March 31, 2022 • 43 mins
Katie revisits the topic of egg freezing (from season 4), but this time she invites on an expert: Fertility physician Dr. Natalie Crawford!
The board certified OBGYN breaks down the medical process (with examples) of how families go from the egg retrieval process to holding a baby. She also outlines some of the most affordable ways to undergo such a process.
Plus, why is it important to be cautious when you're trying to find egg freezing clinics that are less expensive? Dr. Crawford fills us in on the details!
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Episode Transcript
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Speaker 1 (00:00):
Welcome to Katie's Crib, a production of Shonda Land Audio
in partnership with I Heart Radio. When Idea first started,
we didn't have medications to make more than one eggro
at a time, so we followed somebody's natural ovulation, trying
to watch the one egg get mature. And then you
don't have this minimally invasive ego trivial Katie. They would
go like a surgery, a real life surgery through the
(00:21):
abdomen into yeah, yes, and they would stick a needle
into that one little follicle. You get one little shot
at it, but you have to be like general anesthesia
all the way asleep. Wow, you guys, this has come
so far. Information provided by Dr Crawford during this podcast
(00:45):
is for general education purposes and should not be relied
upon as professional medical advice, diagnosis, or treatment for any individual.
Hello everybody, Hello, Hello, Welcome back to Katie's Crib. We've
got a real fancy, impressive doctor in the house today,
(01:05):
which I love. I'm very excited to have this conversation.
This is a conversation that I have with my girlfriends
constantly on all coasts, all cities. It is a hot
topic and this is what Dr Natalie Crawford does all day,
all night. Dr Natalie Crawford is a fertility physician in Austin, Texas,
(01:26):
and she's the co founder of a boutique fertility practice
called for Fertility. She's also the host of the as
a Woman podcast and her YouTube channel, Natalie Crawford m D.
Dr Crawford's work focuses on empowering women and promoting fertility
awareness and education. She's married to Austin Native Jason Crawford
(01:47):
and they have two young children. Welcome to Katie's crib.
Dr Crawford, you must be busy, Katie. Thank you so
much for having me. I am so I am busy.
People are finally talking about fertility or not putting it
away in the closet or having as much stigma as
their husband in the past. And I really feel like
(02:07):
this is an area or even very educated, very successful
women do not understand a lot about their own fertility,
in their own body. And there's huge room for improvement
for making sure that we can all know how our
body works and how it's supposed to work. Because if
we don't know the basics, how do we know when
something's wrong or how do we know to get help.
That's a percent. I can remember the first time, just
(02:29):
trying to get pregnant and going to like an acupunctures
and she was like, what's your ovulation juices? And I
was like, I don't know? And she was like, you
don't know about your body and when what days happen
and when things get egg white versus clear, versus stretchy
versus thick. And I was like, I'm so mortified about
my own not know it, just not knowing about what
(02:50):
my body does and when it does it and why
it does it. And it's so cool that you know
all about that stuff. We've heard about the egg retrieval process.
We've actually done episode about the egg retrieval process from
two of my best friend Stephanie Black and Lindsay Craft.
But I would love to hear about the egg retrieval
experience from an expert's perspective. Yes, I'm excited for you
(03:10):
to explain blastocyst stage. Just take me through like the
big sweeping things about egg retrieval process. Let's do it.
Let's rewind, because I think to understand the agg retrieval
process real quick, we got to understand what happens on
a month to month basis, so you can understand what
we're going to do, and then I'll talk quickly about
(03:31):
egg retrieval, and then what happens after what is a blasts.
The reality is most of us think in our brain
we lose one egg per month. That's the egg that
you ovulate, and that's not really how the human body works.
I like to use this terrible analogy, but if you
can imagine inside your ovary, if there's a little vault
and that's where all your eggs are kept. So when
you're born, you're vault is full. You lose eggs out
(03:53):
of the vault. When the vault is empty, you go
in him in a pause. What actually happens every month
is that a group of eggs is released from the vault.
At one time, one of these is chosen to ovulate,
the rest of them die, and the next month another
group comes out. And you can't change this process. Meaning
when you're pregnant, it happens, when you're on birth control pills,
it happens. We're always losing eggs out of that vault.
(04:16):
But the number of eggs that come out of the
vault is correlated to the number that is inside the vault,
meaning when you're vults really full, you release more every month,
and when you're about to go into menopause you only
release a couple. This is a fact I've never known
any of this. I'm already mind blown. Okay, okay, we're
about to blow your mind. So when you do I
(04:36):
v F for egg freezing, like real big picture. All
I'm trying to do is get the eggs that have
come out of the vault for this one month to grow,
and then I'm going to take those eggs out of
your body. So instead of, for example, having twenty eggs
come out of the vault, one ovulates and nineteen die,
I'm trying to say, hey this month, hey, March of two,
(04:57):
I want to get all twenty eggs to grow. So
I'm gonna give you hormone chots to get all those
eggs to grow, and then I'm going to take them
all out of your body at one time. So that's
what the egg retrieval is. So Number one, understanding how
many eggs you might have is really helpful because it
changes how we get them all to grow. But also
set your expectations appropriately, and that's one thing that all
(05:19):
women can handle this process, but we're really bad. Just
as a whole of walking blindly through a forest when
you have no idea what's coming, everything is going to
be harder. But if you have somebody who tells you, hey,
you have less than average for your age, and that's
why you're going to get fewer than your best friend
when she goes through this process, it helps you set
parameters for expectations. So we can see how many eggs
(05:41):
are outside the vault by ultrasound and a blood test
called a m H. So those things help us quantify
number of eggs. Are they always correct? They give us
categories like average for your age, above average, below average,
because your body is setting an actual number every month.
So if I say average for a thirty year old
(06:01):
is going to be twenty eggs out of the vault
one month, and maybe twenty and then eighteen and the
nineteen and so there's some variation. But the other thing
that happens is that, and we all peripher a Y
know this. The quality of eggs starts to decrease as
we get older. Genetic stability inside the eggs decreases. I
like to think about those eggs inside the vault taking
(06:23):
the wear and tear of your life. They're breaking down.
The proteins are breaking down, and just like our joints
get sore as we get older and we get wrinkles
on our face, the same thing starts to happen inside
our eggs. So at age thirty, the number that's like
brandished in our brain as women, approximately half your eggs
are going to be normal and half of them are not.
And this is why we start talking about doing IVF
(06:44):
or egg freezing. Understanding how many eggs you have helps,
but also understanding expectations for how many maybe genetically normal,
sets the road of expectations. So it's kind of the basis.
So we're gonna do IVF for egg freezing, I want
to understand how old are you? How many eggs am
I expecting to get. You're gonna take hormone shots for
a couple of weeks, which are going to get the
(07:05):
eggs to grow, and then you're gonna come in for
the egg retrieval procedure. People are the most nervous or
anxious about that procedure because it's like the big moment
for egg freezing. It's really a minimally invasive procedure. There's
no knives, there's one needle. Very simple compared to a
lot of other procedures. It is done typically under a
light anesthesia I think colonoscopy, so you're breathing on your own,
(07:29):
no intubation, no breathing machine, none of that stuff. We
don't want you to feel it. We do attach a
really long y'all can't see me. My hands are very
long right now, very long needle to the vaginal ultrasound
and you can see it. It's a little bright white
line on ultrasound. And we enter vaginally into the ovaries
while we watch with the ultrasound, and you see these
(07:50):
follicles that have grown, these small fluid filled structures. Each
one house is an egg. It will enter into a
little follical. The little follical drains and collapses and you
get test tubes follow all that folicular fluid and eggs.
When did this egg freezing procedure first exist? So the
oldest IVF baby is like forty one, So that's the
(08:13):
oldest person who's been born from IVF. When ivy A
first started, we didn't have medications to make more than
one eggrow at a time, so we followed somebody's natural ovulation,
trying to watch the one egg get mature. Oh my god,
what a pain in the ass. And then you don't
have this minimally invasive ego trievill Katie. They would go
like a surgery, a real life surgery through the abdomen
(08:36):
into yeah, yeah, and they would sack a needle into
that one little follicle. You get one little shot at it,
but you have to be like general anesthesia all the
way asleep. Wow, you guys, this has come so far.
Ain't that crazy? And you know it was so stigmatized.
These women would go and they would have to spend
a couple of weeks, like at the hotel outside the
(08:57):
fertility clinic, because it's real sur tree. You don't want
to miss that one egg window, one egg, it's all.
I'd imagine you're waiting on this one moment to maybe
have surgery the next day for your IVF, and if
you miss it and you ovulate, then you gotta wait
a whole another month to get it. I v F
has changed so far, and sometimes we take for granted
(09:19):
how great that is that we can improve these odds
so amazing by having these medications, did it used to
be even more expensive. They did, and because it was
so much less successful, you have to do it multiple times,
and there wasn't just the availability to do that because
there were you know, women and couples who wanted to
do this, and if you could only cycle one patient,
(09:40):
you're watching them so closely. There's no way to scale.
