Speaker 1: Welcome to Katie's Crib, a production of Shonda Land Audio
Speaker 1: in partnership with I Heart Radio. When Idea first started,
Speaker 1: we didn't have medications to make more than one eggro
Speaker 1: at a time, so we followed somebody's natural ovulation, trying
Speaker 1: to watch the one egg get mature. And then you
Speaker 1: don't have this minimally invasive ego trivial Katie. They would
Speaker 1: go like a surgery, a real life surgery through the
Speaker 1: abdomen into yeah, yes, and they would stick a needle
Speaker 1: into that one little follicle. You get one little shot
Speaker 1: at it, but you have to be like general anesthesia
Speaker 1: all the way asleep. Wow, you guys, this has come
Speaker 1: so far. Information provided by Dr Crawford during this podcast
Speaker 1: is for general education purposes and should not be relied
Speaker 1: upon as professional medical advice, diagnosis, or treatment for any individual.
Speaker 1: Hello everybody, Hello, Hello, Welcome back to Katie's Crib. We've
Speaker 1: got a real fancy, impressive doctor in the house today,
Speaker 1: which I love. I'm very excited to have this conversation.
Speaker 1: This is a conversation that I have with my girlfriends
Speaker 1: constantly on all coasts, all cities. It is a hot
Speaker 1: topic and this is what Dr Natalie Crawford does all day,
Speaker 1: all night. Dr Natalie Crawford is a fertility physician in Austin, Texas,
Speaker 1: and she's the co founder of a boutique fertility practice
Speaker 1: called for Fertility. She's also the host of the as
Speaker 1: a Woman podcast and her YouTube channel, Natalie Crawford m D.
Speaker 1: Dr Crawford's work focuses on empowering women and promoting fertility
Speaker 1: awareness and education. She's married to Austin Native Jason Crawford
Speaker 1: and they have two young children. Welcome to Katie's crib.
Speaker 1: Dr Crawford, you must be busy, Katie. Thank you so
Speaker 1: much for having me. I am so I am busy.
Speaker 1: People are finally talking about fertility or not putting it
Speaker 1: away in the closet or having as much stigma as
Speaker 1: their husband in the past. And I really feel like
Speaker 1: this is an area or even very educated, very successful
Speaker 1: women do not understand a lot about their own fertility,
Speaker 1: in their own body. And there's huge room for improvement
Speaker 1: for making sure that we can all know how our
Speaker 1: body works and how it's supposed to work. Because if
Speaker 1: we don't know the basics, how do we know when
Speaker 1: something's wrong or how do we know to get help.
Speaker 1: That's a percent. I can remember the first time, just
Speaker 1: trying to get pregnant and going to like an acupunctures
Speaker 1: and she was like, what's your ovulation juices? And I
Speaker 1: was like, I don't know? And she was like, you
Speaker 1: don't know about your body and when what days happen
Speaker 1: and when things get egg white versus clear, versus stretchy
Speaker 1: versus thick. And I was like, I'm so mortified about
Speaker 1: my own not know it, just not knowing about what
Speaker 1: my body does and when it does it and why
Speaker 1: it does it. And it's so cool that you know
Speaker 1: all about that stuff. We've heard about the egg retrieval process.
Speaker 1: We've actually done episode about the egg retrieval process from
Speaker 1: two of my best friend Stephanie Black and Lindsay Craft.
Speaker 1: But I would love to hear about the egg retrieval
Speaker 1: experience from an expert's perspective. Yes, I'm excited for you
Speaker 1: to explain blastocyst stage. Just take me through like the
Speaker 1: big sweeping things about egg retrieval process. Let's do it.
Speaker 1: Let's rewind, because I think to understand the agg retrieval
Speaker 1: process real quick, we got to understand what happens on
Speaker 1: a month to month basis, so you can understand what
Speaker 1: we're going to do, and then I'll talk quickly about
Speaker 1: egg retrieval, and then what happens after what is a blasts.
Speaker 1: The reality is most of us think in our brain
Speaker 1: we lose one egg per month. That's the egg that
Speaker 1: you ovulate, and that's not really how the human body works.
Speaker 1: I like to use this terrible analogy, but if you
Speaker 1: can imagine inside your ovary, if there's a little vault
Speaker 1: and that's where all your eggs are kept. So when
Speaker 1: you're born, you're vault is full. You lose eggs out
Speaker 1: of the vault. When the vault is empty, you go
Speaker 1: in him in a pause. What actually happens every month
Speaker 1: is that a group of eggs is released from the vault.
Speaker 1: At one time, one of these is chosen to ovulate,
Speaker 1: the rest of them die, and the next month another
Speaker 1: group comes out. And you can't change this process. Meaning
Speaker 1: when you're pregnant, it happens, when you're on birth control pills,
Speaker 1: it happens. We're always losing eggs out of that vault.
Speaker 1: But the number of eggs that come out of the
Speaker 1: vault is correlated to the number that is inside the vault,
Speaker 1: meaning when you're vults really full, you release more every month,
Speaker 1: and when you're about to go into menopause you only
Speaker 1: release a couple. This is a fact I've never known
Speaker 1: any of this. I'm already mind blown. Okay, okay, we're
Speaker 1: about to blow your mind. So when you do I
Speaker 1: v F for egg freezing, like real big picture. All
Speaker 1: I'm trying to do is get the eggs that have
Speaker 1: come out of the vault for this one month to grow,
Speaker 1: and then I'm going to take those eggs out of
Speaker 1: your body. So instead of, for example, having twenty eggs
Speaker 1: come out of the vault, one ovulates and nineteen die,
Speaker 1: I'm trying to say, hey this month, hey, March of two,
Speaker 1: I want to get all twenty eggs to grow. So
Speaker 1: I'm gonna give you hormone chots to get all those
Speaker 1: eggs to grow, and then I'm going to take them
Speaker 1: all out of your body at one time. So that's
Speaker 1: what the egg retrieval is. So Number one, understanding how
Speaker 1: many eggs you might have is really helpful because it
Speaker 1: changes how we get them all to grow. But also
Speaker 1: set your expectations appropriately, and that's one thing that all
Speaker 1: women can handle this process, but we're really bad. Just
Speaker 1: as a whole of walking blindly through a forest when
Speaker 1: you have no idea what's coming, everything is going to
Speaker 1: be harder. But if you have somebody who tells you, hey,
Speaker 1: you have less than average for your age, and that's
Speaker 1: why you're going to get fewer than your best friend
Speaker 1: when she goes through this process, it helps you set
Speaker 1: parameters for expectations. So we can see how many eggs
Speaker 1: are outside the vault by ultrasound and a blood test
Speaker 1: called a m H. So those things help us quantify
Speaker 1: number of eggs. Are they always correct? They give us
Speaker 1: categories like average for your age, above average, below average,
Speaker 1: because your body is setting an actual number every month.
