Fertility Forward
Fertility Forward
Ep 176: An ASRM Abstract: ‘Outcomes for Patients Who Underwent Oocyte Cryopreservation at Age 35 Years and Older: Results from a Large, Multi-Centre Cohort’ with Dr. Michelle Bayefsky
Is fertility preservation worth it for women over the age of 35? In this episode of Fertility Forward, we welcome Dr. Michelle Bayefsky to discuss her ASRM Abstract, ‘Outcomes for Patients Who Underwent Oocyte Cryopreservation at Age 35 Years and Older: Results from a Large, Multi-Centre Cohort’. Tuning in, you’ll hear about the study, who was involved, what she discovered from it, and how she hopes to further her studies on fertility preservation in women over 35 in the future. We even touch on the power and importance of providing patients with data so they can make decisions for themselves. Finally, and as always, we share what we are grateful for today. Thanks for listening!
Hi, everyone. We are Rena and Dara, 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.
SPEAKER_00:Today on our podcast, we have Dr. Michelle Bajewski, who is a second year fellow in reproductive endocrinology and infertility at RMA of New York, Mount Sinai School of Medicine. She completed her residency training at NYU Langone Health, where she was inducted into the Gold Humanism Honor Society. She graduated cum laude from Harvard Medical School and summa cum laude from Yale College. She also worked as a pre-doctoral fellow in the bioethics department of the National Institutes of Health. She's a current member of the American Society for Reproductive Medicine, ASRM, ethics committee. Her research has focused on ethical issues in reproductive medicine as well as fertility preservation. She's published more than 30 articles and journals and has co-authored a book on the ethics of pre-implantation genetic testing. And today, she is on our podcast to speak about her latest abstract that by the time you all will be listening to it, she will have already presented at the ASRM conference. And the abstract is titled, Outcomes for Patients Who Underwent Ocyte Cryopreservation at Ages 35 Years and older results from a large multicenter cohort. Dr. Mayefsky, thanks so much for coming. I appreciate that you're here. We're so happy to meet you. Thank you for having me.
SPEAKER_01:Yeah, I'm super psyched to talk about your study. I think it will speak to so many people. So tell us what you found with this and with fertility preservation above the age of 35. Yeah,
SPEAKER_02:so I thought this was an important study to do because we know that women who freeze their eggs younger typically have very good outcomes. And that's why we encourage women if they think they're going going to have kids at an older age or they might want to have multiple children and they think they're going to start at a little bit of an older age, we encourage them to freeze younger if possible. But a lot of women aren't able to for a variety of reasons until they're a little bit older. And we want to know, is it worthwhile for them? What kinds of outcomes are they going to see when they freeze their eggs at age 35 or older? So that was really the focus of this study. And the goal was also to use data from across the U.S. Fertility Clinic network because it is such a large, large network. We ended up having data from five different clinics across the U.S. And this is really the largest study to focus, especially on women of an older age group or advanced maternal age, 35 and up, who are freezing their eggs. We ended up being able to include 1,185 patients, which is a lot of patients. 838 of those were included in the primary outcome. For the primary outcome, we were really focused on having patients who had used up all of their inventory or had had at least one live birth because we didn't want to have patients who could have done a little bit more but hadn't been able to yet when we were assessing what kinds of outcomes they had. And our primary outcome was the relative probability of achieving at least one live birth per patient. For our secondary outcomes, we looked at the number of embryo transfers per patient, the number of euploid embryos available if they did PGT or pre-implantation genetic testing, the live birth rate per embryo transfer, and the spontaneous abortion rate per clinic pregnancy. In terms, just jumping right to our primary outcome, basically, as expected, patients had poor outcomes the older they were when they went ahead and froze their eggs. The probability of having at least one live birth did decrease by about 13% per year relative to the prior year. But we also found that women who froze in the greater than 42-year-old age group were able to have at least one live birth, 12.8% So that's somewhat significant. Patients can freeze at an older age and will be able to achieve some measure of success. I think it's important to note the caveat that this is a retrospective study. So we're looking at what patients did do. We're not sort of able to look in advance at patients that are completely equal in a lot of different ways and randomize them into pursuing egg freezing or not pursuing egg freezing. So we did see that the patients in the older age group maybe had a little bit of a higher of an anti-mullerian hormone or a somewhat better ovarian reserve for an older age group. So these were patients that are, to some extent, self-selecting into doing egg freezing at an older age. But for those patients who have a bit of a better ovarian reserve and have the drive to pursue it, about 13% of them were able to have at least one life worth using their own eggs, even in the 42 plus age group.
SPEAKER_01:That's amazing. And then I guess the question that I don't know if you get, but I get a lot as well, how many eggs do I I need to have one healthy live birth. So did you study that
SPEAKER_02:also? know that, of course, as patients age, they both see a difficulty because they have decreased euploidy rates or higher aneuploidy rates with their embryos. And also they're typically, unfortunately, able to get fewer eggs per cycle as well.
SPEAKER_01:Okay, but larger takeaway is that in our space, right, 35 is that big sort of scary number. But to take away from this, if you are over 35, you have every reason to believe you can have success if you freeze your eggs. So it's not too late.
SPEAKER_02:Yeah, for people in their 35 to 37 year age range about 50% of them had at least one live birth. So I think it's really important for people to know both sides of it that there definitely is a chance that they will have success but also that frozen eggs is not by any means a guarantee that they will be able to have one live birth and especially if they want to have multiple children from their frozen eggs that they think about that in advance in terms of how many cycles they want to undergo and if they're able to do it a little bit younger that's great but if they're not many people do still see success for sure.
