Welcome to the kick Your Expert led podcast, helping you explore and learn everything about getting pregnancy, birth, and becoming a parent.
On the podcast and our online pregnancy program grow My Baby, we share my experience of helping more than four thousand babies to be born.
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Welcome everyone. I'm Bridget Maloney.
And I'm obstetrician doctor Patrick.
Maloney, and today we're in a brand new studio.
It feels good, doesn't it great? Isn't it?
Yeah, it's out in the country a little bit more. And there's guitars on the walls and a set of drums.
So we might be branching out.
I'm just saying you do not want me to sing, but I will if someone requests it.
There's a banjo, yep, and a bunch of handmade guitars.
It's very exciting, very exciting. So today is an exciting episode as well. Pattern.
Yeah, we're talking about egg freezing. Yeah, when you should why you wouldn't Does it work?
Yep? Because it is a question that is on the lips of lots of people, because you know, we're having our babies later, we're finding our partner later. Maybe we want to go it alone, but we want to do that later. So yeah, let's dive into all those things. But first I want to ask Pat, why would someone consider to do this.
Well, I think that the main reason is somebody who you really wants to have children and feels like they're getting to a point, perhaps in their thirties, where there's a decline in egg number and equality, or that they think that by the time they get to that point that there might be a problem with those things.
And how would they know that there's a problem with say egg quality or quantity.
Well, you can't really know. There are various tests that can be done, AMH levels and so forth, but those things are not terribly useful. What we really need to know is what are the goals of that individual woman. How old is she, is she currently in a relationship, how many babies does she want to have? And sometimes these are things that people know but know about already you know pretty clear about. And other times they're you know,
in terms of that how many do we want? They're not so sure, especially if we're starting with someone who's outside of our relationship.
Yeah, and I suppose a lot of people look towards things like, oh, well, is it time for me to preserve my fertility freeze my eggs because I don't know what's happening. I don't know what my future holds.
And that's the whole point. And once upon a time, at the very start of my career, you could preserve your fertility in a certain sense, but really only by preserving embryos. And to make an embryo you needed some sperms, and the whole problem with that is that that might have been watching the very thing you didn't have. So in those early days of IVF, you could freeze an embryo that had been created, so a fertilized egg, and that worked really well, and they could be they could
be preserved as people. I'm sure, no, practically, and definitely the early experiments with freezing eggs were it didn't work. So they just didn't have the scientific technique necessary. And if you tried to freeze an egg, they would just break open and be lost.
At the time or when people decided to.
At the time, at the time, and of course, sperms freeze. Fine, yeah, they knew that back then as well. So the name of the game was always to try and work out how to get eggs to freeze, because it was that step that meant that a single woman could potentially, you know, take out an insurance policy against the expiration of her practical fertility before she was ready to use it.
I'll take it back to me, Like, you know, I'm sure I'm not alone in thinking that I had a ticking time bomb. You know, I was always working against this loss of fertility at a certain age. But can you tell me a little bit about the decline of that, Like it's a rapid decline towards your later thirties, isn't it.
Well, yes, the quantity and quality of the eggs do decline in your late thirties. The thing is, though, that societal changes are such that so many of my patients now I haven't even really turned their attention to starting a family until they're well into their thirties. One of the things that's also happened in the recent years that people are getting started much later is they want way
fewer babies. So, for example, if you are thirty four years old, and wanted one or perhaps two babies, then it's not the same emergency as if you wanted six.
I don't know if there's many people still wanting six.
Well there's a few, but they start in their early twenties. Yes, it's so we're going to when we talk about this technology, we sort of wonder who it's for. In my experience with this, it's not as simple as saying that these are you know, women excessively focused on Korea who think that they can sort of push their career as hard as they can until their late thirties and then suddenly turn around and want a baby. That's really over simplifying
the situation. I guess there's that's a little bit, but these we're talking about human beings with complex lives, and I would say the main thing that I deal with in my practice in regional Australia is just people who just have not found the right partner and they're trying and they want a family and that process has taken them.
Awhile absolutely I think it is over used that it's a selfish decision for people to wait until that time, until they have a baby or whatever. It just simply isn't the right time for them.
No, I don't think there's anything selfish at all about about having a baby at forty. Yeah, it's a deeply selfless thing to do.
