Impending Menopause: How can fertility be preserved? with Dr. Duru Shah | For Women

Introduction: 

The International Menopause Society is proud to provide the interview series for women on current topics of interest in the field of menopause. In the series, IMS Board Member Dr. Marla Shapiro interviews renowned experts on menopause and midlife women’s health. 

YouTube Link: The interview is also available on video: https://youtu.be/MFXbogTv-Lw 

Disclaimer: The views expressed by speakers are their own and may not necessarily represent the views of the IMS. 

Episode Summary: 

Join Dr. Marla Shapiro and Dr. Duru Shah as they delve into the concept of impending menopause and the critical topic of fertility preservation. In this insightful discussion, Dr. Shah, a renowned gynecologist and fertility expert from Mumbai, India, shares her expertise on premature ovarian insufficiency, the risks associated with early menopause, and the importance of understanding ovarian reserve.

Learn about the factors that contribute to early menopause, such as genetic predisposition, autoimmune disorders, and lifestyle choices. Discover the latest advancements in fertility preservation techniques, including egg and embryo freezing, and understand the success rates associated with these methods.

Dr. Shah also highlights the importance of early intervention for women who wish to delay pregnancy due to career or personal reasons. She emphasises the need for awareness and proactive measures to ensure better fertility outcomes.

Don’t miss this episode packed with valuable information and practical advice for women navigating the complexities of impending menopause and fertility preservation.

Relevant Links & Resources: 

• Menopause Info website
• Menopause FAQs - downloadable PDF
• When Your Periods Leave Too Early with Nick  Panay

 

Host Bio: 

Marla Shapiro C.M.‎, MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP 

Marla Shapiro is a professor in the Department of Family and Community Medicine at the University of Toronto. 

Dr. Shapiro completed medical school at McGill University and trained at the University of Toronto for her Masters of Health Science. She concluded her specialty training in Community Medicine, receiving her Fellowship in Preventive Medicine and Public Health from the Royal College of Physicians and Surgeons of Canada. She also holds a Fellowship in Family Medicine and is currently a Professor in the Department of Family and Community Medicine at the University of Toronto. 

Dr. Shapiro is seen on CTV NewsChannel and is the medical expert on CTV’s National News and NewsChannel. She is the author of the bestselling book, Life in the Balance: My Journey with Breast Cancer. 

Dr. Shapiro is a member of several advisory boards, including the Terry Fox Research Institute. She sat on the Board of Trustees for NAMS for 9 years. She was the President of the North American Menopause Society in 2017 and Scientific Chair of the NAMS Annual General meeting in 2019. She continues to produce and direct both videos in women’s health for health practitioners and the general public for NAMS. The videos can be seen on YouTube and www.menopause.org. She is on the editorial board of both Menopause and Climacteric. 

She received an Award of Excellence from the College of Family Physicians of Canada and was awarded the Excellence in Creative Professional Activity by the University of Toronto. Dr. Shapiro was also chosen in the top 10 of the 50 most powerful doctors in Canada by the Medical Post. 

Episode Transcript

(00:00):
Views expressed by speakers are their own and may not necessarily represent the views of the IMS.
Hello, I'm Dr. Marla Shapiro, and I sit on the Board of Trustees of the International Menopause Society.
And today we're going to be talking about the concept of impending menopause
and fertility preservation.
And to that end, I'm joined by Dr. Duru Shah. Thank you so much for joining us.

(00:23):
Can you please introduce yourself to our audience? I'm Dr. Duru Shah.
I'm from India and I'm the chair of the CAMS or the Council of Affiliated Menopause
Societies, which is part of International Menopause Society.
I'm also a consultant gynecologist and fertility expert at Gynecworld in Mumbai, India.

(00:44):
Okay, so let's start off with the notion of what impending menopause means.
So what is the definition and then who is at risk?
The definition of premature ovarian insufficiency, as we call it,
for impending menopause.
And that is something wherein the woman is less than 40 years of age,

(01:07):
and she has reached a stage where she's not getting her periods for more than four to six months.
And her factors, all her blood work, etc., shows that she's almost menopausal.
So she's actually just reaching there and that's when we determine that she's
got this problem. So that's the definition.

(01:28):
Okay. So then how do we determine who the woman at risk is?
The woman at risk could be due to various reasons. And I think a lot depends
on whether genetically she's carrying a gene, which is running in the family,
whether even her mother reached menopause earlier.
That's one. second thing is that it could be

(01:48):
some autoimmune disorder which is something which
is existing and you know damaging her
ovaries which are you know sort of packing up much earlier and the third reason
could be because of a habit of smoking a lot or maybe exposed to some kind of
radiation or that is more like a iatrogenic problem wherein she's taking treatment for cancer

(02:14):
and she's being exposed to radiation or chemotherapy where the ovaries get affected.
So when we think about menopause, we think about the fact that if we think of
our ovaries as factories that have all our eggs that are sitting there, we're losing those.
So there's this notion of something called ovarian reserve.
Can you explain what that means for all of us? What does that mean?

(02:38):
See, the ovarian reserve is actually estimated in those women who come to us
for of fertility treatment.
And they are at an age, you just say probably an advanced reproductive age is
what we call beyond the age of 35.
This depends, again, on the ethnicity of the population.
Like in India, women reach menopause at 48, 49, whilst in the U.S.