And there was originally one clinic in the US that
didn't and now there's tons of great fertility clinics and
good places you can go. So when the day we
get the eggs out of the egg retri bo, we
consider ovulation day, so that's day zero, so that would
be equating it to natural cons option. The day that
(10:01):
an egg is released from the ovary. We then if
we were doing IVF and going to make embryos, we
get a sperm, example that same day as day zero,
and then we fertilize the eggs with the sperm. Does
it have to happen on day zero? It does if
you're gonna make embryos, it does. Otherwise the eggs have
to be frozen. They only live for twenty four hours
(10:22):
that's in the body or out, meaning if you don't
get them fertilized at just the right time, they are
going to seal off and be they cannot be penetrated
by sperm. This is so stressful. So the egg is
this tiny little window. So in an IVF cycle, luckily
we know exactly what it is. We just took the
egg out of the body. Most places are now doing
(10:43):
a type of fertilization called X which means you take
up a little sperm and a little pipette and you
crack open the egg and you put the sperm inside.
That's the newest and gives us the highest fertilization rates.
These embryologists are amazing. These are the people who train
years to be able to these micro manipulation techniques under
the microscope, so they Number one is the first thing,
(11:04):
you have an actual embryo, meaning the egg is either
accepted the sperm and divided or it has not, So
that's when you have. However, many fertilized that normally happens
in the fallopian tube. So for going back to natural conception,
embryos fertilized in the fallopian tube. They then have to
grow and develop from that little to cell embryo into
about a three hundred cell blast asist over the next
(11:27):
five to six days. That is where the embryo is
separated into what will become the placinta and the baby.
And essentially that is the implantation stage embryo. That's when
an embryo could grow into the uterus. So normally that
process takes five or six days from the fallopian tube
to get in the uterus. And that's what's happening in
the IVF lab, Meaning that's the environment where we're watching
(11:50):
these little embryos growing culture. And I always say, not
like our body, but the I v F flab is
the perfect temperature and pH and there's no inflammation shan
or toxins or others things. So it's this ideal environment. However,
even in that ideal environment, not every egg will be fertilized.
Not every fertilized egg will make it to a blast assist.
(12:12):
Not every blast assist will be genetically normal. That's based
on your age, and not every genetically normal blast assists
will implant and become a baby. Is there a client's
story that you can walk us through for a scenario example,
think of someone you've worked with of how many eggs
you lost through the process all the way to the
birthing process. Let's pretend you're an average thirty two year old.
(12:35):
You have about twenty eggs. Our goal is to try
to get them all to maturity at the same pace.
The body's goal is to not let that to happen,
because your body doesn't want to have twenty babies at
one time, so the ovary is going to resist that.
We are typically unable to get every egg mature that
we can, but we usually do a really good job.
So most of the time you're going to see around
(12:56):
eighty maturity. So let's say if we have twenty eggs,
we go through the process, and let's say we get
eighteen of the mature. Fantastic, they're frozen. We love it.
About eighty five to nine of eggs survived. The freeese
thought that's not a hundred. So you need to in
your brain or have your doctor roll with you. Okay,
I'm gonna lose a couple of eggs just from normal process.
(13:18):
That number, just for comparison ten years ago was forty survival,
So I just have ent survival, so way better. But
so if I have eighteen eggs, okay, now in my brain,
I lost two and that freeze thought process now I
have sixteen six. Typical fertilization rates with sperm are going
to be about seventy. So let's say of the sixteen,
(13:40):
twelve of them have now fertilized. From there, about half
of them will make it through to that blastess of stage.
So now we're at six and then based on age,
we would expect fifty to sixty percent normal, and so
that would be okay, let's say conservatively three and then
each of those is going to have approximately a sixty
(14:03):
chance of a live birth. So in the math equation,
we usually like having two embryos, and the equation for
every baby you want to have. So in this one,
you had eighteen mature eggs frozen. That's the number that's
in your brain. I'm rolling around, I have eight team
at your eggs. Wonderful. That makes us feel good for
a baby and maybe a chance for a second baby.
(14:26):
But if you are dead set I need two kids
because my sister is my world and I would never
want to have an only child, we're going to want
to hire number than eighteen. And this is even in
your early thirties, and so somebody should be working that
equation for you. On the flip end. That should not
scare anybody, right, don is the Hey, I'm trying to
(14:47):
optimize this, and I want to put the numbers in
my camp. I've had somebody go through and get three eggs.
She had bad in demetriosis. She was thirty five. That's
what we could get. She could only afford you the
process once. When we went to thaw them, two of
them fertilized, one of them grew out. It was normal.
It is a living child now. So these numbers give
(15:08):
us perspective, but it's also not everything. It is not everything,
and it doesn't mean that if you have a low
number it's not worth it. As you mentioned on your
As a Woman podcast, it's important that you can view
(15:29):
what you have as the assurance that it may or
may not be. Why should we get our eggs harvested
when there's such a low percentage that the eggs will
even survive. That's a really good question. I always tell
people just to think about their goals overall, and when
we should start thinking about egg freezing is if we
are in our early thirties or later and we're not
(15:52):
ready to have a family. However, we know that is
a goal. We don't want to let pass us by
because we don't know if you are going to run
out of eggs early, and what if you have missed
your window of opportunity. This come about because we'll see
women walk in the office at thirty nine and suddenly
they have a very low account and they need IVF
(16:15):
for whatever reason. But they're looking at multiple cycles, thousands
and thousands of dollars. And if we had had a
cohort of eggs that had a higher percentage genetically normal,
and we had more of them, you just keep doors open.
One thing I don't love is that people will often
equate egg freezing to an insurance policy on their fertility,
Like I'm insuring my fertility, And I always say, an
(16:38):
insurance policy is a guarantee. Right if your house burns
down and you have house insurance, you're going to get
money for a new house. This is an investment. This
is like the stock market. The return on that investment
depends on the environment of which you're going to go
cash it in on, meaning what's the sperm going to be,
what is your medical condition? Other factors that we may
(17:00):
be able to know right now do influence some of
that progression through culture, and what your outcomes look like. However,
investing your money is a good thing, and making smart
financial investments are good, and so investing in yourself and
your future. Fertility is something that has shown in studies
even if you never go and use your eggs later,
that it's giving you happiness along the process because it
(17:23):
allows you to explore other relationships without feeling the pressure
of that biological clock. Oh yeah, I've never had so
many friends do a thing that has brought them peace
of mind. I've had many friends who didn't even use them,
and then I've had friends use them and both the same,
Just very relieved and happy that the option was there
(17:45):
and that they did it. For family planning, one thing
we don't always think about is is not just about
baby one or when you start your family. The good
thing about having frozen eggs that are good quality and
from when you were younger is that if you meet
that life partner or you're ready to get pregnant with
a sperm donor and be a single mom, whatever the
situation is, how old are you going to be if
(18:06):
you want to add a sibling to that? Right? How
many years are going to pass before you're ready? And
we know that those fertility rates, the egg number go down,
the quality of the eggs becomes worse. So having those
eggs expands what you might be able to have as
far as a total family size, and that's important to
people too. We often get really tunnel vision focused on
(18:26):
that baby one. I see people come to me thirty
eight or thirty nine. They're starting their family, but they
really want to have three or four kids because they
grew up with siblings, or they really want a big family.
That's just part of this dream. And I'm I said
here and say look at the math. If you got
pregnant tomorrow, where are we more trying for baby two
and three? And so very often if we're in those
(18:48):
more advanced reproductive ages, we are looking at IVF and
saving embryos for what we call embryo banking, maybe family
planning goals. Hey, I'm for seeing that I want to
have a kid in my four reason that may be tough,
So I'm going to have some normal embryos right now
when they're easier to get in fine, so I can
achieve that goal. And that's why I think about the
(19:08):
big picture, or not just the right now goal. But
maybe your big picture goal, at least in your ideal world.
We all know goals change and we feel different as
time goes on. But if you can do something that's
going to keep doors open or get you closer to
achieving that reproductive goal, we shouldn't just ignore it, like
you know so many of us did for so long,
just because there there was no other option. The reality is,
(19:31):
when I was the right age to freeze my eggs,
I couldn't. There's nowhere that would have done it. It
wasn't a thing that was offered because the technology wasn't
as good. So, just as we talked about how the
ivy of technology has gotten better, an egg is a
single cell. A blast assist is three D cells, So
freezing an embryo it is much stronger and sturdier, and
they survive very well. A single cell mostly of water.
(19:55):
I now need to freeze it, preserve its genetic integrity,
and be able to thaw it with accuracy so that
it can function and accept a sperm and become an embryo.
That's pretty amazing when you think about what is happening,
and so that technology changed from and the success rate
of freezing and throwing eggs went up dramatically. That's when
(20:17):
we started seeing this offered people getting trained in the
new technology, and that's why now you have to wait
till enough people get trained enough clinics. This does feel commonplace,
and it does feel like you can walk in to
any fertility clinic can get your eggs frozen. But ten
years ago you definitely could not. That was not an option. Wow,
I'm so relieved this has come so far. It's comes
(20:37):
so far, and I think sometimes people carry these just ideas.
Are that these misconceptions, which I completely understand. What are
the biggest misconceptions when it comes to egg freezing. The
biggest one that I see is that it's going to work.