Yeah, says people who had their third and four at thirty nine and forty. All right, so someone has decided we'll go into a bit more depth what age somebody should maybe even consider freezing the eggs. But before they do that, let's talk about how it's done. What do people expect.
Well, it's done in exactly the same way as a standard IVF cycle. Basically, you go and see a reproductive clinic like an IVF clinic. They give you some hormonal injections to take over about two weeks, and that causes your ovaries to make a bunch of mature eggs in one cycle in one month instead of instead of just one Yeah, and when those eggs are nice and ripe, you have a little ultrasound guided procedure to collect the eggs out of the ovaries before they have a chance to pop out.
And that's called retrieval, isn't it.
Yep.
Yeah, that's exactly the same as with standard IVF cycle, except when they get the eggs out in a standard cycle, they mix them up with a sperm straight away, create embryos in the laboratory, immediately get the best embryo and put it in fresh and put the rest in the freezer to be thought out and news later on. And with the egg process, if we're going to preserve eggs alone, then they're frozen in a sort of a snap freezing
process called vitrification. And that was the that was the breakthrough that allowed this to be done.
If someone's listening to this episode, I want to help them understand what the retrieval process is. Can you just describe that procedure?
Yees. So the process is quite well tolerated by patients. You come in on the right day when the IVF people have determined that the eggs are ready to go, and under some sedation, an ultrasound probe is put into the vagina, just like a transvaginal ultrasound that we might
use in gynecology. And there's a little set up on the end of that ultrasound probe that allows a needle to be passed through the edge of the vagina and up into the ovaries and then the eggs can just be sucked out one by one out of their little eggs acts in the ovary and collected in the tube and pass through into the laboratory.
Wow, And does somebody have sort of pain after that procedure or yeah, there.
Is pain afterwards. It's like ovulating a whole bunch of times in one day, so that requires some pain relief for sure.
And let's say it's somebody in their thirties, mid thirties or early thirties. I know, because the amount of eggs that you retrieve would be different if they're in towards their forties. But what would you expect. What's a good retrieval rate?
Look, it varies enormously compared to the woman's age and the hormones that jin's been given. You can sort of tell in advance how many you expect to get off ultrasound, but to get ten to fifteen would be terrific. Bearing in mind that they won't all be suitable for freezing, they won't all freeze efficiently, they won't all be genetically normal, they won't all unfreeze at the end of the day.
So Patty, before you mentioned once upon a time that they would freeze embryos and mbryos could freeze, is there a difference, or is embryo versus egg freezing because I'm assuming some couples decide early to do this process if they're not ready to have a baby.
Oh, there's no question that you would freeze embryos over freezing eggs if you were a committed couple and you had access to the wherewithal to make the embryos. Yeah, so that's that's not a question. This is this is basically for people, you know, for a single person or for some other reason, doesn't have the access to the sperm.
So, Patty, if somebody has, you know, got their ten to fifteen eggs, what happens next? What's the success rate? How many people expect to get a pregnancy from that?
Well, the first thing we have to remember is that most people don't use them, So most women with frozen eggs will go on to have their pregnancy the old fashioned way and not require that eggs that are frozen.
And then for those that do actually turn up to use them, around eighty to ninety percent of the eggs would survive thor and about fifty to eighty percent of those would be successfully fertilized, and then about twenty to forty percent of the fertilized eggs would actually go ahead and develop into an embryo, which is sort of the standard success rates in IVF. So you've got to start off with big numbers to wind up with small, usable numbers at the end of the day.
So Patty, for those that have decided to go ahead with the pregnancy and they've got an egg and it's ready to go, it's now met up with the sperm and it's formed an embryo. How what happens next.
Well, you can just thaw out those eggs one by one and fertilize them with semen from your new partner who you've found in the meantime. Then and that forms an embryo, and that embryo is transferred fresh into the urus in a procedure cord an embryo transfer.
Yeah right, okay, And would you also need to have like hormone stimulation or anything for that transfer.
You just make sure that the lining is perfect, is the perfect thickness to receive the transferred embryos. And then these days, there's a lot of stuff that goes on in IVF clinics, which I call them one percent is little things that they've developed along the way to help
the transferred embryo actually take Yeah. Yeah, And there's been a number of those that have come in and out of popular use in IVF over the last dec so as they're trying to get over some of their rate limiting steps, you know, just do things just a little bit better at each little step of the way.
