Melanie Cole (Host): The Reproductive Science Center of New Jersey provides several options of fertility preservation for women, either through freezing eggs or embryos. This technology can give women the potential to conceive in the future should she be unable to become pregnant naturally. My guest today is Dr. William Ziegler. He's a specialist in reproductive endocrinology and infertility and is the Medical Director of the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Ziegler. What is egg freezing?

Dr. William Ziegler (Guest): Well, egg freezing gives a woman an opportunity to preserve her fertility without having a partner in the picture at that time. In this day and age where more women are in the workforce and are striving to achieve higher positions in our business world and more women are postponing childbearing to pursue additional degrees and obtain additional training and their fertility chances decrease as they get older and this gives them the opportunity to preserve their fertility until they are ready to settle down, to have a family, and they're also more psychologically prepared for that part of their life's journey.

Melanie: What's the difference in a woman's eggs in her 20s versus in her 30s, late 30s, or even into her 40s?

Dr. Ziegler: Well, we know that the fertility potential starts to really decrease after the age of 30 and it becomes more of a decline after 35, and a sharp decline after 39 or 40. So, we know that the eggs undergo an age effect. When a woman is born, she has only a certain number of eggs to use throughout her lifetime and during the aging process, the eggs also have a negative effect on them where you can have genetic abnormalities. We know that a woman who’s over the age of 35 has a higher incidence of having a child with Down's Syndrome, which is Trisomy 21 which is 3 copies of chromosome 21, which two is from the egg and one is from sperm. We also know there is a higher incidence for having mechanical abnormalities inside of the egg, too. The egg has DNA and it has all of the assembly lines to make the embryo develop and if you remember back to Biology 101, I know it's a lot of dead memories for many people, but the mitochondria, the ribosome, Golgi Apparatus, those are all organelles, we call them, that do have an age limit on them. So, the embryo in women who are older, may not be genetically normal and it may not be mechanically normal. So, if a woman freezes her eggs at a younger age, they are going to have a higher success in getting pregnant as well as a lower miscarriage rate when they use them at the age they want to have a family.

Melanie: Tell us about the freezing process, Dr. Ziegler. Does that have any effect on the quality of the eggs?

Dr. Ziegler: The freezing process that we use now is called “nitrification” and it is what's called rapid freeze. So, we have moved away from what's called slow-freeze, which caused a lot of problems inside the egg. So, within the last few years, we have perfected what's called “rapid freeze”. So, it gives us better survivability. We usually will let patients know that we'll probably have around an 80-90% survivability with the eggs at this time. A patient will be required to undergo the whole IVF procedure and even the egg retrieval, and then once we have the eggs, we make sure that the eggs are of a certain quality so we can freeze them so they would have a higher success rate just during the thawing process.

Melanie: And, what are some of the pregnancy rates from frozen embryos and/or eggs? Are you seeing a really good pregnancy rate?

Dr. Ziegler: Well, at this time, the embryo success rate for those that are cryo-preserved embryos, they have a higher success rate than frozen eggs. They are at a different debility level. When we use frozen eggs in women who are --excuse me, frozen embryos in women who are less than 35, we have close to a 75% pregnancy rate. With frozen eggs, the literature kind of reports that you'll probably have around 50-60% success rate, or pregnancy rate. At this point in time, many clinics are freezing eggs, and we're waiting for patients to come back to use them, but over the last three years, the data from larger centers are now reporting, like I mentioned before, up to a 60% pregnancy rate with frozen eggs.

Melanie: Then, what's the process after an egg has been frozen if a woman decides then she wants to attempt to get pregnant, what happens next?

Dr. Ziegler: Well, we would see her and just make sure that everything is still normal with her reproductive organs as well as her hormone profile. Then, they would need to undergo what is called a “frozen embryo preparation cycle”, and that is where we use a medication called Lupron, which basically shuts down her ovaries since we don't need to use them at this time. We prepare their uterus with estrogen, either in pill form, or there's injectable estrogen, also. We will also use progesterone, because we have to mimic what the ovary normally produces and at a specific time after she takes the progesterone, is when we would thaw the embryos and transfer them. It is like having a pap smear. And then, they're on medication after the transfer of the embryo and then we would do a pregnancy test around two weeks later.

Melanie: For the woman who is attempting to get pregnant with those frozen eggs, how long can the eggs stay frozen?

Dr. Ziegler: At this time, the eggs are frozen in liquid nitrogen, so they don't undergo any changes. So, at this point in time, they can be frozen indefinitely.

Melanie: Is there a cost to freezing your eggs?

Dr. Ziegler: Yes, and, in most cases, standard insurances do not cover for egg freezing unless you have a diagnosis of cancer and you're undergoing cancer treatment that could affect egg quality and a woman's fertility potential. In those situations, patients sometimes do have coverage for this procedure. The cost of freezing eggs, can range anywhere between $7,000 to around $9,000 dollars. There are different programs out there where patients that have other specific needs that they can get assistance in freezing their eggs. And, within the last few years, the larger companies are actually including in their health benefits, egg freezing. Like Google, Facebook--those organizations actually build that into their medical coverage and the reason for that is that they like to retain good workers and if they provide fertility preservation options, those women can actually freeze their eggs and continue working at those organizations and they can use those eggs later on within their reproductive life.

Melanie: How many eggs do you take out in general for a woman when you're going to freeze them?

Dr. Ziegler: We like to have anywhere between 10-15 eggs, then what happens is, after we assess them, we're probably left with anywhere between 8-10 to freeze.

Melanie: And, how old can a woman be to come back to you and say, "Okay, I want to try this now"?

Dr. Ziegler: Well, I'd like to take a little step back for one second. Women who are over the age of 38, we don't get a lot of eggs from, or good quality eggs. So, we like to freeze in women who are younger than 38 years old. When it comes back to putting back the embryos, or putting back the eggs just as embryos, we like to have the woman be less than 50 years old. We know that women who are over the age of 50, there is an issue with regard to uterine artery vascularization, that the uterine arteries are not as compliant and, therefore, success rates are lower.

Melanie: Dr. Ziegler, in just the last few minutes here, wrap it up for us about elective egg freezing, what you want women to know about this process, and the importance of it to maintain a viable pregnancy later on in their life, should they choose to do that.

Dr. Ziegler: I think what a woman really needs to assess is where is their life going, and if they don't see anybody on the horizon anytime soon, then freezing eggs younger within their life is really going to help them later on. And, I think that it's an option at this time that a lot of women are not just taking note of because they don't see that as a possibility just later on in life. I think more women need to be aware that if they are in a profession that's going to require them to put off childbearing, put off having a relationship, I think they need to consider "Okay. I need to maybe preserve my fertility that I can use this later on."

Melanie: Thank you so much. It's really great information, and thank you, Dr. Ziegler, for being with us today. You're listening to Fertility Talk with the Reproductive Science Center of New Jersey and for more information, you can go to www.fertilitynj.com. That's www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.