Thanks for Watching

– My name is Candace. I’m the clinical manager here at the IVF Center. Today’s webinar is gonna be focused on egg freezing and be presented by our very own fertility specialist, Dr. Lucy Chen. This session is live, but it will also be available for downloading demand later. The first half of our program will be an informative session. The second half will be dedicated to a live question and answer session. You can type questions into the question and answer box on your webinar or in the Facebook live feed, and your name and email address will not be shared. And now I would like to welcome Dr. Lucy Chen. Dr. Chen is a fertility specialist who has completed her reproductive endocrinology and infertility fellowship at Johns Hopkins School of Medicine. She is also duo trained in medical genetics and we are so excited to have her join our IVF Center practice. Take it away, Dr. Chen.

– Thank you Candace. So my name is Dr. Chen and I’m so excited that you could join me today for this live webinar. Today I’ll be talking about egg freezing, which has become a very popular topic among women of reproductive age. We will talk about the process of egg freezing, the pros and cons and to see if this is something that would be right for you. We’ll also try to answer all the submitted questions at the end, and if we don’t get to your question, please just send us an email. So what is egg freezing? Egg freezing is also sometimes called oy cryo preservation. OSA is just a scientific name for an egg and cry preservation just means freezing. So it’s the process of saving or removing eggs from the body and then freezing them in a lab so that they can be used at a later time. There’s been a huge increase in a number of women freezing their eggs in recent years, and this is because many of us are choosing to start our family at a later age. So a woman who freezes her eggs at a younger age will increase the chance that she can have biological kids later on, for example, maybe in her forties. Some people often refer to this process as fertility insurance. I like to think of egg freezing as a tool that gives women more reproductive autonomy. So there are a lot of reasons why a woman may benefit from doing something like freezing their eggs. One of the first group who did egg freezing for fertility preservation included patients with certain medical conditions. For example, there are medical conditions that require treatment that could be beneto toxic or harmful to eggs. These treatments include certain types of cancer therapies such as chemotherapy or radiation that can damage a woman’s ovaries and eggs over time and potentially put her in premature menopause. There are also women with low egg supply and they may benefit from freezing their eggs early on or women with medical conditions such as lupus. Fertility preservation through egg freezing is also an option for our transgender patients prior to transitioning that allows ’em to protect their fertility before that process. Then another group of women who could benefit from egg freezing are those who are simply choosing to delay childbearing. And that could be for a variety of reasons. For example, they may choose to focus on career aspirations before they wanna start a family, or maybe they just haven’t, right? The met the right partner. So delaying the age at which to have a child is now based very common. And there’s been about over a 900% increase in women having their first child after age 35 since the 1970s. And almost half of women with a college education will be over 35 when they have their first child. So because of this trend in our society for delaying childbearing, egg freezing can be really beneficial for a lot of patients. And there are two main reasons. First, is because of the egg quantity or the number of eggs you have decreases as we get older. This is a a chart from a very old study, but it’s a very accurate chart and you’ll often see it in fertility journals or fertility presentations. This chart is showing that women are born with a number of eggs they’ll ever have. So women actually had the most number of eggs when they were in their mother’s womb, and we start with about six to 7 million eggs. But this start, there’s a decline, a steady decline in the numbers we number of eggs we have even before we’re born. So at birth, that number drops about one to 2 million, and this number continues to decline over time until the X supply is extremely low or completely depleted, and that’s when natural menopause occurs. Typically at age 51, in addition to the quantity of eggs, the quality of a woman’s eggs are also negatively impacted with age. When we talk about the quality of an egg, what we’re talking about is that when the egg ovulates and its fertilized with sperm, does that egg have the ability to provide a complete set of genetic information to the embryo as we get older with time, because our eggs are, they’re more prone to DNA damage and the chances of an ovulate egg having a missing or duplicated or simply just the wrong amount of genetic material increases. So this translates to higher rates of miscarriages and a decline in conception rates as a woman gets older. Typically we start seeing this impact around after age 35. So one of the benefits to egg freezing is