So, pat, do you remember back in August twenty three that seems like yesterday, but it was nearly a year and a half ago, we had doctor Ralia lu who's a specialist in IVF, and we asked her the question, when does she see people in her clinic or when does she advise people to go and to have egg freezing if that's what they have decided to do to do in their life. Let's take a listen to what
she said. The women that are coming to have egg freezing, what is the ideal age for that to happen, and are they coming as singles or are they coming as a couple and the couple aren't quite ready to have the baby or what's the most common scenario for you?
The most common scenario is women coming as either singles or in a relationship not yet committed to parenthood, but couples do sometimes come together and consider both egg and embryo banking. The ideal age to freeze eggs, in my opinion,
is in the late twenties or early thirties. Why not earlier, Well, you're definitely more fertile when you're younger, but you're also more likely to have fertile time ahead of you to naturally conceive, and you are more likely to have those opportunities they still available to you a little bit later on in life. And we don't want to be freezing eggs for everybody because it puts patients that risk of undertaking procedures they may never need and keeping eggs in storage,
which can incur costs. What I would say is that when somebody is in their late twenties or early thirties, they're the most fertile they'll ever be from that time point forward, and they have some idea of when they might plan a first child, they wish to be parents, and they have a better notion of how useful having a supply of frozen eggs as an asset will be
for them. And so I think it's that sweet spot between not yet having reached an age where fertility decline is really serious where you still have a reasonable overin reserve in most instances to get a good outcome from an egg freezing treatment, but also being able to look into your feuture think about how useful that asset will be to your future though.
So I think that's really interesting and it's great to hear that. Again. One of the things, one of the comments I would make about that is that I guess, at the absolute peak of your fertility powers, when you might be the very very best egg collector you can possibly be, you don't know you've got a problem. And I think that that's relevant. Also, someone like Raley is a doctor in a reproductive service who sees people who've
perhaps sought her out for that particular service. As a general gynecologist, I'm actually in the lucky old position of raising fertility preservation with people who have not considered that at all, and sometimes who don't think that it's a problem that they needed added to their problem with thank you very much. So it can be challenging to say to someone have you considered this?
Yep?
Some people go, oh my god, thank god you mention it. That's terrific. I'm so glad you brought that up, let's do that. And other times people say no, should I excuse.
Me, I'm not that old exactly, And that is it? Because I don't know. I think we get a bit of a skewed representation of successful pregnancies in people's forties. What we don't see are people that perhaps are keeping their fertility struggles quiet, you know, because so therefore, I think it gives us a false sense of security that we will be fertile well into our late thirties early forties.
Absolutely, that's a problem, and there are there is publication of data reasonably easily available that says how many babies born in Victoria Edge yet are born as a result of assisted reproduction. I would love to know and have
it my finger tips. How many babies are born from a frozen eck, not a frozen embryo as part of an IVF cycle, to a couple experiencing a fertility properm But how many are born from a woman who's thirty three, wants three babies, think she's running out of time, freezes her eggs because she's single, meets a partner, uses those frozen eggs, yeah, and has her babies that way. Yeah, I haven't seen that data.
All right, so you know, if we follow Riley's advice and maybe you know, late twenties or early thirties, we're thinking about having our eggs frozen, like, it's a pretty costly thing to do. It is cost I thought what we could do now is I did a bit of research different IVF clinics. I've got a rough estimate of what it costs. And what people have to be really aware of is often what they're quoted on, say a
website is just about the process of freezing eggs. They're not adding things like the daybed, hospital, the anethetist, the storage costs, the medication costs.
Yeah so, or even just going to see the doctor at the clinic in the first place visit. They tend to quote in terms of how much a cycle costs, and that involves mostly the laboratory costs. There are other costs.
Yeah, So for all up, I think it's about seven and a half thousand dollars, with an ongoing storage fee of about five hundred and fifty six hundred dollars per year. Okay, yeah, so we watched one of those doctor shows. People might find this surprising, but we watch a lot of medical shows like House and one of the doctors remember her parents had said we will pay for you to have your eggs frozen, and she was shocked. She was like, you know, firstly, I'm not of the age that I
should be even worrying about my fertility. Why are you wanting me to go and pop out babies. I've got this big career, don't you know. And then she came back to it and said, n actually it was a really good idea. What are your thoughts, doctor pat. If a parent said I will pay for you to have your eggs froz, do you think it's worth it.
