In this episode,Abby Eblen MD from Nashville Fertility Center, Susan Hudson MD from Texas Fertility Center, and Carrie Bedient MD from the Fertility Center of Las Vegas talk with Lauren Roth, MD who is the Medical Director of the Shady Grove Rockville Fertility Center. During the podcast we discuss the benefits of egg freezing. We explore who might consider freezing their eggs, the ovarian stimulation process, and how frozen eggs can be used in the future. Our conversation covers ovarian reserve, the advantages of freezing eggs at a younger age versus after 35, and the monitoring process before egg retrieval, including AMH, antral follicle count, FSH, and estrogen levels. We also walk through what happens when a woman returns to use her frozen eggs to create embryos for conception. Tune in for an informative discussion on this important fertility option!
This episode was brought to you from ReceptivaDx and Shady Grove Fertility.
Episode Transcript:
Susan Hudson (00:01)
You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.
Susan Hudson MD (00:22)
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Carrie Bedient MD (00:53)
Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am Dr. Carrie Bedient at the Fertility Center of Las Vegas and I am joined by my sexy, sensational, splendiferous co-host, Dr. Susan Hudson from Texas Fertility Center and Dr. Abby Eblen from Nashville Fertility Center. And today we have a special guest, Dr. Lauren Roth, who is the medical director of Shady Grove fertility clinic in Rockville, Maryland. And so we are very excited to have Lauren here and we’re going to talk about egg freezing in a little bit. So welcome Lauren.
Lauren Roth MD (01:29)
Thank you so much. I’m happy to be here.
Carrie Bedient MD (01:32)
So Lauren, we were talking about past times and things that you do in the, so plentiful free hours that all of us have every day, every day of every week. And you mentioned that you have a, it’s not necessarily unique, but the distances of running are unique and that you are an exercise junkie. And so how far have you voluntarily run without bears chasing you?
Abby Eblen MD (01:58)
Hahaha!
Lauren Roth MD (01:59)
Well, it is funny because I run in the dark, of course, before work with a friend. But recently I ran a 25K trail race through the woods and the snow by a creek. It was beautiful, but it did take me a long time, about four hours.
Abby Eblen MD (02:10)
Wow.
Carrie Bedient MD (02:13)
Wait, there was snow too?
Lauren Roth MD (02:16)
Like, yes.
Abby Eblen MD (02:17)
my gosh.
Carrie Bedient MD (02:18)
And you were near a creek, which means there was probably ice nearby.
Lauren Roth MD (02:22)
There was a little ice. I did see some people fall and luckily I wasn’t one of them. But we went slow. That’s why it took so long, but it was a pretty awesome experience.
Carrie Bedient MD (02:30)
So what was it exactly besides the absence of bears or serial killers on your tail that made you think, this is, this is a great idea. I want to do this. And I am extraordinarily impressed because I am slow AF when it comes to running that still try it, but still don’t, don’t get anywhere fast. I would be eaten. And so where were you running and why did you decide to do this and how did you get into it and all of those things?
Lauren Roth MD (02:59)
Yeah, I’ve just sort of been building up running over the last couple years to do local races, but mostly for exercise. But this one, my best friend was in a trail running group. She signed up. So it was peer pressure, but there was a wait list. So I did not expect to get in. So I was like, sure, I’ll sign up. Sure, no problem. And then I got off the wait list and then I had to do it.
Abby Eblen MD (03:13)
haha
Carrie Bedient MD (03:19)
So how much lead time did you get between the waitlist where, crap, I have to legit be training for this versus…
Lauren Roth MD (03:27)
I think it was about two months, but it was winter, so I was a little undertrained. Now, luckily, my best friend and I, who I did it with, were about equally undertrained. So when both of us started hurting, it happened around the same time. So we did a slow, slow shuffle slash walk for the last quarter.
Abby Eblen MD (03:32)
my gosh.
Susan Hudson MD (03:47)
But you finished.
Lauren Roth MD (03:48)
We finished! It was awesome!
