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She's So Lucky
The Truth About Your Biological Clock: Top Fertility Doctor Shares How to Take Action [BONUS]
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The following podcast is a Dear Media production.
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Welcome back to she's so Lucky. My name is Les. I'm your host, and today we have a special bonus episode. If you're watching this episode, the day it drops, it's a special Friday bonus for a very important conversation. So if you're familiar with this show, you know that we talk about the different ways that women create their own luck. We often talk about this from. From the perspective of business and career and mindset. But the reality is, for a lot of women, nothing is more impactful to your ability to create your own luck than motherhood. How you embark on it, when you embark on it, what your support system looks like once you embark on it. So I'm really excited to bring an important conversation about fertility and reproductive health to the show today. And I am joined by Dr. K.A. fisher, who is the medical director at Spring Fertility, based in New York City, which is today's partner for this episode. So please join me in welcoming Dr. Fisher.
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A
Hi. So happy to be here.
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B
I'm so happy to have you. We were having a good kiki before we started. We're just going to keep the good times going.
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Just keep it rolling. It's fine.
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B
Absolutely, Absolutely. So, as I mentioned, you know, I really feel like reproductive autonomy is such a big factor in women's ability to create their own luck. When we think about our health outcomes, when we think about financial outcomes and quality of life, it's so important. And so I think because motherhood is such a big, important topic, having our audience really understand what all of their options are as they embark on that area of life is so important. And I know that that's such a big part of the work that you do. So I'm really excited to talk more about it.
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A
Me, too. I think knowing things and really educating yourself on your fertility is critical. Truly making your own luck and being in control of that and having a lot of decisional autonomy. So I'm so happy to be here talking to your audience about this.
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B
Most definitely. So our audience, we have a good mix of Gen Z and Millennial. So most of our audience is between, I would say, the ages of like 25 to 40, which probably the perfect age to listen to this conversation.
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A
Yeah.
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If somebody is curious about what is happening from a reproductive standpoint, what do you recommend are the first steps that they take to have a better understanding of their reproductive health?
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Such an important question. And here's the most challenging thing about reproductive health is fertility is not something you can actually assess, which is Always like mind blowing problem with fertility is you don't know if you're going to have a struggle until you've actually tried. And most of our planners, we're trying to plot our life and like plot our luck. So, so the way to really get a sense of your reproductive health or fertility is to actually do something kind of annoying, which is you have to track your menstrual cycles. Your regular cycle is going to be the fifth vital sign. And so what every woman needs to conceive is just that doesn't have to be the same day every single month, but a cycle has to be between 21 days and 35 days. And the challenge for most women, especially in that demographic, is we have no idea we're on contraception. We have IUDs, we have birth and triples. We have no sense of this really important kind of vital sign. And so if any of your audience members are thinking about, hey, am I a good candidate for preservation? Do I have something to worry about? You know, what's happening here? It's actually kind of trying to take a contraceptive holiday, which I hate to recommend, especially in this day and age. But the only way to get a sense of your cycles is to see what's going on. And the challenges with birth control pills, A common misconception is that you're having a period and you're not, you're having a hormonal withdrawal. So so often women come to me and say, well, I have regular cycles. I'm like, you have no idea, you've been on pills forever. An IUD is a little bit different because actually with an iud, you cycle, you just can't tell, but I can. And so that's something that has to be removed to get a sense of like what your menstrual cycles are like. But birth control pills mask it. And so actually I would say first talk to a physician, talk to a fertility specialist or your regular gynecologist and say, I'm curious about this, what do you think? And doing that though is going to be really like the most predictive. Is there something to look into here? Because menstrual cycles are the key to fertility and key to true life, reproductive health.
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B
That makes a lot of sense. And when people are on hormonal birth control, how you said there's like a withdrawal bleed as opposed to a regular period. What is happening in your body when you are on a hormonal birth control? Is your reproduction just on hold? What's happening?
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Such a good question. I wish it was. There is nothing, with the exception of one medication that makes you menopausal, which people don't prescribe, a woman don't take, that's going to prevent your body from sort of releasing follicles, releasing eggs, and then with birth control is actually kind of wasting them. So take a step back. What is a menstrual cycle is really important. So all women should know that a menstrual cycle is solely set up to get pregnant. So there's no health benefit from having like a cyclical bleed. It's only important for fertility. So what happens in a spontaneous cycle off of all IUDs, all birth control pills is you bleed. And that's your brain basically saying, hey, we're not pregnant. I want another opportunity. Get rid of that stuff, I'm going to build you new stuff. Then for the next, typically, let's say 11 to 16 days, your focusing on one follicle, so it's growing one egg, even though many were released. And then ovulation is basically the popping or the release of that egg to give an opportunity for a pregnancy. And then two weeks later you get a period or you're pregnant. So that is critical to, like procreation. What birth control pills do is they thwart that. So birth control pills are a combination of the hormones that naturally go up and down in a cycle. And so every single day, hormonally is Groundhog day. So your body is not used to any shifts. Everything stays exactly the same. So that when you stop those pills, typically it's like three to five days. The withdrawal of that consistent hormone causes a uterus to shed a little bit of tissue and then you start it again. But there's actually no up and down of those hormones. And that's why when people do fertility treatments right off of birth control pills, it can actually be emotionally hard because all of a sudden these things that are causing mood changes are going up and down and you're not used to it. So a lot of women who come right off of pills and start cycles, with me, that's an emotionally challenging time. And we talk about that and we go through this is normal. That's what hormones are. But birth controls are just hormones every single day that are not bad for you at all. They are just sometimes masking your spontaneous cycles. And that's where it can be challenging.
