Fertility preservation is receiving increased attention as an evolving area of reproductive medicine. It aims to preserve reproductive tissue for future use, but there are a lot of myths and misconceptions around the practice. Today’s guest is Dr. Lucky Sekhon, a reproductive endocrinologist and infertility specialist and board certified obstetrician and gynecologist who cares for patients at RMA of New York’s Manhattan and Downtown (SoHo) Offices. She specializes in diagnosing and treating reproductive issues and has particular expertise in fertility preservation or egg freezing, LGBTQ family building, and in vitro fertilization with pre-implantation genetic testing of embryos. Dr. Sekhon is active in clinical research at RMA in Mount Sinai, and can also be found frequently in the press and on social media, as a women’s health advocate and educator. She is passionate about improving awareness when it comes to reproductive health, both professionally and personally. She is very open with her patients about her own journey with fertility preservation, and she hopes to counteract stigma and dispel the common myths and misconceptions about fertility preservation and treatment. Tune in to find out more about doing a reproductive consultation, freezing eggs versus freezing sperm, and freezing embryos versus freezing eggs, as well as some of the misconceptions about barriers to entry.
Fertility preservation is receiving increased attention as an evolving area of reproductive medicine. It aims to preserve reproductive tissue for future use, but there are a lot of myths and misconceptions around the practice. Today’s guest is Dr. Lucky Sekhon, a reproductive endocrinologist and infertility specialist and board certified obstetrician and gynecologist who cares for patients at RMA of New York’s Manhattan and Downtown (SoHo) Offices. She specializes in diagnosing and treating reproductive issues and has particular expertise in fertility preservation or egg freezing, LGBTQ family building, and in vitro fertilization with pre-implantation genetic testing of embryos. Dr. Sekhon is active in clinical research at RMA in Mount Sinai, and can also be found frequently in the press and on social media, as a women’s health advocate and educator. She is passionate about improving awareness when it comes to reproductive health, both professionally and personally. She is very open with her patients about her own journey with fertility preservation, and she hopes to counteract stigma and dispel the common myths and misconceptions about fertility preservation and treatment. Tune in to find out more about doing a reproductive consultation, freezing eggs versus freezing sperm, and freezing embryos versus freezing eggs, as well as some of the misconceptions about barriers to entry.
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Speaker 2:Hi everyone. And welcome to fertility forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai hospital in New York city. Our fertility forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate. Welcome today to fertility forward. We're so happy to have on today. Dr. Lucky, she is a reproductive endocrinologist and infertility specialist, reproductive surgeon, and a board certified obstetrician and gynecologist who cares for patients at RMA of new York's Midtown, East and downtown offices. She specializes in diagnosing and treating reproductive issues and has particular expertise in fertility preservation, egg freezing LGBTQ family building and in vitro fertilization with pre-implantation genetic testing of embryos. Dr.[inaudible] is active in clinical research at RMA and Mount Sinai, and can also be found frequently in the press and on social media as a women's health advocate and educator. She is passionate about improving awareness when it comes to reproductive health, both professionally and personally, she is very open with her patients about her own experience with fertility preservation in the hopes that it will help to counteract stigma and dispel the common myths and misconceptions that surround fertility preservation and treatment. Welcome our very own lucky doc. Thank you so much for taking the time to come on today. Well, thank you so much for having me. I'm really excited to be here. So I think maybe we should mention that lucky is taking the time to still on her maternity leave and working and coming on are even more grateful and she looks amazing even though you guys can't see her. So she looks perfectly put yes, no, honestly, there's nowhere. I'd rather be, this is something I'm really passionate about talking, you know, with my patients, with my friends who are in a similar age group to me, I think it's just such an important issue. I think there's a lot of myths and misconceptions, as you said. And I think that the only way we're going to really be able to get good information out there is to continue the conversation. So let's start maybe with, I guess the beginning. So say you're 30 something and you're single and you've heard about egg freezing. You don't know what it is. Where do you start? Who do you call? Where do you go? What do you do? So I think the most important thing to realize is that if you make an appointment with a fertility doctor, it doesn't mean you're signing up to do anything. It doesn't mean you're signing up to freeze your eggs. It just means you're starting a conversation. And what like to do