I'm going to do iba for I'm going to freeze
my eggs and that will work for me. It has
the highest chance of working. It's the only thing that
(20:59):
exceeds natural conception. I mean, I have no other technology clothes,
but it's not a guarantee. And that's really it's hard personally.
It makes my job hard, but it's also hard for
patients because it is financially very expensive. The other kind
of thing is that patients often think they have to
be in the clinic every day forever and ever, and
(21:21):
it's going to be this huge time set of their life.
And it's really not at most clinics. It's definitely not
at ours, because we've perfected the process to know when
we need to see you, to be efficient with your time,
and really most my patients are only taking that day
off of work for the actual egg retrieval. I'm getting
anesthesia process, and so I think though people like I
can't take two weeks off, I can't be driving here
(21:43):
every day for a month, like exactly, if that's not
how you have to do. You take the medications on
your own at home. We'll come in when we need
to see you, but it's not going to be every day.
And we're pretty good at ball parking. This is the
week your retrieval is going to be. So I always say,
don't have your big work meeting, your best friend's wedding.
We're going to plan around those things because you have
(22:04):
to keep having your life while you go through this process.
I know that one of the most common questions that
you receive has got to be what is the best
age to freeze your eggs? What other things impact egg
freezing out than age? Age is still the number one
predictor of success across the board for any fertility treatments,
including egg freezing. Studies that have evaluated this are evaluating
(22:28):
usually the cost effectiveness of the procedure, and so that's
typically age thirty two to thirty three for the average person.
If you're not ready to be trying for a family
at that age, that's when you're still going to have
a really high number of eggs and high quality of
eggs for the average person. Of course, everybody is different,
So I usually say the moment you're considering, it's the
(22:48):
right moment because we don't know, we don't know what
your future will hold, we don't know what happens. You
can always go and get that ovarian reserve, meaning the
ultrasound of the blood work, see your egg count. Because
I have certainly had year old who are having a
lower account than they should and they're very happy they
started this process a little bit earlier so that they
(23:09):
don't run into that situation on the flip in thirty six,
thirty eight, any eggs that those ages are better than
zero eggs, so is they're too old. Not necessarily, with
proper counseling, it does start to become a much harder
when you're forty and older. At age forty about of
your eggs are going to be normal. At age forty
(23:29):
two and above, it will be ten percent. We counsel
really detailed about how many eggs do you have and
what are these personages mean. We do think lifestyle variables matter,
meaning let's use smoking cigarettes, so we know if somebody
smokes cigarettes, they're going to have a higher percentage of
genetically abnormal eggs than somebody who is should be their age,
and they're going to have fewer eggs. It gets in
(23:52):
not to think of it like kills the eggs inside
the vault. There are things and toxins in the world,
a lot of them. We are just star to understand.
The United States isn't a very consumer friendly place when
it comes to toxins in your products and foods and
those type of things. So I feel like that evidence
is emerging. But we do see that the things you
put in and on your body impact your fertility and
(24:15):
appear to impact the quality of your eggs. So that's
where we want to do what we can to be healthy,
especially if we're going through the process and be mindful
of some of those variables, What are some ways to
cope with the roller coaster that this egg freezing process entails.
It's very emotional and triggering and ups and downs. And
(24:37):
I got a good number, I got a low number.
Number one is set your boundaries, So think about it
ahead of time. Set boundaries of who you're going to
tell and what kind of support. And I hear this
from a friend all the time. My friends going through
egg freezing and I don't know what to do to
help them, but I want to help them. Are my
friends going through in fertility? If you're the person going
(24:58):
through it, it is very health to say, Hey, I'm
going through kind of calls event and I really don't
want to hear what other friends have had. I just
want to be a say space. So I'd love if
you had any free time to drive me or help
with shots, or do this thing, or watch this video,
or come with me to this visit so I can
have extra eyes and ears. And if you're a friend,
you can suggest some of those things. Hey, do you
(25:19):
want somebody? I can drive you to that appointment, or
I can come with you and just hear what your
doctor is saying, because I know you you know have
a lot going on right now. Those acts are very
kind and very meaningful. I do think knowing where you
get your support from. Maybe it's your real life friends,
and maybe it's not. Maybe it's a therapist, maybe it
is an online group. But leaning on somebody for support
(25:43):
is very helpful because it is an emotionally draining process.
If we think about it, your estrogen rises, you're gonna
get bloated, you're gonna gain weight, You're gonna have pressure.
You can't work out like you normally can't, you can't drink.
I just took away a lot of people stress for
leaving mechanisms. You're uncomfortable, you don't sleep well, and then
(26:04):
after the egg retrieval, we think it's all going to
be better. You your pain shouldn't be terrible. It usually
feels really crampy, like a bad period. But then you
have this huge hormonal drop. Right each egg made estrogen,
you just group twenty of them. You normally grow one.
Your estrogen is now twenty times what it should be,
and now it's going to fall off a plateau. So
(26:25):
it's like p MS on steroids. You know you're not
gonna feel like yourself and be able to do your
normal things, and if nobody knows, you just get into
this place where you're very isolated. So doing what you
can to set yourself up for success and to not
be isolated, whether it's that one friend or the online
group or your therapist, that's really helpful. My kids were
(26:47):
pregnancies five and six, so there were a lot of
miscarriages along the way. And this was a while ago,
six and seven years old. But I didn't tell anybody,
and I had a lot of stigma. I mean, being
a physician, being in any getting pregnant means you're going
to be out of commission, other people going to work
for you. There's a lot that goes into it. And
(27:08):
I didn't tell anybody, and so then I got into
this situation. How do you How do you tell somebody
you're miscaring and you need help if they never knew
you were pregnant. Now you feel like I didn't tell you. Yeah,
I didn't tell you this moment now, but let me
tell you now that I need. It's just it really
started to separate me from some people who I know
(27:28):
would have really supported me. So the thing that I
often tell people is against that old advice of don't
tell anybody you're pregnant until you're out of the first trimester.
It's who is your core and if something is going
really wrong, who's going to show up? Who are you
going to rely on? And try to let those people in, Hey,
(27:48):
we're having a hard time. Okay. That helps them know
that if they are pregnant, not to just blurt all
over the place and to handle that moment with care. Oh,
tell them when you get the pregnancy test. That way,
if something goes wrong, you can call and say that
pregnancy didn't work out, and they're there for you, because
those moments are so much harder to tolerate alone. Tell
(28:09):
them you're going through in fertility. Tell them you're going
through IVF. Tell them when you get the positive tests.
Have them there to also know, Okay, it's early, we're anxious,
but I'm going through this with you. We're cautiously optimistics.
But I always say, like, if people will tell me
when they're early on and no one else knows, and
I'm like, I'm not saying a word of anything, We're
just saying we're cautiously optimistic, And yeah, I totally I
(28:30):
love that you say that. It's like my favorite way
to phrase that, because there's no reason not to be optimistic,
but we're cautious. We don't know what's going to happen,
and so I think that as a whole, the more
we can talk about it with each other and we
normalize that conversation, the more support we give. And there
are people in everybody's life who a thousand percent would
show up to support you, but you got to give
(28:52):
them the chance. How long do eggs last after they're frozen?
So eggs don't get freezer burned, so right now they
don't like that. Um, we have much more data on
(29:12):
embryos because again, egg freezing still newer. But if we
equate this to embryos, the longest in embryo was frozen
and became a baby was twenty seven years. Holy craps
in that crazy insane. So they don't get freezer burned.
So we don't know. The technology is still on the
new ish side. So might that change in the future. Maybe,
(29:35):
but it does not appear to me. Neither does not
appear to be an expiration date on eggs, and in fact,
many people are saving eggs an extended amount of time.
So I have fertility doctor friends who have eggs frozen
who are planning to keep them in case their daughter
needs eggs or something. So that's what people in the
(29:56):
field are doing. So we do not see or have
data that they're going to be bad next year if
you don't use them or anything like that. God forbid,
something got messed up and they like d thought or
something like at the egg freezing place. Is that like
a thing? So that is a thing, and it happened,
(30:17):
I guess. In twenty eighteen, two different clinics across the country,
owned by different people, both had failures in their tanks.
So they were different, but essentially one was like a
generator based issue lost power. Generator didn't turn on, and
(30:38):
one was a like I don't know, door, didn't clothes
and somebody didn't get notified. Okay, so this is all
speaking towards why things cost money that we don't understand, right,
because the things that we've got to put into these
embryology labs as far as one bajillion generator. So if
you lose power, all the energies going where it needs
to go, alarm systems to have a chain of command,
(30:59):
I'll you from ours. If power goes out if a
door is left open, it starts robo calling certain people
and it does not stop until this problem is corrected.
