Banking for Baby #2
Planning for your future can also include family planning. Dr. Mary Ramie Hinckley discusses how fertility specialists work to plan for your ideal future family.
Featured Speaker:
Learn more about Mary Ramie Hinckley, MD, REI
Mary Ramie Hinckley, MD, REI
Dr. Hinckley is a board certified Reproductive Endocrinologist who completed her training at Stanford University Medical Center. She says her greatest joy is helping patients to realize their dreams in creating a family, but she also enjoys participation in clinical and laboratory studies.Learn more about Mary Ramie Hinckley, MD, REI
Transcription:
Banking for Baby #2
Bill Klaproth (Host): Well, we’ve all been told to invest in our future, but for women, that may take on an additional meaning which may include banking for baby number two, even if you haven’t had a child yet. So, let’s learn more with Dr. Mary Ramie Hinckley about banking for baby number two. Mary is a physician at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. So, Dr. Hinckley, can you explain to us what exactly is banking for baby number two?
Mary Ramie Hinckley, MD, REI (Guest): Well, I’m glad you asked and I’m so happy to be here talking to your today. It’s a topic that often comes up at the initial infertility visit. Or at least, I feel like it should always come up and if it hasn’t, maybe you as a patient should address it with your doctor. One of the things I like to ask is what is your ideal family. What are you picturing? Many times patients are just struggling to have their first baby and while that is taking up enough of their brain space; they are focused on that.
One of the benefits of coming to a fertility doctor is that we can talk about their entire dream for family and that might include siblings for their child. And only by knowing that at the outset can we really develop a plan that is most likely to meet their needs.
Host: So, know what your ideal family is and that will absolutely help in family planning. That makes sense. So, let me ask you this. Some might be thinking, you know what, is it right to be talking about baby number two when I haven’t even had baby number one yet? So, is it wrong to be thinking about baby number two already if you haven’t had baby number one yet?
Dr. Hinckley: Well I don’t think it is. I mean I think this is one of the things we want to address in the best way possible. I think it is always good to remember that there are not guarantees, that there are limitations to what we can do. But I think laying it out there from the outset allows me to be a better doctor and help patients achieve all of their dreams.
It’s important to understand, did they have great siblings and they want to try to allow their children to have that relationship that they valued. Or did they absolutely hate being a twin or having five kids in the family and felt like they didn’t get enough attention and really want to focus on just one child. These are important things for me to know because they are going to alter the plan and the timing I have. I also think it’s really essential to understand what a beautiful gift a sibling can be to a child. And I think back on my own family where the best gift my parents ever gave me was a sibling. I mean sure I loved the water ski that I got one Christmas or the pair of Nike running shoes. But those don’t last. It’s the siblings that create those bonds that are so meaningful in life.
And so part of my job as a physician is to be able to really talk about that and to drive a plan that meets all of those needs for both parts of a couple if they are coming or for a single woman if she’s here.
Host: Now if you were to ask my sisters about a gift that a sibling can be; they may not say that about their baby brother. But it touches me.
Dr. Hinckley: Well everybody is different. Everybody has a different family and that’s important for me to understand.
Host: So, Mary, what is the best strategy for someone thinking of doing this?
Dr. Hinckley: Well, the best strategy is to consider moving to IVF, invitro fertilization sooner and to add to IVF preimplantation genetic testing, also known as PGT or some people will call it CCS. It goes by several different names. Now the reason I would suggest this is because if you are banking for the future, you want to know what’s in the bank. You don’t want to have a black box in there, not knowing if that embryo or those embryos are healthy. You really want to have embryos there with a diagnosis of whether they are normal and have the potential to become a baby.
Even if you have a chromosomally normal embryo in the cryo tank; it still translates into about a 68% chance of a baby. But if you don’t test the embryo, then the chance that you will be able to have a baby from that embryo drops below 68% so, for a woman who might be 42, that chance may only be 10-15%. So, you need to know what’s in your bank in order to make the right decisions and to be realistic. It’s especially important if you have more time to do another cycle.
So, say for example a patient is able to bank two embryos, but she’s 41. Well, that gives her a chance to have future children when she comes back at age 43 or 44, but that’s not a guarantee. However, if she knows she has two chromosomally normal embryos, she has a much higher chance of being able to have a baby in the future and therefore, doesn’t need to consider whether she should bank three embryos, four embryos, five embryos. Because she could feel very secure with two chromosomally normal embryos.