Abby Eblen MD (03:50)
I’m impressed by the distance A, but really, I mean, I don’t run as much as I used to, but when I used to run, it’s one thing to run on a flat surface where you can see where you’re going, and a trail run is a totally different animal because I did about a six mile trail run one time, and I was like, never again, because I did it in the fall and there were leaves around, and you’re stepping down, you’re stepping up, I mean, the terrain is rough, and your foot may, your ankle may get twisted, and I’m like.
I’m too old for this. I don’t want to end up with a sprained or broken ankle. So to do it on ice and in snow is really impressive.
Lauren Roth MD (04:25)
Well, that’s not giving me too much credit. 25 kilometers, so…
Abby Eblen MD (04:28)
Okay, well, that’s still pretty far.
Carrie Bedient MD (04:29)
That’s more like 50 miles more than a half-year of time.
Lauren Roth MD (04:32)
It is. It was long. It the longest I ever ran. Yeah, I mean, I love hiking too. I did all my training at University of Colorado, so I got to do a lot of hiking and skiing. So it’s just like slightly faster hiking. But I mean, it is, you have to be careful with your ankles for sure.
Abby Eblen MD (04:40)
Ugh.
Wow. Well, I’m glad you didn’t end up with anything broken or twisted or anything.
Lauren Roth MD (04:53)
Me too.
Carrie Bedient MD (04:55)
Do you listen to podcasts or music or anything like that while you’re running?
Lauren Roth MD (04:59)
Podcasts and audiobooks. I’m an occasional music listener, but I don’t really have the patience to build a good playlist.
Carrie Bedient MD (05:06)
Got it.
Susan Hudson MD (05:07)
I’m an audiobook junkie. I’m with you. Wow. It’s amazing. For years, I didn’t really read for pleasure. I did when I was younger, like in college and that type of thing. And I think when medical school hit all reading other than after it fell by the wayside. And I would say a couple of years ago, I discovered the beauty of audiobooks. And I mean, I’ll just be like, okay, I want to do something in the house just so that I can listen to my audio book and have an excuse for listening.
Lauren Roth MD (05:39)
I totally agree.
It’s a total game changer because you can do it while you’re doing laundry or cooking or running or walking.
Abby Eblen MD (05:44)
Yeah, it makes you feel so much more well-rounded. You can talk to people who actually really read books.
Lauren Roth MD (05:50)
Yes, I totally agree. I totally agree.
Susan Hudson MD (05:53)
Absolutely.
Carrie Bedient MD (05:54)
All right, well, let’s get to our questions. Susan, what do you have?
Susan Hudson MD (05:59)
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Susan Hudson MD (06:32)
Okay, our question today is, Hello, I’m almost 38 and dealing with secondary infertility. I’ve been trying for 28 months to conceive. Every lab we ever do looks great. I’m always in the good or excellent range BMI 26. No block tubes. I’ve done two IUIs and trying to decide if I should do a third one. My question is, does the hormone shot given to induce ovulation for IUIs and or the Clomid that I’m taking affect the menstrual cycle?
My cycle was pretty consistently 27 to 28 days, but after my first IUI, my period didn’t come until day 31. I am currently on day 34 of my cycle with the second IUI, but every pregnancy test I take is glaringly negative. Is my cycle extending because of these drugs? Is it possible that I am pregnant despite negative tests? This is a good question. I think a lot of our people who have gotten their fertility treatments, especially with IUIs, are faced with
Carrie Bedient MD (07:26)
Mm-hmm.
Susan Hudson MD (07:31)
this question and conundrum.
Carrie Bedient MD (07:33)
So Lauren, what do you think? We all have talked ad nauseum, of course, because it’s our own podcast, so we get to do that. What would you tell this patient?
Lauren Roth MD (07:45)
I think the medicines, both Clomid and the trigger shots certainly can change the cycle because we’re monitoring and we may trigger ovulation slightly sooner than you would ovulate on your own. So certainly cycles can be shorter, but if for whatever reason, this cycle took longer to get the eggs to maturity, certainly the cycle could be longer.
Getting to 34 days when we don’t know when she triggered is a little bit trickier. I think we know home pregnancy tests are very, very sensitive, so very unlikely that there was a pregnancy with negative home pregnancy tests. But there could be something else from the fertility medicines, like an estrogen-producing cyst that could delay the period as well.