Speaker 1: So if I say average for a thirty year old
Speaker 1: is going to be twenty eggs out of the vault
Speaker 1: one month, and maybe twenty and then eighteen and the
Speaker 1: nineteen and so there's some variation. But the other thing
Speaker 1: that happens is that, and we all peripher a Y
Speaker 1: know this. The quality of eggs starts to decrease as
Speaker 1: we get older. Genetic stability inside the eggs decreases. I
Speaker 1: like to think about those eggs inside the vault taking
Speaker 1: the wear and tear of your life. They're breaking down.
Speaker 1: The proteins are breaking down, and just like our joints
Speaker 1: get sore as we get older and we get wrinkles
Speaker 1: on our face, the same thing starts to happen inside
Speaker 1: our eggs. So at age thirty, the number that's like
Speaker 1: brandished in our brain as women, approximately half your eggs
Speaker 1: are going to be normal and half of them are not.
Speaker 1: And this is why we start talking about doing IVF
Speaker 1: or egg freezing. Understanding how many eggs you have helps,
Speaker 1: but also understanding expectations for how many maybe genetically normal,
Speaker 1: sets the road of expectations. So it's kind of the basis.
Speaker 1: So we're gonna do IVF for egg freezing, I want
Speaker 1: to understand how old are you? How many eggs am
Speaker 1: I expecting to get. You're gonna take hormone shots for
Speaker 1: a couple of weeks, which are going to get the
Speaker 1: eggs to grow, and then you're gonna come in for
Speaker 1: the egg retrieval procedure. People are the most nervous or
Speaker 1: anxious about that procedure because it's like the big moment
Speaker 1: for egg freezing. It's really a minimally invasive procedure. There's
Speaker 1: no knives, there's one needle. Very simple compared to a
Speaker 1: lot of other procedures. It is done typically under a
Speaker 1: light anesthesia I think colonoscopy, so you're breathing on your own,
Speaker 1: no intubation, no breathing machine, none of that stuff. We
Speaker 1: don't want you to feel it. We do attach a
Speaker 1: really long y'all can't see me. My hands are very
Speaker 1: long right now, very long needle to the vaginal ultrasound
Speaker 1: and you can see it. It's a little bright white
Speaker 1: line on ultrasound. And we enter vaginally into the ovaries
Speaker 1: while we watch with the ultrasound, and you see these
Speaker 1: follicles that have grown, these small fluid filled structures. Each
Speaker 1: one house is an egg. It will enter into a
Speaker 1: little follical. The little follical drains and collapses and you
Speaker 1: get test tubes follow all that folicular fluid and eggs.
Speaker 1: When did this egg freezing procedure first exist? So the
Speaker 1: oldest IVF baby is like forty one, So that's the
Speaker 1: oldest person who's been born from IVF. When ivy A
Speaker 1: first started, we didn't have medications to make more than
Speaker 1: one eggrow at a time, so we followed somebody's natural ovulation,
Speaker 1: trying to watch the one egg get mature. Oh my god,
Speaker 1: what a pain in the ass. And then you don't
Speaker 1: have this minimally invasive ego trievill Katie. They would go
Speaker 1: like a surgery, a real life surgery through the abdomen
Speaker 1: into yeah, yeah, and they would sack a needle into
Speaker 1: that one little follicle. You get one little shot at it,
Speaker 1: but you have to be like general anesthesia all the
Speaker 1: way asleep. Wow, you guys, this has come so far.
Speaker 1: Ain't that crazy? And you know it was so stigmatized.
Speaker 1: These women would go and they would have to spend
Speaker 1: a couple of weeks, like at the hotel outside the
Speaker 1: fertility clinic, because it's real sur tree. You don't want
Speaker 1: to miss that one egg window, one egg, it's all.
Speaker 1: I'd imagine you're waiting on this one moment to maybe
Speaker 1: have surgery the next day for your IVF, and if
Speaker 1: you miss it and you ovulate, then you gotta wait
Speaker 1: a whole another month to get it. I v F
Speaker 1: has changed so far, and sometimes we take for granted
Speaker 1: how great that is that we can improve these odds
Speaker 1: so amazing by having these medications, did it used to
Speaker 1: be even more expensive. They did, and because it was
Speaker 1: so much less successful, you have to do it multiple times,
Speaker 1: and there wasn't just the availability to do that because
Speaker 1: there were you know, women and couples who wanted to
Speaker 1: do this, and if you could only cycle one patient,
Speaker 1: you're watching them so closely. There's no way to scale.
Speaker 1: And there was originally one clinic in the US that
Speaker 1: didn't and now there's tons of great fertility clinics and
Speaker 1: good places you can go. So when the day we
Speaker 1: get the eggs out of the egg retri bo, we
Speaker 1: consider ovulation day, so that's day zero, so that would
Speaker 1: be equating it to natural cons option. The day that
Speaker 1: an egg is released from the ovary. We then if
Speaker 1: we were doing IVF and going to make embryos, we
Speaker 1: get a sperm, example that same day as day zero,
Speaker 1: and then we fertilize the eggs with the sperm. Does
Speaker 1: it have to happen on day zero? It does if
Speaker 1: you're gonna make embryos, it does. Otherwise the eggs have
Speaker 1: to be frozen. They only live for twenty four hours
Speaker 1: that's in the body or out, meaning if you don't
Speaker 1: get them fertilized at just the right time, they are
Speaker 1: going to seal off and be they cannot be penetrated
Speaker 1: by sperm. This is so stressful. So the egg is
Speaker 1: this tiny little window. So in an IVF cycle, luckily
Speaker 1: we know exactly what it is. We just took the
Speaker 1: egg out of the body. Most places are now doing
Speaker 1: a type of fertilization called X which means you take
Speaker 1: up a little sperm and a little pipette and you
Speaker 1: crack open the egg and you put the sperm inside.