Because some of these things have somebody been notified soon
enough wouldn't have been a big deal, but it's the
extent of time that went on. Also, things that have
happened are transferring the wrong samples. They really are terrifying
(31:24):
if you're a fertility patient to think about. Most of
these circumstances have on uncovered revealed lack of staffine, doing
too many cycles for how many people are there, overall,
not good protocols and cheaper price points. I'm just shaking
my head like is this real? Yeah, so I think
(31:47):
I think it's good to ask, and I tell everybody
what process and procedures do you have to keep my
sample safe? Like how do you know what's going and
how do you keep it safe? Your doctor? Should one
know what is happening in their lab and they are
your representative to use that lab? I can tell you
right now, Like, Okay, the embryos when they're growing, they're
(32:08):
kept in different tanks at different stages of development. Each
one is labeled with a different color and has your
name and your data birth and this is how those
are labeled. Two people have to check it all the time.
That means if you follow up with how many people
work in the lab, there needs to be more than
just one or two people, because if two people have
to check it all the time, two people aren't always
one thousand percent going to be there. And so then
(32:28):
what generators do you have? What alarmed systems do you have?
You don't have to know what the right answer is.
But if your doctor says, oh, I don't know, or
let me find out, I'm not sure what are they doing?
This is one of the most important things that we
do is protect people's reprotective samples. Nothing's perfect, but again
(32:50):
I think it goes to like, really do your research
and your due diligence when you're meeting with fertility claimics
and which doctor you're going to trust. Let's talk about price,
because I know this is a big one for people.
According to NPR, without insurance, egg freezing can range anywhere
from ten thous What is the most affordable yet impactful
(33:12):
way to undergo such a process? This is a good
question and there's a lot to unpack when we think
about it. We are relying on people to freeze a
single cell using the highest technology. We have to rely
that that can be thought and be able to become
an embryo later. The procedure does take anesthesia, has to
be done in a certain type of room. You've got
to go under the stuff. The medications cost a lot
(33:35):
of money too, So when you put all of those
pieces together, that number is relatively accurate, meaning most people
will probably spend from about twelve ten let's say, twelve
tho dollars for the process. Twenty is unusually high for
egg freezing. Potentially somebody's doing multiple cycles that definitely could
get to that number very easily. There are places that
(33:57):
do egg freezing much cheese peper, and we just have
to look in context about how are they accomplishing that.
Are they advertising on a cheap price, but then the
medications make up the difference and other prices are not.
Are they cutting corners somewhere or like? How are they
doing it so much cheaper than other places? Are they
(34:18):
staffed appropriately with the number of embryologists. Are they trying
to to do more cases with one right? How are
some clinics operating up much much lower costs than others?
And I always think that's just an interesting question and
a little red flag if you are getting a price
point that's much lower than that ten thousand. Why is
(34:38):
that some states have mandated fertility coverage and they will
cover a freezing or IVA for certain number of cycles,
while other states do not. So you will see people
who live in Illinois or Massachusetts they are automatically going
to have coverage benefits. People who have here in Texas
with me, they are not. We are luckily seeing a
huge trend in the employer based sector where employers of
(35:02):
especially tech based companies, are covering it, and they're using
that as a benefit to offer people to make them
happy with their job, because studies have shown that if
your place of employment is supporting your family building dreams,
you're happier with them overall. And so I am hopeful
that that trend continues because that is not like traditional insurance.
(35:24):
It's a fertility specific option. There's a lot of different
ways employers are doing it, but it is opening the
doors for so many to do egg freezing and to
do it without restrictions. One thing to think about, let's
use I won't name them by name, but a common
insurance you may have an insurance card for in your wallet.
If you want to come freeze your eggs, your plan
(35:45):
says has fertility benefits, but if I call them, you
have to be trying to get pregnant for twelve months
to tap into any of your fertility benefits. So if
you are single and want to freeze your eggs, if
you're a lesbian and you haven't been trying with intercourse
heater or sexually like they define it, it's so too
Then suddenly you want to have this huge amount that
(36:07):
your insurance covers for fertility, but you don't get to
qualify for any of it. I think it's very discriminating
and very frustrating. I can't believe that exists. Cheez, What
can you do if you can't afford egg freezing but
you want to do it so badly? I mean, I
know friends who have asked for loans from their parents,
you know, put it all on credit card and paid
(36:27):
it off over time. Those are the most common things
are personal loans from family members, small loans from banks,
or getting a credit card that has no interest for
a year and then you essentially are paying it off
to yourself. Some clinics do have payment plan options. Or
they're able to pay it off over a different timeline.
So it's always helpful to inquire if your clinic can
(36:51):
offer that or not. There are grant based programs that
will cover egg freezing. A lot of grants have certain
restrictions also as far as you have to married, or
certain religion or these other annoying factors. But I'm on
the board of a great grant program called baby Quest
and they accept anybody who wants to better their fertility.
For there are some resources you gotta put in the
(37:15):
dirty work of trying to figure out what they are.
So it's an amazing process of what we're able to
accomplish with egg freezing. And it sucks that it's expensive,
But at the same point, of course it's expensive. What
can we do to encourage society to add egg freezing
into all health care policies in general? We need a
lot more fertility advocacy across the board, even when we
(37:37):
see advocacy that seems to make sense. So, for example,
I went to advocate that I'm in Texas here to
get egg freezing coverage for cancer patients because we know
that chemotherapy often decreases your account and you may not
be able to have children for that. To me, that
seems like a bipartisan support, like, you have cancer, let's
(37:58):
help you have a baby later and we can do it.
But you have to decide. It's such a hot moment
for patients with cancer because they have to decide immediately.
You're deciding twenty things at once. You're like deciding about
your cancer and your chemo or your surgery. And if
you want to do egg freezing, and it takes two weeks,
you gotta start today, today, today, and it does cost money.
(38:20):
There are luckily some organizations that help with patients with cancer.
But we've tried to say, hey, across the board, we
feel like patients and Texas should be able to have
this covered by the state if they have cancer, trying
to make it mandated coverage, and some states have accomplished that,
but we've not here. Really, if we could get mandated
fertility coverage, that would be a huge step at leveling
(38:41):
the playing field for everybody. Oh my god, it would
be insane. Is there any other sort of condition that
someone could have where they should consider egg freezing? Oh?
Probably some end Oh yes, yes, so endometriosis certainly is,
especially if you get diagnosed young. It is just a
(39:03):
destructive disease by nature, and we do often see people
progress to ovarian destruction low accounts these ovarian cysts of
endometriosis and much much higher rates of infertility. So if
you have endometriosis and you have the option to freeze
your eggs, your employer covers it, or your parents will
pay for it, or you've saved up some money worth it,
(39:25):
a d worth it. There's some other medical conditions, autoimmune
conditions specifically, especially if they're going to need very strong
medications to mitigate them, you um might want to consider
because some of those medications are very chemotherapeutic or they overlap.
I know my really good friend who I also had
on this podcast, Becky Ofteniser, she has lupus and that
(39:50):
was a huge part of her fertility journey, the medications
she'd been on for a long time and having to
do a retrieval. So it really seems if you have
struggling with any kind of endometriosis, cancer, autoimmune diseases, these
are all things to be speaking with your obi fertility
doctor closely monitoring. Is there any other advice you would
(40:13):
give to other women who are considering egg freezing. Overall,
if you're considering egg freezing, now is the time to
consider it, meaning take at least the next up, schedule
an appointment with a fertility doctor. Hear them give you
some personalized data, get your ovaries looked at, find out
what your odds. Maybe nobody is committing you from that
(40:34):
moment to doing the procedure, but that is education and
that information may change your mind. You may feel really
differently once you find some of these numbers. You may say, gosh,
I want to save up and do this, or that's
not for me and I feel good with it. Go
get an evaluation. Next up, they swear we're nice, and
if you see somebody who's a meani, go to somebody
(40:55):
else like we're nice. Where We do this job because
we want to help you, and it's a very personal job.
I don't think there's any reason not to do that
step like that step do it. Last question that we
ask every guest on Katie's Crib, Parenthood is hard. I
mean probably what everybody says. I love being a mom.
(41:16):
You know, working mom is an extra level as I
think most people who are working parents know My kids
equally complain when I don't go to the school thing
or I don't drop them off in the morning. But
they're also really proud of what I do and I
love watching them take ownership of Mommy's a doctor, and
so it's great. But yeah, they're interesting, right, six and
(41:40):
seven there were twenty in two ages where you know
they have their own personalities, their own likes and dislikes,
their own attitudes, and trying to help shape them into
the best little versions of themselves. You're ahead of me.
I'm terrified. I have four and one six, So they're
crashing into things and bringing their heads and and go
(42:00):
back to one for anything. I love their people and
they have these interests and it's fun, but there's hard
moments about how do you teach them some of these
life lessons? How do you raise them to be good humans?
Good humans? Right? And that's why we've got the Katie's
Cribit community to make us feel less alone and laugh
(42:21):
and learn it a little bit more. And that's why
we have your incredible Fertility Clinic. The name is for fertility.
You have been such an incredible guest, such a wealth
of knowledge. If I was egg freezing, you would be
my top choice. Of just you've made me feel really informed, empowered,
safe and excited. Thank you so You're so fun. Thank
(42:51):
you guys so much for listening to today's episode. I
want to hear from you. Let's chat questions, comments, concerns.
