Fertility specialist's egg freezing advice: 'Time isn't your friend'

The outbreak of the coronavirus has changed so many aspects of our lives that it’s almost impossible to quantify.

For those thinking about seeking reproductive assistance in order to start a family, the pandemic and the ensuing lockdown has been a ‘wakeup call,’ says Dr Devora Lieberman, a Sydney-based IVF and fertility specialist.

After closing the clinic for about a month in line with state requirements, Dr Lieberman tells Yahoo Lifestyle that City Fertility, where she is Clinical Director, experienced ‘a bit of pent up demand’.

“COVID isolation was a trigger for some people to say, ‘right we’ve got to get onto this, you never know what could happen,’” she says.

According to Dr Lieberman, the breathing space in quarantine prompted individuals and couples who had previously considered IVF or egg freezing to reassess their plans, and quickly.

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“It’s a wakeup call. People think they have all the time in the world but then they realise they don’t.”

This is particularly true when it comes to egg freezing, a procedure wherein a woman’s unfertilised eggs are removed and stored for use later, allowing her more control over her reproductive future.

Again, Dr Lieberman’s message is pretty straightforward, regardless of whether there’s a global pandemic or not:

“If you think you might want to freeze your eggs, time is not your friend.

“The older you are the fewer eggs you’ll get and the less likely those eggs will be successful.”

Egg freezing explained

Before rushing out to the nearest fertility clinic in a panic, Dr Lieberman encourages women who are considering having their eggs frozen to ‘take stock’ and educate themselves.

So, what exactly is egg freezing — and is it the same as IVF?

Every month in a woman’s natural menstrual cycle, a whole crop of follicles — little fluid-filled cysts that contain immature eggs — will begin to grow up. Due to the amount of follicle-stimulating hormone (FSH) that the woman’s brain releases, only a single follicle will grow up, dominate and ovulate.

In the egg freezing process, however, the woman will have injections of FSH to try to increase the number of follicles that will grow up and ovulate. But before ovulation occurs, the eggs are collected from the ovaries via the vaginal wall by an ultrasound-guided needle in a technique called ‘transvaginal oocyte retrieval’.

To ensure that the eggs are retrieved at the right stage, the process is “all very carefully timed,” says Dr Lieberman.

The number of eggs that are collected varies from patient to patient, however, Dr Lieberman will ‘take as many eggs as a woman’s ovaries have to give’ at that time.

Up until this step, the process of egg freezing and IVF are exactly the same; “the only difference is what happens next in the lab,” says Dr Lieberman.

In egg freezing, the retrieved eggs are immediately frozen via a cryopreservation technique called vitrification and stored in a special facility where they can remain for years.

In IVF, the retrieved eggs are instead immediately fertilised and implanted back into the uterus.

Common myths about fertility and egg freezing

Now that we’ve covered the basics of egg freezing it’s time to bust some common myths. From whether taking the Pill long-term can affect fertility to the stigma around the ‘type’ of woman who freezes her eggs, Dr Lieberman sorts the fact from fiction below.

Only single, career-obsessed women freeze their eggs

While Dr Lieberman says that 80 per cent of her patients are single, the idea that fertility clinics are filled with workaholic women who’ve neglected their romantic lives is just not true; these type of patients are the ‘exception not the rule’ she says.

“The vast majority of single women I see, [their decision to freeze their eggs is] not about their career, they just haven’t found the right partner yet and there’s lots of research that backs that up.”

On the flip side, the remaining 20 per cent of patients who are in relationships are choosing to freeze their eggs because they’re ‘not ready to start a family yet’.

While it’s uncommon, Dr Lieberman has seen a patient who was planning on conceiving naturally with her partner but also wanted to freeze her eggs so she had them as a ‘backup’.

Is it expensive to have your eggs frozen?

“An egg freezing cycle will cost about $7,000 to $7,500,” Dr Lieberman says.

As egg freezing and IVF are both elective procedures there’s no Medicare rebate available however there are some exceptions for women who are about to undergo a treatment or procedure that will affect their fertility such as chemotherapy or surgery for endometriosis.

As it is such a huge financial commitment, Dr Lieberman suggests women do their research and, when getting quotes from clinics, make sure that it includes pricing for day surgery and the anaesthetist as well as the ‘base’ rate.

And don’t forget to factor in a monthly storage fee to keep the eggs frozen after they’re extracted.

All women who freeze their eggs end up using them

Despite the hefty price tag, less than 10 per cent of women across the globe who freeze their eggs come back for them says Dr Lieberman.

Why? There are several reasons; some women end up conceiving naturally while others simply decide not to have children.

If a woman does decide to get pregnant using one of her eggs, whether with a partner or donor sperm, the process is fairly simple and quick.

First, the eggs are defrosted then fertilised and implanted into the uterus during a two-minute procedure in the clinic. There’s no recovery time and no need for the woman to inject hormones prior as the procedure is timed with her menstrual cycle.

