Fertility preservation

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    Introduction to fertility preservation

    Fertility is a precious resource, limited to just a few years of your life. If you are delaying conception to allow time to develop a stable relationship, pursue an advanced education, or develop a business or career, consider the effects of age on your fertility.

    A woman is most fertile from about age 18 to 29. Over age 30, her fertility progressively declines, and this decline accelerates in her late 30s and early 40s. That’s why conceiving at these ages can be a real challenge for many women. In fact, spontaneous conception—without the help of assisted reproductive technology (ART)—is quite rare over age 43.

    Egg freezing, however, allows you to save some of your youthful fertility resources for later use. This risk-reduction strategy can increase your chances of conception by 5 to 10 times. Egg freezing is also an option for women undergoing treatment such as chemotherapy, which can also impact your fertility.

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    Eggs: A limited resource !

    Women are born with millions of eggs. For unknown reasons, most of these eggs die before they ever have a chance to mature and ovulate. About 1,000 eggs die for every egg that matures and is released.

    In reproductive-age women, about 5–25 eggs are present in each cycle. These “finalists” can respond to FSH and mature. As it turns out, however, humans have natural mechanisms that keep all but one of these finalists from growing, which means only one egg will be ovulated, except in the case of fraternal twins and triplets.

    Very few eggs remain at menopause, which occurs on average at age 51. Remaining eggs no longer respond to FSH. Menopause is the absolute end of the reproductive years. However, women typically lose the ability to conceive in their early 40s, about 5–10 years before ovulation and menstruation finally ends.

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    When should I freeze my eggs?

    When deciding the right age to freeze your eggs, it’s important to consider factors such as your relationship status and education and career plans along with the age-related decline in fertility rates.

    In general, the younger you are, the better the outcomes of egg freezing. Younger women produce higher numbers of better quality eggs that have a better chance of conception. Also, the longer you choose to delay family building, the more benefit you may gain from early egg freezing. On the other hand, a woman in her early 20s has more opportunities to conceive spontaneously, and may not need frozen eggs.

    In your 20s. A large number of high quality eggs are found in a woman’s mid-20s, so the best future outcomes result from eggs stored at this age. With the help of comprehensive chromosome screening (CCS), we know these eggs are highest quality because they have the greatest potential to produce healthy euploid embryos—those that contain a normal number of chromosomes. A 25-year-old doing in vitro fertilization produces an average of about 6 healthy euploid embryos per treatment cycle out of 12–18 eggs.

    In your 30s. The eggs of women in their early- to mid-30s produce progressively fewer euploid embryos. Between ages 30–35, women produce an average of 3 euploid embryos. Between ages 38–40, they produce 1 euploid embryo on average.

    In your 40s. At this age, less than one healthy euploid embryo is found per cycle.

    For women choosing to delay conception, there may be some benefit of egg freezing between ages 38 and 42. Although fewer healthy euploid embryos are expected in this age group and pregnancy rates are lower, a 38-year-old egg is likely to work better than an egg in you.

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    How do I prepare for egg freezing ?

    If you’ve decided to freeze your eggs, the first step in the process is a consultation with the physicians—who are all board certified in reproductive endocrinology and infertility (REI).

    Tests. To assess your reproductive potential, your physician will use fertility tests such as an antral follicle count (AFC) and a blood test for anti-Müllerian hormone (AMH). These tests help determine how many eggs remain (the ovarian reserve) in the ovaries’ small sacs (follicles).

    Done by vaginal ultrasound, the AFC will give you a good sense of how many eggs you will produce. The quality of those eggs is not measured by ultrasound; age is a better predictor of egg quality. An ultrasound wand allows the physician to create images of your ovaries from echoes of sounds. No X-rays are involved.

    Other appointments. Next, you will meet with clinical coordinators to discuss lab work, consent forms, medication and your treatment calendar.

    The clinical coordinator will provide you with clinical clearance to proceed with treatment. You will also meet with a financial coordinator to discuss pricing and the payment process. These appointments can be done in person or by phone.

    Women also have the option to meet with a Marriage and Family Therapist to discuss the risks and benefits of the egg freezing process.

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    What is the process ?

    Fertility medications. The first step in the egg-freezing process is to generate multiple eggs for retrieval. Your physician will prescribe fertility medications to stimulate follicle growth and produce multiple eggs. Using a very fine needle, you inject these medications just beneath the skin. Our staff offer on-site injection classes and will counsel and instruct you throughout the entire process. This phase of treatment lasts about 10 days.

    Ultrasound monitoring and lab tests. The doctor will monitor you on a regular basis to assess follicle growth and the number of eggs being produced. When follicles are mature and ready for retrieval, you stop taking the fertility medication, and take an ovulation trigger, a hormone that brings on the final phase of egg maturation. Egg retrieval is scheduled 36 hours after the trigger. We remove the eggs from the ovaries with a fine needle 4 hours before the predicted time of ovulation, which would naturally occur about 40 hours after the hCG shot.

    Egg retrieval procedure.During this painless and relatively brief procedure, your doctor uses ultrasound guidance to gently retrieve eggs from the ovarian follicles. You will be under sedation and in the care of an anesthesiologist throughout the procedure. We perform the retrieval in our clinic. It takes about 10-15 minutes. After the retrieval, we ask you to take it easy the rest of the day. We also require someone drive you home after the retrieval as you are not able to drive yourself due to the sedation medication. You may resume normal activity the following day.

    Egg preservation. We preserve the retrieved eggs through a rapid freezing process called vitrification. Eggs remain frozen until you need them.

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    What is the cost to freeze my eggs ?

    We uses the most advanced technology for egg freezing. Our pricing is as follows:

    • Monitoring, egg retrieval, egg treatment/laboratory costs, and egg freezing cost $7,745.
    • Medication costs range from about $2,000 to $4,500, depending upon protocol and dose. You pay the pharmacy directly for these medications.
    • Annual storage of eggs costs $600 per year.
      Pre-cycle screening is not included in above estimate.

    Where are eggs stored?
    At the time of this writing in 2017, eggs are stored in cryopreservation facilities. Storage facilities outside San Francisco are available, and we may elect to move eggs to an outside facility at some point in the future.

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    Is it safe and reliable ?

    The technology of egg freezing works! As of mid-2017, Pacific Fertility Center has over 100 births from frozen eggs. Most of these births are from donor eggs retrieved from women under age 30, while the others are older patients’ own eggs. Many of those freezing their own eggs are over age 30, and haven’t used their eggs yet. Therefore, reported outcome data in the older age group will not be available for several years.

    the egg recovery rate after vitrification and later thawing is 83 percent, and fertilization rate is 84 percent. The births from eggs retrieved from women under age 30 achieved a clinical pregnancy rate (ultrasound with gestational sac at 7-9 weeks gestation) of 53 percent.

    Similar work in Italy shows that for each batch of 6 eggs, 2 to 3 transferrable embryos are obtained. Pregnancy rates are inversely proportional to age, declining as egg age increases. For an egg source under age 38, pregnancy rates are approximately 30 percent per transfer.

    Please Note: A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.

Gynécologue à Genève, spécialiste en médecine de la reproduction