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When Should I Freeze My Eggs?

By Dr. Michael Zinger

August 4th, 2016 at 3:43 pm

 

image credit: stockimages/freedigitalphotos.net


Every woman is born with a limited supply of eggs.  As this supply ages, the likelihood of each remaining egg to have the capability to become a baby diminishes.  However, this loss of potential is not spread evenly over the years, rather it is a shallow decline that usually continues into the mid-30’s, followed by a steeper loss that typically happens from the late 30’s into the early 40’s.  Over a matter of 5 years, the odds of one egg having the potential to make a baby decreases by about 80%.  Of course, not every woman is typical and the age at which this transition starts can vary quite a bit.

 

The only way to effectively protect the potential of eggs over time is cryopreservation, also known as egg freezing.  Once frozen, the capacity of the eggs to create a successful pregnancy is maintained through the years.

 

Gynecologists often ask me at which age to refer their single patients to me to discuss egg freezing.  The answer is not simple.  Certainly we do not want to put a patient through this process if it is likely that she will meet the right partner and form a family without ever using those eggs.  It would have been an unnecessary medical procedure with associated expense and lost time and effort.

 

On the other hand, we have to weigh the risk that the steeper decline in the eggs’ potential will happen before the woman has met her future partner and completed her family.  If we could predict when that decline will happen in each woman then this question would be much easier.  Unfortunately, our testing is only accurate in identifying this steeper decline when it is already occurring, at which point we have already missed the opportunity to freeze high-potential eggs.

 

Most of my egg-freeze patients are in their mid-30’s.  On average, at this point, only subtle changes in the potential of eggs have occurred, whereas within a few years, more drastic changes usually start.   Therefore, this timing does make sense for most women, but not everyone.

 

A concern about waiting until the mid 30’s is the possibility of an earlier decrease in egg potential.  While that is unusual, it tends to also be unpredictable.  Factors that contribute may include a history of smoking, a history of ovarian surgery or conditions that may lead to such surgery (e.g. endometriosis), or having a mother or older sister that experienced either an earlier menopause or infertility due to loss in egg potential.  Women with these factors should consider freezing eggs in their early 30’s or even late 20’s.    But, most often, if an early decrease occurs, it is without any predisposing factors and with no known cause.  Therefore, even without predisposing factors, cautious women, who want to minimize the risk of missing the opportunity, should also consider freezing their eggs in their early 30’s.

 

Of course, just as some women unpredictably have an earlier loss, some also have good potential that persists even past 40.  This can be determined at an initial visit with a fertility specialist through sonogram and blood tests.  So, for women who have not yet frozen eggs, even at 41 or 42 it makes sense to come in for evaluation and determine if this could still be worthwhile.

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How Old is Too Old to Get Pregnant?

By David Kreiner MD, and Tracey Minella

January 17th, 2012 at 11:44 pm


I’m the first to admit it would’ve been easier on many levels if infertility hadn’t delayed motherhood for me. I’d have a kid in college instead of a third grader. Sure some days I feel like I’m aging in dog years… but on others I’m sure chasing him keeps me young.

I can make judgments about myself. We all do. But if someone else were to judge whether or not I was too old to become a mother…now that’s a whole different story!

We can probably all agree that, say 65, is too old. But is 60? Or even 55? As we slide that scale downward, we get into a gray area. But what’s a fertility doctor to do?

Read on for Dr. Kreiner’s thoughtful post on how he has handled this controversial issue:

When I saw that Maria de Carmen Bousada (the oldest mother to conceive at the time with donated eggs and the help of an IVF program) had died, my first thought was to extend my sincere condolences to her family and in particular to her two year twin boys. My heart truly went out to them. It is a great tragedy when a death occurs especially when it is the mother of such young children. I hope and pray that Maria’s family and friends find the strength to replace the love and nurturing typically given by a mother to her child. My second thought as a fertility doctor was that once again – the world of infertility was making the news because we continue to push the edges of what society views as acceptable.

This is one of the hardest things about being a doctor in a cutting edge field such as reproductive medicine. We are often put in the position of making decisions with our patients that have even bigger implications to society than the individual patient. I do my best to look at each patient, and each situation individually, but I do rely on my patients to treat me as honestly as I treat them. It is a two way street – and unfortunately, Maria lied to the clinic about her age, telling them she was only 53 years of age.

Questions are being raised regarding the responsibility of the IVF program to verify the veracity of information supplied to them by their patients in addition to confirming their health condition to carry a pregnancy.

Others add that beyond a certain age, it is unnatural to become a mother and it puts the family at risk that she may not be around to help raise the child as what occurred in this case, or even if she is perhaps she lacks the energy and stamina to raise the child properly.