Speaker 3:A lot. When patients come in to learn more about fertility preservation or they think they might be interested in freezing their eggs is they treat it as kind of like biology one Oh one. And we start with the basics. I tell them why egg freezing as a thing. So that's the first most important concept to cover. And we talk about, you know, the biological clock, which everyone's heard of. And unfortunately I think society is all too quick to remind us of it as women. But a lot of people don't really know what the time sensitive issues are. And you know, we go through that in detail and kind of in a nutshell, what we are concerned about is the fact that women are born with all the eggs they're ever going to have. And you know, that means the quantity and the quality over time start to diminish. So a lot of people think that, Oh my gosh, I'm turning 35 tomorrow. I need to go freeze my eggs because they're all going to turn bad tomorrow, but that's not the case. It's not how nature works, but it is true that in your mid thirties and onwards, you start to have an accelerated loss of eggs. And the quality does start to diminish a little bit more rapidly with each passing year. So that gives women a lot of anxiety. And that's why people are talking about egg freezing all the time as a way to kind of circumvent or get around the issue. But I treat each consultation, not just as an education session, but it's also like a reproductive checkup. So we talk about what the issues are, but I think it's also really important to go through a woman's history, including their own medical history. Do they have any pre-existing conditions that could make it even more important for them to be considering fertility preservation? Right? Like I've had patients who have a history of ovarian cysts. They might only have one ovary because they had one removed already or someone whose mom went into early menopause. And so did their sister. Those are the type of red flag things that you can identify in someone's history that they might not be viewing as a risk factor. Right. Whereas I'm looking at it as this might give you even more of a reason. It might be a compelling argument of why you should be really considering something like fertility preservation. And then we do an evaluation, but the evaluation doesn't mean you're jumping into anything. It's just really getting a sense of at this snapshot in time, what is your egg count? And I do clear up a lot of misconceptions. A lot of people think there are tests that you can do to look at your egg quality, but there actually aren't the only thing we can really go off of is your age, but we can look at your egg quantity. And so that's an important distinction that we make. And we can definitely talk about all those things in more detail. So it's kind of just starting a conversation, getting educated about how your body works and what the actual time-sensitive issues are. I know a lot of education about what it looks like to freeze your eggs and to go through the process in great detail with the patient. And if at the end of all of that, they're interested in pursuing it. Then, you know, we have a whole team of people to help them navigate it because it's complicated. So I have an egg freezing coordinator. I have more than one nurse. They're going to walk you through what your test results are and they're going to be there to hold your hand and help counsel you every step of the way. You know, it's really a two-week process. So you're working very closely with your doctor, with their team, with the entire clinic, not just on one day to freeze your eggs, but it's a two week process where you're seeing them day in, day out. And we'll talk about the practical aspects of it later in this conversation, but that's essentially the first step is starting the conversation. I think it makes sense to go to a fertility specialist because we have the extra training and expertise to really walk you through all of the details that I just described. And then you can make an educated, informed decision about what you want to do, and whether it's something you want to pursue this initial step is that covered by insurance. So it depends, we accept many different types of insurances. Many insurance companies will have some sort of fertility benefits, but it might not extend to fertility preservation. Thankfully, we're now seeing a trend where that's no longer the case for certain insurance companies. And it also depends on your employer, right. And what benefits that they've secured for you. But if there's a provision for fertility preservation, then yeah. I mean the initial consult may be covered if it's not, the out-of-pocket fee is always in the range of, you know, a couple of hundred dollars depending on which clinic you're going to, and then egg freezing itself, oftentimes won't be covered, but there are several plans out there, especially if you're working for a very progressive company, they might have a fertility preservation provision in your plan. So we all know Facebook, Google, Starbucks, big companies, like this are starting to provide it as a benefit to their employees, but it's not across the board. And most insurance plans that talk about covering fertility. Aren't really talking about fertility preservation majority of the time. And hopefully that's something that we're going to see change in the coming years.
Speaker 4:Okay. Do you see a lot of GPS like internists or oncologists bring this up to their patients? And if not, I mean, I feel like this should be something discussed annually at a specific point in time.
