Melanie Cole, MS (Host): Have you heard about fertility preservation? There are many avenues with which you can preserve fertility, including freezing your eggs. We're talking about that here today on Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. And joining me is Kelly Curtis. She's a physician assistant with the Reproductive Science Center of New Jersey.

Intro: The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here’s Melanie Cole.  

Kelly, it's such a pleasure to have you join us. I love having you as a guest. So, let's talk about egg freezing today. What is fertility preservation? First of all, what does that even mean? What are some reasons that somebody would want to preserve their fertility?

Kelly Curtis, PA: Hi, Melanie. Good to see you. So, fertility preservation is becoming more and more popular, more for elective reasons, but also medical reasons. So, somebody that has a recent diagnosis of cancer, prior to chemotherapy ideally is when this is done. So, that's lots of reasons that we're seeing that people are coming to us for fertility preservation. Knowing they want a family, just not right now, is a very common reason why we're seeing more and more people.

So, egg freezing, it's a similar process, essentially the same process as what in vitro fertilization is. So, all in all, it's a series of injectable medications and a lot of close monitoring. So, the monitoring is done with blood work, frequent ultrasounds. These appointments are often done early in the mornings, to limit interference with work. Then, once we have followed along with the process and the eggs are ready to be grown to what we assume is mature, then they're ready to be extracted. So, that is done. We use a conscious sedation anesthesia procedure in our office for that where the eggs can be extracted, and then they are frozen. So, certain eligible eggs would be frozen. They do have to be what's called a mature egg to be ready to be frozen, and eventually used when the time is right.

Melanie Cole, MS: Well, thank you for that. So, you mentioned age, illness. There are some reasons, medical conditions, that a woman would want to freeze her eggs and consider fertility preservation. But when is that something that you want to consider? Because I've even heard it talked about with, you know, young adults, if they have to go through chemotherapy or cancer treatments to freeze their eggs and think about fertility preservation. Tell us when in the course of whether it's a medical situation or a woman's life, she just wants to do it for future, when is this something that is really considered?

Kelly Curtis, PA: Yeah. So, we'll kind of separate it. So, if it's a medical reason for doing the egg freezing, then oftentimes we are in touch with oncologists if that's who may be recommending this. And more and more we're seeing oncologists, you know, referring patients to us if they are a good candidate.

So, prior to any gonadotoxic chemotherapy agents or radiation, things like that, we try to get them in as soon as possible to undergo an egg freezing cycle. And then, kind of separating the two for what we kind of refer to as the social aspect or the elective egg freezing, we ideally sooner than later. The younger you are, the better chance you have of using those eggs for a live birth rate.

So, ideally, someone would start this process less than 35 years old. That being said, if you're over 35 and interested in freezing your eggs, it doesn't mean that you're not a candidate. It's just a conversation that we recommend having with the doctor just to kind of see where you're at and if we can help predict the success rates of using your eggs for future use. Thirty-five is a great age, you know, prior to that. That being said, this is the age that's recommended for those who are expected what we call ovarian reserve. So, there are, again, blood tests and ultrasound findings that we can look at to assess someone's ovarian reserve, meaning are your ovaries age appropriate or could you be a person that has what we call diminished ovarian reserve that may not have as many eggs or good quality eggs for freezing?

And all of that can, again, just be determined with the doctor. And this is something that, you know, depending on the OB-GYN, you don't necessarily need to start with a fertility physician to understand where you're at with your ovarian reserve, but kind of clinical findings as well, like if you know you're having irregular cycles and other GYN issues may be an indicator of, "Okay, let's check in on my fertility future" if you're interested in learning about it.

Melanie Cole, MS: Well, I think a big question people want to know is how does egg freezing work? How are they stored and how long, once they're stored, are they good for?