At East Coast Fertility, we had a cutoff of age 50 which was admittedly random and that limit was often broken when faced with an energetic couple with a woman who passes her stress test, medical and high risk maternal fetal medicine clearances. We recently celebrated our latest 54 year old patient’s delivery of a healthy baby that was highly reported in the press.

As I said, it is a struggle to separate my own personal feelings about the proper age to have a child which may be inappropriate for others who have a completely different perspective. My responsibility as the physician offering assistance to patients in need of help with procreation is to the health of my patients, the well being of the child and for the good of society.

Many women in their 50’s have the health and energy to carry a pregnancy and bear a child with no more increased risk than many woman 10-20 years younger whose interest in achieving pregnancy we would never consider questioning. That being said what about the risk that the mother may not still be around to raise the child to maturity.

There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal for raising a family. But, happy, successful families can take on many different faces. Single parent families exist, survive and often thrive. One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity. We do not know that a healthy woman of 30, 40 or 50 may not develop a lethal disease before a child has grown up. In addition, at least 50% of couples in the United States become divorced. One can argue that couples at risk of divorce should not get pregnant. I do not think that society is ready to conclude that any of these women should not be allowed to procreate.

So, what about the clinic’s responsibility regarding confirming that a patient is giving them truthful information? We have been deceived in the past that a couple who is requesting fertility assistance was unmarried when in fact at least one partner was married to someone else. This issue is especially acute as it can raise potential liability to the clinic. As in the case of Maria de Carmen Bousada, she lied about her age and perhaps was beyond the limit the doctors and society was comfortable assisting.

For me and for our program we have raised our bar to do the proper due diligence realizing that we will not be able to get the truth in all cases but minimize the risk that we missed picking up a crucial lie. But I don’t want to be “The Fertility Police”. I am a fertility doctor – and my job is to help people have families no matter how different those families may look to you and me.

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What’s your opinion? Should there be an age limit? Or should it be determined on a case-by-case basis?

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Donor Eggs or Their Own: Are Older Celebrities Lying?

By David Kreiner, MD

September 22nd, 2011 at 3:25 pm

The Fertility news is constantly highlighted in sensational headlines, such as “49 year old woman conceives with own egg through IVF”. In the past, readers have been entertained with “Octomom”, “a woman pregnant with a supposed dozen”, “Jon and Kate plus eight” and “a 62 year old mother through IVF” not to mention the numerous over 45 and sometimes over 50 year old celebrities having babies supposedly with their own eggs.

Reading these “news” stories one may get the impression that Fertility is a thriving business bearing little resemblance to the medical specialty of reproductive endocrinology requiring seven years of post medical school training.

The medical pioneers Drs. Steptoe and Edwards in the UK and Drs. Howard and Georgeanna Jones Jr. in the US envisioned a world in which couples inflicted with the curse of an inability to procreate, would, with the benefit of this technology that they developed, give these couples the ability to build their own families.

They were excited that as the technology improved and became more efficient and the cryopreservation of embryos became routinely available that risky multiple pregnancies could be eliminated. They believed that insurance companies would pay for an IVF benefit that had a high success rate and could deliver healthy singleton pregnancies with far greater confidence than any alternative treatment especially intrauterine inseminations (IUI).

They were unhappy that in the early years when IVF was inefficient, many embryos needed to be transferred in order to give a patient a reasonable chance for success. This resulted in multiple pregnancies, many of which delivered prematurely requiring expensive neonatal intensive care and unfortunately many did not end well. Today, we have control over this with IVF by transferring one embryo at a time but not with IUI.

They also did not believe that women should be subjected to the medications, blood work and retrieval process without a fair chance for a successful outcome.

The idea of subjecting a 49 year old woman to IVF for what may be a 1% chance of conception with a greater than 50% chance of miscarriage is not medically reasonable. Women of this age have a 70 to 80% chance for conception through egg donation.

This is how the 50 something celebrities are getting pregnant.

They are not using their own eggs. Misleading the public with news stories that feature these older pregnant celebrities gives patients the misconception that they too can create their families at the same age using their own eggs.

We have recently performed IVF on two perimenopausal patients with FSH levels over 50 at age 45 after days of counseling regarding the extreme low odds of pregnancy and a live birth. In both cases, they felt they needed to give it one shot before moving on to egg donation.

They had one follicle each and both resulted in pregnancies with a gestational sac seen on ultrasound. One has since miscarried and will now move on to egg donation where her odds of having a live baby jump from less than 5% to 60% per attempt. The other remains pregnant and is miraculously the exception to the rule.

IVF is a medical procedure that is part of a proud tradition of reproductive endocrinology. It is a medical treatment that can cure one of the cruelest maladies known to man, the inability to have a child.