Speaker 3:Right? So I see a wide range of situations. I think it depends on the doctor. It depends on the doctor. It depends on how in tune they are with this issue. Sometimes it depends who the doctor is, right? Like as a 37 year old woman and a position, even if I wasn't a fertility doctor, this would be something that would be top of mind that I would bring up to my patients. For sure. So I think it really just depends on the situation. I often will see a bias towards discussing fertility and the time-sensitive issues only to women who are in a relationship or in a place where they might be ready to start trying. And that's really unfortunate because I think that's counter-intuitive to what we think about when we think about fertility preservation, it's really to expand options to all women. So it depends on the doctor. I agree with you. I think it should be a standard thing, especially because it's time sensitive and these changes to your fertility are irreversible. It's a shame when someone only finds out about these options too late, a passion project that I hope to engage in in the future would be to overhaul sex education in our school system. And instead of talking about how to avoid pregnancy and making that the focus, because that message is coming through loud and clear, which is important. Family planning is really important, but you know, women, as they enter their twenties, their thirties, even their early forties, they know about how to contracept and how to get birth control, but they're not aware of what's happening with their body over time. So I think that it should be taught to everyone in health class about, you know, the fact that you're born with a certain finite number of eggs over time. You're not making more, you can't fix them. And there are things that you can do to plan ahead. I think that that's really important.
Speaker 4:It takes me to the next question is, is there an ideal age to start this? I mean, I'm not sure if I'm the crazy one in this, but I always told my kids, I've told them my story, that both of those kids were paid at the IVF and that my hopes is to when they're 18, before they go off to college, have that discussion and give them that option if they want to freeze their eggs. But is there an ideal time? And of course it's your opinion, but is there a specific age I could be?
Speaker 3:Right. So when it comes to our bodies, our biology, we can never come up with a one size fits all approach. For sure. One thing I will say, though, is the sooner, the better, like if this is something that you're considering or you're worried about, it would be wise to have the conversation as early as possible. Now it should everyone, you know, enter puberty and freeze their eggs. No, not necessarily. I mean, that would be very extreme. But when I say the sooner, the better, what I mean is the sooner you do an egg freezing cycle, the more eggs you will have to freeze quantity-wise and the better the quality will be. Okay. So you have all the eggs that you ever are going to have, right. Kind of step into the ovaries. And they're all kind of in the core of the ovary and every month, a certain subset get pulled to the surface they're recruited at random. And those are the ones that are in play that cycle, whether you're on birth control and not actually getting a real menstrual cycle, doesn't matter, this is always happening. And every month your brain, if you're ovulating will select one of those eggs to be the, that gets to ovulate. And then the rest of them actually die off. So you're always recruiting and wasting eggs. What egg freezing is, is capturing that cohort of eggs in that moment, in that cycle and removing them from the ovary and freezing them so that they can't undergo that degradation and dying off process. You can't freeze more than what's available is my point, right? And the more you have, the more you recruit to the surface and make available to your doctor to extract for egg freezing. So as we get older, your egg freezing cycle will become less efficient, right? Because you're going to have fewer eggs overall. And that means less eggs are being recruited and less eggs can actually be retrieved and they given cycle. So I've had some patients who've done egg freezing at a point in their lives where they have a diminished reserve of eggs. And some of them have opted to do multiple rounds in order to try to make up for that because there's nothing really that I can do as a doctor to increase the number that are getting recruited. That's a process that's completely independent and I have no control over it. All I can do is give you medications to try to get as many of them to grow as possible. And, you know, we'll do the best that we can, but the number that are available depends on how many you have and the younger you are, the more you're going to have, right? Because you've had less time to lose them. On top of that, each egg is supposed to have a certain amount of genetic material. And there are proteins that make sure that, that genetic material stays filed away. And those chromosomes stick together as they should. That starts to break down as we age as well. So even when you're in your twenties, which is considered your fertile prime years, right, even then we know that up to 25% of eggs that are turned into embryos are going to have the wrong amount of DNA. So even by the time you get to your twenties, some of those changes have already occurred. And that's just, you know, the baseline quality that we're dealing with and that changes over time. So once you're 35, 37, you're looking at 35, almost up to 50% of embryos that would result from your eggs in that age group would have the wrong amount of DNA. And without having the right amount of DNA, that egg is not going to be able to give rise to a healthy pregnancy and a live birth of a child. And that is the egg quality piece. And there is no test for that. I have a lot of patients that come to me with, you know, reports from their GYN or from their primary care doctor saying, I have the eggs of a 20 year old. No, you might have the count of a 20 year old. You might have a really high count for your age, but there's no way of telling your individual egg quality. And so it's both the quantity and the quality that are the issue. And so whatever you're capturing in that egg freezing cycle and freezing, you're retaining the quantity and the quality at that age. And that's something that's sure to change as you get older. So on average, how many cycles may lead to a healthy live birth? Or I guess maybe you want to answer it as what number of eggs can you look at? Yeah. So I guess I would take a step back and tell a patient that I'm talking to first, the most important fact, which is of the studies that have been done internally at our clinic with our data and externally, you know, with widely available published data, the two most important factors that determine your odds of coming back and using frozen eggs and having a successful life birth are how old you were when you froze your eggs and how many mature eggs were frozen. Those are