Carrie Bedient MD (08:28)
What do you guys think anything else to add.
Susan Hudson MD (08:30)
Sounds pretty good.
Carrie Bedient MD (08:30)
The one thing that I was thinking is if she’s on progesterone, that’s something that people don’t realize, oh, I got a negative pregnancy test, I need to stop it because the progesterone will delay getting a cycle. And so most of the time, I think that impacts people more than they think and more than they realize because they’re like, oh, I’m just gonna stay on this extra support. And what they don’t realize is that progesterone use in one way supports pregnancies, progesterone use in another way is birth control.
And so that can have an impact too, especially depending on the type of progesterone that you’re using. So pills metabolize differently than the vaginal metabolizes differently than the injections. And sometimes it can take a little bit longer to wear off depending on what kind of progesterone support you’re using. And probably worth going to check in with your doc, getting some hormone levels, seeing what your estrogen is along with your progesterone and the lab HCG, because it’s worth checking. It’s easy. We’ve already poked you. We might as well get the little extra bit of data. But that’s another thing to consider.
Abby Eblen MD (09:34)
Yeah, and I would add too that it’s not uncommon to have cysts, kind like you said, on Clomid particularly. so, getting closer to 34, 35 days, if it continues much longer, within another week or two, I’d let your doctor’s office know they can see you, maybe do an ultrasound, see if there is a cyst there, and figure out what the next step should be for you.
Susan Hudson MD (09:50)
Good thing that usually resolves on its own.
Carrie Bedient MD (09:52)
Yeah, yeah, it’s just, it’s a matter of time and how patient you have the capacity to be because that is pretty much the hardest part of all of this.
Susan Hudson MD (10:02)
It is.
Carrie Bedient MD (10:03)
Okay, so today we are going to talk about egg freezing. And egg freezing is in many respects just the same conversation as IVF when it comes to some of the technical things. But a lot of the surrounding decision making that impacts what you do and how you do it is considerably different than IVF. And so Lauren, are the reasons that people come to us for egg freezing and what are some of the discussions that we have as we’re going through this process with them?
Lauren Roth MD (10:37)
Yeah, so egg freezing really started more for medical issues. When we knew someone was going to get some sort of medical treatment that would be high likelihood of impairing future fertility. Probably the most common is chemotherapy, but there are some other medicines that can certainly affect the ovaries. And then over time, we recognize we can use this in what we’ll call a social way. Where people either want to delay pregnancy or family building, or because they haven’t found a person to build a family with and are not necessarily wanting to be an only parent and use donor sperm. And so the conversation around egg freezing is understanding, of course, the process and, kind of predicting how it’s gonna go based on their own ovarian reserve. But the biggest thing with talking about egg freezing is understanding the chances of having a baby from those frozen eggs down the line.
Carrie Bedient MD (11:38)
So what are the things that are the big hallmarks when you’re talking about freezing eggs with someone? When someone asks, forever and always the question that strikes dread into our hearts because it’s a complicated answer is, how many eggs do I need? So if you have someone here and says, how many eggs do I need? What factors play into that answer?
Abby Eblen MD (11:55)
Yeah.
Lauren Roth MD (12:01)
I mean, the biggest one is age. It’s exhausting that we have to talk about it. It’s not fair, but it is the truth for fertility for women, most of all age. Certainly the younger someone is, when they’re freezing eggs, the higher chance of having a baby from those eggs down the road just because we know they’re higher quality.
And so it’s very much age-related. And that’s why it’s always important to know, besides age, their own ovarian reserve so we can understand how many eggs do we expect at one time so they can really prepare for how many cycles they may need. But in terms of giving specifics, for people less than 38, we probably need 10 to 15 eggs per one desired baby and above 38 more than that. One recent study suggested maybe even like 40 eggs for one baby in people over 38, that’s more than most people will get in a reasonable number of cycles.
Abby Eblen MD (12:49)
Hmm.
Carrie Bedient MD (12:55)
So what information can you tell about the eggs once you get them out? Because with embryos, we’re used to saying, let’s get all this genetic testing. How do you evaluate eggs when they’re on the flip side and we can actually see them to know, are these good or not?