Speaker 1: That's the newest and gives us the highest fertilization rates.
Speaker 1: These embryologists are amazing. These are the people who train
Speaker 1: years to be able to these micro manipulation techniques under
Speaker 1: the microscope, so they Number one is the first thing,
Speaker 1: you have an actual embryo, meaning the egg is either
Speaker 1: accepted the sperm and divided or it has not, So
Speaker 1: that's when you have. However, many fertilized that normally happens
Speaker 1: in the fallopian tube. So for going back to natural conception,
Speaker 1: embryos fertilized in the fallopian tube. They then have to
Speaker 1: grow and develop from that little to cell embryo into
Speaker 1: about a three hundred cell blast asist over the next
Speaker 1: five to six days. That is where the embryo is
Speaker 1: separated into what will become the placinta and the baby.
Speaker 1: And essentially that is the implantation stage embryo. That's when
Speaker 1: an embryo could grow into the uterus. So normally that
Speaker 1: process takes five or six days from the fallopian tube
Speaker 1: to get in the uterus. And that's what's happening in
Speaker 1: the IVF lab, Meaning that's the environment where we're watching
Speaker 1: these little embryos growing culture. And I always say, not
Speaker 1: like our body, but the I v F flab is
Speaker 1: the perfect temperature and pH and there's no inflammation shan
Speaker 1: or toxins or others things. So it's this ideal environment. However,
Speaker 1: even in that ideal environment, not every egg will be fertilized.
Speaker 1: Not every fertilized egg will make it to a blast assist.
Speaker 1: Not every blast assist will be genetically normal. That's based
Speaker 1: on your age, and not every genetically normal blast assists
Speaker 1: will implant and become a baby. Is there a client's
Speaker 1: story that you can walk us through for a scenario example,
Speaker 1: think of someone you've worked with of how many eggs
Speaker 1: you lost through the process all the way to the
Speaker 1: birthing process. Let's pretend you're an average thirty two year old.
Speaker 1: You have about twenty eggs. Our goal is to try
Speaker 1: to get them all to maturity at the same pace.
Speaker 1: The body's goal is to not let that to happen,
Speaker 1: because your body doesn't want to have twenty babies at
Speaker 1: one time, so the ovary is going to resist that.
Speaker 1: We are typically unable to get every egg mature that
Speaker 1: we can, but we usually do a really good job.
Speaker 1: So most of the time you're going to see around
Speaker 1: eighty maturity. So let's say if we have twenty eggs,
Speaker 1: we go through the process, and let's say we get
Speaker 1: eighteen of the mature. Fantastic, they're frozen. We love it.
Speaker 1: About eighty five to nine of eggs survived. The freeese
Speaker 1: thought that's not a hundred. So you need to in
Speaker 1: your brain or have your doctor roll with you. Okay,
Speaker 1: I'm gonna lose a couple of eggs just from normal process.
Speaker 1: That number, just for comparison ten years ago was forty survival,
Speaker 1: So I just have ent survival, so way better. But
Speaker 1: so if I have eighteen eggs, okay, now in my brain,
Speaker 1: I lost two and that freeze thought process now I
Speaker 1: have sixteen six. Typical fertilization rates with sperm are going
Speaker 1: to be about seventy. So let's say of the sixteen,
Speaker 1: twelve of them have now fertilized. From there, about half
Speaker 1: of them will make it through to that blastess of stage.
Speaker 1: So now we're at six and then based on age,
Speaker 1: we would expect fifty to sixty percent normal, and so
Speaker 1: that would be okay, let's say conservatively three and then
Speaker 1: each of those is going to have approximately a sixty
Speaker 1: chance of a live birth. So in the math equation,
Speaker 1: we usually like having two embryos, and the equation for
Speaker 1: every baby you want to have. So in this one,
Speaker 1: you had eighteen mature eggs frozen. That's the number that's
Speaker 1: in your brain. I'm rolling around, I have eight team
Speaker 1: at your eggs. Wonderful. That makes us feel good for
Speaker 1: a baby and maybe a chance for a second baby.
Speaker 1: But if you are dead set I need two kids
Speaker 1: because my sister is my world and I would never
Speaker 1: want to have an only child, we're going to want
Speaker 1: to hire number than eighteen. And this is even in
Speaker 1: your early thirties, and so somebody should be working that
Speaker 1: equation for you. On the flip end. That should not
Speaker 1: scare anybody, right, don is the Hey, I'm trying to
Speaker 1: optimize this, and I want to put the numbers in
Speaker 1: my camp. I've had somebody go through and get three eggs.
Speaker 1: She had bad in demetriosis. She was thirty five. That's
Speaker 1: what we could get. She could only afford you the
Speaker 1: process once. When we went to thaw them, two of
Speaker 1: them fertilized, one of them grew out. It was normal.
Speaker 1: It is a living child now. So these numbers give
Speaker 1: us perspective, but it's also not everything. It is not everything,
Speaker 1: and it doesn't mean that if you have a low
Speaker 1: number it's not worth it. As you mentioned on your
Speaker 1: As a Woman podcast, it's important that you can view
Speaker 1: what you have as the assurance that it may or
Speaker 1: may not be. Why should we get our eggs harvested
Speaker 1: when there's such a low percentage that the eggs will
Speaker 1: even survive. That's a really good question. I always tell
Speaker 1: people just to think about their goals overall, and when
Speaker 1: we should start thinking about egg freezing is if we
Speaker 1: are in our early thirties or later and we're not
Speaker 1: ready to have a family. However, we know that is
Speaker 1: a goal. We don't want to let pass us by
Speaker 1: because we don't know if you are going to run
Speaker 1: out of eggs early, and what if you have missed
Speaker 1: your window of opportunity. This come about because we'll see
Speaker 1: women walk in the office at thirty nine and suddenly
Speaker 1: they have a very low account and they need IVF
Speaker 1: for whatever reason. But they're looking at multiple cycles, thousands
Speaker 1: and thousands of dollars. And if we had had a
Speaker 1: cohort of eggs that had a higher percentage genetically normal,
Speaker 1: and we had more of them, you just keep doors open.