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Yeah, that makes sense. It also makes sense that if someone goes directly into fertility treatment right after that, like, your body is going through a lot.
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Yes, it's like a roller coaster but it's not reason honestly not to do it, it's just you need to be counseled and kind of aware of what are you signing up for. Doing a cycle right off the pill is really advantageous because it allows you to control it. The timing of it is really at your discretion as opposed to your spontaneous cycles, who knows? So it's, it gives you a lot of power to stay on the pills, but it's case by case.
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B
And if somebody was on hormonal birth control and wanted to get off of it for a while to understand what's happening with their cycle, maybe they're interested in exploring fertility options in the future, but they're not quite ready. The second they come off of birth control, what is the amount of time that you recommend someone take to look at their cycles and what should they be looking for?
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A
I love this question because I feel like there's so much misinformation out there. So the first thing to know is birth control pills, I guess I should say any medication that you take every single day, the half life is short, so it wears off really quickly. So birth control pills, as soon as you stop them, your body should, what I call it, off to the races, it's ready to get pregnant. So there isn't this like long duration of washing out pills that I hear about all the time. When you stop the pill within 35 days, you should get a period, right. In a real, like for the first time in your life, teenage period will come back to you. And the goal is to just have one more of those to prove, hey, this is a consistent like period of time. This makes sense. I have a regular cycle, so I would just say two months should be sufficient. If you don't get your cycles in two months, forget what the Internet says, that's not normal.
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Right.
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Your body really should respond to the withdrawal or cessation of these hormones. You should talk to a gynecologist or fertility specialist kind of quickly because that's exactly what we're trying to assess is what's up, what's going on. So it should be as soon as you stop that pillow, then 35 days, full flow period, and then another one, and then I say, okay, we did it, but you don't have to come off of the pills before you do like an egg freezing or an embryo freezing cycle. That's a little bit of misinformation.
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Okay, got it. And then is being birth on birth control, if you're doing like an egg freezing or embryo cycle, is that advantageous or Just neutral.
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It should be neutral.
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Okay.
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What birth control pills can do is they can sometimes mask the number of follicles that we see on ultrasound. So it might be harder for me to set expectations, but when push comes to shove, the outcome will be the same. And so what I'll say is, listen, I don't know if it's going to be, let's say somewhere between 10 and 15 or between like, 12 and 17, if that's really impactful for you. Yeah, let's stop the pills and come back in a month and see what's going on. But most patients are comfortable with plus minus one to three, and so we just move forward. But it just depends on, like, who you are, like, what your risk tolerance level is. And a lot of women are super hesitant to come off pills. And I respect it. You've been on it for so long, you feel good on it. But I will say, sometimes you come off of it and they're like, oh, my God, I feel great. Is this what hormones are like? I love this. Which is fine. But then you have Remus condoms, which apparently is not so cool anymore. But you should use condoms.
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It needs to be everybody. It is always cool to be safe from pregnancy, STIs, all of the things.
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Couldn't agree with you more.
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Condoms are always cool. Lucky girls use condoms.
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Spring patients use condoms. You want to get pregnant?
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Yes. Yes. And for people who, let's say they were on hormonal birth control, they got off hormonal birth control, they're interested in seeing what's going on with their fertility. Maybe it takes a little while for their cycle to come back, or there is some sort of challenge there. What is usually causing that challenge? Is it something like PCOS or endometriosis, like those kind of common conditions or something else?
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It's a great question. So the most common cause of irregular cycles for women who are less than 35 is PCOS. But it's not the only cause. Right. And PCOS, the diagnostic criteria is actually pretty easy to meet. And so when you see someone like me, right, who I'm a fellow specialist, but I'm also a reproductive endocrinologist, which means I deal with hormones all the time. What I'm trying to glean is what's up with the cycles, right? What's their cadence? Are they coming too quickly? They're coming too far apart? And the evaluation that's going to help us understand what are variables that I can just tweak and say, hey, this is it. You're okay. Or I can't help you with this. I can't fix this problem per se, but we can work around it. So pcos definitely most common. But thyroid disease can cause cycle irregularities. Lots of travel, believe it or not, can cause cycles to be kind of erratic. Not for hormonal reasons, we're not quite sure. But if you travel all the time, patients always tell me, hey, my cycles are really weird. You can have some medical conditions that can cause your cycles to be irregular, some autoimmune diseases. So it's really, really vast. But the most common is PCOS when you're less than 35. Got it.
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And it might just be my algorithm, my for you page, because I, you know, previously was in the wellness space and get a lot of wellness content. It seems like a lot more people are talking about things like PCOS over the past few years than ever before. Is it because it's happening more or people are being properly diagnosed or one of those things that the Internet's gotten a hold of and people think they have, but maybe don't?