Lauren Roth MD (13:12)
I mean, that’s the biggest downside of egg freezing is we really can’t know anything about them except the number. We can know if they’re mature, meaning, the genetic material fully pulled apart and those are the eggs we can freeze because those are the ones that can fertilize down the road, but you really can’t tell egg quality. And that’s probably the biggest missing piece for us in terms of helping people know their real chances of having a baby down the road.
Abby Eblen MD (13:37)
So Lauren, when you’re talking egg quality, specifically what do you mean by egg quality?
Lauren Roth MD (13:41)
Generally, when we’re saying egg quality, we mean the genetic makeup of the egg, right? Is there extra genetic material? Is there missing genetic material? And that’s what we can test when we’re doing IVF and doing PGTA. There are many other things about egg quality that right now we have no ability to test.
Susan Hudson MD (13:59)
Is there a sweet spot where you encourage people? Obviously anybody who wants to freeze their eggs, we can at least discuss it and look at some of the ovarian reserve testing we have available and that type of thing. But is there a sweet spot for age when we’re sitting there balancing chances of actually maybe using those eggs with good quality?
Lauren Roth MD (14:23)
Yeah, I think that’s the biggest question. So if someone’s asking me, my ideal time is age like 32 to 34. If we do it too, too early in someone in their 20s, yeah, we’re going to get probably really good quality eggs, but we know the chance that they’re going to use those eggs is quite low because there’s a lot of time to potentially find a partner. They’re likely to be fertile on their own. And even if they’re not, they can come do fertility treatment with the eggs in their body and still have great chances. Whereas if we’re dealing with people in their very late 30s early 40s while it still may be worth it, we know we need a lot more eggs. So that’s what I would say, but of course we freeze eggs for people far outside that 32 to 34 year age range.
Susan Hudson MD (15:09)
Talk a little bit about the egg freezing process so that for people who really haven’t ever thought about the details of this just to give a little bit of a background and then we can talk a little bit about storage.
Lauren Roth MD (15:22)
Sure. The way things really start is understanding ovarian reserve. So important to understand that ovarian reserve or egg number varies person by person. It’s not something that people can control on their own as far as we know, but we do know the number of eggs available slowly goes down over time but also that it’s not really a fertility predictor. So, if we find someone with a high egg number, that does not mean they shouldn’t freeze their eggs. It just might mean they need less egg freezing cycles. And if we find someone with a low egg number, it doesn’t mean that they’re going to have infertility in the future, but it does mean maybe they’re going to need more attempts or more cycles at egg freezing or if they do other fertility treatment.
So the most useful tests for ovarian reserve are the AMH hormone, which is nice because it doesn’t need to be cycle specific, and then an antral follicle count with ultrasound, where we can see how many resting eggs or antral follicles are there in the cycle we’re seeing them. And that number will stay approximately stable cycle to cycle.
Susan Hudson MD (16:27)
Do you find any value in an FSH level?
Lauren Roth MD (16:30)
I mean, we do get them at our clinic. And just out of convenience, we see people on day three and do the FSH, antral follicle count, and AMH altogether. But it is rare that that’s going to change my treatment recommendation at this point. And if people or practices don’t have the ability to do day three testing, we can get most of what we need without that. Especially if OBGYNs are doing the testing, think an AMH is great because it doesn’t require people to be on a specific day.
Abby Eblen MD (17:03)
So can you talk a little bit about how someone is stimulated? I think people are kind of confused when they come in for egg freezing because they’re like, well, I don’t really want to do IVF, but I want to freeze my eggs. So will you kind of explain what that process is and how that differs from somebody who is going to do IVF?
Lauren Roth MD (17:18)
Yeah, I totally agree with you. People are often shocked by how much is involved with egg freezing. And it would be nice if we could do this in a less invasive way. But for the time being, this is what we have. And in truth, it is really the first half of IVF. Egg freezing is just splitting IVF in half, essentially. And the really invasive part of IVF is happening with egg freezing.