the two most important things. Now you can't modify your age, right? You can't go in a time machine and do this at a younger age. So the one thing you can modify, as you mentioned, is potentially doing more than one round to accumulate a certain number of eggs that are going to give you the best chance of success. Another factor that should weigh into your decision of whether you need to do more than one cycle is how many kids do you want, right? Not every egg is going to lead to a live Burr. So we should talk about that. We should talk about the funnel, which is basically how evolution was set up. For whatever reason, a lot of eggs aren't going to make it to the finish line, right? Not every egg is destined to become a baby. That's why women who obviate an egg, every cycle aren't getting pregnant. Every cycle, when they're trying, there's a lot of inefficiency built into human reproduction, not every egg that you freeze is going to survive the thought, okay, we can talk numbers. You know, I can give you rough numbers. Not every egg is going to survive the thaw. When you come back to use it, not every egg that you thought out successfully will fertilize successfully when you inject it with sperm, not every injected with sperm, egg, fertilized egg is going to turn into an embryo a week later. That's how long it takes for it to turn into an embryo. That would be at a stage of development where it's ready to implant into the lining of the uterus and not every healthy embryo is going to implant in the uterus. So there's all this drop-off and attrition that happens. And that leads to the million dollar question, which is, well, then how many eggs do I need to get me a guaranteed library? Right? It depends on how old you are, because that determines your egg quality. The younger you are, the fewer eggs you need, there's going to be less drop-off. And more of those eggs are likely to be normal and healthy. Meaning having the right amount of DNA, the older you are, the more eggs you need to overcome. The fact that a lot of those eggs are going to be abnormal and a lot more of those eggs. Aren't going to turn into an embryo. They're going to die off before that stage. So there are actual calculators online. I would talk to your doctor before doing this homework at home, playing around with the calculator and coming up with your own number. There's some that are based on really as well, designed as we can possibly get studies, looking at mathematical models of what is the average thought survival rate, depending on how old you are, when you froze your eggs, what is the average fertilization rate of the clinic you're using? Because you can look at IVF data to get this information, right? When we do IVF cycles and we directly fertilize each egg with sperm, we see about 70 to 80% fertilized successfully. And we see only about 60% of those fertilized eggs turn into an embryo a week later. And the proportion of those embryos that are healthy and normal meaning having the right amount of DNA or chromosomes depends on your age. So it might be 25% that are abnormal in your twenties up to 50 to 60% that are abnormal 38 to 40. So that's all going to factor in. So they actually have calculators where you can put in your age and you can put in the number of eggs that you froze, and it will give you a percent probability of having one live birth of being able to come back and have two kids out of that cohort of eggs that you've frozen, or even having three kids or more. And I think tools like that are helpful, but obviously you take them with a grain of salt. You really have to make sure you talk to your doctor and see what their rates are at their clinic. And that's going to also factor into your decision, but I've had patients who've done more than one round because they unfortunately have a lower count. And therefore we retrieve a lower number of eggs every time. And the only way to overcome that is to do more than one round.
Speaker 2:There's so many questions to ask. And what if you freeze your eggs in one state, but then you move, can you move your eggs with you? Or how does that work? So you can move your eggs with you as an investor.
Speaker 3:So every egg freezing consult, you know, I give all the information at the end, I kind of give my insider take. And there are certain things that only people in our field really know, and this is one of them. Yes, you can transfer eggs. You can transfer embryos. Knowing what I know, the fact that every lab has its own specific environment, every lab is tweaking slightly, you know, their protocols to do things a certain way. So my philosophy is that whoever froze your eggs, whoever froze your embryos is best positioned to throw them out. I think that that's always going to be the best thing to play it safe is to go back and use them wherever you frozen. I've had some patients that despite me telling them that, regardless of whether they froze at our clinic or froze somewhere else and want to transfer in our clinic. Now I tell them the same thing across the board, because that's the advice I would give a friend or a family member, because you just don't know, and you never want to kick yourself or question and say, would I have had a better thought survival rate if I had just done it, where they froze the eggs, but I think there could be temperature variations in transit, you don't. And again, like I said, there could be small changes in the protocol from lab to lab, even if they're using the same type of kit or equipment, those little changes could make a difference. So I think it's actually not as complicated as people think. If you're coming back to use your eggs, you don't have to come fly to New York. Let's say you froze your eggs at RMA. Doesn't mean you have to fly to New York and stay in a hotel for a month in order to use the eggs. No, you can do a lot of preliminary prep wherever you are, wherever you're living. You can do monitoring at a clinic that's local to you, and then just fly in to have the actual transfer of the embryo, right? So we could throw out the eggs a week in advance and we could turn them into embryos. If you're using a partner sperm, we could have that sperm frozen and advance and available. And then we could grow those injected with sperm, eggs, into embryos over the course of a week. And you could fly in the day before your transfer, right? And you could be doing all the prep where you are that involves taking around two weeks of estrogen to support your lining and thicken it. And then about a week of progesterone, which can be done as pills or as shots. And you could do, you know, the blood work and the ultrasound, which there aren't that many required. You would do one at the beginning of your period, you would do one, maybe two weeks in to taking estrogen pills every day to see that your lining got thick. And then you'd do another one a week later the day before your transfer. So it's like three visits at an outside clinic flying to New York, have you're transferring to fly back that same day or the next day. So it's actually not as complicated as what most people assume.
