chemo would have shut down that remaining ovary and put her into full-on menopause.

ANNE DOWER: We don't know. It's not a guarantee. We just gotta see.

MOLLY: So Oktay does the procedure. Again, it's super simple. He implants a few bits of ovary in the skin next to her belly button.

ANNE DOWER: And ...

MOLLY: Two months later ...

ANNE DOWER: Started to feel the first little marbles.

MOLLY: Down around her belly button, she had these lumps.

ANNE DOWER: I don't know how to describe it. But, like, under the skin, you can actually, like, kind of grab it.

GREG DOWER: And Annie would always say, "Put your -- put your finger right here, 'cause you can feel them." And, you know, certain times of the month, they would -- it would get bigger.

ANNE DOWER: Huge eggs on the skin. It was really weird. I mean, I'd have all different sizes. Like, sometimes less than dimes, sometimes as big as a quarter.

MOLLY: What did it feel like?

GREG DOWER: It just feels like if you rubbed your finger across -- almost like just a bigger version of kind of like, you know, they have, you know, like the Braille on the elevators.

ANNE DOWER: We would go to New York and Oktay would actually measure them.

KUTLUK OKTAY: It was interesting.

ANNE DOWER: With, like, a measuring tape and, like, put like marks on. And he'd, like, measure their circumference. And he'd be like, "Great! That's a good size!"

MOLLY: And Annie says they hurt.

ANNE DOWER: I mean, I couldn't buckle my jeans, because the buckle -- like, the button on the jeans would hurt pressing against the skin, because they were sticking out, you know?

MOLLY: Did you move to elastic pants?

ANNE DOWER: Oh, yeah. It was, like, real pretty, you know?

MOLLY: So about a month after the marbles show up, they fly down to New York City for a series of appointments. First, a cancer checkup, they get a PET scan. Next day, they go see Oktay.

KUTLUK OKTAY: And that's when all these interesting things beginning to happen.

MOLLY: Annie's on the exam table.

ANNE DOWER: He starts to do an ultrasound, which is always so uncomfortable.

MOLLY: And then all of a sudden ...

ANNE DOWER: Oktay says, "Oh my God! Oh my God!"

KUTLUK OKTAY: And I think I almost passed out.

ANNE DOWER: And I'm like, "Is everything okay?" He's like, "This can't be."

KUTLUK OKTAY: This can't happen.

ANNE DOWER: And I'm looking at him and I'm like, "Dr. Oktay, what is wrong?" He's like, "Hold on." He kept looking, he's looking at the monitor and doing all this stuff. I said, "What can't be?" He goes, "You're pregnant."

MOLLY: What?

ANNE DOWER: Yeah!

KUTLUK OKTAY: It was just an unbelievable moment.

ANNE DOWER: I was like, "I'm pregnant? No."

KUTLUK OKTAY: You know, am I looking at the right patient? You know, like, take a look at the charts again.

JAD: Wait, she's pregnant. What does that mean?

MOLLY: I mean, no one really knows what it means. It means that there are eggs that are protruding out of her skin, and yet somehow there's also an embryo in her uterus.

ANNE DOWER: I said, "How?" He goes, "The old-fashioned way, sweetheart." [laughs]

MOLLY: But Annie was like, "No, no. Really. How?"

ANNE DOWER: You know, what -- I don't understand. He's like, "I don't know."

MOLLY: And then he's like, "Wait."

ANNE DOWER: "I'm trying to find a heartbeat."

MOLLY: It turns out ...

KUTLUK OKTAY: There was no heartbeat.

JAD: [gasps]

MOLLY: It's not viable.

JAD: Oh, fuck!

MOLLY: And it -- it goes on from there. They get into the car. Phone rings.

MOLLY: It's Dr. Moscowitz from Sloan. I'm like, "Shit. Like, why is he calling us? The shoe's gonna drop. The cancer's back, right?" Because we just had the PET scan, like literally the day before.

MOLLY: So she picks up the phone.

ANNE DOWER: I'm like, "Everything okay?" He's like, "Your scans are fine. You're clear." I said, "Huh, okay. I thought you were calling ..." He goes, "I know what you thought." He goes, "You thought I was calling to tell you that the cancer is back and to get back to the hospital." And I was like, "Yeah." And he's like, "No. You're cancer-free." He goes, "Did you know you're pregnant?" And I'm like, "Just found out." He's like, "You went to Oktay?" And I said, "Yep." And he goes, "Did you know you were pregnant before you had the PET scan?" And I said, "No." I said, "Could the PET scan have killed it?" He said, "Yes."

ANNE DOWER: So that was kind of hard.