Our goal is getting most of the eggs that are there in the ovaries for that month to develop in unison. And so we’re going to give the same hormones that normally go from the brain to the ovary, just at higher levels to make enough hormone available for most of the eggs that are there for that month to develop in unison. And those are the injections that people take with IVF, so it’s two to three injections a day over about a one and a half to two week time period. During that time, you’re going to be into the office frequently for monitoring with a combination of ultrasound and blood work to allow for medication adjustment if needed. And once we see that the eggs are ready, then we move on to the egg retrieval, which is the surgery.
Abby Eblen MD (18:28)
And when you stimulate patients in that way, does that zap their egg pool? Are we taking eggs out that they won’t, and it’ll make them get through menopause earlier, for example?
Lauren Roth MD (18:36)
That’s another thing that people are always shocked about, right? We know that each month there’s a group of eggs and without contraception, without fertility medicines, one egg ovulates, the rest die off. And then the next month a new group of eggs comes. And so when we’re doing egg freezing or IVF, we’re just saving eggs that were otherwise going to die. So it does not alter ovarian reserve or future fertility or time to menopause. And people are usually so relieved to hear that.
Abby Eblen MD (18:39)
That’s true.
Susan Hudson MD (19:04)
One thing I’d like to mention, you mentioned the day of the egg retrieval and I find that this is a good topic to mention, especially to our egg freezers because sometimes they’re doing this and no one else knows. This is not the day to catch an Uber or Lyft. You really need to have a friend or family member who can take you from the surgery center back home that day just because it’s not a safe thing to hop into a car with a stranger after surgery and anesthesia.
Lauren Roth MD (19:32)
Totally agree.
Carrie Bedient MD (19:32)
Absolutely.
Why do you tell people where, like you said, a lot of people come in saying, I don’t want to go through IVF. We get several patients who say, well, I’m releasing eggs every month. Just get that one and save it. How do you think about that? And how do you how do you explain like, this really isn’t necessarily in your best interest?
Lauren Roth MD (19:52)
Yeah, I mean the issue is that reproduction overall is just inefficient and egg freezing and IVF doesn’t fix that inefficiency really. It combines a lot of cycles into one so we can see which eggs will fertilize and which fertilize eggs develop to an embryo and then which embryos can result in a pregnancy. even in fertile people, best case scenario, it’s only a 20 % chance of pregnancy any given cycle. And I think it’s probably even lower if we’re going to do a natural cycle egg retrieval because it’s not even a guarantee we’re going to get an egg because the timing has to be so precise.
Susan Hudson MD (20:31)
Is there a shelf life to these eggs?
Lauren Roth MD (20:33)
Not as far as we know, the real advancement that let us freeze eggs is this vitrification. Fast freezing or a glass-like state. So once the egg is frozen, really no degradation is going on. It’s not like the food we put in our freezer is where we can get freezer burn or, big ice crystals, which…we used to have a problem with when we did slow freezing, which embryos did okay and sperm did fine, but eggs did not tolerate just because they’re such a large cell with so much liquid.
Susan Hudson MD (21:04)
How much does it cost to keep these eggs until I want to use them in the future?
Lauren Roth MD (21:10)
So I think that varies clinic to clinic. I would love to hear what your guys’ clinics do. Mine is $70 a month.
Carrie Bedient MD (21:19)
That’s about what ours is, because we all share kind of a storage facility. And I want to say it’s like 60, 70 bucks a month for someone who’s storing it offsite in the dedicated storage facility. And then there’s usually an option to store it on site at the clinic, which is more expensive, mostly because there’s less real estate there. And so we usually tell people, especially for egg freezing, where it’s likely going to be several years before they use it.
Take the offsite option, those storage facilities are dedicated to just storing eggs, sperm and embryos. And so it’s worth it to send them there, them be in a dedicated place where they’re gonna take good care of them and it’s a little bit less expensive.
Abby Eblen MD (22:01)
I was just going to ask, so Lauren, tell me how someone will feel after an egg retrieval. Will they be able to go to the gym that day or back to work or?