Host: Right so, it’s always good to understand what’s in the bank. And when is the best age to do this?
Dr. Hinckley: Well, really, the younger you are, the better your outcomes. So, even young women in their 20s are candidates for freezing embryos if they have a partner that they are committed to and think that they want to have more children in the future. But in general, at about age 35, I would start to have patients thinking about baby number two or baby number three because at that age, we know if we help them get pregnant tomorrow and have a nine month gestational period and maybe breast feed the baby for a year; they are not coming back to see me until they are 38 and if they were having trouble getting pregnant at 35; they may have more problems at 38. And so by having some embryos that were created at age 35, in the bank for the future; they will have a higher chance of having a successful second baby at age 38.
Host: So, how might technology then change in the future and how would that affect someone who does this?
Dr. Hinckley: Well, our field has really changed rapidly. I mean we are only 40 years old and when IVF first started, success rates were fairly dismal around 10-15%. Now we are looking at overall success rates around 50% and certainly with the testing and the frozen cycles that I have been discussing previously those success rates are closer to 68-70%.
But I do think that we will see some changes. Right now, we are checking for the major chromosomes just like an amniocentesis would check if someone were pregnant. And that’s very helpful because the majority of reasons, the majority of times that IVF fails is because we are transferring an embryo that’s not normal. The majority of miscarriages are embryos that are not chromosomally normal. So, right now, we have really good testing, but I expect it’s going to improve in the future. I expect that we’re going to be able to check for more potential causes of failure to implant or miscarriages.
We are also going to be able to check for things like microdeletions or smaller chromosome problems that might result in some of the diseases we’re seeing in children that we didn’t even know were really genetically based. I think we are going to move to a whole genome testing. Now, currently, some of this testing is deemed demo’d but not really on a large scale that’s affordable for most people. Our changes with the PGT testing or the embryo biopsy testing right now are significantly better than what they were ten to fifteen years ago but the changes that have been made in the last year or so aren’t really much different.
So, I think it will slowly improve in terms of our genetic testing. But an area where we are really probably not going to improve is on the survival of frozen embryos. Right now, our clinic, Reproductive Science Center, has a 98% cryo survival rate. So, while that’s not 100% and I want 100% survival; 98% is really good. So, I don’t anticipate that that is going to improve much.
The other thing I think is that we will be able to identify the best embryo out of a group of embryos with even greater clarity in the future. So, many patients may only make one embryo. There may not be a lot of choice. But if you are lucky enough and young enough to maybe make a handful of embryos; to be able to choose the best one first to put back in so that you can get to live birth that’s a healthy baby sooner; I do think that’s going to improve in the next five to ten years. so, I’m looking forward to that.
And I think some of that improvement may come with noninvasive testing. So, right now, when we do the embryo biopsy, that’s considered invasive testing. In the future, I hope, that some of the strategies that will improve are noninvasive, ones that don’t involve a biopsy of an embryo. And so, I’m hopeful that there will be some changes, although I don’t think that will preclude us from using embryos in storage. I think the embryos we have in storage will be good and will be usable. We may just want to layer on additional tests or other sorts of assessments at that point when you wish to use them in the future. I don’t think these embryos will be unusable if you freeze them.
Host: Right. So, that is good news and it sounds like there’s good things on the horizon with technology and overall Mary, it sounds like if you are thinking about banking for baby number two; it’s actually a pretty smart strategy to think about it earlier rather than later.
Dr. Hinckley: I do. I think it’s one of those benefits of having to come to see us. And I know a lot of people don’t want to see a fertility doctor and I completely understand that. So, but I like to think about some of the positive things that can come out of this and I know for many people that might be the opportunity to have a bigger family, to have two children or three children as the case may be. And I thin that’s really exciting. I also think one last thing I want to mention is that right now, the current climate is that a lot of insurances are offering coverage for IVF and that’s great. I mean I love the fact that more patients are able to have access to technology that can help them have families when they otherwise wouldn’t. We don’t know how that’s going to change in the future and so I so think if you are one of those people that is fortunate enough to have infertility coverage or to have the means to be able to afford treatment like this; it’s a great idea to take advantage of it so that you have more options for the future. And from the professional standpoint; if you have those embryos frozen for the future; that’s going to mean less time away from work, away from your job, more time enjoying your family and I think that’s ultimately what many businesses are hoping is to provide a benefit to their workers that will really help them live a full and productive life both in the office and at home.