MOLLY: Kinda!

ANNE DOWER: You know, because it was like, "Shit!"

JAD: Wow, that is crazy whiplash.

MOLLY: Yeah.

JAD: Wait, can I just -- let me just catch up here. How did this -- like, she's got marbles in her belly button.

MOLLY: Marbles in her belly button.

JAD: And now you're saying that suddenly a baby appeared in her uterus? That's a long way away from her belly button.

MOLLY: I don't get it.

JAD: I don't get it. Like, so what did the belly button -- how does -- is it -- what happened?

MOLLY: That ...

KUTLUK OKTAY: That's the question.

MOLLY: There are so many different possible answers.

KUTLUK OKTAY: Definitely something happened there. And what was that something? Divine intervention? I don't know.

MOLLY: So Oktay eventually does publish two papers on this. And he raises, like, a lot of different ways this -- this could happen. In Annie's -- here's maybe the thing to remember for all these explanations.

JAD: Yes.

MOLLY: So in -- so if you think about Annie's body right now, there's the one ovary that was left inside that is now defunct.

JAD: It's dead.

MOLLY: Right? Everyone describes as like a dead ovary.

JAD: Because it's been killed by the chemo.

MOLLY: Right. So you've got the dead ovary inside her. You've got the transplant below her belly button in the skin, which is very much alive, full of eggs.

ANNE DOWER: Little marbles.

MOLLY: So to get a pregnancy, here's what might have happened. A couple different options. First, maybe one of these immature sort of egg cells near her belly button slips out of the transplanted ovarian tissue, gets into the bloodstream, is transported through the bloodstream all around the body.

KUTLUK OKTAY: Into the opposite ovary.

MOLLY: The dead one. Where it is like, "Oh, this is the place I want to be."

JAD: Oh, my God.

MOLLY: It settles. And then in there is matured, and then can be sucked up by the Fallopian tube and made into a baby.

KUTLUK OKTAY: Correct. So biologically speaking, it's plausible. Let's remember, germ cells got to the ovary through a long migration.

MOLLY: Remember last episode?

KUTLUK OKTAY: The Great Migration.

MOLLY: The Great Migration.

KUTLUK OKTAY: Yeah.

JAD: But this would be the Great Migration times a million because it's going all around the body.

MOLLY: Yeah. The most likely and most reasonable thing that -- that probably happened is that the ovarian transplant, in reconnecting with the body sends out its signals like, "Hey, hey! Hey, hey! We've got some hormones going on here."

KUTLUK OKTAY: And these hormones help the other ovary wake up.

MOLLY: Turn back on. And then if it had any remaining egg cells that were, like, dormant, maybe you could, like, rejuvenate them or get them to mature, and then those could become a baby.

JAD: Wow. So either these eggs are going on a journey like no other, or they're waking the dead.

MOLLY: Yeah, just two very reasonable options.

JAD: That's bananas both ways.

MOLLY: Yeah.

JAD: That's like double bananas.

MOLLY: It is so bananas that when it happened, Oktay just thought it was ...

KUTLUK OKTAY: Luck.

MOLLY: Like, maybe that ovary inside her, the dead one, just had, like, one last egg. But a month and a half later?

ANNE DOWER: Pregnant.

MOLLY: Again.

JAD: In the same way?

MOLLY: Yeah.

JAD: In her uterus?

MOLLY: Yeah.

ANNE DOWER: Like, holy crap! My body healed enough, I could actually achieve a pregnancy without intervention.

MOLLY: And so September 25th, 2005. Sienna Anne Dower was born.

[NEWS CLIP: A healthy baby weighing 8 pounds 6 ounces.]

MOLLY: The first baby ever born in the US of an ovarian transplant.

[NEWS CLIP: Even though the chances of conceiving a child was unthinkable.]

[ANNE DOWER: Like, one in five million.]

[NEWS CLIP: Greg and Anne Dower gave birth to a miracle baby.]

[GREG DOWER: The end result is awesome. We got a beautiful baby girl.]

MOLLY: Greg, Annie, Oktay ...

[NEWS CLIP: Dr. Kutluk Oktay ...]

MOLLY: Little baby Sienna. Hit the road on a media blitz.

[NEWS CLIP: She is now the mother of a bouncing baby girl. The first ever to be born in the US by using this particular technological breakthrough.]

MOLLY: So that happens. And then three years later ...

ANNE DOWER: [snaps fingers] Pregnant.

MOLLY: It happened again.

ANNE DOWER: With little Greg.

JAD: Same thing? The old-fashioned way?

MOLLY: Yes. And at this point, they're like, "We're good."

