Transcription:

Deborah Howell (Host): Many couples these days are interested in preserving fertility for women facing diseases that could impair ovarian function as well as women choosing to delay fertility for social or personal reasons. So this is exciting. We have two guests on the show today, Dr. Jennifer Hirshfeld-Cytron, who is Board Certified in both Obstetrics and Gynecology and Reproductive Endocrinology and egg freezing patient, Rachel Brody. Together, we're going to talk about everything egg freezing. This is The Time To Talk Fertility podcast. I'm your host, Deborah Howell.

Welcome Dr. Hirshfeld-Cytron and Rachel.

Jennifer Hirshfeld-Cytron, MD, MSCI (Guest): Thank you.

Rachel Brody (Guest): Thanks for having me.

Host: We'll begin with you Doctor, as a physician who has been helping women freeze their eggs for several years, what trends have you noticed?

Jennifer Hirshfeld-Cytron, MD, MSCI (Guest): I would say what we have noticed without question is the increase in those interested in egg freezing. I think this has many reasons. I think a piece of this is just the knowledge has increased that the technology exists and that it is effective. I think also we are seeing portions of different employers that are providing coverage. And so this then is creating an opportunity for more and more people to utilize this technology. So without question, the greatest trend is just the increased utilization.

Host: That's wonderful. Rachel, I know that making the decision to freeze eggs, isn't an easy one. Can you share the process that led tyou here?

Rachel Brody (Guest): Yeah. I had heard that it was better to freeze eggs when younger. So I've been bringing it up with my OB-GYN every year, since I was about 30 and a couple of years ago, my company actually started offering an elective egg freezing benefit like Dr. Hirshfeld-Cytron had mentioned. And so I wanted to take advantage of that. And I turned 34 this year and when I brought it up with my doctor, she suggested it would be a good time to pull the trigger.

Host: Amazing. For women who are interested in egg freezing, Dr. Hirshfeld-Cytron, who would you consider a candidate? And in what scenarios would this option not be available?

Dr. Hirshfeld-Cytron: So I'd say who's considered an option is broader and broader. Optimal is exactly sort of, as Rachel is describing someone who is young, cause that's when our eggs are at their best quality, but many of us are not as much as a planner, as Rachel has been, or as much sort of focused on this when they're in their sort of prime reproductive window. And so I would really say between the ages of 27 and early forties, it is feasible to freeze your eggs. The challenge is the number of eggs we need for this to be an effective technology, will, without question increase for women, as we get beyond age 35, it'll also more substantially increased really beyond age 38.

And so it is feasible for really all groups of women in these ages. It is the most effective when we are youngest. Candidates, when someone is absolutely not a candidate is a woman who has stopped getting her periods. She's menopausal. We are unable to harvest eggs. There are cases when someone is unable to receive the medications for various reasons.

Although this is rare, if someone would be concerned or unable to receive anesthesia for the retrieval, then they would be excluded although this is rare. So I would say that it's a pretty wide umbrella of who was included, but the caveat, the thing that is so important is it's most effective the younger we are, which is really the peak time to do this is with between the ages of 28 and probably 35.

Host: Makes total sense. Rachel, let's learn a little bit about you. Can you tell us a bit about youself?

Rachel: Sure. Like I mentioned, I'm 34, I'm single, which was really irrelevant for me and my decision making. Most of my career has been in consulting and human resources. And I'm also a part-time mental health therapist and I'll be transitioning to do that full-time early next year.

Host: Wonderful for Dr. Hirshfeld-Cytron and to give listeners an idea of what to expect. Can you share the process of egg freezing?

Dr. Hirshfeld-Cytron: So typically egg freezing is started with an appointment either just as Rachel had described with your OB GYN, or perhaps with an infertility specialist, I would say just sort of starting the ball rolling. The next piece is to do testing. So, the goal of testing, what we call ovarian reserve or egg health testing is it can predict really well how someone would respond to medications to do egg freezing, and it can predict really well how many eggs you would likely get if you did an egg freezing cycle? What it cannot do that it is unfortunately it is advertised to be able to on social media is it cannot predict whether you would have challenges with fertility. And I think that is incredibly powerful. So the purpose of the testing is to gauge, okay, I'm thinking of doing egg freezing.