Host: Those are really important considerations and I’m glad you brought those up. Dr. Hinckley, thank you so much. It’s always a pleasure speaking with you. To get hooked up with a provider such as Dr. Hinckley, and to learn more please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.
Banking for Baby #2
Bill Klaproth (Host): Well, we’ve all been told to invest in our future, but for women, that may take on an additional meaning which may include banking for baby number two, even if you haven’t had a child yet. So, let’s learn more with Dr. Mary Ramie Hinckley about banking for baby number two. Mary is a physician at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. So, Dr. Hinckley, can you explain to us what exactly is banking for baby number two?
Mary Ramie Hinckley, MD, REI (Guest): Well, I’m glad you asked and I’m so happy to be here talking to your today. It’s a topic that often comes up at the initial infertility visit. Or at least, I feel like it should always come up and if it hasn’t, maybe you as a patient should address it with your doctor. One of the things I like to ask is what is your ideal family. What are you picturing? Many times patients are just struggling to have their first baby and while that is taking up enough of their brain space; they are focused on that.
One of the benefits of coming to a fertility doctor is that we can talk about their entire dream for family and that might include siblings for their child. And only by knowing that at the outset can we really develop a plan that is most likely to meet their needs.
Host: So, know what your ideal family is and that will absolutely help in family planning. That makes sense. So, let me ask you this. Some might be thinking, you know what, is it right to be talking about baby number two when I haven’t even had baby number one yet? So, is it wrong to be thinking about baby number two already if you haven’t had baby number one yet?
Dr. Hinckley: Well I don’t think it is. I mean I think this is one of the things we want to address in the best way possible. I think it is always good to remember that there are not guarantees, that there are limitations to what we can do. But I think laying it out there from the outset allows me to be a better doctor and help patients achieve all of their dreams.
It’s important to understand, did they have great siblings and they want to try to allow their children to have that relationship that they valued. Or did they absolutely hate being a twin or having five kids in the family and felt like they didn’t get enough attention and really want to focus on just one child. These are important things for me to know because they are going to alter the plan and the timing I have. I also think it’s really essential to understand what a beautiful gift a sibling can be to a child. And I think back on my own family where the best gift my parents ever gave me was a sibling. I mean sure I loved the water ski that I got one Christmas or the pair of Nike running shoes. But those don’t last. It’s the siblings that create those bonds that are so meaningful in life.
And so part of my job as a physician is to be able to really talk about that and to drive a plan that meets all of those needs for both parts of a couple if they are coming or for a single woman if she’s here.
Host: Now if you were to ask my sisters about a gift that a sibling can be; they may not say that about their baby brother. But it touches me.
Dr. Hinckley: Well everybody is different. Everybody has a different family and that’s important for me to understand.
Host: So, Mary, what is the best strategy for someone thinking of doing this?
Dr. Hinckley: Well, the best strategy is to consider moving to IVF, invitro fertilization sooner and to add to IVF preimplantation genetic testing, also known as PGT or some people will call it CCS. It goes by several different names. Now the reason I would suggest this is because if you are banking for the future, you want to know what’s in the bank. You don’t want to have a black box in there, not knowing if that embryo or those embryos are healthy. You really want to have embryos there with a diagnosis of whether they are normal and have the potential to become a baby.
Even if you have a chromosomally normal embryo in the cryo tank; it still translates into about a 68% chance of a baby. But if you don’t test the embryo, then the chance that you will be able to have a baby from that embryo drops below 68% so, for a woman who might be 42, that chance may only be 10-15%. So, you need to know what’s in your bank in order to make the right decisions and to be realistic. It’s especially important if you have more time to do another cycle.
So, say for example a patient is able to bank two embryos, but she’s 41. Well, that gives her a chance to have future children when she comes back at age 43 or 44, but that’s not a guarantee. However, if she knows she has two chromosomally normal embryos, she has a much higher chance of being able to have a baby in the future and therefore, doesn’t need to consider whether she should bank three embryos, four embryos, five embryos. Because she could feel very secure with two chromosomally normal embryos.
Host: Right so, it’s always good to understand what’s in the bank. And when is the best age to do this?