Kelly Curtis, PA: Sure. So, egg freezing works, like I said, it's a series of injectable medications. Generally, I mean, it typically depends on the type of protocol that we would use, but it's anywhere from eight to 12 days of injections daily. And then, you would undergo the retrieval process after you've done all of the monitoring for the cycle. The retrieval process, once the eggs are extracted for us, our lab is directly attached to the procedure room, the lab will assess at the time of extraction the quality of the egg, if it's mature. And if it is, then that egg meets criteria for vitrification or freezing. Once frozen, it can be frozen for an indefinite amount of time.

Generally, these eggs are used during the reproductive years, meaning if you are 28 and freezing your eggs, if you're going to use them, they're usually used within 10 years, which is they can be frozen indefinitely.

Melanie Cole, MS: Wow, isn't that amazing really now? Is there a number? Because you've talked about mature eggs a few times, but is there a specific number? How many eggs can a woman store, and how many should she store?

Kelly Curtis, PA: That is the question. Again, it's all dependent on age. We know if you have per cycle-- let's start there, so per retrieval cycle, so this is, we expect anywhere from eight to 12 eggs per one retrieval cycle. That being said, we know that the live birth rates, they see an actual higher live birth rate if you have 15 frozen. So, not to say again, age plays a factor. But that 10 to 15 range, would be a good hopeful indicator for at least one live birthrate. So, it's all based on family planning, if you want multiple children, things like that. How many cycles can you afford to do more cycles? So, it's a tough one to have an exact number and, again, everything's individual, but we can expect around 10 eggs to be stored per retrieval.

I also want to add in too once we want to use the eggs, there is a normal attrition rate that we expect. Not every egg retrieved will be mature, not every mature egg will survive the thaw, not every survived thaw will fertilize, and then not every fertilized egg will make an embryo that meets criteria to be used for what we call a an embryo transfer in the future.

Melanie Cole, MS: Well, thank you for letting us know that. And Kelly, what are a woman's options? Or a couple, if they decide not to use those stored eggs, what happens to them?

Kelly Curtis, PA: Yeah, I think a good point, and sometimes, you know, we may miss during counseling is these eggs, once they're frozen, you know, we've discussed they can be frozen indefinitely. But there is a storage fee with these. It's not as substantial comparatively to most things in fertility. But that is another factor just, you know, for those wanting to use them in the future is that there is a maintenance storage fee.

So, it's typically billed annually. So, your year is up, you can kind of decide each year, like, do you want to continue storing them, or what we call it discarding them? There may be some programs that you may be able to donate your eggs, but that is something that you would have to see with the FDA for eligibility and things like that. It's not something that we commonly see, but may be an option for that.

Melanie Cole, MS: Well, I'm glad you brought that up, because that's a good question. So before we wrap up, because this is really an interesting topic, and so many women who are having babies a little bit later in their years now want to think about egg freezing so that they can assured that they'll be able to get pregnant later on. And really, it's just a fascinating bit of technology. So Kelly, what would you like women and couples to know before considering freezing their eggs? What's really your best advice here?

Kelly Curtis, PA: Yeah, the earlier the better. If you are interested, I encourage you to at least find out more about where you stand as far as your ovarian reserve, and just learning the process early. It may be something that you're not financially ready to do as, you know, it may or may not be covered by certain insurances, but the recommendation is just, you know, sooner is better when it comes to egg freezing.

And then, I think, it's big and scary, you know, with the injections and things like that. It is a process to go through. But generally, you know, people do very well with it. They tolerate the medications very well with very few side effects. And I promise you, you are not alone. It's very common. I know it's not talked about a lot, but a lot of people have gone through this. And there's tons of resources to help, even if that's with medication and things like that. There's certain programs to get discounted rates. There's a lot. So, I think you just need to start looking and kind of get a jumpstart on it.

Melanie Cole, MS: Thank you so much, Kelly. You're just such a great guest. Thank you again for joining us. And for more information, you can visit fertilitynj.com to get connected with one of our providers. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole, and I'm so glad you could join us today.