SPEAKER_00:People like numbers. And so it's, I think it's great to be able to see, you know, working with such a large sample size to see it's true as the ages go up, the success of live birth goes down, but still you're seeing, as you said, almost 50%, 35 to 37 year olds, 38 to 40 is about 33%, which is pretty good. 41 to 42 is about 20%. And then you said about 13% for above 42. Those are again, better numbers than I would have expected. So that's quite reassuring to some degree.
SPEAKER_02:Yeah. I mean, I think if somebody is motivated and they're not sure what the future holds for themselves, it's certainly worthwhile to pursue even at a bit of an older age.
SPEAKER_01:I think that's amazing. Do you have any future implications in terms of like a next step on this study?
SPEAKER_02:You know, I think one thing you can always do is get bigger and bigger sample sizes. I will say that for our greater than 42 age group, it would be better to have even more people. But we know that people are, you know, some practices actually discourage outright doing egg freezing above a certain age. And so it's not always common that people do pursue it at that age. So that's, you know, one thing as time goes on and we see more people pursuing it. And the other thing is, as we see people returning more often to use their frozen eggs, because we know that return rates have historically been quoted to be somewhere between 10 to 15 percent for people who froze their eggs. But we expect that as time goes on, people do come back to use them at higher rates and then we'll have even more data on outcomes.
SPEAKER_00:I was actually interested to see that something that I learned, it said the medium number of years between the first cryocycle and the first thaw was about three years.
SPEAKER_02:Yes.
SPEAKER_00:That was new news to me. I always wondered, you know, typically what's the time that people come back?
SPEAKER_02:You know, it's interesting. I would imagine that with a younger group of patients, that number will be higher because many of them will be banking specifically to use them multiple years in the future. But Jen, generally people who are freezing at an older age might be more likely to come back and use them sooner and that's probably for the best if they're able to for having you know somewhat safer pregnancies if they're not well advanced into their 40s as well
SPEAKER_00:that makes sense yeah i was thinking i guess for the 35 year olds but i guess that's overall in terms of the population group that's 35 and older so maybe it's a little bit more narrow which is again new information for me of which i never really would have thought of before, which I think is great now that we have some information on that.
SPEAKER_01:I think it's great because, I mean, what I see a lot is that women, a lot of times they wait because they really hope to meet a partner. And then 35 is more that age of like, okay, I haven't met someone, so I guess I'll freeze my eggs now. Versus, you know, I don't see a lot of, you know, 25, 30 year olds freezing eggs as much, you know, and also, especially if people don't have insurance coverage, the younger you are, the less, you know, kind of stable your financial situation might be. So I typically see women, yeah, kind of that like 33 to 35 range egg freezing. So I think this is great to put out there and provide reassurance because with that, I also see them get really nervous about freezing eggs at a later age.
SPEAKER_02:Totally. And we also have a related study using this data set looking at people who came back to fertilize their eggs with either donor sperm or partner sperm. And it actually was about a third of patients in this 35 and older age group at the time of initial freeze that ended up using donor sperm and the outcomes were the same for donor sperm or intimate partner sperm. And so they can be reassured that if they do come back to use them, if they don't have a partner, that they can still do great with their frozen eggs with donor sperm.
SPEAKER_00:That's wonderful. Yeah, that's great to hear. This time of the year is always exciting for me because there's always new and interesting things on the horizon. And I just love this field because it really is constantly changing and evolving, and we're finding out new info and new data to help us fuel, hopefully, better care for our patients. Many of us, like myself included, it's nice to hear the numbers. Yes, it may just be a snapshot, but it still can be reassuring to hear the numbers.
SPEAKER_02:I think it's just really important for patients to be able to have the data so they can make decisions for themselves. I think what's reassuring to one patient might be scary to another patient, and that's okay. you know, they just have to be able to know what's really out there. So, you know, to be able to make the decision for whether it's worthwhile to proceed for themselves. Definitely.
SPEAKER_01:Well, thank you so much for doing such amazing research and putting it out there and coming on to share it with people.
SPEAKER_02:Thank you for having me.
SPEAKER_00:Of course. So how we like to end our podcast is with words of gratitude. So today, what are you grateful for? I
SPEAKER_02:am always grateful for our patients who put their trust in us. And that's really what drives me to do this kind of research. It's a difficult road for many of our patients, whether they're doing IVF or they're egg freezing and thinking years into the future. And it's really a place of privilege to be able to work with people who are trusting us with their futures.
SPEAKER_00:That's beautiful.
SPEAKER_02:That's great.
SPEAKER_00:Reena, what about you?
SPEAKER_01:Today, I'll go with my dog. She's just napping right here next to me. And she's just my little buddy. I What about
SPEAKER_00:you? I have to say my cat too, but he's not here right now with me. I love the time of the year, the change of the season. So I'm just grateful. In the past, I don't typically like when the weather gets cooler, but I am trying to embrace how change is great. And it's the Jewish New Year coming up. And I love it. It's a time of reflection and a time to look ahead of how I want to live this year and who I want to be this year. So I'm very grateful for the possibilities that lie ahead. I love that. Again, thank you so much, Dr. Bajewski. Really happy to have you on and can't wait to hopefully continue having you on in the coming months and years.
SPEAKER_01:Thank you again. Thanks so much.
SPEAKER_00: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, visit us at www.rmany.com. And tune in next week for more Fertility Forward.