Dr. Hinckley: Well, really, the younger you are, the better your outcomes. So, even young women in their 20s are candidates for freezing embryos if they have a partner that they are committed to and think that they want to have more children in the future. But in general, at about age 35, I would start to have patients thinking about baby number two or baby number three because at that age, we know if we help them get pregnant tomorrow and have a nine month gestational period and maybe breast feed the baby for a year; they are not coming back to see me until they are 38 and if they were having trouble getting pregnant at 35; they may have more problems at 38. And so by having some embryos that were created at age 35, in the bank for the future; they will have a higher chance of having a successful second baby at age 38.
Host: So, how might technology then change in the future and how would that affect someone who does this?
Dr. Hinckley: Well, our field has really changed rapidly. I mean we are only 40 years old and when IVF first started, success rates were fairly dismal around 10-15%. Now we are looking at overall success rates around 50% and certainly with the testing and the frozen cycles that I have been discussing previously those success rates are closer to 68-70%.
But I do think that we will see some changes. Right now, we are checking for the major chromosomes just like an amniocentesis would check if someone were pregnant. And that’s very helpful because the majority of reasons, the majority of times that IVF fails is because we are transferring an embryo that’s not normal. The majority of miscarriages are embryos that are not chromosomally normal. So, right now, we have really good testing, but I expect it’s going to improve in the future. I expect that we’re going to be able to check for more potential causes of failure to implant or miscarriages.
We are also going to be able to check for things like microdeletions or smaller chromosome problems that might result in some of the diseases we’re seeing in children that we didn’t even know were really genetically based. I think we are going to move to a whole genome testing. Now, currently, some of this testing is deemed demo’d but not really on a large scale that’s affordable for most people. Our changes with the PGT testing or the embryo biopsy testing right now are significantly better than what they were ten to fifteen years ago but the changes that have been made in the last year or so aren’t really much different.
So, I think it will slowly improve in terms of our genetic testing. But an area where we are really probably not going to improve is on the survival of frozen embryos. Right now, our clinic, Reproductive Science Center, has a 98% cryo survival rate. So, while that’s not 100% and I want 100% survival; 98% is really good. So, I don’t anticipate that that is going to improve much.
The other thing I think is that we will be able to identify the best embryo out of a group of embryos with even greater clarity in the future. So, many patients may only make one embryo. There may not be a lot of choice. But if you are lucky enough and young enough to maybe make a handful of embryos; to be able to choose the best one first to put back in so that you can get to live birth that’s a healthy baby sooner; I do think that’s going to improve in the next five to ten years. so, I’m looking forward to that.
And I think some of that improvement may come with noninvasive testing. So, right now, when we do the embryo biopsy, that’s considered invasive testing. In the future, I hope, that some of the strategies that will improve are noninvasive, ones that don’t involve a biopsy of an embryo. And so, I’m hopeful that there will be some changes, although I don’t think that will preclude us from using embryos in storage. I think the embryos we have in storage will be good and will be usable. We may just want to layer on additional tests or other sorts of assessments at that point when you wish to use them in the future. I don’t think these embryos will be unusable if you freeze them.
Host: Right. So, that is good news and it sounds like there’s good things on the horizon with technology and overall Mary, it sounds like if you are thinking about banking for baby number two; it’s actually a pretty smart strategy to think about it earlier rather than later.
Dr. Hinckley: I do. I think it’s one of those benefits of having to come to see us. And I know a lot of people don’t want to see a fertility doctor and I completely understand that. So, but I like to think about some of the positive things that can come out of this and I know for many people that might be the opportunity to have a bigger family, to have two children or three children as the case may be. And I thin that’s really exciting. I also think one last thing I want to mention is that right now, the current climate is that a lot of insurances are offering coverage for IVF and that’s great. I mean I love the fact that more patients are able to have access to technology that can help them have families when they otherwise wouldn’t. We don’t know how that’s going to change in the future and so I so think if you are one of those people that is fortunate enough to have infertility coverage or to have the means to be able to afford treatment like this; it’s a great idea to take advantage of it so that you have more options for the future. And from the professional standpoint; if you have those embryos frozen for the future; that’s going to mean less time away from work, away from your job, more time enjoying your family and I think that’s ultimately what many businesses are hoping is to provide a benefit to their workers that will really help them live a full and productive life both in the office and at home.
Host: Those are really important considerations and I’m glad you brought those up. Dr. Hinckley, thank you so much. It’s always a pleasure speaking with you. To get hooked up with a provider such as Dr. Hinckley, and to learn more please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.