S1: Welcome in San Diego. It's Jade Hindman on this episode of KPBS Midday Edition. Freezing your Eggs what women should know before making the decision. This is KPBS Midday Edition. Connecting our communities through conversation. A few weeks ago , US Congresswoman Alexandria Ocasio-Cortez announced her decision to begin the process of freezing her eggs. Since then , she's been documenting her journey on social media.
S2: All right. It's 530 in the morning. Day 14 , egg retrieval day. And it's time to head out. I've got my bag packed , fuzzy slippers , cosmetics bag , hairbrush , water bottle , things like that.
S1: Her goal is to normalize conversations around fertility. Now , here in San Diego , Congresswoman Sarah Jacobs has also been public about her egg freezing journey. It inspired her to write legislation to reimburse military members for egg freezing. A pilot program launches later this month. But it's not just politicians. Year after year , more people are choosing to freeze their eggs. And they're starting the process younger , too. According to research out of UCLA. So on today's show , we wanted to have a conversation about the process , the cost , and how to decide if it's right for you. Joining me now is fertility expert doctor Irene Sue. She's a reproductive endocrinologist and professor at UC San Diego School of Medicine. She directs the reproductive survivorship program there. Doctor. Sue. Welcome to Midday Edition.
S3: Thank you so much for having me.
S1: So glad to have you here for this conversation. In the simplest terms , how would you describe the process of egg freezing?
S3: Yeah , the goal of egg freezing is to store eggs at the current age for use , possibly in the future. The biology is really pretty. The idea is that a reproductive age female would have two kinds of eggs in her ovaries. The first kind is just most of what we have. It's quiet. It's waiting in the wings. But every month , a small group will call it. A cohort starts to grow. Normally , our brain signals to our ovaries to grow , one of that cohort to ovulation to release. And then that hopefully , you know , is the baby that we have if we're trying to become pregnant that month. But all of the remaining members of that cohort , like the other ten , 15 eggs , they die off because they weren't needed. So in hopefully simple , relatively simple terms to beautiful biology , we can use medicines to have some of those other 10 to 15 eggs that otherwise we're going to be thrown away in that month. Grow through a small surgery procedure , remove the eggs and freeze them in the future so that , for example , a person who is 35 but who may be wanting to have her last kid when she is in her 40s , would have 35 year old eggs frozen for the future.
S1: Because if you wait to have the eggs frozen later , what what what risks , um , are presented?
S3: Yeah , that's a great question. So , um , we think a lot about fertility. We measure it by , you know , how likely is it to become pregnant , for example , by the end of the year? Infertility generally is defined as trying to become pregnant for a year with a male partner , or with sperm for a year and not becoming pregnant. And so that rate of infertility , it increases as we age. So in that same 35 year old person , by the end of the year , there's like an 85 to 90% chance that if she were , you know , sexually active with a male partner , that she would be pregnant by the end of the year. But at age 40 , that looks like maybe 40 , 50% of women by the end of a year. And there are many more miscarriages because so many starting pregnancies are not going to be chromosomal normal. And then by the age of 45 , the likelihood of fertility unassisted is super low. And so that's really the basis for if we think that family building is continuing into our , you know , early to mid 40s , it may be smart for some folks to consider egg freezing early because our fertility is so much lower later on in our 40s.
S1: So that said , who is this process right for? Who's a great candidate for it? Yeah.
S3: Yeah. Um , well , near and dear to my heart are populations of females who face medical treatments that would harm their fertility. Most obviously , some or many cancer patients or people who are going through gene therapy for sickle cell , for example. Those people have a really high risk of having all of the eggs wiped away by the same treatments , for example , to cure sickle cell. So that's a really obvious population that if that person may want the opportunity to have family using their biological eggs in the future , then that they would freeze the general population. I feel it's really one of shared decision making where with fertility specialists , a person could discuss , you know , what could family building look like in the future? And if I think that I'm going to have five kids and I'm 35 , it probably would be a good idea to freeze some eggs because I will be well into my 40s by the time I'm on my third , fourth , or fifth kid. The converse is that , um , sometimes we see really younger individuals or younger reproductive age individuals. For example , someone who is in her 20s and maybe already knows who she's going to build a family with , and they're going to try next year to have a baby , That person probably has really good fertility on her own , and it may not make sense to spend the extra effort of freezing eggs in their 20s. Mhm.
S1: Mhm. And you know the big question to with all of this is cost. So yeah. How expensive is the process of egg freezing.
S3: Ah it's a big it depends. So um some people will have insurance benefits that cover planned egg freezing. Planned egg freezing meaning that there's not a medically a medical threat for example , cancer treatment. So planned egg freezing. Some employers will opt to cover that. That's a minority. And of all of the state laws that mandate fertility preservation , currently , none of them cover planned egg freezing. And so out of pocket. Probably the range for the ultrasounds , bloodwork , surgery , egg freezing somewhere around 10 to $18,000. Women need medications to make the eggs grow and how much medications you need. Depends , in part on what that reserve that cohort looks like. And so anywhere from another , you know , 3 to 5000 on top of that. And that's that's really a lot. When eggs are out there frozen and then so there is a storage fee every year. And that generally runs in the hundreds of dollars per year. And then of course someday if they will use it , then there is a cost of buying the eggs , making embryos , and then using the embryos to help us grow families.
S1: How often do employers cover the cost of egg freezing?
S3: It's really all over the place. Um. Uh , I'll I'll give a shout out to our my health system , where our trainees actually have some coverage for planned fertility preservation , for example , um , our residents and and such. The most most don't. I think it's it's pretty rare. You'll hear it a lot with technology companies. Um , sort of large employers may choose to do that. And how people know is by looking at your insurance form or calling your human resources to say is planned. Egg freezing cupboard.