Speaker 2:So I think a lot and people just don't know the questions to ask, or they're afraid to ask. Yeah, patient advocacy is really important and asking, because I think there are all sorts of situations that arise and people either work out of town or they moved or whatever, and there really are ways to make it work. It's just asking the right question,
Speaker 3:Right? I think there's a lot of misconceptions about what it even looks like to freeze your eggs till now. I mean, people will say I have to be on shots for like a month and a half, right? And I say, no, that's not how it works. It's really two weeks of a concerted effort where you need to be near your clinic and available. And after your egg retrieval, you're waiting two weeks to get your period and nothing is required of you at that time. So I think people overestimate how much it disrupts their life. Sometimes they underestimate it. I mean, I've had some patients who weren't aware that once your ovaries are stimulated and enlarged, it means avoiding things like sex or high impact exercise, not just during the stimulation, but also for the week to two weeks after, because it takes time for your ovaries to kind of recover and shrink back down to their pre stimulation size. So there can be misconceptions in both directions.
Speaker 2:Sure. I mean, I think it is definitely an undertaking, but think as long
Speaker 3:As you have the information, you can plan, it's a finite period of time. And I think it really saves yourself heartache and hardship down the road. I think it really is an investment in yourself. I think it gives you some peace of mind that you have this backup or contingency plan. It's like insurance.
Speaker 4:Sure. And in terms of, we speak a lot about women and female preservation, but in terms of male preservation, is that something that is spoken about on the men's side? Is it something that can be done? Is it done? Is it recommended
Speaker 3:Much easier actually? So, you know, on the male side, it's spoken about less because fortunately for men, they're always making sperm for the rest of their lives, barring any circumstance, you know, like they've had chemotherapy or surgery where now they can't, but if they're healthy and they have no issues, they should be making new sperm every 72 days for the rest of their lives, no matter how old they are. Well, I was just going to say, so they don't have the issue of quantity. And people used to think that the same was true of quality, but now there's a lot of emerging data to show links with advanced maternal age and things like autism, childhood cancers, neurodevelopmental issues. We know that older men and I'm talking more extreme age. So they always have a little bit more leeway. I mean, you know, we're talking 50 and older, maybe late forties and older, you start to see a higher prevalence in these issues in their children. And this is controlling for female age because a lot of people say, well, the older men have older partners, but that's not always the case. And you know, they've looked at data where this applies to donor egg cycles, where the egg is coming from someone in their twenties. So it's really isolating the male age and you see a lot more of these issues. So it's not such a clear relationship as it is with female age where, you know, Oh, this percent of the eggs will give rise to genetically abnormal embryos. According to data, there isn't as much of a clear relationship, which makes it a bit scarier too, because it's hard to know who will be affected and what the risks are. Exactly. But yeah, so I've had couples where the male partner wants to freeze sperm because you know, he's in his late thirties and he's concerned that they want to space their children out. And, you know, it might just be easier in that case to have everything frozen as embryos. Right? We should talk about the difference between egg and embryo freezing. What's the difference between eggs and embryos. So I'm going to definitely get into that, but to finish the thought about male preservation, it's actually really easy for them because we're asking them to and provide a sample of semen and then it's washed and the sperm is frozen and they can do it multiple times. It's not requiring shots or s timulation or an egg retrieval. So it's easy. It's very cheap. I think that it's probably u nder u tilized because men are as worried about it, but there are some men that are extra vigilant who want to do it. And of course any man, that's going into some sort of treatment that could affect their fertility, whether it's testicular surgery, even men who are kind of going away in combat or who have jobs, where they're exposed to radiation, there's all sorts of indications for male fertility preservation, but yes, egg versus embryo freezing is something I love to talk about because this is where taking a history and really understanding your patient's situation in life, comes into play. And I