Let me know you can always I Me at Katie's
Crib at shondaland dot com. Katie's Crib is a production
of Shondaland Audio in partnership with I heart Radio. For
more podcasts from Shondaland Audio, visit the i heart Radio app,
(43:13):
Apple Podcasts, or wherever you listen to your favorite shows.
Welcome to Katie's Crib, a production of Shonda Land Audio
in partnership with I Heart Radio. When Idea first started,
we didn't have medications to make more than one eggro
at a time, so we followed somebody's natural ovulation, trying
to watch the one egg get mature. And then you
don't have this minimally invasive ego trivial Katie. They would
go like a surgery, a real life surgery through the
(00:21):
abdomen into yeah, yes, and they would stick a needle
into that one little follicle. You get one little shot
at it, but you have to be like general anesthesia
all the way asleep. Wow, you guys, this has come
so far. Information provided by Dr Crawford during this podcast
(00:45):
is for general education purposes and should not be relied
upon as professional medical advice, diagnosis, or treatment for any individual.
Hello everybody, Hello, Hello, Welcome back to Katie's Crib. We've
got a real fancy, impressive doctor in the house today,
(01:05):
which I love. I'm very excited to have this conversation.
This is a conversation that I have with my girlfriends
constantly on all coasts, all cities. It is a hot
topic and this is what Dr Natalie Crawford does all day,
all night. Dr Natalie Crawford is a fertility physician in Austin, Texas,
(01:26):
and she's the co founder of a boutique fertility practice
called for Fertility. She's also the host of the as
a Woman podcast and her YouTube channel, Natalie Crawford m D.
Dr Crawford's work focuses on empowering women and promoting fertility
awareness and education. She's married to Austin Native Jason Crawford
(01:47):
and they have two young children. Welcome to Katie's crib.
Dr Crawford, you must be busy, Katie. Thank you so
much for having me. I am so I am busy.
People are finally talking about fertility or not putting it
away in the closet or having as much stigma as
their husband in the past. And I really feel like
(02:07):
this is an area or even very educated, very successful
women do not understand a lot about their own fertility,
in their own body. And there's huge room for improvement
for making sure that we can all know how our
body works and how it's supposed to work. Because if
we don't know the basics, how do we know when
something's wrong or how do we know to get help.
That's a percent. I can remember the first time, just
(02:29):
trying to get pregnant and going to like an acupunctures
and she was like, what's your ovulation juices? And I
was like, I don't know? And she was like, you
don't know about your body and when what days happen
and when things get egg white versus clear, versus stretchy
versus thick. And I was like, I'm so mortified about
my own not know it, just not knowing about what
(02:50):
my body does and when it does it and why
it does it. And it's so cool that you know
all about that stuff. We've heard about the egg retrieval process.
We've actually done episode about the egg retrieval process from
two of my best friend Stephanie Black and Lindsay Craft.
But I would love to hear about the egg retrieval
experience from an expert's perspective. Yes, I'm excited for you
(03:10):
to explain blastocyst stage. Just take me through like the
big sweeping things about egg retrieval process. Let's do it.
Let's rewind, because I think to understand the agg retrieval
process real quick, we got to understand what happens on
a month to month basis, so you can understand what
we're going to do, and then I'll talk quickly about
(03:31):
egg retrieval, and then what happens after what is a blasts.
The reality is most of us think in our brain
we lose one egg per month. That's the egg that
you ovulate, and that's not really how the human body works.
I like to use this terrible analogy, but if you
can imagine inside your ovary, if there's a little vault
and that's where all your eggs are kept. So when
you're born, you're vault is full. You lose eggs out
(03:53):
of the vault. When the vault is empty, you go
in him in a pause. What actually happens every month
is that a group of eggs is released from the vault.
At one time, one of these is chosen to ovulate,
the rest of them die, and the next month another
group comes out. And you can't change this process. Meaning
when you're pregnant, it happens, when you're on birth control pills,
it happens. We're always losing eggs out of that vault.
(04:16):
But the number of eggs that come out of the
vault is correlated to the number that is inside the vault,
meaning when you're vults really full, you release more every month,
and when you're about to go into menopause you only
release a couple. This is a fact I've never known
any of this. I'm already mind blown. Okay, okay, we're
about to blow your mind. So when you do I
(04:36):
v F for egg freezing, like real big picture. All
I'm trying to do is get the eggs that have
come out of the vault for this one month to grow,
and then I'm going to take those eggs out of
your body. So instead of, for example, having twenty eggs
come out of the vault, one ovulates and nineteen die,
I'm trying to say, hey this month, hey, March of two,
(04:57):
I want to get all twenty eggs to grow. So
I'm gonna give you hormone chots to get all those
eggs to grow, and then I'm going to take them
all out of your body at one time. So that's
what the egg retrieval is. So Number one, understanding how
many eggs you might have is really helpful because it
changes how we get them all to grow. But also
set your expectations appropriately, and that's one thing that all
(05:19):
women can handle this process, but we're really bad. Just
as a whole of walking blindly through a forest when
you have no idea what's coming, everything is going to
be harder. But if you have somebody who tells you, hey,
you have less than average for your age, and that's
why you're going to get fewer than your best friend
when she goes through this process, it helps you set
parameters for expectations. So we can see how many eggs
(05:41):
are outside the vault by ultrasound and a blood test
called a m H. So those things help us quantify
number of eggs. Are they always correct? They give us
categories like average for your age, above average, below average,
because your body is setting an actual number every month.
So if I say average for a thirty year old
(06:01):
is going to be twenty eggs out of the vault
one month, and maybe twenty and then eighteen and the
nineteen and so there's some variation. But the other thing
that happens is that, and we all peripher a Y
know this. The quality of eggs starts to decrease as
we get older. Genetic stability inside the eggs decreases. I
like to think about those eggs inside the vault taking
(06:23):
the wear and tear of your life. They're breaking down.
The proteins are breaking down, and just like our joints
get sore as we get older and we get wrinkles
on our face, the same thing starts to happen inside
our eggs. So at age thirty, the number that's like
brandished in our brain as women, approximately half your eggs
are going to be normal and half of them are not.
And this is why we start talking about doing IVF
(06:44):
or egg freezing. Understanding how many eggs you have helps,
but also understanding expectations for how many maybe genetically normal,
sets the road of expectations. So it's kind of the basis.
So we're gonna do IVF for egg freezing, I want
to understand how old are you? How many eggs am
I expecting to get. You're gonna take hormone shots for
a couple of weeks, which are going to get the
(07:05):
eggs to grow, and then you're gonna come in for
the egg retrieval procedure. People are the most nervous or
anxious about that procedure because it's like the big moment
for egg freezing. It's really a minimally invasive procedure. There's
no knives, there's one needle. Very simple compared to a
lot of other procedures. It is done typically under a
light anesthesia I think colonoscopy, so you're breathing on your own,
(07:29):
no intubation, no breathing machine, none of that stuff. We
don't want you to feel it. We do attach a
really long y'all can't see me. My hands are very
long right now, very long needle to the vaginal ultrasound
and you can see it. It's a little bright white
line on ultrasound. And we enter vaginally into the ovaries
while we watch with the ultrasound, and you see these
(07:50):
follicles that have grown, these small fluid filled structures. Each
one house is an egg. It will enter into a
little follical. The little follical drains and collapses and you
get test tubes follow all that folicular fluid and eggs.
When did this egg freezing procedure first exist? So the
oldest IVF baby is like forty one, So that's the
(08:13):
oldest person who's been born from IVF. When ivy A
first started, we didn't have medications to make more than
one eggrow at a time, so we followed somebody's natural ovulation,
trying to watch the one egg get mature. Oh my god,
what a pain in the ass. And then you don't
have this minimally invasive ego trievill Katie. They would go
like a surgery, a real life surgery through the abdomen
(08:36):
into yeah, yeah, and they would sack a needle into
that one little follicle. You get one little shot at it,
but you have to be like general anesthesia all the
way asleep. Wow, you guys, this has come so far.
Ain't that crazy? And you know it was so stigmatized.
These women would go and they would have to spend
a couple of weeks, like at the hotel outside the
(08:57):
fertility clinic, because it's real sur tree. You don't want
to miss that one egg window, one egg, it's all.
I'd imagine you're waiting on this one moment to maybe
have surgery the next day for your IVF, and if
you miss it and you ovulate, then you gotta wait
a whole another month to get it. I v F
has changed so far, and sometimes we take for granted
(09:19):
how great that is that we can improve these odds
so amazing by having these medications, did it used to
be even more expensive. They did, and because it was
so much less successful, you have to do it multiple times,
and there wasn't just the availability to do that because
there were you know, women and couples who wanted to
do this, and if you could only cycle one patient,
(09:40):
you're watching them so closely. There's no way to scale.