Speaker 1: One thing I don't love is that people will often
Speaker 1: equate egg freezing to an insurance policy on their fertility,
Speaker 1: Like I'm insuring my fertility, And I always say, an
Speaker 1: insurance policy is a guarantee. Right if your house burns
Speaker 1: down and you have house insurance, you're going to get
Speaker 1: money for a new house. This is an investment. This
Speaker 1: is like the stock market. The return on that investment
Speaker 1: depends on the environment of which you're going to go
Speaker 1: cash it in on, meaning what's the sperm going to be,
Speaker 1: what is your medical condition? Other factors that we may
Speaker 1: be able to know right now do influence some of
Speaker 1: that progression through culture, and what your outcomes look like. However,
Speaker 1: investing your money is a good thing, and making smart
Speaker 1: financial investments are good, and so investing in yourself and
Speaker 1: your future. Fertility is something that has shown in studies
Speaker 1: even if you never go and use your eggs later,
Speaker 1: that it's giving you happiness along the process because it
Speaker 1: allows you to explore other relationships without feeling the pressure
Speaker 1: of that biological clock. Oh yeah, I've never had so
Speaker 1: many friends do a thing that has brought them peace
Speaker 1: of mind. I've had many friends who didn't even use them,
Speaker 1: and then I've had friends use them and both the same,
Speaker 1: Just very relieved and happy that the option was there
Speaker 1: and that they did it. For family planning, one thing
Speaker 1: we don't always think about is is not just about
Speaker 1: baby one or when you start your family. The good
Speaker 1: thing about having frozen eggs that are good quality and
Speaker 1: from when you were younger is that if you meet
Speaker 1: that life partner or you're ready to get pregnant with
Speaker 1: a sperm donor and be a single mom, whatever the
Speaker 1: situation is, how old are you going to be if
Speaker 1: you want to add a sibling to that? Right? How
Speaker 1: many years are going to pass before you're ready? And
Speaker 1: we know that those fertility rates, the egg number go down,
Speaker 1: the quality of the eggs becomes worse. So having those
Speaker 1: eggs expands what you might be able to have as
Speaker 1: far as a total family size, and that's important to
Speaker 1: people too. We often get really tunnel vision focused on
Speaker 1: that baby one. I see people come to me thirty
Speaker 1: eight or thirty nine. They're starting their family, but they
Speaker 1: really want to have three or four kids because they
Speaker 1: grew up with siblings, or they really want a big family.
Speaker 1: That's just part of this dream. And I'm I said
Speaker 1: here and say look at the math. If you got
Speaker 1: pregnant tomorrow, where are we more trying for baby two
Speaker 1: and three? And so very often if we're in those
Speaker 1: more advanced reproductive ages, we are looking at IVF and
Speaker 1: saving embryos for what we call embryo banking, maybe family
Speaker 1: planning goals. Hey, I'm for seeing that I want to
Speaker 1: have a kid in my four reason that may be tough,
Speaker 1: So I'm going to have some normal embryos right now
Speaker 1: when they're easier to get in fine, so I can
Speaker 1: achieve that goal. And that's why I think about the
Speaker 1: big picture, or not just the right now goal. But
Speaker 1: maybe your big picture goal, at least in your ideal world.
Speaker 1: We all know goals change and we feel different as
Speaker 1: time goes on. But if you can do something that's
Speaker 1: going to keep doors open or get you closer to
Speaker 1: achieving that reproductive goal, we shouldn't just ignore it, like
Speaker 1: you know so many of us did for so long,
Speaker 1: just because there there was no other option. The reality is,
Speaker 1: when I was the right age to freeze my eggs,
Speaker 1: I couldn't. There's nowhere that would have done it. It
Speaker 1: wasn't a thing that was offered because the technology wasn't
Speaker 1: as good. So, just as we talked about how the
Speaker 1: ivy of technology has gotten better, an egg is a
Speaker 1: single cell. A blast assist is three D cells, So
Speaker 1: freezing an embryo it is much stronger and sturdier, and
Speaker 1: they survive very well. A single cell mostly of water.
Speaker 1: I now need to freeze it, preserve its genetic integrity,
Speaker 1: and be able to thaw it with accuracy so that
Speaker 1: it can function and accept a sperm and become an embryo.
Speaker 1: That's pretty amazing when you think about what is happening,
Speaker 1: and so that technology changed from and the success rate
Speaker 1: of freezing and throwing eggs went up dramatically. That's when
Speaker 1: we started seeing this offered people getting trained in the
Speaker 1: new technology, and that's why now you have to wait
Speaker 1: till enough people get trained enough clinics. This does feel commonplace,
Speaker 1: and it does feel like you can walk in to
Speaker 1: any fertility clinic can get your eggs frozen. But ten
Speaker 1: years ago you definitely could not. That was not an option. Wow,
Speaker 1: I'm so relieved this has come so far. It's comes
Speaker 1: so far, and I think sometimes people carry these just ideas.
Speaker 1: Are that these misconceptions, which I completely understand. What are
Speaker 1: the biggest misconceptions when it comes to egg freezing. The
Speaker 1: biggest one that I see is that it's going to work.
Speaker 1: I'm going to do iba for I'm going to freeze
Speaker 1: my eggs and that will work for me. It has
Speaker 1: the highest chance of working. It's the only thing that
Speaker 1: exceeds natural conception. I mean, I have no other technology clothes,
Speaker 1: but it's not a guarantee. And that's really it's hard personally.