always preface the conversation with my patients. I'm not being nosy. I'm not just trying to pry into your personal business, but sometimes it involves really delicate conversations about, okay, you're in a relationship and you're coming to me to talk about egg freezing. Let's talk about your relationship. Is it stable? How long have you been with this partner? Is this someone you know, that you want to have children with? The reason why I ask these really probing type questions is because a lot of my patients don't realize, or they're not thinking about embryo freezing, they're coming in to talk about egg freezing. They're focused on their decision to freeze their eggs, but some of them are in committed relationships with someone that they a hundred percent feel confident that they're going to have children with. In which case I tell them, maybe you want to consider freezing embryos, or maybe you want to do two cycles and freeze embryos and eggs. I've had patients do that. The reason I bring it up is that embryo freezing has a few major advantages from a medical standpoint. So it's really important to understand the differences between egg and embryo freezing the major advantage of egg freezing is that you have ultimate flexibility. It only involves you. So you can come back and use your eggs with whomever you like, however you like whenever you like. And it only involves one person embryo freezing holds all of the medical advantages, right? So that's the difference when it comes to embryo freezing, you're obviously locked into having formed that embryo with a specific sperm source, whether it's donor sperm or a partner's sperm. So that embryo is if you did this with a partner at the time, legally, you know, you both have ownership of that embryo. And so there's inflexibility there, but from a medical standpoint, all of the benefits lie with embryo freezing. The first major benefit is the thoughts. Survival rate is higher for embryos. When we go to thought eggs, the proportion of eggs that successfully thought out and survive, the thought depends on how old you are and your egg quality, but roughly speaking, an average of 85% of eggs that are frozen will survive the thaw. If you were younger in your twenties or early thirties, when you froze your eggs, it could be as high as 90 to 95%, but you are going to lose some eggs during the thought that is in contrast to when you go to thought out, embryos embryos are hardier. They have a hundred to 200 cells. They're not just a single cell, like an egg and so many more will survive the thawing process, no matter how old you were when you created them. And there's less variability there. So about 98% or more of embryos that are frozen will survive the thought. So that's one less thing to worry about. And then the second major medical advantage to embryo freezing is that you really know what you're freezing. We talked about the inefficiency of human reproduction and the high rate of drop-off or attrition. Not every egg is destined to become a healthy embryo or a healthy live birth. But when you turn those eggs into embryos, you've already gone past that. Drop-off, you've had some exited fertilize. You have some fertilized eggs that didn't turn into an embryo. And a major point is, is that you can actually genetically test your embryos. And I'm sure you guys have an episode or will on genetic testing of embryos. That's a huge topic in and of itself, but there is a way to biopsy and embryo send off that biopsy so that you can actually count how many chromosomes each embryo has. So you can know that information, you can freeze those embryos and then come back and say, okay, of the embryos, I froze. These are normal and have 46 chromosomes and are capable of giving rise to a healthy life birth. And these other ones aren't useful to me. So you're leaving that fertility preservation cycle, knowing what you have for future use. And there's very few steps between you and that healthy lifer. All you have to do is come back and transfer that embryo. And there's a really high chance of it in planting and turning into a healthy child. And so there's just less unknowns are question marks when you're using frozen embryos versus coming back to use frozen eggs. But that doesn't mean that everyone should, even if you're single and you're wanting to preserve your fertility, that you should go ahead and commit to using a sperm donor and presented Rios. Like I said, the major advantage to egg freezing is that you have flexibility. So as long as you're well counseled and you know what you're getting into, and you feel comfortable after speaking with your doctor, that you've frozen a decent number of eggs given your age, that is going to give you a really good chance of getting to the finish line and having a healthier life birth. If you come back to use those eggs, then I think it is a great option and it doesn't tie you down and it gives you a lot of choices for the future.