And there was originally one clinic in the US that
didn't and now there's tons of great fertility clinics and
good places you can go. So when the day we
get the eggs out of the egg retri bo, we
consider ovulation day, so that's day zero, so that would
be equating it to natural cons option. The day that
(10:01):
an egg is released from the ovary. We then if
we were doing IVF and going to make embryos, we
get a sperm, example that same day as day zero,
and then we fertilize the eggs with the sperm. Does
it have to happen on day zero? It does if
you're gonna make embryos, it does. Otherwise the eggs have
to be frozen. They only live for twenty four hours
(10:22):
that's in the body or out, meaning if you don't
get them fertilized at just the right time, they are
going to seal off and be they cannot be penetrated
by sperm. This is so stressful. So the egg is
this tiny little window. So in an IVF cycle, luckily
we know exactly what it is. We just took the
egg out of the body. Most places are now doing
(10:43):
a type of fertilization called X which means you take
up a little sperm and a little pipette and you
crack open the egg and you put the sperm inside.
That's the newest and gives us the highest fertilization rates.
These embryologists are amazing. These are the people who train
years to be able to these micro manipulation techniques under
the microscope, so they Number one is the first thing,
(11:04):
you have an actual embryo, meaning the egg is either
accepted the sperm and divided or it has not, So
that's when you have. However, many fertilized that normally happens
in the fallopian tube. So for going back to natural conception,
embryos fertilized in the fallopian tube. They then have to
grow and develop from that little to cell embryo into
about a three hundred cell blast asist over the next
(11:27):
five to six days. That is where the embryo is
separated into what will become the placinta and the baby.
And essentially that is the implantation stage embryo. That's when
an embryo could grow into the uterus. So normally that
process takes five or six days from the fallopian tube
to get in the uterus. And that's what's happening in
the IVF lab, Meaning that's the environment where we're watching
(11:50):
these little embryos growing culture. And I always say, not
like our body, but the I v F flab is
the perfect temperature and pH and there's no inflammation shan
or toxins or others things. So it's this ideal environment. However,
even in that ideal environment, not every egg will be fertilized.
Not every fertilized egg will make it to a blast assist.
(12:12):
Not every blast assist will be genetically normal. That's based
on your age, and not every genetically normal blast assists
will implant and become a baby. Is there a client's
story that you can walk us through for a scenario example,
think of someone you've worked with of how many eggs
you lost through the process all the way to the
birthing process. Let's pretend you're an average thirty two year old.
(12:35):
You have about twenty eggs. Our goal is to try
to get them all to maturity at the same pace.
The body's goal is to not let that to happen,
because your body doesn't want to have twenty babies at
one time, so the ovary is going to resist that.
We are typically unable to get every egg mature that
we can, but we usually do a really good job.
So most of the time you're going to see around
(12:56):
eighty maturity. So let's say if we have twenty eggs,
we go through the process, and let's say we get
eighteen of the mature. Fantastic, they're frozen. We love it.
About eighty five to nine of eggs survived. The freeese
thought that's not a hundred. So you need to in
your brain or have your doctor roll with you. Okay,
I'm gonna lose a couple of eggs just from normal process.
(13:18):
That number, just for comparison ten years ago was forty survival,
So I just have ent survival, so way better. But
so if I have eighteen eggs, okay, now in my brain,
I lost two and that freeze thought process now I
have sixteen six. Typical fertilization rates with sperm are going
to be about seventy. So let's say of the sixteen,
(13:40):
twelve of them have now fertilized. From there, about half
of them will make it through to that blastess of stage.
So now we're at six and then based on age,
we would expect fifty to sixty percent normal, and so
that would be okay, let's say conservatively three and then
each of those is going to have approximately a sixty
(14:03):
chance of a live birth. So in the math equation,
we usually like having two embryos, and the equation for
every baby you want to have. So in this one,
you had eighteen mature eggs frozen. That's the number that's
in your brain. I'm rolling around, I have eight team
at your eggs. Wonderful. That makes us feel good for
a baby and maybe a chance for a second baby.
(14:26):
But if you are dead set I need two kids
because my sister is my world and I would never
want to have an only child, we're going to want
to hire number than eighteen. And this is even in
your early thirties, and so somebody should be working that
equation for you. On the flip end. That should not
scare anybody, right, don is the Hey, I'm trying to
(14:47):
optimize this, and I want to put the numbers in
my camp. I've had somebody go through and get three eggs.
She had bad in demetriosis. She was thirty five. That's
what we could get. She could only afford you the
process once. When we went to thaw them, two of
them fertilized, one of them grew out. It was normal.
It is a living child now. So these numbers give
(15:08):
us perspective, but it's also not everything. It is not everything,
and it doesn't mean that if you have a low
number it's not worth it. As you mentioned on your
As a Woman podcast, it's important that you can view
(15:29):
what you have as the assurance that it may or
may not be. Why should we get our eggs harvested
when there's such a low percentage that the eggs will
even survive. That's a really good question. I always tell
people just to think about their goals overall, and when
we should start thinking about egg freezing is if we
are in our early thirties or later and we're not
(15:52):
ready to have a family. However, we know that is
a goal. We don't want to let pass us by
because we don't know if you are going to run
out of eggs early, and what if you have missed
your window of opportunity. This come about because we'll see
women walk in the office at thirty nine and suddenly
they have a very low account and they need IVF
(16:15):
for whatever reason. But they're looking at multiple cycles, thousands
and thousands of dollars. And if we had had a
cohort of eggs that had a higher percentage genetically normal,
and we had more of them, you just keep doors open.
One thing I don't love is that people will often
equate egg freezing to an insurance policy on their fertility,
Like I'm insuring my fertility, And I always say, an
(16:38):
insurance policy is a guarantee. Right if your house burns
down and you have house insurance, you're going to get
money for a new house. This is an investment. This
is like the stock market. The return on that investment
depends on the environment of which you're going to go
cash it in on, meaning what's the sperm going to be,
what is your medical condition? Other factors that we may
(17:00):
be able to know right now do influence some of
that progression through culture, and what your outcomes look like. However,
investing your money is a good thing, and making smart
financial investments are good, and so investing in yourself and
your future. Fertility is something that has shown in studies
even if you never go and use your eggs later,
that it's giving you happiness along the process because it
(17:23):
allows you to explore other relationships without feeling the pressure
of that biological clock. Oh yeah, I've never had so
many friends do a thing that has brought them peace
of mind. I've had many friends who didn't even use them,
and then I've had friends use them and both the same,
Just very relieved and happy that the option was there
(17:45):
and that they did it. For family planning, one thing
we don't always think about is is not just about
baby one or when you start your family. The good
thing about having frozen eggs that are good quality and
from when you were younger is that if you meet
that life partner or you're ready to get pregnant with
a sperm donor and be a single mom, whatever the
situation is, how old are you going to be if
(18:06):
you want to add a sibling to that? Right? How
many years are going to pass before you're ready? And
we know that those fertility rates, the egg number go down,
the quality of the eggs becomes worse. So having those
eggs expands what you might be able to have as
far as a total family size, and that's important to
people too. We often get really tunnel vision focused on
(18:26):
that baby one. I see people come to me thirty
eight or thirty nine. They're starting their family, but they
really want to have three or four kids because they
grew up with siblings, or they really want a big family.
That's just part of this dream. And I'm I said
here and say look at the math. If you got
pregnant tomorrow, where are we more trying for baby two
and three? And so very often if we're in those
(18:48):
more advanced reproductive ages, we are looking at IVF and
saving embryos for what we call embryo banking, maybe family
planning goals. Hey, I'm for seeing that I want to
have a kid in my four reason that may be tough,
So I'm going to have some normal embryos right now
when they're easier to get in fine, so I can
achieve that goal. And that's why I think about the
(19:08):
big picture, or not just the right now goal. But
maybe your big picture goal, at least in your ideal world.
We all know goals change and we feel different as
time goes on. But if you can do something that's
going to keep doors open or get you closer to
achieving that reproductive goal, we shouldn't just ignore it, like
you know so many of us did for so long,
just because there there was no other option. The reality is,
(19:31):
when I was the right age to freeze my eggs,
I couldn't. There's nowhere that would have done it. It
wasn't a thing that was offered because the technology wasn't
as good. So, just as we talked about how the
ivy of technology has gotten better, an egg is a
single cell. A blast assist is three D cells, So
freezing an embryo it is much stronger and sturdier, and
they survive very well. A single cell mostly of water.
(19:55):
I now need to freeze it, preserve its genetic integrity,
and be able to thaw it with accuracy so that
it can function and accept a sperm and become an embryo.
That's pretty amazing when you think about what is happening,
and so that technology changed from and the success rate
of freezing and throwing eggs went up dramatically. That's when
(20:17):
we started seeing this offered people getting trained in the
new technology, and that's why now you have to wait
till enough people get trained enough clinics. This does feel commonplace,
and it does feel like you can walk in to
any fertility clinic can get your eggs frozen. But ten
years ago you definitely could not. That was not an option. Wow,
I'm so relieved this has come so far. It's comes
(20:37):
so far, and I think sometimes people carry these just ideas.
Are that these misconceptions, which I completely understand. What are
the biggest misconceptions when it comes to egg freezing. The
biggest one that I see is that it's going to work.
I'm going to do iba for I'm going to freeze
my eggs and that will work for me. It has
the highest chance of working. It's the only thing that
(20:59):
exceeds natural conception. I mean, I have no other technology clothes,
but it's not a guarantee. And that's really it's hard personally.