Speaker 1: It makes my job hard, but it's also hard for
Speaker 1: patients because it is financially very expensive. The other kind
Speaker 1: of thing is that patients often think they have to
Speaker 1: be in the clinic every day forever and ever, and
Speaker 1: it's going to be this huge time set of their life.
Speaker 1: And it's really not at most clinics. It's definitely not
Speaker 1: at ours, because we've perfected the process to know when
Speaker 1: we need to see you, to be efficient with your time,
Speaker 1: and really most my patients are only taking that day
Speaker 1: off of work for the actual egg retrieval. I'm getting
Speaker 1: anesthesia process, and so I think though people like I
Speaker 1: can't take two weeks off, I can't be driving here
Speaker 1: every day for a month, like exactly, if that's not
Speaker 1: how you have to do. You take the medications on
Speaker 1: your own at home. We'll come in when we need
Speaker 1: to see you, but it's not going to be every day.
Speaker 1: And we're pretty good at ball parking. This is the
Speaker 1: week your retrieval is going to be. So I always say,
Speaker 1: don't have your big work meeting, your best friend's wedding.
Speaker 1: We're going to plan around those things because you have
Speaker 1: to keep having your life while you go through this process.
Speaker 1: I know that one of the most common questions that
Speaker 1: you receive has got to be what is the best
Speaker 1: age to freeze your eggs? What other things impact egg
Speaker 1: freezing out than age? Age is still the number one
Speaker 1: predictor of success across the board for any fertility treatments,
Speaker 1: including egg freezing. Studies that have evaluated this are evaluating
Speaker 1: usually the cost effectiveness of the procedure, and so that's
Speaker 1: typically age thirty two to thirty three for the average person.
Speaker 1: If you're not ready to be trying for a family
Speaker 1: at that age, that's when you're still going to have
Speaker 1: a really high number of eggs and high quality of
Speaker 1: eggs for the average person. Of course, everybody is different,
Speaker 1: So I usually say the moment you're considering, it's the
Speaker 1: right moment because we don't know, we don't know what
Speaker 1: your future will hold, we don't know what happens. You
Speaker 1: can always go and get that ovarian reserve, meaning the
Speaker 1: ultrasound of the blood work, see your egg count. Because
Speaker 1: I have certainly had year old who are having a
Speaker 1: lower account than they should and they're very happy they
Speaker 1: started this process a little bit earlier so that they
Speaker 1: don't run into that situation on the flip in thirty six,
Speaker 1: thirty eight, any eggs that those ages are better than
Speaker 1: zero eggs, so is they're too old. Not necessarily, with
Speaker 1: proper counseling, it does start to become a much harder
Speaker 1: when you're forty and older. At age forty about of
Speaker 1: your eggs are going to be normal. At age forty
Speaker 1: two and above, it will be ten percent. We counsel
Speaker 1: really detailed about how many eggs do you have and
Speaker 1: what are these personages mean. We do think lifestyle variables matter,
Speaker 1: meaning let's use smoking cigarettes, so we know if somebody
Speaker 1: smokes cigarettes, they're going to have a higher percentage of
Speaker 1: genetically abnormal eggs than somebody who is should be their age,
Speaker 1: and they're going to have fewer eggs. It gets in
Speaker 1: not to think of it like kills the eggs inside
Speaker 1: the vault. There are things and toxins in the world,
Speaker 1: a lot of them. We are just star to understand.
Speaker 1: The United States isn't a very consumer friendly place when
Speaker 1: it comes to toxins in your products and foods and
Speaker 1: those type of things. So I feel like that evidence
Speaker 1: is emerging. But we do see that the things you
Speaker 1: put in and on your body impact your fertility and
Speaker 1: appear to impact the quality of your eggs. So that's
Speaker 1: where we want to do what we can to be healthy,
Speaker 1: especially if we're going through the process and be mindful
Speaker 1: of some of those variables, What are some ways to
Speaker 1: cope with the roller coaster that this egg freezing process entails.
Speaker 1: It's very emotional and triggering and ups and downs. And
Speaker 1: I got a good number, I got a low number.
Speaker 1: Number one is set your boundaries, So think about it
Speaker 1: ahead of time. Set boundaries of who you're going to
Speaker 1: tell and what kind of support. And I hear this
Speaker 1: from a friend all the time. My friends going through
Speaker 1: egg freezing and I don't know what to do to
Speaker 1: help them, but I want to help them. Are my
Speaker 1: friends going through in fertility? If you're the person going
Speaker 1: through it, it is very health to say, Hey, I'm
Speaker 1: going through kind of calls event and I really don't
Speaker 1: want to hear what other friends have had. I just
Speaker 1: want to be a say space. So I'd love if
Speaker 1: you had any free time to drive me or help
Speaker 1: with shots, or do this thing, or watch this video,
Speaker 1: or come with me to this visit so I can
Speaker 1: have extra eyes and ears. And if you're a friend,
Speaker 1: you can suggest some of those things. Hey, do you
Speaker 1: want somebody? I can drive you to that appointment, or
Speaker 1: I can come with you and just hear what your
Speaker 1: doctor is saying, because I know you you know have
Speaker 1: a lot going on right now. Those acts are very
Speaker 1: kind and very meaningful. I do think knowing where you
Speaker 1: get your support from. Maybe it's your real life friends,
Speaker 1: and maybe it's not. Maybe it's a therapist, maybe it
Speaker 1: is an online group. But leaning on somebody for support
Speaker 1: is very helpful because it is an emotionally draining process.
Speaker 1: If we think about it, your estrogen rises, you're gonna
Speaker 1: get bloated, you're gonna gain weight, You're gonna have pressure.
Speaker 1: You can't work out like you normally can't, you can't drink.
Speaker 1: I just took away a lot of people stress for
Speaker 1: leaving mechanisms. You're uncomfortable, you don't sleep well, and then
Speaker 1: after the egg retrieval, we think it's all going to
Speaker 1: be better. You your pain shouldn't be terrible. It usually
Speaker 1: feels really crampy, like a bad period. But then you
Speaker 1: have this huge hormonal drop. Right each egg made estrogen,
Speaker 1: you just group twenty of them. You normally grow one.
