One Woman's Egg Freezing Story & Hope for Brighter Futures

As discussed in October, the American Society for Reproductive Medicine no longer considers egg freezing experimental. The topic was big news, covered by everything from national to local media affiliates.

This interview show on NPR offered an opportunity to hear the patient's perspective of oocyte cryopreservation, as told by well-known New York Times blogger, Suleika Jaoaud. She's the young woman who shares her experience with leukemia in “Life, Interrupted”, including her need to confront the possibility of infertility after life-saving chemotherapy. In this interview, Suleika describes how she learned about the option of oocyte cryopreservation on her own, not from her oncology physicians, and what it was like to go through the egg freezing process just prior to her initial treatments.

Also speaking is Dr. Samantha Pfeifer, one of the physicians on the ASRM committee that made the decision which should result in more expedient coordination of treatment for such patients. I and my Houston Fertility Center staff look forward to continuing teamwork with physicians who are helping save lives, so that our patients can have the brightest futures possible.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Egg Freezing Is No Longer Experimental

I spent part of the past week at the annual meeting of the American Society for Reproductive Medicine. Each year, thousands of individuals from all realms related to fertility come together to share research news and camaraderie. This year, as always, the days were filled with hopeful ideas and grounded conclusions about how best to help men and women with their reproductive medical needs. One of the big announcements this year was not about a brand new technique; rather, an announcement was made about a change in perspective toward techniques that have been in limited use for several years now.

Oocyte cryopreservation, or egg freezing, has been offered by several clinics in the world since the early 2000's. Specialists in Italy, especially, charged ahead with making egg freezing a viable option, because of that country's stringent laws regarding freezing embryos. It took reproductive lab experts a long time to finally “get it right” – specifically, egg cells (the human body's largest cells) were easy to freeze but often did not survive the thaw. When the science began closing in on successful freeze-thaw methods, many fertility specialists started offering the service to women for the deferment of conception.

In 2008, the ASRM published “Ovarian Tissue and Oocyte Cryopreservation” (Fertil Steril 2008;90:S241-6) which stated egg freezing, while not harmful, should still be considered experimental because of the unknown efficacy of the process. In that same year, I published a website called BabyLater introducing Houston Fertility Center's egg freezing services for women who wanted to preserve their fertile potential for later use with IVF. I joined many fertility providers around the country who saw the enormous need for cancer patients (and others who undergo sterility-causing chemotherapy or radiation treatments) to be able to “put their eggs on ice” before undergoing life-saving therapy, in hopes of parenthood later.

At this year's ASRM meeting, the announcement was made that egg freezing is no longer considered experimental. Enough data now exists to demonstrate that the science and clinical techniques behind the process is solid enough to present acceptable success rates. The committee continues to strongly advise that patients interested in egg freezing must be fully informed about the limitations of the technique, which primarily include the age factor: As always, eggs from younger women survive the process and result in pregnancy more often than eggs from older women.

I expect far more fertility providers to start offering egg freezing, and as with any “new” technique, tenure of experience can have an impact in treatment success. I'm happy to respond to related inquiries about how oocyte cryopreservation can be part of a reasonable family-building plan.

You can read the new guidelines from the Practice Committee of the ASRM here.

Image: FreeDigitalPhotos.net

Why I Attend the Meetings of American Society for Reproductive Medicine

One of the reasons I felt compelled to move from straight OB/Gyn work to reproductive endocrinology-infertility (REI) is because of the constant advances in science. I find it exciting to apply techniques that have developed along a continuum from creative brainstorming on how to meet patients' fertility challenges all the way through validation in labs and clinics.

I'm heading to Denver this week with some of my Houston Fertility Center staff to attend the 66th Annual Meeting of the American Society for Reproductive Medicine. ASRM is always a great place to catch up with colleagues from around the world and hear about the latest ways to treat our patients. This year promises to be even more enjoyable as we'll be honoring two pioneers of IVF, Dr. Howard Jones, who performed America's first IVF procedure, and Professor Robert Edwards, who recently was awarded the 2010 Nobel Prize in medicine for his development of IVF.