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I think, I hope, gosh, I hope the latter. I hope that people are getting more education and getting diagnosed. What used to be the case is one would go in in their early 20s and have irregular periods. And the fix was to be on birth control pills because it regulates your hormones, which by itself is not wrong. Right. For pcos, the first line treatment actually is a combined birth control pill. But what was missing there was like the deep dive into, yeah, but so a lot of women weren't educated on why they started the pills, if it was for acne or really heavy periods. And so that piece was missing. I think as we have gotten more knowledgeable thanks to the Internet, we've been better advocates. And so before we do that, we ask questions, which I think is wonderful. But I do think the Internet has taken hold of this in a way that a lot of people are self diagnosing. And so I spend a lot of time undoing that and saying, hey, yes, you have this one criteria but not the other ones and you actually don't have pcos. And why that's impactful is PCOS has other long term health sequelae that really, that's what we want to know about. A lot of women's health has been set back because we're not so great at like preventative care. And so the purpose of having this diagnosis at 21 is to say, hey, you're at increased risk of things like cardiovascular disease or diabetes and so be screened for this in A way that typically you're not. So a lot of the times I speak to women and say, yes, you have acne and you have hair loss, but you don't have the other stuff, so you don't actually have this diagnosis. And that's okay. Right. Because it means you don't have to do these tests, but you still have that. You still have acne and hair loss. And let's talk, let's talk about that and target that in particular. But I do think the wellness world in particular has kind of glommed onto PCOS because it's so easy to like say, oh yeah, that sounds just like me. And then once you click on that button, there's like 15 things you can take and do to help with whatever symptom we have like Googled. Yeah.
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And I think sometimes it can be hard where people maybe are under medical care where they feel like they're not getting answers or they're not getting heard. And I do think that's where a lot of turning to the Internet and self diagnosis comes from, where it's like, okay, I'm not getting answers and the help that I need, so let me try and like DIY it. And this sounds kind of right and I'm just going to go with it. And I know it springs something that you all focus on a lot is patient centered care. Can we talk about what that means and how people can advocate to have that?
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Yeah, I mean we also. The medical world is so hard right now because there's so much demand, so much patient volume and not fertility per se, but like across the board and, and there isn't that much time. So I have the luxury of spending an hour with a patient and getting to know them and really say like, what are your needs? What are your wants, what are your questions? Because I honestly just have the time with them. Like a lot of physicians, especially gynecologists who are primary care providers, they just, they wish they could, honestly. Right. Doctors wish they could. They just. In this sort of structure, it's really, really hard to. So it's spring. I just feel lucky, honestly, that I can really get to know somebody and go through what are things that have bothered you, what are questions you may have? How do I target those? How do I like unpack this? And if I can't do it, who can help you with it? Right. This is where let's start it and then like, let's head in this direction because most of the time my relationships with patients are pretty brief or I hope they Are right. I hope that you're coming to see me to help you get pregnant. You're pregnant in a couple of months. You're freezing your eggs. It's pretty quick, right? So typically I'm just like beginning these conversations, but for me, a lot of it is just having the time and seeing my patients. And so that's how our clinic is set up. It's really set up so that your provider is really your primary care provider. In the fertility world, you're mostly seeing that one person. And so every single time you show up, I kind of know what's going on so I can say, hey, any new questions, Any new symptoms? What's happening there? And that, I think is really, really helpful for patients to feel heard. And then they don't necessarily seek out the Internet so much, or if they do, they say, hey, do you think it's maybe this thing? I'm like, oh, it's a great thought. Let me look into it. Right. But you're never on your own with the Internet, which I think is important.
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Yeah, definitely. And it makes information so readily accessible and available.
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And honestly, I often tell my patients and ask them, if you find something that you think applies to or you're curious about, send it to me. Like, in the world of fertility, there's so much stuff out there and some of it is harmful and some of it is really beneficial. And so if I haven't thought about it, I love to hear it from patients and say, oh, interesting, let me run this down. And like, yes, do this, or hey, this is why you shouldn't do this. And I feel like a lot of the times when I explain things to patients really clearly, they get it, they're on board. Right. Everyone is gratefully, really, really educated and really invest in educating about their own health, which I think is wonderful. Yeah.
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And so important.
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So important. They're your best advocate.
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Absolutely. I would love to talk more about the egg freezing process because it's a very hot topic.
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I know it does feel like it's a really hot topic all of a sudden in the past, like four to five years, because it's coming up a lot.
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It is, yeah. I have a lot of friends who have gone through the process of freezing their eggs. I have some friends, and it's is a little bit different, but who have also conceived through IVF and heard more about their experiences. So I would love to talk a little bit more about that process. If people are not familiar with what the egg freezing process entails and who could benefit the most from it.
