Latest / The Home of Fertility with Liz Walton & Helen Zee / Part 1- What Egg Freezing Estimators Measure And What They Miss - Fertility Specialist Insights

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Part 1- What Egg Freezing Estimators Measure And What They Miss - Fertility Specialist Insights · The Home of Fertility with Liz Walton & Helen Zee

• 0:02
  SPEAKER_01: Hello, everyone, and to our listeners.
• 0:05
  SPEAKER_01: It's a delight to share this episode with you today on understanding the myths around the egg freezing estimators and calculators.
• 0:15
  SPEAKER_01: And today I'm joined by Dr.
• 0:17
  SPEAKER_01: Sasha Edelstein, who is a fertility specialist at Thrive Fertility, situated at the Northern Private Hospital in Epping in Melbourne.
• 0:28
  SPEAKER_01: Thank you so much, Dr.
• 0:30
  SPEAKER_01: Sasha.
• 0:31
  SPEAKER_00: Helen, thank you for having me.
• 0:32
  SPEAKER_00: It's a great pleasure always to chat.
• 0:34
  SPEAKER_00: And it's an interesting conversation that you've got, interesting conversation topic that we've got this afternoon.
• 0:39
  SPEAKER_01: Oh, yeah, I'm I'm thrilled to get to dive in and discuss the frustrations that you get to see in your clinic space when patients are overwhelmed by the generic statistics that can be presented in front of them.
• 0:55
  SPEAKER_01: I'm going to preface that by talking about the egg-freezing calculator, an estimator that was funded by the federal government, and the research done by the University of New South Wales created this calculator, and it is based on population statistics.
• 1:15
  SPEAKER_01: And the tool was designed to help people understand their estimated egg-freezing success rates and the probability of IVS success based on aged infertility history.
• 1:29
  SPEAKER_01: And so when people do go in and put in their statistics and answer those seven or eight questions, it is based on age, the age of the sperm provider, if known, whether the person was previously pregnant, if they've had an infertility diagnosis, if they have endometriosis or some other medical conditions, and also whether they have had previous IVF treatment.
• 1:59
  SPEAKER_01: So these are the stats that go into the algorithm in a population-based statistic that then comes back to that person, which can talk about the success of uh their results in cumulative pregnancies, which we all uh and outcomes, which we'll talk about later.
• 2:22
  SPEAKER_01: And also the stats based on a first cycle, second cycle, and the like.
• 2:30
  SPEAKER_01: So, Dr.
• 2:31
  SPEAKER_01: Sasha, I want to hear from you.
• 2:33
  SPEAKER_01: We have had a rise in calculators, and we feel that there is a confusion between clinic-based calculators, which some clinics do around the whole world, um, as well as government, the government calculators.
• 2:50
  SPEAKER_01: Now, it's great that there is proactive awareness and understanding of your fertility health, but there is also confusion with the different calculators.
• 3:00
  SPEAKER_01: So I'd love to hear from you, and I know that our listeners will too.
• 3:05
  SPEAKER_00: So the University of New South Wales is the uh people that are overseeing all of the data for the Fertility Society of Australia and New Zealand.
• 3:13
  SPEAKER_00: So they will have a large database, and that's useful information that can give us an idea about success following fertility treatment, IVFXE, um, for both the female age and the male age and the underlying diagnosis.
• 3:28
  SPEAKER_00: So certainly at a population level, uh, that's the best data that we would have that is Australia specific.
• 3:35
  SPEAKER_00: Um I think, you know, uh uh every year all of the clinics in in Australia are required to submit their treatment cycle data anonymously.
• 3:44
  SPEAKER_00: Uh and that it can be help, that can help uh inform patients who are planning fertility treatment about what their what what their probabilities of achieving a pregnancy are or live birth are.
• 3:57
  SPEAKER_00: Um so the calculator is definitely a useful starting point.
• 4:01
  SPEAKER_00: Uh the problem is you can only put in so many variables, and and that can then give one an idea uh uh or um a ballpark figure, but it's by no means accurate or personalized to the individual.
• 4:15
  SPEAKER_00: Um certainly you can use that to begin the discussion, and then you would want more detailed, specific information relating to the patient.
• 4:26
  SPEAKER_01: Yeah, wonderful.
• 4:27
  SPEAKER_01: Thank you for that information.
• 4:29
  SPEAKER_01: That's wonderful.
• 4:30
  SPEAKER_01: It's a great segue to talk about what I refer to with my clients and what I do in my practice, and that's the bridging the fertility context gap.
• 4:41
  SPEAKER_01: And I look at it from a holistic lens, and it's wonderful that we're going to start taking a deeper dive from a fertility specialist perspective because people can then get a really good understanding from the fertility specialist perspective as well as other holistic factors in making sense of this data.
• 5:04
  SPEAKER_01: I'm gonna start by having uh letting you know about and and our listeners know about uh a client that called me, a potential client that called me.
• 5:16
  SPEAKER_01: It was about, it would have been a good eight months ago.
• 5:20
  SPEAKER_01: And they were bereft.