Speaker 1: Your estrogen is now twenty times what it should be,
Speaker 1: and now it's going to fall off a plateau. So
Speaker 1: it's like p MS on steroids. You know you're not
Speaker 1: gonna feel like yourself and be able to do your
Speaker 1: normal things, and if nobody knows, you just get into
Speaker 1: this place where you're very isolated. So doing what you
Speaker 1: can to set yourself up for success and to not
Speaker 1: be isolated, whether it's that one friend or the online
Speaker 1: group or your therapist, that's really helpful. My kids were
Speaker 1: pregnancies five and six, so there were a lot of
Speaker 1: miscarriages along the way. And this was a while ago,
Speaker 1: six and seven years old. But I didn't tell anybody,
Speaker 1: and I had a lot of stigma. I mean, being
Speaker 1: a physician, being in any getting pregnant means you're going
Speaker 1: to be out of commission, other people going to work
Speaker 1: for you. There's a lot that goes into it. And
Speaker 1: I didn't tell anybody, and so then I got into
Speaker 1: this situation. How do you How do you tell somebody
Speaker 1: you're miscaring and you need help if they never knew
Speaker 1: you were pregnant. Now you feel like I didn't tell you. Yeah,
Speaker 1: I didn't tell you this moment now, but let me
Speaker 1: tell you now that I need. It's just it really
Speaker 1: started to separate me from some people who I know
Speaker 1: would have really supported me. So the thing that I
Speaker 1: often tell people is against that old advice of don't
Speaker 1: tell anybody you're pregnant until you're out of the first trimester.
Speaker 1: It's who is your core and if something is going
Speaker 1: really wrong, who's going to show up? Who are you
Speaker 1: going to rely on? And try to let those people in, Hey,
Speaker 1: we're having a hard time. Okay. That helps them know
Speaker 1: that if they are pregnant, not to just blurt all
Speaker 1: over the place and to handle that moment with care. Oh,
Speaker 1: tell them when you get the pregnancy test. That way,
Speaker 1: if something goes wrong, you can call and say that
Speaker 1: pregnancy didn't work out, and they're there for you, because
Speaker 1: those moments are so much harder to tolerate alone. Tell
Speaker 1: them you're going through in fertility. Tell them you're going
Speaker 1: through IVF. Tell them when you get the positive tests.
Speaker 1: Have them there to also know, Okay, it's early, we're anxious,
Speaker 1: but I'm going through this with you. We're cautiously optimistics.
Speaker 1: But I always say, like, if people will tell me
Speaker 1: when they're early on and no one else knows, and
Speaker 1: I'm like, I'm not saying a word of anything, We're
Speaker 1: just saying we're cautiously optimistic, And yeah, I totally I
Speaker 1: love that you say that. It's like my favorite way
Speaker 1: to phrase that, because there's no reason not to be optimistic,
Speaker 1: but we're cautious. We don't know what's going to happen,
Speaker 1: and so I think that as a whole, the more
Speaker 1: we can talk about it with each other and we
Speaker 1: normalize that conversation, the more support we give. And there
Speaker 1: are people in everybody's life who a thousand percent would
Speaker 1: show up to support you, but you got to give
Speaker 1: them the chance. How long do eggs last after they're frozen?
Speaker 1: So eggs don't get freezer burned, so right now they
Speaker 1: don't like that. Um, we have much more data on
Speaker 1: embryos because again, egg freezing still newer. But if we
Speaker 1: equate this to embryos, the longest in embryo was frozen
Speaker 1: and became a baby was twenty seven years. Holy craps
Speaker 1: in that crazy insane. So they don't get freezer burned.
Speaker 1: So we don't know. The technology is still on the
Speaker 1: new ish side. So might that change in the future. Maybe,
Speaker 1: but it does not appear to me. Neither does not
Speaker 1: appear to be an expiration date on eggs, and in fact,
Speaker 1: many people are saving eggs an extended amount of time.
Speaker 1: So I have fertility doctor friends who have eggs frozen
Speaker 1: who are planning to keep them in case their daughter
Speaker 1: needs eggs or something. So that's what people in the
Speaker 1: field are doing. So we do not see or have
Speaker 1: data that they're going to be bad next year if
Speaker 1: you don't use them or anything like that. God forbid,
Speaker 1: something got messed up and they like d thought or
Speaker 1: something like at the egg freezing place. Is that like
Speaker 1: a thing? So that is a thing, and it happened,
Speaker 1: I guess. In twenty eighteen, two different clinics across the country,
Speaker 1: owned by different people, both had failures in their tanks.
Speaker 1: So they were different, but essentially one was like a
Speaker 1: generator based issue lost power. Generator didn't turn on, and
Speaker 1: one was a like I don't know, door, didn't clothes
Speaker 1: and somebody didn't get notified. Okay, so this is all
Speaker 1: speaking towards why things cost money that we don't understand, right,
Speaker 1: because the things that we've got to put into these
Speaker 1: embryology labs as far as one bajillion generator. So if
Speaker 1: you lose power, all the energies going where it needs
Speaker 1: to go, alarm systems to have a chain of command,
Speaker 1: I'll you from ours. If power goes out if a
Speaker 1: door is left open, it starts robo calling certain people
Speaker 1: and it does not stop until this problem is corrected.
Speaker 1: Because some of these things have somebody been notified soon
Speaker 1: enough wouldn't have been a big deal, but it's the
Speaker 1: extent of time that went on. Also, things that have
Speaker 1: happened are transferring the wrong samples. They really are terrifying
Speaker 1: if you're a fertility patient to think about. Most of
Speaker 1: these circumstances have on uncovered revealed lack of staffine, doing
Speaker 1: too many cycles for how many people are there, overall,
Speaker 1: not good protocols and cheaper price points. I'm just shaking
Speaker 1: my head like is this real? Yeah, so I think
Speaker 1: I think it's good to ask, and I tell everybody
Speaker 1: what process and procedures do you have to keep my
Speaker 1: sample safe? Like how do you know what's going and
Speaker 1: how do you keep it safe? Your doctor? Should one
Speaker 1: know what is happening in their lab and they are
Speaker 1: your representative to use that lab? I can tell you
Speaker 1: right now, Like, Okay, the embryos when they're growing, they're
Speaker 1: kept in different tanks at different stages of development. Each
Speaker 1: one is labeled with a different color and has your
Speaker 1: name and your data birth and this is how those
Speaker 1: are labeled. Two people have to check it all the time.