ANNE DOWER: We had a girl, a boy. They were healthy. No issues, thank God.

MOLLY: They felt like, "We have executed the dream of the placemat."

ANNE DOWER: No intention of having another one. Like, zero.

MOLLY: But four months later ...

ANNE DOWER: Pregnant.

MOLLY: Again!

KUTLUK OKTAY: Three babies, back-to-back-to-back. I mean, how do you become super-fertile after being in clinical menopause for two years?

JAD: Does he still think that Annie and Greg got lucky? That this was kind of a one-off?

MOLLY: No, because since Sienna was born, we've had many more babies born from this procedure.

KUTLUK OKTAY: As we stand now, there are perhaps over a hundred babies born all around the world.

MOLLY: And it's no longer, like, just happening within the fertility community. I bumped into doctors that are experimenting using it with women who are going into menopause. An ovarian patch that will inject hormones to delay menopause. The other place where I bumped into it is in the trans community, where kids who are transitioning from female to male are opting to -- or their parents are choosing to freeze their ovary so they have a chance of possibly having biological kids if they want to do that.

MOLLY: So it is -- it is cool, because you -- you have this feeling of, like, when I was standing in the room with Annie, I kept having this, like, feeling of -- you just feel, like, really close to some sort of power. Like, maybe because it's an -- which is kind of ridiculous because I have this power too, right? I have ovaries. But them being outside the body, and like -- like she said kind of, like, sci-fi experiment. It's just like humans are marching towards this moment of just, like, regulating every part of the human process. But then almost as quickly as you have that thought, you realize it's 13 years later. You have these kids running around. And Oktay still doesn't really understand what happened.

ANNE DOWER: So this is Molly.

MOLLY: Hi!

ANNE DOWER: This is Sienna.

MOLLY: I'm Molly.

MOLLY: I don't know if anyone does.

MOLLY: How are you?

SIENNA DOWER: Good.

MOLLY: What are you working on?

SIENNA DOWER: My science fair project.

MOLLY: What is this?

SIENNA DOWER: I didn't even know you had this, Mom.

GREG DOWER: They're just now getting to the age to where we talk -- you know, talk to them about it. And we showed Sienna some of the tapes, and we showed her some of the footage from being on the Today Show.

SIENNA DOWER: I seen this picture before, though. Because if you search up my name on Google -- I searched up my name and this picture came up, and a bunch of other ones of me as a baby. So ...

MOLLY: Wait. What is this, you guys? You have a whole magazine?

SIENNA DOWER: The world's best -- the world's most amazing baby.

GREG DOWER JR.: With her 10 cute fingers and her 10 cute toes. Sienna ...

MOLLY: This is Greg. Baby number two.

GREG DOWER JR.: ... Anne Dower is not just another adorable newborn. She is a miracle of ...

MOLLY: And baby number three, Kate, was feeling a little overlooked.

KATE DOWER: Why is everything signed to Sienna? Like, this magazine has Sienna.

ANNE DOWER: Well, because she was the first baby that was born in an ovarian tissue transplant, and you guys are number two and three in the country.

KATE DOWER: 10 cute fingers and 10 cute toes.

[GONAD DISCO: Gonads! It's gonad time! It's gonad time!]

MOLLY: This episode was reported by me, Molly Webster, and produced by Pat Walters. With original music and scoring by Dylan Keefe. The Gonads theme is written, performed and produced by Majel Connery and Alex Overington. Radiolab Presents: Gonads is Rachael Cusick, Pat Walters, Jad Abumrad and Molly Webster.

MOLLY: So in the last couple of weeks, we teamed up with the website Romper.com to turn some Radiolab listeners stories about trying to conceive into this web special. There's a lot of different perspectives. You should totally check it out. It's over at Romper.com/trying. Plus, I was on The Bustle Huddle talking about what it's like to be 35 and whether or not there's really a reproductive cliff. Check it out at Romper.com/trying or wherever you get your podcasts.

[ISANNA: This is Isanna calling from London. Radiolab was created by Jad Abumrad and is produced by Soren Wheeler. Dylan Keefe is our Director of Sound Design. Maria Matasar-Padilla is our Managing Director. Our staff includes Simon Adler, Maggie Bartolomeo, Becca Bressler, Rachael Cusick, David Gebel, Bethel Habte, Tracie Hunte, Matt Kielty, Robert Krulwich, Annie McEwen, Latif Nasser, Malissa O'Donnell, Arianne Wack, Pat Walters and Molly Webster. With help from Shima Oliaee, Carter Hodge and Liza Yeager. Our fact-checker is Michelle Harris.]







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