Recent Advances in Infertility Treatment
Fertility preservation is a vital yet sensitive topic among women. The advancement in fertility medicine in the last 15 years has been drastic.
Earlier restricted to only heterosexual couples, egg freezing has now been considered a potent option for people who consider the risk of losing their fertility & want to prevent their chances of having a baby later on in life.
This includes women undergoing chemotherapy, women who have faced miscarriages, and women who choose to drive a successful career path before having a baby.
If you are a woman in your late 20s, 30s, or even late 40s who wants to boost her chances of getting pregnant and giving birth when you plan to have a baby, this blog is for you!
In this blog, you will get to understand:
- Advancement in fertility medicine in the last decade
- Determination of quality of egg
- Rapid increase in cancer patients opting to preserve egg
- Balancing biological and career clock
- Factors affecting egg quality- in women
- Factors affecting sperm quality- in men
- Health Saving Plans and IVF
- The ideal number of eggs to freeze
- Best time to retrieve frozen eggs
- Ways to create awareness about IVF/ fertility preservation
- Success Rate of Pregnancy from frozen eggs
Before we start let us first know a little about the one who has witnessed the advancement in fertility medicines and has been an integral part of it, Dr. Jane Frederick, MD, FACOG, Reproductive Endocrinology and Infertility Specialist.
Jane Frederick is a Reproductive Specialist who has been practicing since 1990. She is certified in both Reproductive Endocrinology/Infertility and Obstetrics/Gynecology from the University of Southern California.
This blog is based on the conversation between Dr. Frederick and Dr. Chellam about fertility in women and factors that affect the quality and quantity of eggs.
Let’s get right into it!
Revolutionizing advancement in fertility medicine
30 years ago when Dr. Fredrick started, she treated heterosexual couples who were struggling to have a baby. There were limited opportunities for IVF at the time. 30 years later, she has seen her practice evolve with an array of people in different situations looking for advanced fertility interventions. Women who are undergoing chemo are freezing their eggs, men, and women consciously asking to save their fertility. Cancer survivors are coming back to have their children.
Today, more single women who don’t have a partner yet just want to save their eggs for the time when they find their partners. Dr. Fredrick says that the biological clock that is ticking can be put on hold for some time by freezing your eggs and you can give yourself the best opportunity to have a baby in your 40s.
For people who have repetitive miscarriages, patients over 40 where egg perseverance is low, the process can help them preserve a healthy embryo that will lead to a successful pregnancy.
Determination of quality of egg
An egg is a single cell in the body, and it is mostly filled with water. It is frozen by dehydrating the water and placing it in liquid nitrogen. Later, it is rehydrated at the time of starting the process of fertilization and is allowed to grow in a laboratory. The quality of the egg depends on how well it goes through the process of freezing, then thawing, and then fertilizing. It is hard to tell just by looking under the microscope. However, FSH hormone, AMH, and Estradiol also help in determining the health of your egg.
There are cases where miscarriage occurs again and again. To avoid further miscarriage, the doctor harvests the egg through IVF which is then fertilizes to form an embryo. That cell goes to the genetics lab where it is established which embryo out of those that have been frozen is healthy.
The same technique is used for patients who have a genetic disorder where they carry a gene for cystic fibrosis or the hemophilia gene that usually affects the male children.
Rapid increase in cancer patients opting to preserve egg
Times are changing and technology is developing at a fast pace. The technology that has been developed allows freezing eggs successfully. The last 15 years have seen tremendous growth in fertility medicine by the development of vitrification, which is a rapid process of being able to freeze an egg without causing any damage.
Dr. Fredrick shares that, due to development in technology, doctors have seen a lot more cancer therapies being successful. They see more cancer survivors returning for their eggs. Cancer patients before going for their chemo choose to protect their eggs and preserve their fertility by freezing their eggs.
Balancing biological and career clock
As per Dr. Fredrick, the best age to freeze your egg is in your 30s however the optimal age to freeze your eggs is below 30. Freezing the eggs allows you to control your reproductive health. It also allows the egg to be in a steady state in the lab. It gives the patient more time to achieve career goals and then focus on childbearing.
There is a sharp decline in quality and quantity of eggs observed after 37 years and even sharper in the 40s. There are fewer chances of successful In vitro fertilization after the 40s. Women are born with a finite number of eggs and most of the eggs start dropping with the increasing age and changes occur in her body. The maximum number of changes occur 10 years before menopause and that is when there is a major drop in the number of eggs.
Dr. Fredrick suggests that a woman should get her FSH, Estradiol, and AMH (Anti-Müllerian Hormone Test) blood levels checked on day 3 of the menstrual cycle- to get an idea of her biological track and egg quality and quantity.