Speaker 1: That means if you follow up with how many people
Speaker 1: work in the lab, there needs to be more than
Speaker 1: just one or two people, because if two people have
Speaker 1: to check it all the time, two people aren't always
Speaker 1: one thousand percent going to be there. And so then
Speaker 1: what generators do you have? What alarmed systems do you have?
Speaker 1: You don't have to know what the right answer is.
Speaker 1: But if your doctor says, oh, I don't know, or
Speaker 1: let me find out, I'm not sure what are they doing?
Speaker 1: This is one of the most important things that we
Speaker 1: do is protect people's reprotective samples. Nothing's perfect, but again
Speaker 1: I think it goes to like, really do your research
Speaker 1: and your due diligence when you're meeting with fertility claimics
Speaker 1: and which doctor you're going to trust. Let's talk about price,
Speaker 1: because I know this is a big one for people.
Speaker 1: According to NPR, without insurance, egg freezing can range anywhere
Speaker 1: from ten thous What is the most affordable yet impactful
Speaker 1: way to undergo such a process? This is a good
Speaker 1: question and there's a lot to unpack when we think
Speaker 1: about it. We are relying on people to freeze a
Speaker 1: single cell using the highest technology. We have to rely
Speaker 1: that that can be thought and be able to become
Speaker 1: an embryo later. The procedure does take anesthesia, has to
Speaker 1: be done in a certain type of room. You've got
Speaker 1: to go under the stuff. The medications cost a lot
Speaker 1: of money too, So when you put all of those
Speaker 1: pieces together, that number is relatively accurate, meaning most people
Speaker 1: will probably spend from about twelve ten let's say, twelve
Speaker 1: tho dollars for the process. Twenty is unusually high for
Speaker 1: egg freezing. Potentially somebody's doing multiple cycles that definitely could
Speaker 1: get to that number very easily. There are places that
Speaker 1: do egg freezing much cheese peper, and we just have
Speaker 1: to look in context about how are they accomplishing that.
Speaker 1: Are they advertising on a cheap price, but then the
Speaker 1: medications make up the difference and other prices are not.
Speaker 1: Are they cutting corners somewhere or like? How are they
Speaker 1: doing it so much cheaper than other places? Are they
Speaker 1: staffed appropriately with the number of embryologists. Are they trying
Speaker 1: to to do more cases with one right? How are
Speaker 1: some clinics operating up much much lower costs than others?
Speaker 1: And I always think that's just an interesting question and
Speaker 1: a little red flag if you are getting a price
Speaker 1: point that's much lower than that ten thousand. Why is
Speaker 1: that some states have mandated fertility coverage and they will
Speaker 1: cover a freezing or IVA for certain number of cycles,
Speaker 1: while other states do not. So you will see people
Speaker 1: who live in Illinois or Massachusetts they are automatically going
Speaker 1: to have coverage benefits. People who have here in Texas
Speaker 1: with me, they are not. We are luckily seeing a
Speaker 1: huge trend in the employer based sector where employers of
Speaker 1: especially tech based companies, are covering it, and they're using
Speaker 1: that as a benefit to offer people to make them
Speaker 1: happy with their job, because studies have shown that if
Speaker 1: your place of employment is supporting your family building dreams,
Speaker 1: you're happier with them overall. And so I am hopeful
Speaker 1: that that trend continues because that is not like traditional insurance.
Speaker 1: It's a fertility specific option. There's a lot of different
Speaker 1: ways employers are doing it, but it is opening the
Speaker 1: doors for so many to do egg freezing and to
Speaker 1: do it without restrictions. One thing to think about, let's
Speaker 1: use I won't name them by name, but a common
Speaker 1: insurance you may have an insurance card for in your wallet.
Speaker 1: If you want to come freeze your eggs, your plan
Speaker 1: says has fertility benefits, but if I call them, you
Speaker 1: have to be trying to get pregnant for twelve months
Speaker 1: to tap into any of your fertility benefits. So if
Speaker 1: you are single and want to freeze your eggs, if
Speaker 1: you're a lesbian and you haven't been trying with intercourse
Speaker 1: heater or sexually like they define it, it's so too
Speaker 1: Then suddenly you want to have this huge amount that
Speaker 1: your insurance covers for fertility, but you don't get to
Speaker 1: qualify for any of it. I think it's very discriminating
Speaker 1: and very frustrating. I can't believe that exists. Cheez, What
Speaker 1: can you do if you can't afford egg freezing but
Speaker 1: you want to do it so badly? I mean, I
Speaker 1: know friends who have asked for loans from their parents,
Speaker 1: you know, put it all on credit card and paid
Speaker 1: it off over time. Those are the most common things
Speaker 1: are personal loans from family members, small loans from banks,
Speaker 1: or getting a credit card that has no interest for
Speaker 1: a year and then you essentially are paying it off
Speaker 1: to yourself. Some clinics do have payment plan options. Or
Speaker 1: they're able to pay it off over a different timeline.
Speaker 1: So it's always helpful to inquire if your clinic can
Speaker 1: offer that or not. There are grant based programs that
Speaker 1: will cover egg freezing. A lot of grants have certain
Speaker 1: restrictions also as far as you have to married, or
Speaker 1: certain religion or these other annoying factors. But I'm on
Speaker 1: the board of a great grant program called baby Quest
Speaker 1: and they accept anybody who wants to better their fertility.
Speaker 1: For there are some resources you gotta put in the
Speaker 1: dirty work of trying to figure out what they are.