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A
So I guess we'll tackle the second part of that first, which is who can benefit the most. This really speaks to what you are doing by educating like your audience on this. Every woman can benefit from fertility preservation. The question is, what's the strategy for you? Right? How is it going to be helpful? And then ultimately like how many eggs do you need to freeze? But as long as you have a reproductive age, which depending on like your menstrual cycles can be up until like your mid-40s, thinking about this is really, really helpful. So first thing is everyone is a candidate should have a conversation, honestly, right? Even if you're like, I think I'm too old, that's just not true. Come in and talk to somebody and get a sense of like, what are your options? I think egg freezing, the biggest misconception is that it's like this forever process, right? Or and also that's kind of a guarantee, right? So it's important to understand what it can and cannot offer. First thing to know is that the number of eggs a woman has is set by her system. So the medications that we give are synthetic versions of the natural hormones. The natural hormones are typically limited, right? They're only secreted in amount, a quantity enough to grow one egg. So what we try to do is give enough of those medications to grow X number of E. But the number of eggs is set by each woman's physiology. And that's why we talk about trying to freeze your eggs at your youngest possible self because you have the most eggs available. Women are born with every egg we're ever going to have, which your audience probably knows, which I'm so proud that everyone knows. But each cycle what happens is your body releases whatever amount it thinks it can spare. And so what's truly happening is the system is calibrating and going, okay, what do we have at this point? And based on that, I think I can release 20 or, or 5 or 15. And typically those numbers are going to be associated with ages, but not always. So you can be younger, let's say 28, and have lower quantity. That doesn't mean egg freezing isn't beneficial. It just means you won't freeze as many eggs as maybe your age matched peer. But those eggs will take you further because their quality is better. So the first thing truly to know about egg freezing is the numbers are set by your body that can be evaluated at consultation with an ultrasound, which is the most predictive, and then a blood test. And then based on that convers, what's possible from one cycle. And will that number achieve your goals, whatever your goals are? Some women, it's just, I want to freeze some eggs. Whatever it is, I feel good. Others, it's a very specific ask. I want to freeze X number, so my chance for pregnancy is Y and I can have six children. It's a big ask, but we can talk about. I've had a lot of. I want to have four kids recently, which is shocking to me as a native New Yorker. I'm like, four kids, okay, that's a lot. It's a lot of kids, but we could do it. So egg freezing is just to know numbers are just that. And numbers have nothing to do with fertility. That's the other thing it's important to know. I find a lot of times women get really upset when I tell them that their numbers are low for their age. And then sometimes get like, really? They feel guilty. They blame themselves for lifestyle things that have nothing to do with it. And what everyone needs to know is numbers are just that. It has nothing at all to do with your ability to conceive in the future. Your ability to conceive is just, are your cycles regular? That is it. Whether you release 50 eggs or 5 eggs is irrelevant. You always have one opportunity. So don't be afraid of numbers.
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I actually think that that's really empowering because I think so many of the conversations around fertility are like, you're getting old, you're 35, it's over, everything's over. You ruined it. You, it's, you're out of time, you.
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Ruined it was always the sense of like, what you did, you ruined it.
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As somebody who's over 35, I'm like, oh, oh, no. Okay, I guess, I guess so. But it, it is, I don't know, just comforting to hear that there are options and that it's not necessarily a morality thing. It's just information that you get to decide what to do with.
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I think that's so important. I think the world of fertility is so challenging because so many women place so much of their self worth on their fertility. And I see this all the time when couples are struggling. And it's so challenging to like tease that apart and say, just because at this moment you can't conceive does not make you less valuable, right? To yourself or society or to your partner. And I think the narrative around that, the shame, I mean, of course, I think we all kind of know where it comes from, but I wish we could root that out. And rooting that out as just having More conversations like this. Right. And talking through, like, how can you potentially try to have a little bit of control over this to the extent that one can, and then also recognize that if things are hard, that doesn't make you bad.
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Right.
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It just, it just is. And sort of remove a lot of the emotional baggage that comes along with this. And I think having conversations early with the right person is really helpful.
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Right.
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And I've had a lot of people come to me and say, well, I saw so and so three years ago and they told me that this wasn't going to work. So I just didn't do anything. But now I'm rethinking, I'm kind of back to thinking, oh my God, what if three years ago the competition was different?
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Right.
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What if that person didn't scare you out of this? And it's not to say that like age and fertility aren't linked. They age absolutely are. I wish they weren't. Right. But it's also important to know that fertility is not necessarily a binary. You can be older and have success. It's just it might take us longer, it might be a more challenging road, but no one should be afraid of that. Right. It's just finding like the right partner through that journey. And I think that's really important.
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B
Most definitely, yeah. I've also seen some headlines recently. Around the age of first time moms in the US being higher than it's ever been. We have women in their 40s are now having children. More teen pregnancy is like almost eradicated, which is, I think, great news actually.
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Yeah.
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I'm curious from your perspective what you think some of the factors are that have contributed to those shifts.
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I think women are, I mean, I would imagine more focused on sort of career and self and not necessarily prioritizing family at a younger age. Right. It's always something we're considering but coming to it a little bit later and we see that certainly like in big cities where a lot of like a high percent women work, we see that. I also think a lot of women are using fertility services. And so the double edged sword here is not always that often when you're in your 40s, you've probably had some assistance, whether it's IVF or just like more minimal interventions. You've probably spoken to somebody about this and a lot of women don't talk about that. And so what happens then is we assume it's easy, easy. We assume we can get pregnant at 45 and don't necessarily have the conversations early enough. And so I Wish people were more forthcoming about their journey to parenthood, even if it was a spontaneous conception and really, quote, unquote easy for them. Great. That's a story that should be told too. But they should all be told. I think a lot of times we hold up, especially celebrities in particular, and say, well, look, so. And so did it. I can do it. Of course you can. But you should know that that was 17 rounds of IVF. Right. And I've treated no celebrities.