I think it's a brave parent who would bring it up. Yeah, but if you knew that was an issue within your family, then yeah, I guess why not. There's certainly I mean, you know, they're biggish figures. It's common in Australia for grandparents to pay for things that the current generation might be priced out of.
Yeah.
Oh, we're seeing that in the clinic, aren't we. We're seeing a lot of anti natal care being paid for by the grandparent.
We do, so I guess this is no exception.
Yeah, all right, So people might also ask, hang on a minute, can Medicare pay for any of this?
I think Medicare gets involved and some of the providers get involved in a sort of a charitable sense. If you're having reproductive preservation done because you've got cancer, yeah, and you might be about to start a course of chemotherapy for your breast cancer, what have you. So the big providers of IVF have got a sort of a hotline that you can ring and say, my patient's about
the start chemo. Can you give them a really quick and discounted or free cycle to put their eggs or embryos, depending on their circumstances in the freezer before we start that potentially destructive treatment.
Yeah. Otherwise, if it's elective, there's no Medicare rebate on any of this.
There is for IVF, there's not for egg freezing.
Yeah, all right, good, Now you did mention chemo, and I did want to say, like we've talked about your age, but what about those people that have got perhaps endometriosis or PCOS or a known problem that could cause fertility. Would you recommend that that's I think that they should consider to.
Yeah, definitely, so that that's one of the things that comes into the decision. And it's definitely one of the things that drives my decision about whether to bring it up and whether to discuss it, and whether to encourage it.
For example, there's a thing called an ovarian edometrioma, which is a form of endometriosis where a whole lot of endometriosis forms in a big blob inside the ovary and the woman develops essentially an ovarian cyst that's made out of endometriosis, and it's very destructive to ovarian tissue, and
sometimes you might have one on both sides. So a woman with bilateral ovarian endometriomas might run out of fertility of usable eggs much sooner than a woman who had no endometriosis or the ordinary type of peritoneal endometriosis on the pelvic lining, and that woman I would definitely be talking earlier about egg preservation, and then the woman with ordinary endometriosis perhaps a bit later, and the woman with no reproductive problems other than her social issue probably the latest all.
Right, and any other conditions like pcos or perhaps if they've had an earlier ectopic pregnancy, lost an overtube yea.
Each one of those circumstances has some potential issues that would come into the discussion. Yeah, for sure. You know, if they'd lost one tube to an ex topic but the other side was fine, then their fertility is not greatly reduced. If they're still young, they've already got their partner. I don't think I'd be saying much other than try again when you're ready. Someone who'd lost both tubes is clearly going to need some reproductive assistance, and some of
those other conditions severe phos and so forth. I think they all would come into what amounts to quite a complex and rich discussion.
Good well, I think people will know by this episode what questions to ask their GP to begin with. Hopefully get onto a gynecologist so they can sort of deep dive on some of these issues, yes, and then make a really informed decision about whether they want to freeze their own eggs or not.
Absolutely, it used to be easier to wasn't possible, so you could just say bad luck, not bad luck, but you know what I mean. You could you could say, look, this is the limits of technology. Yeah, and then it became possible. And like a lot of technological breakthroughs, sometimes the technology arrives before we know exactly what to do with it. So one thing's for sure. Though for a long time it was considered experimental, it often didn't work,
and then suddenly it did. Yeah. And as suddenly as it did work, it was being offered commercially.
Yeah.
So there's a Kate Stern is a leading a reproductive a professor in Melbourne who who I remember getting up at a conference and saying, just the take home message for your patients is this is no longer experimental. Yeah, it's it's real. It works. So you know, the question is who should who should do it? But there's no longer a question of does it work? Yeah, and I think inspect that more and more people will look at this great.
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All Right, everyone that's us for this week will be back in your ears next week. We're looking forward to it. Thanks for listening by for now. Hey, even though doctor Pat is well a doctor and we get lots of other doctors and other experts on our podcast, I just need to remind you that this this podcast is for informational purposes only. We share lots of medical insights and experience, but everything we talk about is general in nature and
may not apply to your specific situation. Please always consult with your own healthcare provider for your individual medical advice. When you grow your baby