This problem is featured in the bible with several references including from the woman’s perspective with Hanna weeping for a baby of her own. The Old Testament proclaims the commandment to procreate. This is part of the human condition.

Does it not make sense then that insurance companies provide the financial coverage to allow IVF, a treatment that can be controlled by transferring one embryo at a time to result in a singleton pregnancy? Regulations to prevent costly dangerous multiple pregnancies and the performance of IVF in patients with unreasonably low odds of success need to be instituted.

Financial programs that make it no more expensive to patients to transfer one embryo at a time such as our Single Embryo Transfer program at East Coast Fertility need to be the news highlight of the day not the 49 year old who conceived on her sixth try.

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Do YOU think any of the older celebrity moms… who claim or imply that their children are not conceived through donor egg programs… are being untruthful?

Do you think their right to privacy is more important than the disservice such lies do to the public’s misconception about how old women can be and still conceive with their own eggs?

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TTC and the “Generational” Clock

By Tracey Minella

August 19th, 2011 at 12:00 am

Nearly everyone TTC or doing IVF has heard of their biological clock running out. That phrase refers to the woman’s advancing age, diminished supply and questionable quality of eggs, the rapid approach of menopause, the potential increase in miscarriage and fetal abnormality rates, and the eventual cliff-dive in IVF success stats.

But this week I was reminded of the “other” clock. The more silent clock. Sometimes, the ticking is almost a whisper.

I’m going to call this other clock the “Generational” clock.

The Generational clock is the one that makes you worry that your parents are not going to live long enough to see you have your children. Or maybe not live long enough to become grandparents at all… if you having a baby is their only hope. Or they may have fewer years with your kids because of the infertility delays.

Like the biological clock, the generational clock is tied to your life and your infertility journey, but the generational clock is also tied to your parents’ and in-laws’ lives. That makes it twice as worrisome…twice as likely to blow up in your face.

Mine blew up in 1994 and again in 1996. My parents never became grandparents as I was an only child. My IVF babies were born in 1998 and 2002. Fortunately, my kids have had my wonderful in-laws. They easily give enough love and attention to cover for two sets of grandparents.

 

This week, my husband’s generational clock exploded with the passing of his dad. I am sad and angry over many aspects of this loss, but mostly that my young children have been deprived of the love of the world’s best grandfather.

He lived long enough to see his other grandchildren graduate college, saw some marry and have children. My oldest would have been 20, not 13, if not for infertility. It’s just not right.

Only one precious grandmother left.

I should stop typing now, so I can plug my ears and drown out the deafening whisper of that ticking…

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Have you feared the loss… or actually experienced the loss… of a parent during the infertility journey? How do you cope?

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“Your Ovaries Don’t Look a Day Over 34″

By Tracey Minella

February 28th, 2011 at 12:00 am


Ten years ago yesterday, on the day before she turned 40, I dragged a close friend into the stirrups for a consultation with Dr. Kreiner. She conceived on her own but miscarried, and on the eve of the big 4-0, she was concerned her time was running out. So was I.

A medical assistant at the time, I’d drag my friends and family into the office whenever they were careless enough to casually mention they were trying to conceive and thought they might have “issues”. To my delight, they’d often ask me to stay in the room so I could check out their ultrasound. I think they thought I’d tell them something Dr. Kreiner was holding back from them. Which “A” he wouldn’t do, and “B” I wouldn’t have a clue about anyway.

So here’s my friend on the exam table… a bona fide weakling normally… crushing the hand I offered in support, as I’m struggling to write notes in the dark with the other working hand. No worry, I thought. I would get even when it was time to draw her blood later with my mangled digits. The silence was broken and I was snapped back to reality by Dr. Kreiner’s announcement:

“Your ovaries don’t look a day over 34.”

Now, there’s a compliment you don’t hear every day. We exchanged glances as the news sank in.

Well, I guess it’s a compliment, right? It’s the fertility equivalent of the usual age-related compliment: “You don’t look a day over ‘X’”, where you tell someone they look ten years younger than they actually are.

I have to admit I was shocked. I was guilty of wrongly assuming (and you know what they say about that!) that if she had a history of miscarriage and was now 40, that the sonogram would show a bleak picture.

I offer this story not to encourage similarly-situated women to further delay their own fertility evaluation in the hope that their ovaries are looking younger than their years, too, but instead to approach the evaluation with some measure of hope and cautious optimism, because you never know what the doctor is going to find.

So, with those eight words, Dr. Kreiner delivered the best birthday present my friend could have gotten. She took her 34 year old ovaries home and now tucks her eight year old into bed every night.

I know you don’t want to hear this number my friend, but here is a special Happy 50th Birthday to you. Your story will make the day of many older women still TTC.

And if it’s any consolation, I’m sure your ovaries don’t look a day over 43!

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