How would my body respond? What would be the type of doses I would need? What would be the likely egg number I would get. Important because the number of eggs we obtain is going to impact the likelihood this will work, but it really does not have the power to tell us if you do this testing, you would or would not struggle with fertility.

I think that the reason that is so important is we don't want to make more of the testing than what reality is, what it can tell us. The other piece of testing that we do besides ovarian health, which is assessed with blood work and an ultrasound, is really, this is the ultimate in preconception.

So people who are thinking of egg freezing, this is the time to make changes in the future when their desire to be pregnant. So, I mean by that is we screen viral titers things like chicken pox and rubella uniquely can impact pregnant women. If we identify someone is not immune, we all know that immunity can wean.

COVID has taught us this about different viruses. So let's say someone's immunity weaned to chickenpox. She's freezing her eggs today. She knows in five years she wants to be pregnant. She knows between today and five years from now, she needs to get revaccinated. So that's the purpose of doing that type of testing is the awareness.

We also offer something called genetic carrier testing. Which has nothing to do with egg freezing. It's a preconception test so that you can learn more about illnesses you may be a carrier for, and things that are important for your future partner to be tested. So, that's sort of like part A then part B is actually doing the egg freezing.

So egg freezing is about 10 days of injection based medications with monitoring ultrasound and blood work about every other day. Restrictions occur when you start these medicines, you're not exercising, we're restricting intercourse, we're restricting alcohol during the process of the monitoring. When you come in, we adjust the doses.

On average, 10 days after medicine, a final medication is given to mature the eggs, 36 hours after that final medicine. So if you started on day one, you do the final medicine on day 10 and day 12 is the retrieval. The retrieval is under anesthesia like twilight anesthetic, or conscious sedation, where you were put to sleep on top of an ultrasound probe, that's placed vaginally.

A small needle is utilized that aspirates the eggs. There are no incisions on the belly. The needle goes through the back of the vagina, the vaginal wall to aspirate the eggs in each ovary. The procedure is maybe 10 minutes, but you're with us a good hour, hour and a half until you recover, until you able to eat on your own, drink on your own. A week and a half later you get a menstrual cycle and that's when you can resume all activity.

Host: That is a beautiful explanation of all the whole process. Now, Rachel, how did you feel going through your cycle?

Rachel: Yeah. So my cycle lasted about 12 days until retrieval and physically, I felt mostly normal and actually had a lot of energy about the first week. The second week I started getting pretty bloated and pretty uncomfortable, but it wasn't painful or anything. Actually emotionally, I found the process challenging throughout the cycle and also the decision leading up to it.

Because as a single person, the experience put me really close to my desire to have biological children with a partner, and frankly, very close to the absence of both of those things in my life. Personally at the end, I was, also pretty anxious about the procedure and the possible side effects in the few days, leading up to the retrieval, even though I understood that it was relatively low risk and that I was being very carefully monitored.

Host: Okay. That's all, subjective and every patient's a little bit different and you got through it and Dr. Hirshfeld-Cytron, and I know some cycles can result in many eggs being retrieved while others are not as fruitful. So how many eggs should a woman aim for?

Dr. Hirshfeld-Cytron: This really is dependent on your age. And so when a woman is young, which I would define as 34 or less like, 28 to 34, our goal is to accumulate somewhere between 12 and 15 eggs per desired child. And so it is again, 12 to 15 eggs per one desired child, not 12 to 15 eggs for 10 children.

I think people are often pretty surprised by that. So, this is at our peak when our ovaries are at their best. Let's say you have 12 eggs that will yield in the future somewhere three embryos, we expect 80 plus percent of the time, one of those embryos to go all the way to term. And so this is how those 12 eggs have the opportunity for one desired child.

To have that same sort of 80 plus percent chance of success when you are even 38. So we're talking about four years different. Now the goal is not 12 to 15. It's doubled it's about 30. And so that's what we see is that as we get older, the number we need will increase. And unfortunately, the number you get per cycle is less. So for women in their late thirties and forties, it is almost always multiple cycles to accumulate enough eggs for success in the future.

Host: Sure. And I'm sure that experience was hard won by, early women who were doing this treatment. Rachel, would you mind sharing the outcome of your cycle?

Rachel: Yeah. I got 29 eggs. I think that makes me a high responder.