S1: Um , are there any legalities that complicate egg storage , um , right now that you'd like to address?
S3: Yeah , that's a great question. Um , certainly we're fortunate to live in California. Um , so there's no national law or actually for any state law that , um , currently has any implications that eggs are anything but cells , single cells. Um , and so there are no laws that really , um , challenge what individuals can do with the eggs that they store. Mhm.
S1: Mhm. Well let me ask you this as well because research also finds racial disparities in who gets access to fertility treatments like egg freezing. I mean , what barriers stand in the way of access.
S3: Um , so many. So I think it starts with , uh , kind of awareness. Right. So , so thank you for having , you know , folks like me on this , on this type of program. So first , you know , do we really understand the most people understand female fertility , male fertility , where the inflection points are. Did most people discuss kind of what future family building looks like , how many kids and when? So general knowledge about reproductive health. Then you come to point of care for , for for women , which is generally ob gyn. And so how often do ob gyn screen patients for their reproductive family building goals and then inappropriate ones , or refer to fertility specialists when appropriate. The third so that right. And then from OBGYN to fertility specialist. We are fortunate in California there's very few fertility deserts as opposed to the rest of the country. There are huge swaths where there are no fertility specialists , which is why telehealth is such an important tool now and then. Finally , if you see a fertility specialist. Yeah , I think IVF labs , they really matter. IVF , the labs are where we freeze eggs. The quality of the lab , the experience and the ability to give good data on how will these eggs do in the future when we saw them , those data need to be real transparent with the patients who are considering doing this. And then what you said that big elephant in the room is affordability. Um , and being able to finance and things like these , these are all barriers along the way. But fortunately , you know , we really are addressing each of these , um , Steps to try to scale , I guess , people's understanding so that that women can make informed decisions. Okay.
S1: Okay. And so this I mean , it is a process that is deeply entailed. I mean , walk us through the actual process because I know it is not just one appointment , as you've alluded to. I mean , what are people actually signing up for here? Yeah.
S3: Yeah. So , um , when you when you meet with a fertility specialist , they will measure ovarian reserve. And ovarian reserve is either ultrasound or bloodwork to see how many possible eggs we can get in a given cycle , the menstrual cycle. Then for the people who choose to undergo fertility preservation , um , there you'll hear them called protocols , basically , um , a plan to stimulate the ovaries to make multiple eggs , very parallel to how it takes us about two weeks to grow one egg from the beginning of a menstrual cycle until that egg is ready to ovulate. All we're doing is stopping at that. That , that that physiologic process. So , um. Whether it's after birth control pills , after some estrogen pills , or with the beginning of a menstrual cycle , um , a person who is trying to egg freeze will undergo over 10 to 12 days of daily injections. These are small needles. What it's delivering is FSH , LH , the same hormones that we make in our body to make grow one egg. If you give more of it , it will rescue some of those other eggs. Right. And so that usually is 1 or 2 additional injections usually at night. We teach people to give it to themselves or a family member to help give it. Not too bad. They feel like bee stings doing those 10 to 12 days of injections because we've got it addressed. Whether we're giving you the right amount of medicines , then there are blood draws. Mhm. Every other , you know , at least three , 4 or 5 times over those two weeks , as well as ultrasounds , largely through the vagina. Short ultrasounds. They feel much. It's never comfortable , but much more comfortable than , for example , speculum exam so that we can watch those eggs grow. At the end , there is going to be something called a trigger shot that makes those eggs get ready to be evicted from the their their follicles , getting ready to be ovulating and then under anesthesia. So deep sedation for about half an hour. There's a small surgery to remove those eggs. That surgery entails an ultrasound in the vagina with a small needle. And that allows us to put that small needle into each of these follicles , suck out the fluid , and hopefully a mature egg comes out. When women wake up , they largely feel pretty comfortable. Still pretty bloated. Um , and we know how many eggs that there are. And on that same day , or sometimes for some eggs that are not quite mature. Some labs will wait an additional day. The eggs are frozen , and then we really wrap up the cycle a week or two weeks later with the patient just to review , hey , what happened in the cycle? What is the fertility potential of what we have frozen? Um , so that there's a closing loop and an overview.
S1: Now , are there any long term side effects from from this? Yeah.
S3: Yeah. Um , actually , they're pretty good data. And I think a lot of that data comes from IVF. Um , where people are using the process of stimulating deliveries to get eggs in order to make embryos , to help them grow their families. So long term , we really the things that we worry about , we don't see we don't see higher risks of breast cancer , ovarian cancer. There is a type of a tumor on the ovary called borderline ovarian tumors. Pretty rare , but it's slightly increased in women who have undergone these types of fertility treatments. Um , I think one always is whatever we froze , it didn't result in the family that that person thought that it would. Right. And we have no visibility until we are ready to thaw the eggs and use them. Short term , I think. I think that's worth mentioning is that after the egg retrieval. Um , there's a condition called ovarian hyperstimulation , where if too many eggs were stimulated and retrieved , the shells of those eggs make a hormone that makes our blood vessels leaky. And so that can lead to fluid in the belly. Fluid and the lungs is short lived , but very uncomfortable and rarely once in a lifetime life threatening. And that's why we watch women so carefully during that stimulation process and use medications to decrease hyperstimulation risk.
S1: There is a lot to consider , and I'm so glad that we had this conversation. And thank you so much for taking the time. We'll have links to resources on our website at kpbs.org. I've been speaking with Doctor Irene Sue. She's a reproductive endocrinologist at UC San Diego School of Medicine , and she directs the reproductive survivorship program there. Doctor Sue , thank you so much again.
S3: Thank you for having me.