It makes my job hard, but it's also hard for
patients because it is financially very expensive. The other kind
of thing is that patients often think they have to
be in the clinic every day forever and ever, and
(21:21):
it's going to be this huge time set of their life.
And it's really not at most clinics. It's definitely not
at ours, because we've perfected the process to know when
we need to see you, to be efficient with your time,
and really most my patients are only taking that day
off of work for the actual egg retrieval. I'm getting
anesthesia process, and so I think though people like I
can't take two weeks off, I can't be driving here
(21:43):
every day for a month, like exactly, if that's not
how you have to do. You take the medications on
your own at home. We'll come in when we need
to see you, but it's not going to be every day.
And we're pretty good at ball parking. This is the
week your retrieval is going to be. So I always say,
don't have your big work meeting, your best friend's wedding.
We're going to plan around those things because you have
(22:04):
to keep having your life while you go through this process.
I know that one of the most common questions that
you receive has got to be what is the best
age to freeze your eggs? What other things impact egg
freezing out than age? Age is still the number one
predictor of success across the board for any fertility treatments,
including egg freezing. Studies that have evaluated this are evaluating
(22:28):
usually the cost effectiveness of the procedure, and so that's
typically age thirty two to thirty three for the average person.
If you're not ready to be trying for a family
at that age, that's when you're still going to have
a really high number of eggs and high quality of
eggs for the average person. Of course, everybody is different,
So I usually say the moment you're considering, it's the
(22:48):
right moment because we don't know, we don't know what
your future will hold, we don't know what happens. You
can always go and get that ovarian reserve, meaning the
ultrasound of the blood work, see your egg count. Because
I have certainly had year old who are having a
lower account than they should and they're very happy they
started this process a little bit earlier so that they
(23:09):
don't run into that situation on the flip in thirty six,
thirty eight, any eggs that those ages are better than
zero eggs, so is they're too old. Not necessarily, with
proper counseling, it does start to become a much harder
when you're forty and older. At age forty about of
your eggs are going to be normal. At age forty
(23:29):
two and above, it will be ten percent. We counsel
really detailed about how many eggs do you have and
what are these personages mean. We do think lifestyle variables matter,
meaning let's use smoking cigarettes, so we know if somebody
smokes cigarettes, they're going to have a higher percentage of
genetically abnormal eggs than somebody who is should be their age,
and they're going to have fewer eggs. It gets in
(23:52):
not to think of it like kills the eggs inside
the vault. There are things and toxins in the world,
a lot of them. We are just star to understand.
The United States isn't a very consumer friendly place when
it comes to toxins in your products and foods and
those type of things. So I feel like that evidence
is emerging. But we do see that the things you
put in and on your body impact your fertility and
(24:15):
appear to impact the quality of your eggs. So that's
where we want to do what we can to be healthy,
especially if we're going through the process and be mindful
of some of those variables, What are some ways to
cope with the roller coaster that this egg freezing process entails.
It's very emotional and triggering and ups and downs. And
(24:37):
I got a good number, I got a low number.
Number one is set your boundaries, So think about it
ahead of time. Set boundaries of who you're going to
tell and what kind of support. And I hear this
from a friend all the time. My friends going through
egg freezing and I don't know what to do to
help them, but I want to help them. Are my
friends going through in fertility? If you're the person going
(24:58):
through it, it is very health to say, Hey, I'm
going through kind of calls event and I really don't
want to hear what other friends have had. I just
want to be a say space. So I'd love if
you had any free time to drive me or help
with shots, or do this thing, or watch this video,
or come with me to this visit so I can
have extra eyes and ears. And if you're a friend,
you can suggest some of those things. Hey, do you
(25:19):
want somebody? I can drive you to that appointment, or
I can come with you and just hear what your
doctor is saying, because I know you you know have
a lot going on right now. Those acts are very
kind and very meaningful. I do think knowing where you
get your support from. Maybe it's your real life friends,
and maybe it's not. Maybe it's a therapist, maybe it
is an online group. But leaning on somebody for support
(25:43):
is very helpful because it is an emotionally draining process.
If we think about it, your estrogen rises, you're gonna
get bloated, you're gonna gain weight, You're gonna have pressure.
You can't work out like you normally can't, you can't drink.
I just took away a lot of people stress for
leaving mechanisms. You're uncomfortable, you don't sleep well, and then
(26:04):
after the egg retrieval, we think it's all going to
be better. You your pain shouldn't be terrible. It usually
feels really crampy, like a bad period. But then you
have this huge hormonal drop. Right each egg made estrogen,
you just group twenty of them. You normally grow one.
Your estrogen is now twenty times what it should be,
and now it's going to fall off a plateau. So
(26:25):
it's like p MS on steroids. You know you're not
gonna feel like yourself and be able to do your
normal things, and if nobody knows, you just get into
this place where you're very isolated. So doing what you
can to set yourself up for success and to not
be isolated, whether it's that one friend or the online
group or your therapist, that's really helpful. My kids were
(26:47):
pregnancies five and six, so there were a lot of
miscarriages along the way. And this was a while ago,
six and seven years old. But I didn't tell anybody,
and I had a lot of stigma. I mean, being
a physician, being in any getting pregnant means you're going
to be out of commission, other people going to work
for you. There's a lot that goes into it. And
(27:08):
I didn't tell anybody, and so then I got into
this situation. How do you How do you tell somebody
you're miscaring and you need help if they never knew
you were pregnant. Now you feel like I didn't tell you. Yeah,
I didn't tell you this moment now, but let me
tell you now that I need. It's just it really
started to separate me from some people who I know
(27:28):
would have really supported me. So the thing that I
often tell people is against that old advice of don't
tell anybody you're pregnant until you're out of the first trimester.
It's who is your core and if something is going
really wrong, who's going to show up? Who are you
going to rely on? And try to let those people in, Hey,
(27:48):
we're having a hard time. Okay. That helps them know
that if they are pregnant, not to just blurt all
over the place and to handle that moment with care. Oh,
tell them when you get the pregnancy test. That way,
if something goes wrong, you can call and say that
pregnancy didn't work out, and they're there for you, because
those moments are so much harder to tolerate alone. Tell
(28:09):
them you're going through in fertility. Tell them you're going
through IVF. Tell them when you get the positive tests.
Have them there to also know, Okay, it's early, we're anxious,
but I'm going through this with you. We're cautiously optimistics.
But I always say, like, if people will tell me
when they're early on and no one else knows, and
I'm like, I'm not saying a word of anything, We're
just saying we're cautiously optimistic, And yeah, I totally I
(28:30):
love that you say that. It's like my favorite way
to phrase that, because there's no reason not to be optimistic,
but we're cautious. We don't know what's going to happen,
and so I think that as a whole, the more
we can talk about it with each other and we
normalize that conversation, the more support we give. And there
are people in everybody's life who a thousand percent would
show up to support you, but you got to give
(28:52):
them the chance. How long do eggs last after they're frozen?
So eggs don't get freezer burned, so right now they
don't like that. Um, we have much more data on
(29:12):
embryos because again, egg freezing still newer. But if we
equate this to embryos, the longest in embryo was frozen
and became a baby was twenty seven years. Holy craps
in that crazy insane. So they don't get freezer burned.
So we don't know. The technology is still on the
new ish side. So might that change in the future. Maybe,
(29:35):
but it does not appear to me. Neither does not
appear to be an expiration date on eggs, and in fact,
many people are saving eggs an extended amount of time.
So I have fertility doctor friends who have eggs frozen
who are planning to keep them in case their daughter
needs eggs or something. So that's what people in the
(29:56):
field are doing. So we do not see or have
data that they're going to be bad next year if
you don't use them or anything like that. God forbid,
something got messed up and they like d thought or
something like at the egg freezing place. Is that like
a thing? So that is a thing, and it happened,
(30:17):
I guess. In twenty eighteen, two different clinics across the country,
owned by different people, both had failures in their tanks.
So they were different, but essentially one was like a
generator based issue lost power. Generator didn't turn on, and
(30:38):
one was a like I don't know, door, didn't clothes
and somebody didn't get notified. Okay, so this is all
speaking towards why things cost money that we don't understand, right,
because the things that we've got to put into these
embryology labs as far as one bajillion generator. So if
you lose power, all the energies going where it needs
to go, alarm systems to have a chain of command,
(30:59):
I'll you from ours. If power goes out if a
door is left open, it starts robo calling certain people
and it does not stop until this problem is corrected.
Because some of these things have somebody been notified soon
enough wouldn't have been a big deal, but it's the
extent of time that went on. Also, things that have
happened are transferring the wrong samples. They really are terrifying
(31:24):
if you're a fertility patient to think about. Most of
these circumstances have on uncovered revealed lack of staffine, doing
too many cycles for how many people are there, overall,
not good protocols and cheaper price points. I'm just shaking
my head like is this real? Yeah, so I think
(31:47):
I think it's good to ask, and I tell everybody
what process and procedures do you have to keep my
sample safe? Like how do you know what's going and
how do you keep it safe? Your doctor? Should one
know what is happening in their lab and they are
your representative to use that lab? I can tell you
right now, Like, Okay, the embryos when they're growing, they're
(32:08):
kept in different tanks at different stages of development. Each
one is labeled with a different color and has your
name and your data birth and this is how those
are labeled. Two people have to check it all the time.