Lauren Roth MD (22:09)
No and no. They’re getting anesthesia, so certainly we don’t want them going to the gym or doing exercise just because they’re not going to be totally feeling normal. And then the ovaries are bigger than normal. We just push them to make a lot more eggs. And even though we drain the fluid, those follicles that we drain refill with fluid and blood. So the ovaries end up being about the same size after an egg retrieval as before, and then they slowly return to the normal size over a week or two after the egg retrieval. Most people, at least at my practice, we stop giving narcotics to go home with after the egg retrieval, and people really do well. I mean, it’s amazing how much we’ve changed the thinking around narcotics for all surgical procedures. And I think it’s good because we know that the problems from narcotic addiction essentially often come or start with excess medication sitting around the house. Most people do fine with ibuprofen and Tylenol afterwards. And most of my patients, if they don’t have a very physical job, are fine to work the next day. I tell people have a physical job, try and try and take an extra day off, just because you don’t know exactly how you’re going to feel. But usually the day of we recommend pick a spot on the couch, basically rest, take it easy.
Abby Eblen MD (23:06)
Mm-hmm.
Susan Hudson MD (23:23)
So you practice in Maryland, correct? And that is a mandated state, correct? Okay. And so for our listeners, there are certain states in the United States that mandate that there have to be certain levels of fertility coverage. Some states are mandated, some states are not mandated. Abby, Carrie and I do not practice in mandated states. So our lives are a little bit different, but I’m curious in…your mandated state or any other mandated states that you may know in your region, is fertility preservation and cryopreservation a covered benefit or do most people end up having to use other resources to pay for egg freezing outside of like a cancer diagnosis?
Lauren Roth MD (24:09)
Right, so outside of a cancer diagnosis, is not a covered benefit in Maryland.
Abby Eblen MD (24:12)
No.
Lauren Roth MD (24:14)
I’m not super familiar with each mandated state in terms of the coverage, although a lot of our surrounding states or states and where our other practices are do not seem to have egg freezing as a benefit. I see some employer benefits have egg freezing and there certainly is a little bit of data that when an employer benefit has egg freezing included, more people will seek out egg freezing. And I think we know that from general fertility care as well, but egg freezing outside of cancer diagnosis is not mandated.
Carrie Bedient MD (24:47)
What kind of things change when you’re doing this for preventative egg freezing where someone is intentionally delaying because of whatever life circumstance versus for medical fertility preservation where there’s an impending cancer diagnosis or some other big treatment that is going to dramatically impact or could even just potentially dramatically impact childbearing? Like what are the differences in the cycle? What are the differences in the way that ways that people are managed when they come in saying, hey, I just got a diagnosis of breast cancer. We’re in the process of working out, do I need surgery or do I need chemo or do I need radiation? And my doc said, I should come see you to talk about fertility preservation. What are the differences in those types of cycles versus a preventative egg freezing cycle?
Lauren Roth MD (25:33)
Yeah, for medical reasons for egg freezing or fertility preservation, often we’re on a time crunch.
Right, we have to get it done so we’re not delaying the medical care they need for their medical diagnosis. And so we are often starting kind of just in the middle of wherever they are in their cycle, right? Ensuring that they’re not pregnant, but they’re just getting going. Often, we’re seeing because of the age breast cancer patients, right? Where a lot of the time their cancers have some estrogen or receptor positivity, meaning that the hormones, estrogen and progesterone, can stimulate the growth of those cancer cells. And we know estrogen and progesterone really go up in an IVF cycle or an egg freezing cycle. And so we’ll give some other medications to keep those lower. And then oftentimes we’ll freeze eggs that aren’t mature, which we don’t normally do for preventative egg freezing.
Just because we don’t know how the technology is gonna change over the years and for cancer patients or patients doing this for medical indications, this might be our only chance to get eggs.
Carrie Bedient MD (26:41)
What are some of the outcomes that are different perhaps with cancer patients than with preventative freezing in terms of number of eggs that you get and ability to use them later and those types of things that may be extra as you are considering counseling with these patients?