that you can freeze your eggs when we were younger and that, and then you can use them later so that you can have a higher chance of pregnancy and lower chance of miscarriage. So there’s been lots of studies looking at the cost effectiveness of egg freezing because it’s a investment. And what we show is that a woman who’s 35, if she freezes her eggs and then wait until she’s 40 to have a pregnancy with those frozen eggs, that process is more cost effective than if she waits until 40 and then tries to do IVF. And that’s because the likelihood of live birth is so much higher when we’re using a 30 5-year-old egg compared to a 40 year old’s egg. So with everything in the medical field, there’s always pros and cons. And so the pros and cons of egg freezing really depends on the timing of egg freezing. So for example, if you freeze your eggs at a really young age, for example, in the twenties, the pro is that you’ll likely yield a really high number of eggs per cycle, and the quality of the eggs will likely be very high. This means that you may require only one IBS cycle to reach your full yield and you are maximizing your IVS cycle. The downside of freezing your eggs at such an early age is that you may never actually use those eggs because you’ll conceive on your own. For example, maybe in your thirties and the longer you have eggs frozen, the higher cumulative egg storage fees there are. However, if you freeze your eggs at a later age, let’s say when you’re 35 or older, you may need more than one idea cycle to get enough eggs to reach your ideal family size. And the quality of your eggs at that point might also be lower. However, on the other hand, you have a much higher likelihood of using those eggs in the near future. So this chart is showing the predicted live birth rate based on the number of eggs frozen. So this is a question I often hear from patients, which is, well, how many eggs do I need to have one child or two child children or three? So freezing just 10 eggs when you are less than 35 has roughly a 60% chance of giving you a live birth compared to only about 30% if you’re 35 and older. So this is not to say that you should not freeze your eggs if you’re 35 or older. There’s actually no age cutoff at our clinic on when you can freeze your eggs. It just sets the expectation that you may need to go through more IVS cycles to freeze more eggs in order to complete your ideal family size. Okay, so now you may be asking, okay, well if I want to do egg freezing, what is the process like? What is involved? What do I need to do? So the first step is to set up a consultation with consultation board certified reproductive endocrinologist and infertility specialist. This is an opportunity for that physician to get to know you and also see what your reproductive or family building goals are. We also will get a baseline blood work to see what your ovarian reserve is. We check to make sure that you’re in a good state of health and that it would be safe for you to go through this process. We also perform a pelvic ultrasound at that visit to look at your pelvic anatomy and your ovaries and look to see how many antral follicles you have. The egg freezing process takes about two weeks from start to finish. So it’s a good idea to start thinking about a timeline and plan accordingly, especially if you have a fairly demanding job. So I like to use the analogy of a flower garden when I describe the process of IVF to patients because the process is a little bit confusing and overwhelming. So I mentioned at the start of our talk that women are born with a number of eggs they’ll ever have. Think of that as you are born with a bag of seeds and some patients are born with a very large egg reserve some form with an average egg reserve some form with a more modest sized egg reserve, and that’s the size of the bag of seeds you are born with. Every month your body reaches into that bag of seeds and scoops out a handful of flower seeds and puts it into your garden. Normally you only have enough resources to get one of those seeds to grow completely and bloom into a flower, and that’s that one egg that gets to grow and ovulate and potentially get fertilized with sperm. In IVF, what we do is we give you a boost of all those resources. Think of it as extra nutrition, extra fertilizer, extra sunlight, extra water. We’re trying to get every single seed that your body recruited to put into your garden to grow and bloom into a flower. And then when they’re all fully bloomed, we go in and so we’re not touching the egg reserve you were born with. We’re not. Nobody can touch that egg reserve. We can’t create more eggs and we can’t take away eggs. We’re only working with eggs that your body recruited for that month. And if we did not do IVF, those follicles or those eggs would’ve just undergone program cell death. We are not putting you through anything that would make you at risk of early menopause or depleting your egg reserve faster by doing IVF. And so the reason why it takes takes about 10 days to go through this process is because that’s about how many days it takes for the injections to help the eggs mature. So usually the process starts with a baseline ultrasound. You come into our clinic, it’s a monitoring ultrasound we do in the mornings between seven and