Speaker 4:I love that there's a lot of potential options, much more than I ever thought. And I know we mentioned this at the beginning, but I think it's so important for people to get this education in early. So, I mean, I was very impressed. I didn't even think about like the idea of even just speaking about it to some capacity when children are younger, but I wish people had this discussion with their internists, with their just throughout the stages of their life. So they can have just the knowledge. And then of course they can make these decisions on their own or with a partner. But just the idea that there is that knowledge, as opposed to what often is the case is we look back and say, Oh, I wish I would've known that. And not to say that it's too late, but it's often in a position where me may have wanted to know about this earlier,
Speaker 3:For sure. And that's why I always say it's important to pay it forward as someone who is a specialist in this field and as a 37 year old woman who froze embryos with her partner at age 34. I talk about this both professionally and personally all the time, because I'm passionate about it. I know the peace of mind. It gave me to take those steps. And even though I am a private person, I oftentimes force myself to really talk about the personal aspect of it. Because I think that it helps take down barriers. It allows people to be vulnerable and open up to this type of conversation. And it really is paying it forward to share this information because you can't assume that someone's doctor is going to bring it up with them. And I think it's a delicate balance too. I mean, if you had a great experience, you froze eggs or embryos, you know, it, isn't great either to push it on everyone and, and give unsolicited advice. But I think there is a rule for being open with your friends, with your colleagues, with your family members, if you're comfortable to do so, you could really be helping someone out by sharing this information that you've learned from your experience,
Speaker 4:Information it's knowledge. It doesn't have to necessarily be advice. It could just be knowledge and information and people can take it in. However they like,
Speaker 3:And I have a lot of patients who come to me and they don't seem as apprehensive as you might assume that they would be because they tell me, you know, I've had several girlfriends who have gone through the process. I even helped them or saw them do their shots. I came over and, and familiar with it because they were really open about it. And that takes away that layer of insecurity, fear, anxiety, and they feel a lot more ready to learn. And not as apprehensive, especially apprehensive about things that aren't really the truth, right? Like some people think that all the injections are intramuscular with these huge needles. And that's not true that might've been the way these medications were delivered a long time ago or administered a long time ago. And nowadays with the protocols we're using, it really is eight to 10 days of injectable medications. The injections are superficial with really small, thin needles that are easy to administer on your own. And there's a lot of teaching and support that's given you're coming in for frequent monitoring in the clinic, usually every two to three mornings at the beginning, and then maybe every day for the last couple of visits. So like five to six visits over the eight to 10 days of shots. And what we're doing in that, his blood work to track your hormone levels. We're doing ultrasounds to look at the size of the follicles, which are fluid-filled spaces that each one contains an egg floating inside of it. And that's how we can gauge if the eggs are maturing and ready for the egg retrieval. So we'll tell you once we think you're ready to stop taking your medications at that last visit. And two days later, we do the egg retrieval. I think it's important for women to know that the egg retrieval isn't this big scary surgery, but it is a procedure and it is serious, right? You have to make sure that you're prepped mentally for that day, that you're going to be under anesthesia. It's light sedation when you're asleep for maybe about five to 10 minutes at the most, but you are going to need someone to escort you home because you've been sedated. So that could be a friend family member during COVID. I think a lot of people are apprehensive about having anyone come out of their house to help pick them up if they were doing the cycle during that time. So we also have medical escorts. So there's always a way to find the support you need and make sure things are done in a safe way, but someone escorts you home and you're going to sleep that day off. And, you know, by the next day, most people feel recovered. You might need an extra day or two, particularly if you had a high number of eggs retrieved, you might have some spotting cramping, but usually by the next day, you'll feel pretty much back to your regular self. You might have some bloating that lasts for like a week to two weeks. We tell you not to have sex or exercise for the next one to two weeks until you get your periods, that's a safe guide. And then you can say officially that the cycle is over. So it's really more of an intense experience for that two week period of time where you're doing something every day, you're getting a lot of frequent visits and then it's culminating in that egg retrieval procedure. And after that, you're pretty much done. If you're doing embryo freezing, then it's just the waiting game of, you know, a week after the egg retrieval, finding out how many the eggs turned into embryos and were actually frozen. But basically the process looks identical in terms of your experience, whether you're freezing eggs or embryos. Thank you. This was so, so helpful. There's so many questions they could ask. There's so much more to go into, but I think this is a really comprehensive overview of the process and hopefully gave people really good information and gave them a better idea that, you know, yes, this is certainly not just going to get a cup of coffee, but it's something that is doable. It's something that's important to think about that you really can make accessible to you. And don't be dismayed feeling like either you're alone and you want to help with it, or you can't afford it. There are certainly ways to