• 5:22
  SPEAKER_01: So when I did a um a uh foundational call with them, they were bereft that at the age of 46 they received a letter from the egg freezing bank.
• 5:36
  SPEAKER_01: They had totally forgotten that they had eggs in storage from 10 years ago.
• 5:42
  SPEAKER_01: And and I know that we're going to touch on this later, but this is where I also want to preface the fertility uh context gap because we can't just set and forget.
• 5:55
  SPEAKER_01: There's a whole heap of principles.
• 5:57
  SPEAKER_01: And one thing is the health of those gametes that get stored in time.
• 6:03
  SPEAKER_01: And I, you know, I say to people, it's like you're wanting to have a party and you're wanting to have lots of ice in the freezer.
• 6:13
  SPEAKER_01: And do you use the muddy water from outside?
• 6:16
  SPEAKER_01: Do you use tap water or do you use filtered water?
• 6:19
  SPEAKER_01: And we're gonna freeze those ice cubes, and they're the ice cubes that we want that we want to put in our drink, you know.
• 6:27
  SPEAKER_01: So, but what was happening with this particular client is she was single when she made that decision 36 years ago.
• 6:34
  SPEAKER_01: And 10 years ago.
• 6:36
  SPEAKER_01: Right.
• 6:37
  SPEAKER_01: And then 46 at 46, it's like I'm a dilemma, or I've got this precious cargo that that has been in storage.
• 6:47
  SPEAKER_01: I'm still single.
• 6:48
  SPEAKER_01: What do I do?
• 6:49
  SPEAKER_01: Right?
• 6:50
  SPEAKER_01: What do I do?
• 6:51
  SPEAKER_00: That's a real missed opportunity, unfortunately.
• 6:53
  SPEAKER_00: I was suggesting there's a there's a range of things that you would say that I would want to unpack.
• 6:57
  unknown: Yeah.
• 6:58
  SPEAKER_00: First of all, first of all, if we're doing egg freezing, uh, it shouldn't be uh, did you say set and forget?
• 7:04
  SPEAKER_00: You you you should update um and touch bases with the clinic, with the fertility specialist, or actually just you know with yourself about what what are your goals and intentions?
• 7:14
  SPEAKER_00: You know, why why what were you hoping to do?
• 7:16
  SPEAKER_00: And so one of the things that I'm concerned about is not your patient, but it's the 32-year-old who who who who thinks that because she's got eggs frozen, she doesn't need to consider uh uh a fertility, and then that can eclipse, uh potentials can eclipse if she doesn't come back.
• 7:34
  SPEAKER_00: Um your patient's difficulty is that um um she may now not want to try to achieve a pregnancy, uh she may not be in a situation, but if it were that she wanted to, once she's used her frozen eggs, there's no chance of going back and getting fresh eggs again that are gonna be able to compete with that.
• 7:56
  SPEAKER_00: So so so um the eggs will the eggs won't have changed.
• 8:00
  SPEAKER_00: Like I like I don't I don't want you to be the the the eggs are in a suspended state, uh their potential will be the same whether she whether she thores them after one year or after five years, or actually after ten years.
• 8:15
  SPEAKER_00: That that's not the problem.
• 8:16
  SPEAKER_00: The problem is that her own potential have shifted.
• 8:20
  SPEAKER_00: Yeah.
• 8:21
  SPEAKER_00: Um yeah.
• 8:22
  SPEAKER_00: Um but so it is actually, I mean, it's a strange situation because the you would think that the clinic is sending her a pill on a regular basis to freeze those eggs, and and and you would think that somebody would have notified her about these eggs in storage.
• 8:37
  SPEAKER_00: Yeah.
• 8:38
  SPEAKER_00: Um so that that's definitely been a missed opportunity to have a conversation and a discussion and to think about how she wanted to use those eggs.
• 8:46
  SPEAKER_01: Absolutely.
• 8:47
  SPEAKER_01: Let's tap into the fertility context gap and what you see, and let us have a look through a specialist lens with someone that has endometriosis.
• 9:00
  SPEAKER_00: Right?
• 9:00
  SPEAKER_00: You you you you raised that you raised that point in in discussion previously.
• 9:04
  SPEAKER_00: So essentially, I mean, and that endometriosis is a very common condition.
• 9:08
  SPEAKER_00: We're seeing that uh uh many women um are being diagnosed with the condition, but it has a varying severity and very varying impact.
• 9:17
  SPEAKER_00: So so uh endometeosis certainly can and does cause significant pain symptoms.
• 9:24
  SPEAKER_00: Uh, and the the actual um difficulty is that the pain symptoms don't necessarily correlate to the extent of of the of the pathology that the disease within the woman's pelvis.
• 9:35
  SPEAKER_00: Um so one can have uh so-called superficial peritoneal endometriosis that is causing significant pain that may not impact egg quality, egg reserve as much as an ovarian cyst.
• 9:47
  SPEAKER_00: So they're definitely just having a diagnosis is quite a broad range of severity.