Bestowing accolades on esteemed professionals is just part of the reason for gathering. More importantly, I look forward to returning to Houston Fertility Center with new ideas to share with patients on clearing their family-building hurdles. Sometimes, even a simple treatment can be years in the making. Once new technology is available, a whole new group of once-infertile men and women can find themselves parents, and that's why I do what I do.

ASRM Embryo Guidelines Should Improve Overall Picture for Fertility Patients

This year, the American Society for Reproductive Medicine took an expected step forward to increase the safety and health of prospective IVF moms and their future babies. They issued guidelines stating specifically that women under age 35 should have no more than two embryos transferred per IVF treatment cycle.

The goal is to prevent multiple pregnancy, which is full of risks to both mother and babies.

The patient's prognosis, not just her age, should also be taken into account. In cases of a woman younger than 35 having optimal chances at pregnancy, the ASRM further recommends that single embryo transfer be considered.

Other ASRM embryo transfer recommendations, by which Houston Fertility Center adheres, are:

Patients 35 to 37 years old with good prognosis -- 2 embryos
Same age group with less optimal prognosis -- up to 3 embryos (or up to 2 resulting from extended culture)

Patients 38 to 40 years old with good prognosis -- up to 3 cleavage-stage or 2 blastocysts
Same age group with less optimal prognosis -- up to 4 cleavage-staged or 3 blastocysts

Even in cases of patients who typically have the least optimal chances of pregnancy -- women 41 to 42 years old -- no more than 5 cleavage-stage or 3 blastocysts should be transferred.

Women Want Working Options for Motherhood

At last November's ASRM meeting, some of us had the pleasure of listening to Lindsay Nohr Beck, the founder of Fertile Hope, present the patient's perspective on egg freezing. A podcast of that presentation is now online and available.

I think you'll find Lindsay's remarks (and the photos of her beautiful children) to be meaningful. The point she consistently boils down to is that women want the option to freeze their eggs, and they want it to work.

Our Presentation at ASRM: More Pieces of the Pregnancy Puzzle

We were pleased to have our poster presentation accepted into this year's meeting of the American Society for Reproductive Medicine. The title -- Differential Relationship Between the Total Number of Oocytes Retrieved and the Implantation Rate in IVF and ICSI Patients -- may sound dry, but our results were positive news for patients who need IVF to have a baby.

The Houston Infertility Clinic staff, in conjunction with the Department of OB/Gyn at the University of Sydney in Australia, examined 351 IVF cycles. In each case, patients were using their own eggs and non-frozen embryos. We looked at:

the number of eggs retrieved
number of embryos transferred
results of clinical pregnancy tests

Next we compared those cycles that included ICSI and those that used "conventional" IVF for insemination. These two groups were then split up into three sub-groups, based on the number of eggs that were retrieved (either 1-10 eggs, 11-20 eggs, or 21-40 eggs.)

It might seem a simple question of statistical odds that the more eggs you produce, the better your chances, but...

Here's the good news: We concluded that, at least in our hands, patients using ICSI who were in the 11-20 egg group had the highest implantation rate. Patients using "conventional" IVF w/o ICSI had higher implantation rates when they were in the subgroup producing the most eggs (21-40 eggs).

It's important to note that quality of eggs -- rather than quantity -- is the more important measure. Patients shouldn't be discouraged if their bodies aren't producing a high number of eggs. As our study indicates, the use of ICSI seems to make a noticeable difference in outcome.

On a related note -- in some cases, women's ovaries will produce far fewer eggs than everyone hoped for in an IVF cycle. Different clinics have different policies; many are, frankly, guided by heavy concern about success rate statistics.

Our policy is that if a patient wants to move forward and retrieve the one follicle that her ovary brought forth, we will respect her wishes and do our best to render highest quality care toward the best possible outcome.

We want every patient to have a fighting chance at getting pregnant.