Factors affecting egg quality- in women
- Genetics: play a major role in determining egg quality. You should be aware of the age when your mother and grandmothers had their menopause.
- Excess Body Weight: Your Body Mass Index is important and should be under control. Overweight or under-weight patients usually face issues with getting pregnant.
- Eating Habits: Eating right, exercising regularly, and not consuming marijuana or smoking is very important.
- PCOS Patients: Should be more careful with their food habits and body weight.
- Stress: Your stress level directly affects your fertility and can create problems while you are trying to conceive.
- Lifestyle Habits: A healthy, stress-free, and peaceful lifestyle is very important to preserve your fertility.
Factors affecting egg quality- in men
For men to have good quality and quantity of sperm, the measures are very similar to that of women.
- Weight: Obesity affects the sperm quality
- Eating habits: Eating right and exercising regularly is suggested to everyone for a healthy life and quality sperms.
- Avoid drinking and smoking: You should avoid smoking, vaping, or consuming marijuana. Drinking also affects sperm quality, so you should be careful.
- Steroid: Men usually take testosterone injections for bodybuilding without knowing that they might lose quality sperms completely.
Dr. Fredrick recommends that you should be upfront with your doctor about your history and should not hide anything.
Health Saving Plans and IVF
Health Savings Account can be used for the process of IVF. States like Massachusetts, Illinois in the US cover the cost of infertility for their citizens. You should ask your insurance company about the available options.
Companies like Apple and Facebook pay women employees to get their eggs frozen.
Dr. Fredrick shares that 30% of her patients have insurance coverage for infertility treatment in California. She also shares one of her programs- Capex- a loan program in which over 300 IFV centres participate and help in funding your IVF cycle at a low interest rate.
“You don’t want the financial burden to be a reason why you don’t move forward with your treatment.”- Dr. Jane Fredrick
What is an ideal number of eggs to freeze?
At each retrieval, doctors try to get 10-15 eggs, ideally. Dr. Fredrick suggests that more is better. Hence, 15 to 30 eggs should be collected for a lifetime that would give the doctors enough eggs that can be thawed in the future and hopefully survive and produce the embryo to lead to a successful pregnancy.
If an individual’s FSH and AMH levels are not healthy, 10-30 eggs would be difficult to gather at once. Hence, she recommends repeating the process twice or thrice to have enough eggs for future
Best time to retrieve frozen eggs
You can come back to retrieve the eggs and to start the process of fertilization within 5 to 7 years. Dr. Fredrick recommends that you should not leave your eggs in the freezer for longer than that as a freezer burn might occur. The longer eggs are frozen, the more likely for them to become less viable. You should discuss with your doctor about the best time to come back. However, Dr. Fredrick recommends that within 5-7 years is the most suitable time to come back. It is not necessary to use the frozen eggs and they can be treated as a backup option.
Dr. Fredrick shares that some of their patients never came back because they got pregnant on their own. They never needed their frozen eggs. It’s not a not necessity to use these eggs. They are your backup.
Ways to create awareness about IVF/ fertility preservation
- Family history: A woman should know her family history and the age at which their mother and grandmothers got their menopause.
- Visiting OB-GYNs: A woman should make an appointment with an OB-GYN and keep a check on her FSH and AMH levels.
- Seminars and discussion: Doctors should hold seminars among their community and share knowledge about IVF.
- A one-on-one conversation with patients: Doctors should deliberately bring up the topic of IVF with their patients who are in their late 20s,30s or early 40s and make sure that the patient knows that there are options available for preserving their fertility.
Dr. Fredrick cites an example and shares; If a 35-year-old patient comes to you, bring up the conversation and ask your patient if they have checked their AMH and FSH levels just so they have an idea of where they are at with their fertility.
- Social media and webinars: Outreaching women through social media platforms to help them understand that there is a viable option of egg freezing.
Success Rate of Pregnancy from frozen eggs
If you have good FSH and AMH levels, you can get 15-30 eggs frozen. Usually, there is a 50-50 chance that you will have a successful embryo grow in the future. It is very important to come early, when you are young, to save the opportunity for yourself in the future.
This blog covers the interactive session between Dr. Nisha Chellam, Board Certified Internist and Reproductive Specialist, Dr. Jane Fredrick from our latest podcast on advances in fertility medicine.
You can check out the entire podcast on our YouTube channel by clicking this link: https://youtu.be/e_CCpdxTzDw
Hope this blog was helpful, if you have any other questions related to fertilization and its process, please drop us an email with your question and a brief about yourself at firstname.lastname@example.org or email@example.com and we will get back to you shortly.