Lauren Roth MD (27:00)
For cancer patients or patients having a medical condition leading to thinking about fertility preservation, oftentimes they are sick. Their body’s sick, not necessarily that they’re outwardly sick, but that can often…suppress hormones. And so we sometimes get less eggs than we would expect just on the ovarian reserve testing itself. I don’t know that we have a great study of this, of saying like, this is the reason why, but we see it with sperm, men freezing sperm before cancer treatment, that oftentimes their sperm numbers will be low. Doesn’t mean that they would normally be low, but rather their body kind of knew they were sick. And so we’ll have a little bit less to work with, less energy to put towards reproduction at that time. Also, often for medical egg freezing, we really only get the one shot. So we can’t often…cycle multiple times to build up more eggs. Or sometimes we’ll cycle really close together. Right after we retrieve eggs, we’ll start going again, and that’s the duo-stim. So that we don’t wait until they get a period. We’ll start another stimulation kind of right after the retrieval in an effort to get more eggs in a shorter period of time.
And then depending on the extent of their disease, it may not be safe for them to get pregnant down the road. And so always the consideration of discussing beforehand, but certainly when they come to use the eggs, safety of pregnancy and consideration of use of a gestational carrier.
Abby Eblen MD (28:28)
Can you talk a little bit about what happens when a patient comes back and when they decide to use their eggs and that whole process of how the eggs develop?
Lauren Roth MD (28:36)
Yeah, absolutely. So we talk about this, and I’m sure you all do as well, at the first visit when they’re thinking about freezing eggs to start out with, because it’s something else to understand. But usually, I actually recommend they still try and get pregnant on their own before using the eggs, especially if they want to have more than one child. They can keep those eggs in the freezer for next time when they’re even a little bit older. But if they don’t get pregnant, on their own. kind of do the typical fertility evaluation for them and their partner, and then discuss all the fertility treatment options. And again, this is very much age-related and based on the results of their evaluation. it can be hard to decide whether to try a new IVF cycle with the eggs in their body at that point versus using the frozen eggs. And it’s very person-to-person, situation-to-situation. But when we go to use the eggs, we thaw them.
We fertilize them in the lab with the sperm and then grow the embryos over the next five to seven days. This is the second half of IVF. And we still, have the choices of doing a, I’m going to say a fresh embryo transfer, in the same time that we thaw the eggs. So we prepare the uterus for an embryo transfer versus freezing all the embryos with the potential of doing PGTA prior to transfer.
Carrie Bedient MD (29:53)
So a lot of people think, oh, I have frozen eggs from when I was 28 or 32 or 34 or whatever. This is an insurance policy. And with most insurance policies, if you pay the premium every month and your house burns down, you will get the ability to build a new house. You will get the financial capacity to do that. What are the differences in egg freezing and thinking of it as an insurance policy compared to kind of the homeowners car, whatever insurance policies that most of us have, at least in some capacity in our lives?
Lauren Roth MD (30:30)
Yes, what I say at every consult is this is your backup plan, not an insurance policy. Unfortunately, we cannot guarantee it’s going to result in a baby. And that’s also the hard thing when you’re trying to decide. We always say you might not need these eggs, right? You could get pregnant on your own. You could decide that you don’t want a child or you could really need these eggs. And it’s not a guarantee that it’s going to happen, which is hard. And I think several years ago, there was a lot of articles in the popular media about people who went through this process and felt very disappointed by the outcomes. And I think even though we know we can counsel, it’s hard to take in all of that information and people are certainly kind of depending on these eggs because they spent a lot of time and money and physicality on getting them. And so it is hard to do that and then not have any guarantee that you’re gonna have the outcome you want.
Carrie Bedient MD (31:22)
Mm hmm. What do people do when they get to the point so they frozen eggs? It’s however many years later and they decide I don’t need these eggs. They either have kids, they decided not to whatever, whatever it may be, but they still have eggs that are frozen that they know, okay, I’m not going to use these. So number one, when do you tell people, okay, it’s fine to let the eggs go out of your control? Then number two, what are the options with what they can do with them?
Lauren Roth MD (31:53)
Yeah, I mean, I think if your family’s complete, it’s a good time to discard the eggs or if you decide you don’t want kids, fine to discard the eggs because you have spent a lot of money storing these eggs over time and there comes a time where it doesn’t make sense to do so anymore.