Speaker 1: So it's an amazing process of what we're able to
Speaker 1: accomplish with egg freezing. And it sucks that it's expensive,
Speaker 1: But at the same point, of course it's expensive. What
Speaker 1: can we do to encourage society to add egg freezing
Speaker 1: into all health care policies in general? We need a
Speaker 1: lot more fertility advocacy across the board, even when we
Speaker 1: see advocacy that seems to make sense. So, for example,
Speaker 1: I went to advocate that I'm in Texas here to
Speaker 1: get egg freezing coverage for cancer patients because we know
Speaker 1: that chemotherapy often decreases your account and you may not
Speaker 1: be able to have children for that. To me, that
Speaker 1: seems like a bipartisan support, like, you have cancer, let's
Speaker 1: help you have a baby later and we can do it.
Speaker 1: But you have to decide. It's such a hot moment
Speaker 1: for patients with cancer because they have to decide immediately.
Speaker 1: You're deciding twenty things at once. You're like deciding about
Speaker 1: your cancer and your chemo or your surgery. And if
Speaker 1: you want to do egg freezing, and it takes two weeks,
Speaker 1: you gotta start today, today, today, and it does cost money.
Speaker 1: There are luckily some organizations that help with patients with cancer.
Speaker 1: But we've tried to say, hey, across the board, we
Speaker 1: feel like patients and Texas should be able to have
Speaker 1: this covered by the state if they have cancer, trying
Speaker 1: to make it mandated coverage, and some states have accomplished that,
Speaker 1: but we've not here. Really, if we could get mandated
Speaker 1: fertility coverage, that would be a huge step at leveling
Speaker 1: the playing field for everybody. Oh my god, it would
Speaker 1: be insane. Is there any other sort of condition that
Speaker 1: someone could have where they should consider egg freezing? Oh?
Speaker 1: Probably some end Oh yes, yes, so endometriosis certainly is,
Speaker 1: especially if you get diagnosed young. It is just a
Speaker 1: destructive disease by nature, and we do often see people
Speaker 1: progress to ovarian destruction low accounts these ovarian cysts of
Speaker 1: endometriosis and much much higher rates of infertility. So if
Speaker 1: you have endometriosis and you have the option to freeze
Speaker 1: your eggs, your employer covers it, or your parents will
Speaker 1: pay for it, or you've saved up some money worth it,
Speaker 1: a d worth it. There's some other medical conditions, autoimmune
Speaker 1: conditions specifically, especially if they're going to need very strong
Speaker 1: medications to mitigate them, you um might want to consider
Speaker 1: because some of those medications are very chemotherapeutic or they overlap.
Speaker 1: I know my really good friend who I also had
Speaker 1: on this podcast, Becky Ofteniser, she has lupus and that
Speaker 1: was a huge part of her fertility journey, the medications
Speaker 1: she'd been on for a long time and having to
Speaker 1: do a retrieval. So it really seems if you have
Speaker 1: struggling with any kind of endometriosis, cancer, autoimmune diseases, these
Speaker 1: are all things to be speaking with your obi fertility
Speaker 1: doctor closely monitoring. Is there any other advice you would
Speaker 1: give to other women who are considering egg freezing. Overall,
Speaker 1: if you're considering egg freezing, now is the time to
Speaker 1: consider it, meaning take at least the next up, schedule
Speaker 1: an appointment with a fertility doctor. Hear them give you
Speaker 1: some personalized data, get your ovaries looked at, find out
Speaker 1: what your odds. Maybe nobody is committing you from that
Speaker 1: moment to doing the procedure, but that is education and
Speaker 1: that information may change your mind. You may feel really
Speaker 1: differently once you find some of these numbers. You may say, gosh,
Speaker 1: I want to save up and do this, or that's
Speaker 1: not for me and I feel good with it. Go
Speaker 1: get an evaluation. Next up, they swear we're nice, and
Speaker 1: if you see somebody who's a meani, go to somebody
Speaker 1: else like we're nice. Where We do this job because
Speaker 1: we want to help you, and it's a very personal job.
Speaker 1: I don't think there's any reason not to do that
Speaker 1: step like that step do it. Last question that we
Speaker 1: ask every guest on Katie's Crib, Parenthood is hard. I
Speaker 1: mean probably what everybody says. I love being a mom.
Speaker 1: You know, working mom is an extra level as I
Speaker 1: think most people who are working parents know My kids
Speaker 1: equally complain when I don't go to the school thing
Speaker 1: or I don't drop them off in the morning. But
Speaker 1: they're also really proud of what I do and I
Speaker 1: love watching them take ownership of Mommy's a doctor, and
Speaker 1: so it's great. But yeah, they're interesting, right, six and
Speaker 1: seven there were twenty in two ages where you know
Speaker 1: they have their own personalities, their own likes and dislikes,
Speaker 1: their own attitudes, and trying to help shape them into
Speaker 1: the best little versions of themselves. You're ahead of me.
Speaker 1: I'm terrified. I have four and one six, So they're
Speaker 1: crashing into things and bringing their heads and and go
Speaker 1: back to one for anything. I love their people and
Speaker 1: they have these interests and it's fun, but there's hard
Speaker 1: moments about how do you teach them some of these
Speaker 1: life lessons? How do you raise them to be good humans?
Speaker 1: Good humans? Right? And that's why we've got the Katie's
Speaker 1: Cribit community to make us feel less alone and laugh
Speaker 1: and learn it a little bit more. And that's why
Speaker 1: we have your incredible Fertility Clinic. The name is for fertility.
Speaker 1: You have been such an incredible guest, such a wealth
Speaker 1: of knowledge. If I was egg freezing, you would be
Speaker 1: my top choice. Of just you've made me feel really informed, empowered,
Speaker 1: safe and excited. Thank you so You're so fun. Thank
Speaker 1: you guys so much for listening to today's episode. I
Speaker 1: want to hear from you. Let's chat questions, comments, concerns.
Speaker 1: Let me know you can always I Me at Katie's
Speaker 1: Crib at shondaland dot com. Katie's Crib is a production
Speaker 1: of Shondaland Audio in partnership with I heart Radio. For
Speaker 1: more podcasts from Shondaland Audio, visit the i heart Radio app,
Speaker 1: Apple Podcasts, or wherever you listen to your favorite shows.