Host: Congratulations.

Rachel: Thank you.

Host: All right now, we're going to do a lightning round with some common questions that you both hear all the time. Dr. Hirshfeld-Cytron, you can answer first based on what you've heard from patients, and then Rachel, you can weigh in on your experiences, ready to go?

Dr. Hirshfeld-Cytron: Sure.

Host: Do the shots hurt?

Dr. Hirshfeld-Cytron: A little bit.

Rachel: I would say not really like maybe a little pinteresting, it's really more weird than painful.

Host: Okay, can you still work?

Dr. Hirshfeld-Cytron: Yes, you can still work, but it creates a real business to your schedule and it makes it more complicated.

Rachel: Yes. And I worked throughout the first week and I had some time to available to take off. So I took off my second week basically just to manage the business and my own anxiety.

Host: Right. Can you have sex during the cycle?

Dr. Hirshfeld-Cytron: No, you can not have sex during the cycle. You can not have intercourse during the time you're taking the medications and for a week and a half post retrieval.

Rachel: Also no.

Host: Okay. And how did you feel after. the retrieval?

Dr. Hirshfeld-Cytron: I will hear descriptions of a really painful cycle. Some will say it's worse two or three days after than the first day. The bloating and cramping does not instantly go away. It takes a full week, week and a half until the period comes for that to improve. I would also say people will describe that their moods really diminish somewhere around one to two days post retrieval that they feel a bit off.

Rachel: I think that sounds consistent with my experience. I was really bloated, for about four days after, and pretty lethargic, that started to go away, but there was still a little bit of cramping for maybe a week after the retrieval.

Host: Got it. Did insurance cover anything?

Dr. Hirshfeld-Cytron: It's incredibly varied.

Rachel: My insurance didn't cover anything. But I had that supplemental benefit separately. That's it.

Host: Wonderful. And a last lightning round question for Dr. Hirshfeld-Cytron, will this process remove all of my eggs?

Dr. Hirshfeld-Cytron: No. So when you start a cycle, you have like contenders. This is what we call someone's antral follicle count. This is what I think of as like the high school class. Each of us has a different class size. As Rachel has shared, she has many available eggs, so she has a big class size each and every month and the body chooses one to ovulate. The others die off in atresia. the valedictorian ovulates, the others sort of fail the class. The next month it's a whole new group. So we are using the eggs that otherwise die off in atresia. We are not using up eggs that would have ovulated. So it was really a net neutral on your capacity to conceive on your own.

Host: And Doctor the biggest question of all, how much does an egg freezing cycle cost? And can you break it down for us?

Dr. Hirshfeld-Cytron: So I would say conservatively somewhere between 12 and $13,000. To do the egg freezing cycle, the cost to the fertility clinic, meaning the monitoring, the visits, the retrieval, the anesthesia, the embryology costs, that would probably be somewhere in the vicinity of $7,500. The medications can be very different in costs, depending on how much somebody needs. I would say that can range anywhere as high as about $5,000.

Host: Okay. And for Rachel, would you mind sharing how you navigated the costs of egg freezing?

Rachel: Yeah. So without insurance, which, I didn't know, in advance what the costs would be exactly, but my total costs for the cycle and the medication was around 13,000. And so that means that I had about 5,500 in medication and like I mentioned, I had that benefit from my company that ended up covering about half of that cost and I paid the rest out of pocket.

I realize there's a lot of privilege and the fact that I didn't think much about the personal financial burden. And so I'm wondering maybe Dr. Hirshfeld-Cytron can win on what is typical for others and navigating the financial piece.

Dr. Hirshfeld-Cytron: Yes. So I would say that those that have a benefit, it's an easier decision and we will see across the gamut. So, what Rachel had that somebody has a supplementary fund or that the insurance covers the monitoring, but not the egg freezing or covers the egg freezing, but not the storage or the fertility medicines, but not the egg freezing.

And it really is dependent on what your company's human resources sort of opted in or opted out of. And I had a patient who worked in the music industry and she had surveyed the different music industry equivalent companies, and she did not have coverage, but the remainders did. And she actually created an argument to her human resources and she got coverage.