I think most people discard them. In the lab, we’ll take care of that in terms of taking them out of the freezer and doing appropriate discarding. And right now, to my knowledge, there’s not a great way to do de-identified egg donation, meaning that we’re gonna donate them to someone you’re not gonna know who the recipient is and they’re not gonna know who you are. And that’s really because that’s an FDA regulated process that requires specific evaluation and testing in a very tight time period around the time of egg freezing. But you can do directed donations. So if you had a friend or a family member who was in need of eggs and between you two, you felt like this was a good idea and you have a legal agreement and you’ve done counseling, you could directly donate to someone you know.
Susan Hudson MD (32:59)
I’m curious, do any of the embryo banks take eggs?
Lauren Roth MD (33:03)
That I don’t know.
Susan Hudson MD (33:04)
I had never really thought of that until now, but I’m curious if that’s something for the future is embryo or egg banks accepting these types of, because you can use, you can still have sort of de-identified embryos that were not created with the intention of being used in an FDA sense, just kind of thinking outside the box.
Carrie Bedient MD (33:31)
I bet some of those embryo repositories have started to consider this because egg freezing has really only been available for like the past 13-ish years as non-experimental treatment. And so we’re just now getting to the point where people, more and more people are at a point in their lives where they can say, yeah, I’m not going to use these for whatever reason. And so I bet some of those facilities are working on taking in those eggs and figuring out how to repurpose them. Yeah. Huh, interesting. You’ll have to look into that. Is there anything else, Lauren, you think we have not covered about egg freezing that we should have touched upon?
Abby Eblen MD (34:00)
That’s a good question.
haha
Lauren Roth MD (34:13)
I think we did touch upon it, but just understanding that as we get older, the chances of having a baby from these eggs, unfortunately, goes down. So really thinking about, does it make sense with your own personal circumstances, Usually finances, but is it worth freezing eggs at the age you are considering the chances of a baby down the road or considering other options for family building?
Carrie Bedient MD (34:40)
One thing that I noticed that I counsel a lot of my patients on when they have done the cycle, they’ve got the eggs, they come back and they say, okay, do I need to do another cycle? That counseling I find is very different than when someone is doing IVF and they have embryos. Because with embryos, we have a much tighter idea of what we have. Do we have embryos? How many based on how many eggs? How many have passed genetic testing? And what are the family building goals of that patient? Do they want one kid? Do they want three?
And how that factor is in. With egg freezing, it’s very different because you can get five beautiful embryos from 10 eggs. You can also have 49 eggs and get maybe two subpar quality embryos depending on whatever circumstances come up in the future and you’re not testing them. And so I find I’m almost always in a, well, if you can do another cycle, let’s do another cycle, which is a very unsatisfying response for women because they want to know.
Yep, you’re good. You can stop. You can not think about this and you can go on. And that counseling after the fact is very different. I always warn people like, I’m going to tell you right now, this is what I’m going to say afterwards because of how uncertain this is. So that’s one thing for folks to think about as well.
Lauren Roth MD (35:47)
Yeah. Yeah.
It’s always because you can’t tell the reproductive potential of the egg, right? We know that the freezing of the egg doesn’t change the reproductive potential, which is another thing people are always worried about, does the freezing damage the eggs? Probably not. But we still can’t predict the future of all the things that need to happen to get to the baby.
Abby Eblen MD (36:08)
And we don’t know about the sperm either.
Carrie Bedient MD (36:10)
Yeah, that’s always a big one. So, okay. Well, thank you. I hope this episode is super useful to our patients who are thinking about this and contemplating this, because we get a ton of questions about it. It’s a very common thing for people to come to us to talk about. And so I hope that this information is useful for our listeners. So thank you so much. We’ve had Dr. Lauren Roth, who’s the medical director of Shady Grove Fertility in Rockville, Maryland with us, so thank you, Lauren. We appreciate it.
Lauren Roth MD (36:38)
Thank you so much, it was great to be here.
Carrie Bedient MD (36:40)
And to our audience, thank you so much for listening. Please subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Be sure to subscribe to YouTube, which really helps us spread reliable information and help as many people as possible.
Abby Eblen MD (36:56)
You can also visit us on fertilitydocsuncensored.com to submit specific questions you have and sign up for our email list.
Susan Hudson MD (37:02)
As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we’ll talk to you soon. Bye.
Carrie Bedient MD (37:12)
Bye!
Carrie Bedient MD (37:13)
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