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Right.
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But I think that's really critical to be much more forthcoming about all journeys to get here. And I think women are delaying and I'm supportive of that because I do think you can only have your own luck if you have opportunities. And the hard thing about pregnancy is it's challenging and it's long and it sometimes doesn't. It's not so easy. And so you might have to be in the hospital, you might be really exhausted. You might not be able to like, take that last minute trip to like Taiwan.
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B
And.
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A
And so I think it's really critical that women, you can, you can try to have it all. You have to have the conversations just really early about it.
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B
And I think that there can be a lot of power too, in embarking on motherhood when you truly feel ready for it.
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Absolutely.
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Super important.
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Absolutely. And I think that to your point, can be at any age. Right. There's no like a judgment. It's more that if it doesn't feel like it's going to be in your early 30s, like own that that is okay. And truly, most fertility physicians and hopefully all, it's always a judgment free space. And I think oftentimes patients come to me and they're sort of apologizing for what they're saying. And I wish I could just remove that. Right. There should only be confidence and sort of pride in the decisions you're making. And then we just think through how do we achieve that goal. It's never like a question of like, oh, why is that your goal? I don't care. Right. No one should care. But understanding that there are some things that are harder, of course, as we get older, but truly most things are possible with a little bit of planning and support. And support. I think that's really critical too. Yeah. And honesty and knowing when, like it, it may be really hard. And so at what point do we say this may not be the path that we want to take? Do we want to talk about other options, other paths towards like building a family? And I have a talk a lot too, and that, that Isn't a failure if you have to use someone else's eggs to become the mother you've always wanted to be? That's okay.
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B
Yeah, I, I do actually really want to come back to that because I know especially a large portion of our audience is women of color. And I do think that there are fewer people kind of donating their eggs and fewer women of color having access to donor eggs to use. So I definitely want to talk to you about that a little bit later on. But I am curious, with egg freezing increasing in popularity over the past few years, do we have any data yet around success rate, around outcomes of if and when people freeze their eggs? How many people are then able to have pregnancies as a result of eggs that they've frozen? What does that look like?
- [25:01]
A
Yeah, I mean, so a little plug for spring, right? We have been really transparent about our egg freezing outcomes for a long time because a part of it is, that's, that's key, right? You want to know that if you freeze your eggs or when you freeze your eggs, what is the return on that investment going to be and what's realistic and what's not realistic? And I think back to like Kardashian years ago made this comment that she froze like eight eggs and didn't have a child from those eggs. And like, what a waste. And in my thought as a family doctor was like, well, you should have been counseled on that. Like, what were the chances of a pregnancy from fewer than 10 eggs at more than 35 years old? Right. It's not that it's a waste, it's that it's challenging. And so what are the true statistics there? So at spring, we have this all truly forecasted on our website. There's a clear, like egg freeze calculator that's based on our internal data and our outcomes. And we updated it about every six months. And so what women can do, and anyone can do it, no matter where you're freezing your eggs, you put in your age and then some number of eggs, whether it's the ones you actually have frozen or like aspirational numbers. And what it will produce is what's the probability of having a live birth from X number of eggs based on age. And what typically we'll see is there's unfortunately a pretty clear demarcation of women who are less than 36 and older than 36. And there's just a really big study that came out that sort of confirmed this, which is to say for thing reasons we don't quite understand There is really a change in quality as we get into our deeper 30s. And so again, doesn't mean it's impossible, but means you need more eggs. And so then you typically need more cycles. But the data is way better now than it was a decade plus ago because egg freezing one, we're doing so much more of it, but to the technology is better. And because there's so much more conversation around it and so much more utilization, people are coming back more frequently. And so like, their return to use your eggs very much depends on like the reason behind freezing them. Most people are coming back for their eggs because you're plotting right, you're saying, hey, I'm freezing eggs at 34 and I'm going to use them at 37 with my partner. And it's a very different way to like approach this. And so I think the numbers are out there and they're pretty strong. But we should know that to give yourself or to give oneself, let's say a probability of more than 90% of having a child and you're less than 35, that's freezing like 20 eggs, right? Or thereabouts at strong clinics. And when you're 36, 37, that's more like 30 eggs. And again, it's still not a guarantee, just a very strong probability. And so the hard part there is, well, we never know because there's no way to test egg quality. This is also really critical. There's no egg quality test. It is just, is the egg mature, as in, can it become an embryo in the future or is it immature? So can I freeze it or not? Kind of black and white. There's no way to know if that egg is going to become an embryo or a healthy embryo. And so that's where like age comes into it. If I'm wrong, if for whatever reason you're 34 and your egg quality is really poor, maybe because you've been a heavy smoker for a long time or a heavy drinker. I have no way to kind of forecast that. And so I say, I know you're 34 and the calculator says this, but what if I made your eggs 39? How would you feel about that outcome? So all the times, the hardest thing about egg freezing is that piece, which is the quality piece. So quantity is one. And you can usually overcome quality issues if you freeze enough quantity. But then you're talking about a lot of expense and a lot of time. But outcome data, at least for us, is really transparent. On our website, I think more clinics are heading towards this because someone's number one question, okay, well, what are these going to give for me in the future? And I think that's an important conversation to have with your doctor. And ask them that question, exactly what are your outcomes? What happens when I come back from in five years?