And that is a rare story that takes a ton of effort, but that is one option. And there's something called resolve R-E-S-O-L- V-E. It's a patient advocacy organization that helps with that type of piece about how you get insurance potentially covered by your employer. I will tell you that for many that benefited for her the company changed their mind pretty fast.

Usually it's a benefit sorta for those that will come next in very frank terms. The other ways, if it's not covered, and there's not an ability to find that benefit to change is either a combination of sort of loans or nonprofits. And so some of the loans are there's a whole host of companies the fertility clinics are aware of.

There is one that was started by a patient of mine who was an egg freezing patient who wanted to provide financial options with reasonable interest rates. And it's called Emborrow, E-M-B-O-R-R-O-W. And there are others as well that provides financing in that way. There are non-profits that will provide coverage. I will tell you that if a patient is doing egg freezing, not for elective reasons, but for a cancer diagnosis, then there's a ton of coverage options through non-profits. When it's for elective reasons the nonprofits, although they exist, the likelihood is less. And so it is a financial burden. I don't think that should be minimized. I think when women are making this decision, that is a huge negative that needs to be considered.

Host: Right. Well, thank you both for weighing in on that. Doctor, what would you say to women who are on the fence about egg freezing?

Dr. Hirshfeld-Cytron: I would say in my mind, the negatives of egg freezing, what we've reiterated here is cost and time. Recent studies tell us potentially theoretical concerns of anxiety with utilization of their eggs. And what I mean by that, which was things that we really hadn't thought of when people initially were doing egg freezing, was it if, for instance, someone ever needs their eggs, do they have any hesitancy in discarding them or donating them to someone and so recreating future theoretical problems today? I think that's a theoretical risk. I have not really heard that from any patient. Most patients that have a very positive experience will tell me that I am glad that I froze my eggs.

Even if I don't need them. It is viewed as an insurance policy, just like our car. We all pay car insurance, but none of us ever really want to use it. And if that's the perspective and the cost piece is feasible and the time, and the side effects, I think it's a really good option. Personally, for me when I was in medical school and residency and for that reason not having a family, this option really didn't exist. The technology was not good enough. It would have been wasteful. The technology is now there. So if someone's on the fence, I would say what is your reproductive plan? What is your desire to have a genetically connected child?

What is your thought process? And when you may be starting that. And so if someone's thinking, well, the next six months, I'm going to consider having a family, either with my partner or with a sperm donor then it is really useless to freeze your eggs, six months is tomorrow reproductively. But if your thought is, you know, five, 10 years from now, and it's incredibly important to me, then I would at least get information. I mean I think that's the place to start.

Host: That is such a thoughtful answer. And Rachel you've been through it all. What would you say to those who are unsure?

Rachel: Yeah, it's obviously a really personal decision. And so when I thought about it, I thought about it in three different categories. So there was the emotional piece and the financial piece, and I guess the logistic piece. And so emotionally, it was really about thinking about my desire to have biological children or the ability to maintain that option like Dr. Hirshfeld-Cytron said, that insurance policy, against my perceptions of how or when or if that might happen for me naturally. Financially again, it's a very big burden, although one that I didn't personally have to think as much about, and then logistically managing the couple of weeks of hassle and potential discomfort.

But to me, that last part was actually a no-brainer once I had resolved to be the earlier pieces. I guess I also just say that I'm really happy with my decision. No matter if I use the eggs or don't, I feel a lot less pressure trying to work with my biological clock. And I'm also finding now that I've gone through the process, I'm really able to start thinking about how or when I might use the eggs in the future, which is really exciting to be able to envision more possibilities.

Host: Absolutely. Well, thanks everyone for listening. If you're interested in learning more about egg freezing join Fertility Centers of Illinois for An Egg Freezing Webinar, or to book a consultation appointment with a physician, you can also have your fertility and egg health tested for just $90 through a fertility awareness checkup. Learn more at fcionline.com or call. 877-324-4483. Dr. Hirshfeld-Cytron and Rachel, we can't thank you enough for being with us today and for letting us learn about the egg freezing process and your particular journey Rachel.

Rachel: Thank you.

Dr. Hirshfeld-Cytron: Thank you so much.

Deborah Howell (Host): That was Dr. Jennifer Hirshfeld-Cytron, and a patient, Rachel Brody. If you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like, and a follow if you do. This has been The Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.