That means if you follow up with how many people
work in the lab, there needs to be more than
just one or two people, because if two people have
to check it all the time, two people aren't always
one thousand percent going to be there. And so then
(32:28):
what generators do you have? What alarmed systems do you have?
You don't have to know what the right answer is.
But if your doctor says, oh, I don't know, or
let me find out, I'm not sure what are they doing?
This is one of the most important things that we
do is protect people's reprotective samples. Nothing's perfect, but again
(32:50):
I think it goes to like, really do your research
and your due diligence when you're meeting with fertility claimics
and which doctor you're going to trust. Let's talk about price,
because I know this is a big one for people.
According to NPR, without insurance, egg freezing can range anywhere
from ten thous What is the most affordable yet impactful
(33:12):
way to undergo such a process? This is a good
question and there's a lot to unpack when we think
about it. We are relying on people to freeze a
single cell using the highest technology. We have to rely
that that can be thought and be able to become
an embryo later. The procedure does take anesthesia, has to
be done in a certain type of room. You've got
to go under the stuff. The medications cost a lot
(33:35):
of money too, So when you put all of those
pieces together, that number is relatively accurate, meaning most people
will probably spend from about twelve ten let's say, twelve
tho dollars for the process. Twenty is unusually high for
egg freezing. Potentially somebody's doing multiple cycles that definitely could
get to that number very easily. There are places that
(33:57):
do egg freezing much cheese peper, and we just have
to look in context about how are they accomplishing that.
Are they advertising on a cheap price, but then the
medications make up the difference and other prices are not.
Are they cutting corners somewhere or like? How are they
doing it so much cheaper than other places? Are they
(34:18):
staffed appropriately with the number of embryologists. Are they trying
to to do more cases with one right? How are
some clinics operating up much much lower costs than others?
And I always think that's just an interesting question and
a little red flag if you are getting a price
point that's much lower than that ten thousand. Why is
(34:38):
that some states have mandated fertility coverage and they will
cover a freezing or IVA for certain number of cycles,
while other states do not. So you will see people
who live in Illinois or Massachusetts they are automatically going
to have coverage benefits. People who have here in Texas
with me, they are not. We are luckily seeing a
huge trend in the employer based sector where employers of
(35:02):
especially tech based companies, are covering it, and they're using
that as a benefit to offer people to make them
happy with their job, because studies have shown that if
your place of employment is supporting your family building dreams,
you're happier with them overall. And so I am hopeful
that that trend continues because that is not like traditional insurance.
(35:24):
It's a fertility specific option. There's a lot of different
ways employers are doing it, but it is opening the
doors for so many to do egg freezing and to
do it without restrictions. One thing to think about, let's
use I won't name them by name, but a common
insurance you may have an insurance card for in your wallet.
If you want to come freeze your eggs, your plan
(35:45):
says has fertility benefits, but if I call them, you
have to be trying to get pregnant for twelve months
to tap into any of your fertility benefits. So if
you are single and want to freeze your eggs, if
you're a lesbian and you haven't been trying with intercourse
heater or sexually like they define it, it's so too
Then suddenly you want to have this huge amount that
(36:07):
your insurance covers for fertility, but you don't get to
qualify for any of it. I think it's very discriminating
and very frustrating. I can't believe that exists. Cheez, What
can you do if you can't afford egg freezing but
you want to do it so badly? I mean, I
know friends who have asked for loans from their parents,
you know, put it all on credit card and paid
(36:27):
it off over time. Those are the most common things
are personal loans from family members, small loans from banks,
or getting a credit card that has no interest for
a year and then you essentially are paying it off
to yourself. Some clinics do have payment plan options. Or
they're able to pay it off over a different timeline.
So it's always helpful to inquire if your clinic can
(36:51):
offer that or not. There are grant based programs that
will cover egg freezing. A lot of grants have certain
restrictions also as far as you have to married, or
certain religion or these other annoying factors. But I'm on
the board of a great grant program called baby Quest
and they accept anybody who wants to better their fertility.
For there are some resources you gotta put in the
(37:15):
dirty work of trying to figure out what they are.
So it's an amazing process of what we're able to
accomplish with egg freezing. And it sucks that it's expensive,
But at the same point, of course it's expensive. What
can we do to encourage society to add egg freezing
into all health care policies in general? We need a
lot more fertility advocacy across the board, even when we
(37:37):
see advocacy that seems to make sense. So, for example,
I went to advocate that I'm in Texas here to
get egg freezing coverage for cancer patients because we know
that chemotherapy often decreases your account and you may not
be able to have children for that. To me, that
seems like a bipartisan support, like, you have cancer, let's
(37:58):
help you have a baby later and we can do it.
But you have to decide. It's such a hot moment
for patients with cancer because they have to decide immediately.
You're deciding twenty things at once. You're like deciding about
your cancer and your chemo or your surgery. And if
you want to do egg freezing, and it takes two weeks,
you gotta start today, today, today, and it does cost money.
(38:20):
There are luckily some organizations that help with patients with cancer.
But we've tried to say, hey, across the board, we
feel like patients and Texas should be able to have
this covered by the state if they have cancer, trying
to make it mandated coverage, and some states have accomplished that,
but we've not here. Really, if we could get mandated
fertility coverage, that would be a huge step at leveling
(38:41):
the playing field for everybody. Oh my god, it would
be insane. Is there any other sort of condition that
someone could have where they should consider egg freezing? Oh?
Probably some end Oh yes, yes, so endometriosis certainly is,
especially if you get diagnosed young. It is just a
(39:03):
destructive disease by nature, and we do often see people
progress to ovarian destruction low accounts these ovarian cysts of
endometriosis and much much higher rates of infertility. So if
you have endometriosis and you have the option to freeze
your eggs, your employer covers it, or your parents will
pay for it, or you've saved up some money worth it,
(39:25):
a d worth it. There's some other medical conditions, autoimmune
conditions specifically, especially if they're going to need very strong
medications to mitigate them, you um might want to consider
because some of those medications are very chemotherapeutic or they overlap.
I know my really good friend who I also had
on this podcast, Becky Ofteniser, she has lupus and that
(39:50):
was a huge part of her fertility journey, the medications
she'd been on for a long time and having to
do a retrieval. So it really seems if you have
struggling with any kind of endometriosis, cancer, autoimmune diseases, these
are all things to be speaking with your obi fertility
doctor closely monitoring. Is there any other advice you would
(40:13):
give to other women who are considering egg freezing. Overall,
if you're considering egg freezing, now is the time to
consider it, meaning take at least the next up, schedule
an appointment with a fertility doctor. Hear them give you
some personalized data, get your ovaries looked at, find out
what your odds. Maybe nobody is committing you from that
(40:34):
moment to doing the procedure, but that is education and
that information may change your mind. You may feel really
differently once you find some of these numbers. You may say, gosh,
I want to save up and do this, or that's
not for me and I feel good with it. Go
get an evaluation. Next up, they swear we're nice, and
if you see somebody who's a meani, go to somebody
(40:55):
else like we're nice. Where We do this job because
we want to help you, and it's a very personal job.
I don't think there's any reason not to do that
step like that step do it. Last question that we
ask every guest on Katie's Crib, Parenthood is hard. I
mean probably what everybody says. I love being a mom.
(41:16):
You know, working mom is an extra level as I
think most people who are working parents know My kids
equally complain when I don't go to the school thing
or I don't drop them off in the morning. But
they're also really proud of what I do and I
love watching them take ownership of Mommy's a doctor, and
so it's great. But yeah, they're interesting, right, six and
(41:40):
seven there were twenty in two ages where you know
they have their own personalities, their own likes and dislikes,
their own attitudes, and trying to help shape them into
the best little versions of themselves. You're ahead of me.
I'm terrified. I have four and one six, So they're
crashing into things and bringing their heads and and go
(42:00):
back to one for anything. I love their people and
they have these interests and it's fun, but there's hard
moments about how do you teach them some of these
life lessons? How do you raise them to be good humans?
Good humans? Right? And that's why we've got the Katie's
Cribit community to make us feel less alone and laugh
(42:21):
and learn it a little bit more. And that's why
we have your incredible Fertility Clinic. The name is for fertility.
You have been such an incredible guest, such a wealth
of knowledge. If I was egg freezing, you would be
my top choice. Of just you've made me feel really informed, empowered,
safe and excited. Thank you so You're so fun. Thank
(42:51):
you guys so much for listening to today's episode. I
want to hear from you. Let's chat questions, comments, concerns.
Let me know you can always I Me at Katie's
Crib at shondaland dot com. Katie's Crib is a production
of Shondaland Audio in partnership with I heart Radio. For
more podcasts from Shondaland Audio, visit the i heart Radio app,
(43:13):
Apple Podcasts, or wherever you listen to your favorite shows.
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Every week comedian and infamous roaster Nikki Glaser provides a fun, fast-paced, and brutally honest look into current pop-culture and her own personal life.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.