- [28:26]
B
That's really interesting that there's no way to test for, ignore quality. I didn't know that.
- [28:30]
A
No. And it's so sperm is different. Sperm is just biologically different. Men don't start producing sperm until they're at least 10, but typically 11 to 13 when they hit puberty. And then they reproduce sperm every three months. So they get a total do over. So let's say that you've been really heavy in your past, or smoke a lot of cigarettes, or drink a lot of alcohol. All of that can be washed away within a matter of three to six months. Sperm also looks abnormal, as in have like two tails, six heads when they have bad DNA. So we are able to select against the poor quality sperm in a way that we can't with eggs. I would say eggs are wily, they're perfect. They all are great. They're all pygmies. They want no one to exclude them. But that makes it really hard for us. And so all we can say is again, mature or not mature. And then based on age and then other risk factors, and the most impactful one beyond age is smoking. Smoking cigarettes and vaping. Unfortunately to you guys, we gotta put down the vapes. Lucky vapes. It's hot oil. It's not better. And I think, I think for a while we were hoping that it was, it's not. So any sort of smoking habit like that is really going to impact egg quality. And unfortunately it also doesn't go away. So if you're a heavy smoker in college, your eggs have seen all of that. And that's the other important piece. Egg quality is cumulative exposure. I have a lot of patients, probably a lot of your listeners, who say, okay, for three months I'm gonna go on a cleanse. And then after this cleanse, I'm gonna freeze my eggs. That three months cleanse is not helping your egg quality. It's delaying your time to getting your cycle over with. And I find whenever you delay things, sometimes they get delayed for a very long period of time. And there's no reason to be who I call like Polyperfect. Before you freeze your eggs, your eggs have been with you for a while. They've seen all your stuff, good and bad and changing who you are for A short period of time and kind of martyring yourself doesn't improve your outcome. And the key here is never to sacrifice to the point that already a struggle before we even start the process. And I hear and, like, see that all the time. Like, I'm not gonna have any more alcohol. Why have a glass of wine? Like, your eggs are okay.
- [30:27]
B
And in that example that you gave, like with Kourtney Kardashian where she froze eight eggs and, you know, none of.
- [30:33]
A
That, some number might not be able to number. Yes.
- [30:35]
B
Froze a certain number of eggs, or if anybody, you know, maybe freezes eggs and is unable to get a pregnancy from them. I'm curious if there is any information around why that is. Is it because, you know, the eggs don't survive? Like the. I don't want to say defrost.
- [30:53]
A
No thaw. And the thaw, the warning.
- [30:54]
B
Yes. These are technically, like you're taking meat out of the freezer.
- [30:57]
A
I feel like it's like, defrost, like.
- [30:58]
B
Frosty because they don't defrost. Or maybe there was some sort of quality issue or maybe like, chromosomal issue that we couldn't test for. Do we know why that is?
- [31:10]
A
Once you warm an egg, you get more information because it's that once that egg warms and you fertilize it with sperm and then you create the embryo, that's when you really get your intel, honestly. So first is like, how does it survive the thaw? The percentages should be in the low 90s. So it's not 100%, but most eggs, not all eggs, will survive. So if we find that we have a much lower rate than that, we already know something is up. Right. And much lower would be like, less than 50%. And we're talking about the why of that immediately. The next kind of benchmark is, okay, how many eggs fertilize with sperm, which means combined, on average, that should be about 80, 85%. That's both of a sperm and an egg issue. But that's another point. You're okay. Are we average? Above, below? How we doing? And then truly most critically is from that point of an early embryo, which is now egg and sperm together, to a final embryo, which takes about a week, what's our conversion rate? And that's where the age of the egg is really going to be impactful. So what we see is younger eggs have higher conversion rates. But I have to tell you, even a really high conversion rate, it's a low conversion rate. So when you're like, in your late 20s, it's going to be 55% at most on average. And so that means almost half of your eggs when you're in your 20s are not going to become embryos. So that's a piece that's always also mind blowing to people. When I say, okay, if you freeze your eggs at 34, I think about 35% of them become embryos. You're like 30. What? How? Just a lot of attrition. And that's why the numbers we talk about being so high at the start, because I'm assuming all of this loss along the way. So I'm assuming we're lose 20%. 20%, 20%. And so at the end of that, the key is have enough embryos to achieve your goals and enough healthy embryos. And so we don't know anything about the eggs until we warm them and then we find out a lot of stuff. But at that point, it could be a little bit more challenging because it's hate to say too late, but the sooner you find things out, the better. So if one freezes eggs at 31 and you come back to me at 43 and, and we don't deliver for you, we're in a much harder predicament. Which is why, at least for me, part of my consult is always, hey, when do you want to start your family? Right? Because if you tell me in a year, I'm way less concerned. You tell me in a decade, I'm like, okay. And decade means we have to really protect against the possibility that these eggs may not be what we think they are. So let's talk about that and be.
- [33:23]
B
Ready for those exercises.