nine. And this ultrasound looks at your ovaries to make sure that there’s nothing like a cyst that could prevent you from starting the medications. With every ultrasound monitoring visit, you also will get blood work done to CYS to make sure that your hormones are responding appropriately After that first visit. If everything looks good, you’re going to start doing your daily IVF injections. You’ll continue for about four days and come back on the fifth day for us to take a look to see how your body’s responding. The combination of ultrasound and hormone lasts is the only way for us to know that your body’s responding appropriately. And it’s also a a time for us to titrate the medication dose if needed. After that visit, you might come back for two or maybe sometimes three more ultrasounds, but roughly after 10 days of injections, the follicles are appropriate in size. And then we give you one last injection called the trigger injection. After this, your egg retrieval will be 36 hours later. What is the egg retrieval process like? Well, it’s actually very low risk. The procedures performed at our outpatient surgery center, we have a board certified anesthesiologist who makes sure that you will be fully asleep and comfortable during this procedure. We use a transvaginal ultrasound with a needle to carefully isolate your ovaries in the follicles and aspirate the fluid in those follicles with hope that there’ll be a mature egg in that fluid. We then immediately pass it off to our embryologist and they will look under the mic microscope to see how many eggs we were able to retreat. So you’ll actually know the day of your retrieval, how many eggs you are able to get afterwards. The embryologist will freeze your eggs and they will be frozen until you are ready to come back and use them. So egg freezing is a very safe procedure, but like any medical procedures, there’s potential complications. The most adverse complication from medication is some abdominal bloating in some nausea and vomiting. And then there’s also a condition called ovarian hyperstimulation syndrome. This is when you, the elevated estrogen state causes a degree of fluid retention and results in a lot of bloating and discomfort and potentially third spacing of fluid. This rarely happens, although some mild ovarian hyperstimulation can be common. We take great care to ensure that your dosing is appropriate so that this does not occur. There’s also some minor risk in egg retrieval procedures. So there can be infection, there can be injury to other organs and there can be bleeding. But as you can see in the statistics, the likelihood of that happening is very, very, very low. In fact, at our center, it’s even less than 0.1%. So to be feel very reassured that we’re gonna take great care to ensure your egg retrieval process goes without any complications. Most patients go home with just over-the-counter pain medication and most patients are typically back to their baseline and able to go back to work the next day. There are also other ways to protect your fertility if you do not do egg freezing. So those include embryo cryopreservation. That process is almost identical to egg freezing. It’s simply that at the point where we would typically just freeze eggs, if you have a partner or if you have sperm that you would like to use, we can then just go ahead and inseminate the eggs and create embryos for you and freeze the embryos instead. This is a great option for patients who have a partner that they would like to create a family with, or if they have sperm that they, that is available that they likely to use. The al. Another fertility preservation option is something called ovarian tissue prior preservation. This is a great option for patients who cannot wait two weeks in order to freeze their eggs. They have to undergo some sort of medical treatment immediately. Or it’s a patient who is a child and has not gone through puberty yet and they either need some sort of medical treatment for cancer or a bone marrow transplant. Then freezing their ovarian tissue is the only viable option for them to preserve their fertility. This allows us to thaw the ovarian tissue later on and transplant it back into the patient in the future when she is ready to start having her own family. So another question I often get asked is, where are the eggs stored? So after the retrieval, the eggs are frozen through a process called vitrification and they’re stored in nitrogen tanks. Our lab has around the clock monitoring system. We have experience and certified PhD embryologists and all our laboratories are CLIA certified. If you know that you’re not going to use your eggs for a very long period of time, then you have the option to find a offsite egg or embryo storage facility, and they might have more less annual fees because they aren’t designed to store large number of patients’ eggs. So in summary, it’s very individualized on when the right time to start a family is. And so egg freezing is a tool to help empower women in their passion for patients facing medical treatments such as cancer treatments where they’re not quite ready to start a family yet, but they don’t want to lose that option in the future. So if you are interested in this process, speak with a fertility specialist so you can learn more.