pursue making it happen for you. You know, I'm really big into patient advocacy. So I think the best thing you can do is pick up the phone, make the call. That's the hardest part. And then, you know, I know, especially at our practice at RMA, we're also caring and we want to make it work for people. So we'll do the best we can to make it accessible for you. And patients can call to just get information about their insurance and out of pocket costs before even seeing a doctor, because sometimes feel like that's a barrier and they wish they had that information upfront. And you can certainly call and get that information up front before even scheduling a consultation. And certainly, you know, if you're comfortable speak to your employer, you know, I know that might be tricky, but I do also, I think it is important to put in here to clash and people about clinics that may not be the most ethical. They may try and sell. You just be careful where you're going. I think that's really important in this case, you know, a lower price doesn't mean it's the best and just be careful on you want to make sure you're going to a reputable clinic. That's very important. So I'm really glad that you brought that up because that's another insider tip or point. Then I will tell my patients, you know, in addition to talking about the issue of transferring eggs or embryos from one clinic to the next, I also say that you can get a lot of information about the quality of the practice and its lab, which is really important when it comes to freezing your eggs. If you just look at their IVF outcomes, because that's going to tell you about whether they're good at what they do and whether they have good quality control measures. So I would be reluctant to freeze my eggs anywhere where they don't do IVF, or they don't actually do anything with the eggs after, because how do you know that they know how to throw them out and use them? And I think that's a really important component. That's the main point of why you're doing all of this. So yes, it's really important to do your research. And if you're not comfortable after you have a consultation with someone, follow your gut, right. And get a second opinion and see how you feel. I think, you know, a lot of times we don't want to think of this as a business because it's something so personal. It's about Stanley building and children and using them as private, intimate parts of our bodies. But I think at the same time, it is a business and we have to be really careful and look out for ourselves and again, advocate for ourselves. And there are unfortunately people out there who will say anything to sell you and get your money. And you don't want to spend all this time and money on something. That's not going to get you on at the end. So it is important to have that information and be aware as top of that is to swallow because we want to think that this is just very personal and caring and not a business, but in altruistic, right. Just make sure that you look out for yourself and take care of yourself and make sure, you know, kind of that there are people out there who might take advantage. I love, I said that to trust your gut and also come up with a list of questions. I think that's also great. So that way you can check the box with those questions and see if it's the right fit for you in terms of how we like to wrap up our discussions is we'd like to discuss gratitude what we're grateful for today. So dr. CECAN, what are you grateful for? I know you have a lot to be grateful for. I mean, definitely my family is of mine because as you mentioned, I've had a really rare, beautiful opportunity to be home for the last month and a half on maternity leave. And so I've really taken a lot of stock in my family. And I think all of us have, I think this year has been a particularly challenging one where it's made us all kind of slow down, take a pause and really focus on what's important. And when you strip away all of the exterior and all of the superficialis things that kind of went away with the pandemic and locked down, it kind of made us all realize what's important. And so I'm really grateful for my family. I'm grateful for my two daughters. One of which started her first full day of school today, which I'm really excited about. And I'm hopeful that things will continue to move in a really positive direction for New York city. I'm really grateful to see low rates of COVID and as the situation that's continually improving lots to be grateful. Rena. Yeah. The same thing I think that has certainly put things in perspective and I'm someone who is certainly typing and routine and go, go, go, and it's definitely made me have to pivot and learn how to be flexible and kind of strip away those things that really weren't serving me. And so, you know, similar to what dr.[inaudible] so grateful for my daughter and that's certainly been potentially right now, figuring out a little bit unsettling, but I'm grateful for all this time at home. And I think if anything, I've been more productive and busy with work than before, because I've just been around. People have needed me so much more. And I think it's sort of this cycle that gives me a purpose, which helps me to help them. And so I feel really happy with where my work is that right now I'm really, really grateful for that. So many people are struggling and Dara similar vein, I'm grateful for the slower pace life we've been living in. Yes, September is usually a very fast paced life with kids going back to school and work, building up. What I've taken from the pandemic is the ability to slow down and be more in the moment and really appreciate the moment to moment things. And like for me right now, the fact that we're back recording our podcast is bringing me so much joy and happiness. I love learning, but of course the things that I'm familiar with, but some of the things within this world of fertility that I am not familiar with and disseminating this beautiful information to everyone else. So, so grateful for being with you ladies right now. Thank you. Thank you for having me. Thank you so much for coming.
Speaker 2:Thank you so much for listening today and always remember practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support,
Speaker 4:Visit us@wwwdotrmaandy.com and tune in next week for more fertility forward,
Speaker 1:[inaudible].