- [33:24]
A
Be ready for that and at least know either we do the exercise now or you warm them earlier or we're just like prepared, right? It's, I think a big, big part of my job is expectation setting, right? As long as I can tell you the truth to the best that I know it and we can plan, we're good. It's. If I'm not honest or disingenuous, it gets really, really hard. So at least, I mean, everyone at spring is really trying to be very clear about outcomes, expectations, because also it's so emotional. And as we said, women tie so much of their self worth to this. And so what I try to do every day is pull that apart and go. Doesn't matter if you're under responding, you're still great. Your overheads are great too. They just need a little bit more time.
- [34:07]
B
Yeah, I think that that's really important too, because Some of the ways that I think egg freezing has been talked about is like, it's this guarantee or it's just this insurance policy of just like throw your eggs in the freezer and then you'll be good and you can just do whatever you want or have. And it's important to understand the different factors that go into it so that you can make the best decision for you with the information. So I think the fact that you are having those types of really honest conversations with patients and looking at it from every angle is really important.
- [34:35]
A
Yeah, I think so. And I also. Just because it's not a guarantee doesn't mean it doesn't have value. Right. It's still. Let's say you freeze five eggs at 33. Those five eggs are still incredibly useful. Yes, of course, you Wish it was 25. Right. But those five will serve you really well in the future. And I think that's important too, to say, like, if the numbers are lower, it doesn't mean it's futile to do this. And it's just understand if it's 5, the chance is maybe 60%. That's still better than 0%. And that's really the, like, angle that I, like, take all the time. Most definitely. Yeah.
- [35:07]
B
I would also love to talk a little bit about accessibility because I think that that's probably a big barrier for people who are interested in getting reproductive support, particularly around egg freezing, where there are a lot of unknowns of freezing these eggs. I don't necessarily know when I'm going to use them. I think that that's a very different thing than someone who's maybe going in for ivf, who is like, I want to start a family now and has a better idea of what that roadmap looks like. So can we talk a little bit more about the process, about the cost, about the difference between going through the process of egg retrieval, what it looks like to store them, like, what does that look like for people?
- [35:42]
A
So the first thing to know is that egg freezing and IVF or embryo freezing, from my perspective and a patient's perspective, are actually the same. The injections, the time, all of that is the same. The shift comes after the retrieval in the lab. So what's important to know is, unfortunately, right, cost is a huge barrier. Access is a huge problem. I think more companies are understanding that this is beneficial for them very candidly, and therefore, like, this helps us, so we will offer this benefit. I don't think it should ever be viewed as, like, a perk. I feel like it's a really necessary part of building like a career, especially as a young woman. And I think more companies are getting hip to this. Certain industries are more forward than others. But once that barrier is removed, it's a much easier conversation. Honestly, patients are much more like inclined to do this procedure at a time that's going to really benefit them. The challenge is a lot of young women in like your late 20s, early 30s. I didn't have a slush fund to put towards this. Right. So you have like difficult choices to make. A big part of like the other thing that I'm very proud of at spring is the idea that I don't ever want as efficient in general costs of healthcare to get in the way of good decision making. Right. I want everyone to be able to make the best choices they possibly can with information I'm providing sometimes that's trying to alleviate some of the financial burden. So for egg freezing we actually have a payment plan, has no interest attached to it and it's basically a deduction of around $250 a month every month for typically I think it's 36 to 40 months. And this allows women, I hope to have this be much more manageable bite sized pieces towards a goal as opposed to like one large lump sum at the start of a cycle. So if financing's something that's on people's mind, which it's almost people's mind, one, check with your HR team to see do you have benefits. It's a two week process of these injections and then from an egg freezing perspective, it's always a conversation around like what's possible for your physiology, how do we maximize it? And then each time that you're coming to the office and it's spring, it's you're seeing your physician, what's happening, what's going on, how are we going to try to optimize what are your questions? Right. What are expectations? But it's like 10 to 12 days of shots which no one loves but they're manageable. And then in terms of like restrictions on activities, usually by about a week is when women start to feel kind of full. It's not bloated, it's like heavy like Thanksgiving. It's like heavy. Too much pasta, pizza. And so that lasts for typically like five to six days. It kind of straddles the egg retrieval and the egg retrieval, which people don't take seriously enough for my liking, is a surgical procedure. It's minimally invasive, which is why I think people think it's like Not a big deal. It's done, at least in spring, and kind of our office space right next to our laboratory, and it takes us, like, 15, 20 minutes, but it's still something you have to recover from. You need to take that day and then typically, the next two days off.
- [38:33]
B
Okay, that's good to know. And then in terms of storage, what does that look like?
- [38:37]
A
Storage? So, again, it's spring. I can really only speak to spring. It's with us. And this is really key. You have worked really hard and paid a lot of money to create this material. And so for us, it's stored in house in our lab, which means humans are looking at it every day to make sure everything is well maintained. I think of storage is like paying rent. So, unfortunately, the little embryos and the rent's too damn high. Okay. But we keep your material with us, and we will bill you on an annual basis. And in New York City, on average, it's about $1,000 a year to store, like, eggs and embryos. And every year, you're gonna get a little bill from us saying, this is it. And how long eggs or embryos are stored for is immaterial. So whether you use them in 5 years or 15 years doesn't matter at all. My only strong piece of advice is don't discard your material until you're 100% certain that you're not going to use it. Right. I've had a couple of people decide, like, the storage is too much, which I totally understand, and then discard it and then find themselves needing my assistance in a couple of years. And that is really hard. So whenever I see someone trying to, like, offload storage, I call them, like, what's going on? Are we okay? What's happening? Just to make sure that I'm giving them the best counsel I possibly can about stuff.