All women should have a fertility test, even if they’re not about to get pregnant

First of all, there is no definitive test for ‘fertility,’ says Dr Lieberman.

Women can, however, get an idea of their ‘ovarian reserve’ which is the number of follicles they grow each month. There are a few ways to test ovarian reserve, one is via an ultrasound where the follicles are quite literally counted.

Another method is a blood test that measures the level of a hormone produced by the follicles themselves called AMH or anti-Müllerian hormone, which indicates the number of eggs the woman may produce in a stimulated cycle.

In general, a high AMH means a high ovarian reserve and a better chance of a successful pregnancy. On the other hand, “if you have low ovarian reserve then we’re not likely to get many eggs, therefore, the chance of a baby from those eggs is much lower.”

Before attending their first appointment with her, Dr Lieberman recommends patients have their ovarian reserves tested at their GP but warns that both tests are more of a ‘guesstimate’ than a cut and dry result.

She also discourages women from placing ‘fertility’ tests in the same category as routine preventative health checks like cervical screening and mammograms.

“I would advise not to get an AMH test unless it’s in the context of looking at your fertility-preserving options.

“Doing it because you’re curious just sets you up for a lot of angst if the results are low”.

A low ovarian reserve isn’t necessarily cause for panic, however.

“Just because a woman has a low ovarian reserve or low AMH it doesn’t mean she will necessarily struggle to get pregnant because it is not a measure of egg quality, it’s a measure of egg quantity,” Dr Lieberman says.

Women are most fertile in their 20s

This is a bit of a myth as a woman can be young and have a low ovarian reserve.

“You can’t look at your calendar age or how young you look in the mirror and think that’s your ovarian age,” Dr Lieberman explains.

“I worked in the menopause clinic at [Sydney’s] Royal North Shore hospital for 17 years and the youngest woman I ever looked after was 18-years-old,” she adds.

The cause of early menopause or low ovarian reserves is typically unknown but genetics likely play a significant part. There are also certain lifestyle factors that can increase a woman’s ovarian age.

“Cigarette smoking is probably the worst thing they can do as it can advance their ovarian age by up to ten years,” she says.

Having said that, the belief that women who are healthier will conceive more easily is not exactly true either.

“If a woman is reasonably healthy, being healthier won’t make her eggs any better. There are no supplements you can take or naturopathic anything that will improve your egg quality,” Dr Lieberman says.

Instead, she recommends eating a reasonably healthy diet and maintaining a BMI in the normal range of 19 to 25 as “being underweight can be harmful for fertility”.

The combination of a high ovarian reserve and a young age is a good sign because “you’re probably not heading toward a fertility cliff and you’ve got time on your side”.

Women older than 35 will have problems getting pregnant

Just as being young isn’t a guarantee for fertility success, nor is being older necessarily cause for lower expectations — a lot comes down to egg quality.

“If you are 35 and freeze a dozen beautiful eggs and you try to get pregnant at 38 you probably won’t struggle much.

“If you freeze a dozen not-so-great eggs at age 35 then try to get pregnant at 38 then you’ll probably struggle because your eggs weren’t great at 35.

“That’s a function of the biology not the technology.”

In terms of success rates, for a woman under the age of 35, the maximum chance of having a baby is 70 to 80 per cent if she has 15 to 20 eggs in storage.

The key thing to bear in mind is that a frozen egg now does not necessarily equal a child in the future.

“In general, women will overestimate their fertility and also overestimate the ability of frozen eggs to become babies. It’s important to know that it’s by no means a guarantee of a baby in the future,” Dr Lieberman explains.

Taking the Pill long-term can permanently affect your fertility

This is a tricky one — the answer is ‘yes’ but also, ‘no’.

“Being on the Pill can suppress a woman’s AMH level by up to 50 per cent so if a woman has been on the Pill for a long time she may get a falsely low reading,” Dr Lieberman explains.

The ‘suppressive’ effect of the Pill on AMH is not permanent and levels will ‘recover’ once a woman stops taking it.

She warns women who are planning to stop taking the Pill — or who have just done so — that they are at their ‘most fertile’ in the first month or two after stopping.

“It’s a myth that you need to let the Pill ‘get out of your system’. But that’s a topic for another article!” she laughs.

Women who are taking the Pill are still able to have their eggs collected — in fact, it can be an advantage as it allows the doctor to time the patient’s hormone injections more accurately.

Do frozen eggs last forever?

“As far as we know there is no use-by date [for frozen unfertilised eggs] but mind you we have only been using this technology for about 10 years so time will tell,” Dr Lieberman says.

As mentioned before, less than 10 per cent of women actually return to use their eggs.

On the other hand, there is an unofficial age limit for women wanting to use their frozen eggs which can vary from doctor to doctor.

“We all have our own cut-offs. I won’t treat anyone over 51 years old but I have some colleagues who will go up to age 55,” she explains.

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