(02:59):
Or maybe Europe, they would reach menopause at 52, 53.
So we reach menopause earlier. And therefore, when women come to us at 37,
38, we are worried about them being able to conceive.
So there are certain tests we do to determine whether
they have sufficient ovary eggs in their ovaries and whether
those eggs are of good quality because as age

(03:21):
advances the quality of the eggs gets worse
and worse and deteriorates so that is what it's you know well i was just going
to say that when you talk about advancing age most women don't think of themselves
as advancing age over the age of 35 but from an ovarian point of view 35 really
is a landmark year if you will Yes, absolutely.

(03:43):
Actually, that's what I'm saying, that the ovaries age much faster than your chronological aging.
And this is something we must understand because today women are into careers.
Women are wanting to postpone their pregnancies.
They're getting married late. and therefore we need to understand that there
is a certain age in which your chances of getting pregnant are the best and

(04:06):
therefore today when young women are leaving jobs because they want to have
their families much earlier,
there are instances where the companies are offering them you know sort of the
facility to freeze their eggs so that they can have their pregnancies even at
a later age and they don't have to be pregnant.
So let's talk about that because often even though we might know that under

(04:28):
35 is ideal to become pregnant.
It may not just be feasible with your life, your career, your opportunities, your circumstance.
So we talk about freezing eggs and sometimes women hear that phrase, freezing my fertility.
So what does that mean and what type of options are available?
Oh, there are brilliant options today. As a matter of fact,

(04:49):
we would freeze eggs by stimulating the woman with injections so that many eggs
develop at a time in the ovaries when normally only one egg develops every month.
So we give them injections, get eggs ready, take her into the OT when the eggs
are sort of ready or mature, get them out, aspirate them out, and then freeze them.

(05:11):
That's what we do. She can use it whenever she wants those eggs.
When she's got a partner in life and she's keen to have a baby,
that's when those eggs get fertilized with the sperm, embryos are made, and put into her uterus.
So it works brilliantly, and that's what we've been doing quite a bit now, freezing the eggs.
And there are other methods also of freezing fertility. but this

(05:35):
is the so when we we talk about that
and we talk about the difference between freezing an egg versus freezing
an embryo there's a notion that freezing an egg
may not be as successful as freezing
an embryo so what are the success rates of pregnancy let's say first if a you
know a younger woman is coming in or in her mid-30s worried about her you know

(05:57):
ability to get pregnant and wants to freeze her eggs what's the likelihood that
when she comes back whenever she does come back that there will be success?
No. You know, in the past the freezing facility wasn't great.
It was slow freezing which didn't give good results.
But now when we do vitrification, we get excellent results.
There is no issue. We hardly lose any eggs, maybe a small percentage when we thaw them.

(06:21):
But yes, if you compare freezing eggs to freezing embryos, I think freezing
embryos do better because they are probably more sturdy because of the sperm being in it and if,
Pregnancy rates and the success rates are slightly better with the embryos as compared to the eggs.
Now, the question remains is if a woman hasn't found a partner in her life,

(06:44):
at least in India, most of the girls do get married by 30, 31, but career women don't.
And so they lose out on getting the right partner because those right partners are already married.
So then they're in a hurry because, oh, I need to get pregnant.
I need to find a partner. They may find the wrong person to get a baby with.
So therefore, those women who are the right women, when they come to me,

(07:07):
I tell them, you're 32, 33.
You're not dating anybody. By the time you date somebody, you're sure you want
to have a baby through them.
It may be another year, another two years. So this is the right time,
freeze your eggs, and then you can take your time in finding the right partner and then get started.
So generally then, the younger you are, the more likely you are to be successful

(07:30):
in the the number of successful egg retrievals?
Absolutely. The numbers are more, the quality is more.
As a woman ages, if you see the normal physiology, the normal physiology is
a woman is born with a certain bank of eggs and those eggs are released every
month once she reaches puberty.
And through her reproductive age, she may have approximately 400 menstrual cycles and may get pregnant.

(07:57):
But with every egg which grows, there are another 20 eggs which grow along with it.
But when that one egg grows further, those 20 eggs settle down or they get atrophic,
they are lost, and it's only that one egg which grows.
So these 20 are boosting that one egg to grow up and then self-sacrifice.

(08:17):
So every cycle, you're losing so many eggs, and therefore the best ones come out first.
What remains are the aging ones, which remain, and therefore the fertility definitely
reduces as the age advances.
So depending on what country you're in, for example, I'm in Canada,
the cost of freezing eggs can be quite extraordinary and very expensive it's

(08:41):
not necessarily covered by health plans by that are run by in canada provinces
or health plans that may be run in the united states so the costs can be quite
prohibitive in some countries.
Actually in our country too nowadays career women
are quite happy to freeze their eggs but i tell you i think that i when i was

(09:01):
the president of the society of assistive reproduction production I approached
the government and I told them you need to help women improve their fertility
and therefore WHO has counted infertility as a disease today.
I convinced and now they have convinced the insurance companies to cover fertility
and that has started in the last two years quite well and gradually you know

(09:26):
there will be instances where there are many
corporates who are helping to retain their good clients or their good workers,
not clients, good lady workers who are otherwise leaving, and they are offering
them the help to freeze their eggs.
Which is exciting news. So I think the notion for our women who are listening
about freezing my fertility is an age-related event, and that message has been clearly heard today.

(09:51):
Thank you so much for joining us today, Dr. Shah.
Thank you so much for having invited me. Thank you.