- [39:49]
B
We are also in a very challenging time, at least here in the states, when it comes to our political climate.
- [39:56]
A
We all know we've been living it.
- [39:57]
B
The past couple years. I'm curious if, from your perspective, you foresee any of that impacting people's options when it comes to reproductive support in this way.
- [40:09]
A
I know I used to feel much more positive about this than I have of late. Cause I feel like things that I thought would never happen are happening. So hard to really answer this other than to say eggs are just like sperm. Right? They're, like, very, very, very early in this process. So I really feel like egg freezing. Having frozen eggs will be a safe space for a long time. Yeah.
- [40:33]
B
Do Eggs have rights.
- [40:34]
A
I don't think so. Okay. Not like, not legally yet.
- [40:37]
B
Okay.
- [40:37]
A
Because again, there's you. One could never make an argument that an egg has a right to life, because in that argument would apply to sperm. So that means every single time.
- [40:47]
B
Like.
- [40:47]
A
Like what? Like you can't ejaculate anymore. Like, that would. It just would never happen. Right. So that would be my equivalence there. Okay. Embryos are more complicated. Yeah. And what's always striking to me is a lot of my patients who are attorneys are not making embryos, which is fascinating. And I'm like, what do you know that I don't know? But I can see a world where we are told that we can't discard abnormal embryos. I don't see a world where someone's ever forced to have it transferred or carry a pregnancy they do not want. But I can understand conceptually a world where we're told we can't discard tissue. And that will get really expensive. Right. I'm hopeful that it wouldn't necessarily be worse than that. And so I joke, but I'm sure it's happening. There'll be like a fringe industry of like, low cost storage of these things, and it's fine. But I. I think now my counseling around embryos, it's not so much more conservative, but it's just thinking through all the angles. And I'm telling you, many, many, many, many more couples to have like, embryo prenups, because at least in the state of New York, embryos are property. And so it's really critical that we think through how we want to distribute that property in the event of like a divorce, relationship breakdown, and know that embryos are always shared. Fertility preservation and eggs are autonomous. And so I tell every couple that I see that they should do both.
- [42:05]
B
Right.
- [42:05]
A
And whether they list or not is a different story. But every couple, I say, this will really benefit you because it can be really. Female fertility is much more fragile and age based than male fertility. And so you just don't ever want to potentially sacrifice your future fertility in the name of, like, a partnership that may not serve you in the future.
- [42:23]
B
That makes a lot of sense. So much to think about. So interesting that embryos are considered property. I didn't know that. But I do think putting language around reproduction in prenups is so smart.
- [42:34]
A
So smart. And it's so. A lot of couples that I see are not legally married. And so we talk about this because then embryos aren't purgatory. Unless you tell me in advance how you want me to distribute them in the event that there's relationship breakdown. Unless you both agree they're just with me and that sucks. Right? So all couples, I say in a divorce you have to distribute properties so you're forced to say who gets what. Yeah, but in other relationships you are not. So we talk about that. And I am no attorney. We talk about that all the time. Like consult your legal team to figure out what's the right thing for you.
- [43:06]
B
So interesting.
- [43:07]
A
It's wild. I know.
- [43:08]
B
Dr. Keitha, thank you so much. I learned a ton from this conversation. If people are interested in learning more about their reproductive health in potentially coming into Spring Fertility, getting a consultation, what does that look like?
- [43:23]
A
We have a great team in New York so we actually have a Long island office and a Manhattan based office. We have a fantastic group of people. It's a small team but everyone is amazing. We have a website, just springfertility.com and you can email us at hello Spring also, but go to the website, peruse it. There's a lot of great information on there too as inclusive of an egg freeze calculator to just kind of play with. But that's how you can find us and me. And it's been such a pleasure talking to you. Thank you for the time.
- [43:48]
B
Yes, thank you so much for joining me. I hope you enjoyed this episode and learned as much as I did. I will make sure that we put Spring Fertility's information in the description so that you can check it out. And I believe they've also given us a code Lucky where you can get a discount on a consultation. If you are interested in learning more about your reproductive health. If you enjoyed this episode, please make sure that you're subscribed to she's so Lucky. Wherever you get your podcasts, leave us a five star rating and review. And if you're watching on YouTube, comment below and tell me one new thing that you learned from watching this episode. Thank you for tuning in and I'll see you next week. Thank you for tuning in to this week's episode of she's so Lucky. If you're ready to create your own luck, hit that subscribe button wherever you get your podcasts or on YouTube so you don't miss an episode and head to the show Notes for resources, links and discount codes. And if you are really feeling lucky, we would appreciate your rating and your review. It really helps us be able to improve the show to get great guests and to understand and what you want to hear more of. Thank you for tuning in and I'll see you next week. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.