Egg Freezing
Egg freezing can be a life-changing opportunity, but it’s important that you know all of the basics. Often we don’t really understand what it means, what the process entails, who is a good candidate, and what your chance of success is. It is expanding our reproductive options. I’m a huge believer that you have to have data that is given in a transparent way.
Does egg freezing guarantee a pregnancy?
Egg freezing was experimental until 2012. That is not that long ago. If you ask me about long term data, there is none. Now it is switching gears and not just an option for oncofertility. Now women who are intentionally delaying their childbirth are looking for an option to counteract the side effects of age and fertility. This is a great option, but we have to be aware of what it means. I’m not trying to scare you. I love egg freezing. It is female empowerment to the extreme. However, it is a controversial topic. Egg freezing is not an insurance policy for future pregnancy. Anybody who is trying to sell you this idea does not know what they are talking about. You should go somewhere else. I tell my patients, “You are setting yourself up for the best option you have. You are preparing for the future, but is it by no means a guarantee or an insurance plan.”
How does age affect my eggs?
One of the main reasons why I started this platform was because of the lack of information women have on age and fertility. They are shocked by the statistics. Women have the most eggs they will ever have when they are in their mother’s womb. As we age, the number of eggs significantly decreases as well as the quality of the eggs. At the start of each month, a group of eggs is released. If you are older or running out of eggs early, the number of eggs released is lower. The goal of egg freezing is to get all of the eggs released to grow. We don’t want any eggs to die that month.
Can I test my egg count?
A blood test called AMH (anti-mullerian hormone) can measure this number of eggs released or ovarian reserve. We categorize this number as above average, average, below average, or critically low. AMH should not be used to tell women not to freeze their eggs. It must set expectations appropriately because there is strength in numbers. The live birth rate per egg when you freeze your eggs is not very high. On average it is five to eight percent per egg. If you are under 30 it is 7.4 percent, 30-34 7%, 35-37 6.5 percent, 38 or older 5.2 percent. What does this mean? If you are 38 or older you need 20 eggs for an optimal outcome for one child. It’s important that you can view what you have.
Why are these numbers so low?
Not every frozen egg will survive the freeze-thaw. Not every egg that survives will be fertilized with sperm. Not every egg that is fertilized with sperm will grow into an embryo. Not every embryo that makes it to the blastocyst stage will be genetically normal. Even every genetically normal embryo does not result in a live-born baby. There is a lot of loss throughout this process that is really important to understand. You are going to lose eggs in the freeze-thaw process so you have to be thinking about that when you are being counseled on this. Someone may tell you that you have a better chance of freezing a fertilized embryo and they are not wrong. A blastocyst is stronger and is going to survive the process better than a single-cell egg. That is a fact. I tell patients there is about an 85 percent chance of survival for an egg and for a blastocyst at the embryo stage it is a 98-99 percent chance. That doesn’t mean you have to make your egg into embryos if you don’t have a partner with sperm. If your goal is to have got pregnant with a future and undetermined partner then it makes no sense for you to use donor sperm at this point.
What is egg freezing?
The point of egg freezing is to make the eggs grow. We do that by exposing them to high levels of FSH than what they would normally see in a natural cycle. We do this with hormone injections. They are just versions of the natural hormones we already make. These are peptide hormones, and it goes in your small fat areas. The process lasts for two weeks and is injected nightly between 8-12 days. It must be monitored by your doctor. We do this with transvaginal ultrasound and a blood draw checking your estrogen levels every 2-3 days. Every clinic is different. The process of IVF and egg freezing are identical until you get the eggs in a lab. There is another part of the protocol and that is suppressing the body’s natural desire to ovulate with high estrogen levels. The brain is blind but it can hear. Estrogen is the normal signal to the brain that you have a mature egg. So we have to block that with an ovulation blocker. When you have the highest number of mature eggs you will use a trigger shot. This helps the egg get into the final stages of meiosis and get to the next stage of maturation so they can be fertilized at a later date.
What is the egg retrieval procedure?
The egg retrieval is generally 35-36 hours after the trigger shot. It is the most invasive part of this process. You get an IV and a light anesthetic. It usually takes about 20-30 minutes. We start by taking the transvaginal ultrasound probe and attach a needle guide and it is used to go vaginally while we observe. We enter follicles and drain out the fluid. Each egg grows inside a follicle so as we drain out the follicular fluid, we drain out the eggs as well, and they go into test tubes. They then go off to the lab, they look through the fluid, identify the eggs, and strip off the outer cells of each egg called the cumulus. Then they determine which cells are mature or not. The mature eggs are frozen.
What age is best to freeze your eggs?
If you are under the age of 37, you are in the best group as far as statistics go. In recent studies, between age 32-33 is where we start to see a decline in egg number and quality. If you are 28, married, and looking to have two kids starting around age 30-31, I’m not saying you need to go freeze your eggs right away. I am talking to the women who are 32-35, not ready to start a family, and purposefully delaying. It doesn’t mean you should not do it if you are older. It is just important for us to lay the facts out before you make the decision. You also have to be open to options such as donor sperm, donor eggs, or adoption.
If you are considering egg freezing you need to:
Schedule an appointment with a fertility specialist.
Have an evaluation of your antral follicle count and AMH level.
Ask how many eggs are expected based on your test results and how many eggs you are expected to need to have one live birth.
Ask how many cycles are suggested based on your specific data.
Ask what their success rates are for patients at their clinic.
My final challenge to you
We are curious beings. When we see someone who is married or in a relationship we want to know when they are planning on it. We see someone rockstarring it at their job and not yet married, we want to know what her plans are. It is not supportive to ask these questions. We need to change our mindset. As a woman in medicine, here are things I have heard or been told.
“Wait to have kids.”
“You haven’t had kids yet?”
“Don’t you want kids?”
“Your kids will never see you.”
“You can’t be a good doctor and a good mother.”
“Who will raise your kids if you are at work?”
“You are taking birth control, aren’t you?”
“Are you going to quit your job after having kids?”
“Don’t you want more kids?”
“Having more kids won’t be fair to your other kids because you work so much.”
“It’s too hard to have kids when you are at a private practice.”
“We shouldn’t hire her because she’ll have to take off for maternity leave.”
“Your patients will not want you to be their fertility doctor if you are pregnant again.”
Yes, these things were actually said to me and my colleagues. Nobody was trying to be mean. They were most likely projecting their own feelings about themselves. You make the choice for yourself. Don’t delay freezing your eggs because you are afraid to take off from training. Don’t prolong trying to get pregnant because you are afraid of what your co-residents will think. You have to look out for the family you want in your future. You get the data you need to make the choices you need to make because you cant make decisions about things you don’t know.