• 9:54
  SPEAKER_00: Uh, so you'd want to have a more uh nuanced uh evaluation uh in the context of endometriosis in addition to the history.
• 10:02
  SPEAKER_00: Um, you're gonna look at uh ultrasound scan features, and you would certainly look at egg reserve markers and whether or not the ovaries are involved.
• 10:10
  SPEAKER_00: Um, because that will that will change the the outcome and the and and the the consequences.
• 10:19
  SPEAKER_01: Do you find that in your clinic and with your patients, people that present with endometriosis are wanting to freeze their eggs while undergo treatment or so the context where people are where people are thinking about freezing eggs is before surgery.
• 10:38
  SPEAKER_00: Um so that certainly would be would be a context.
• 10:41
  SPEAKER_00: I think that also women who have a diagnosis of endometriosis have a heightened concern about their reproductive potential and are looking to protect that.
• 10:49
  SPEAKER_00: I think that that's a that's a that's a that's a good idea, that's being proactive.
• 10:54
  SPEAKER_00: Um so we definitely see endometriosis as one of the reasons why a woman would be thinking about uh doing egg freezing.
• 11:01
  SPEAKER_00: And and you know, it in in addition to any underlying gynecological gynecological condition, there'll also be an age factor.
• 11:07
  SPEAKER_00: So we would certainly hope if a woman has endometriosis, um, if she were to consider her options earlier rather than later.
• 11:16
  SPEAKER_00: Um in the context of egg-freeze, age becomes a factor as well as we go when we go beyond the age of 35 and 37.
• 11:23
  SPEAKER_00: Um but but women that are planning surgery are frequently being referred to have uh egg freezing before surgery, if that surgery is going to involve an ovarian cyst.
• 11:36
  SPEAKER_00: Yeah.
• 11:36
  SPEAKER_00: Um uh if it's just superficial peritoneal endometriosis or a diagnostic laparoscopy, which many women would be undergoing, that's not a clear indication to be doing egg freezing.
• 11:46
  SPEAKER_00: Um on its own.
• 11:49
  SPEAKER_00: So so there's definitely a nuance, and it's not it's not uh uh like a basket that fits that fit all fits everything into it.
• 11:57
  SPEAKER_01: That's where the personalized care comes into it, which is why you know coming with that statistic as a is just a starting point.
• 12:06
  SPEAKER_01: And then there are diagnostics that need to take place to get an overall picture to be able to represent represent the patient holistically.
• 12:15
  SPEAKER_01: Yeah.
• 12:16
  SPEAKER_01: Um there is a myth on the quality versus the quantity and and this insurance policy of egg freezing is done and it's my insurance into uh my future.
• 12:29
  SPEAKER_01: Can we address the false reassurance that these calculators can sometimes create?
• 12:36
  SPEAKER_01: And what your philosophy is with your patients?
• 12:39
  SPEAKER_00: Okay, well, I don't like the word insurance.
• 12:41
  SPEAKER_00: I prefer to see it as an opportunity because it's it represents an opportunity, but it's by no means a guarantee.
• 12:47
  SPEAKER_00: It's not the same as an insurance policy.
• 12:50
  SPEAKER_00: Um uh and uh so certainly what we're doing when we do egg freezing is we is we're capturing eggs now for some time in the future.
• 13:00
  SPEAKER_00: So it represents an opportunity uh to hold your current reproductive potential if you're gonna come back at a later stage.
• 13:08
  SPEAKER_00: And unfortunately, we know that uh age is a factor.
• 13:10
  SPEAKER_00: So the 32-year-old woman's eggs will on uh on balance statistically have a better quality than the 37-year-old.
• 13:20
  SPEAKER_00: Um quality translates into the probability of the fertilized egg, the embryo, achieving a live birth, achieving a viable uh pregnancy and alive birth.
• 13:30
  SPEAKER_00: And and really how we see that is um when we're fertilizing the eggs, the fertilized egg, the embryo, um will differ in its ability to multiply, to progress, to divide, with the strongest differentiator being a woman's age.
• 13:46
  SPEAKER_00: So uh if we're in our reproductive prime um and we're storing those eggs, then they would have a better ability to achieve a live birth than when she comes back later.
• 13:58
  SPEAKER_00: But the fear that I have is the um forgetting about and not updating one's fertility goals and alignment with with you know with what's happening in one's life, and thinking that because one has eggs frozen, one doesn't have to worry about building a family, where in reality it's important to re-evaluate uh on a regular basis as things change and as one ages.
• 14:23
  SPEAKER_01: And also what physical health you're in, because you're gonna be marrying up your eggs to your physical body again.
• 14:32
  SPEAKER_01: And so what physical health are you in um at that time?
• 14:37
  SPEAKER_01: And if you are with your primary partner, I mean you've done all this work on you, would a woman may have even done a lot of um uh lifestyle factor changes to be able to get the best quality eggs.
• 14:51
  SPEAKER_01: Uh, but if the lifestyle is not maintained, then even when it comes at the time of, say, a male partner being used, you know, to fertilize those eggs, that could be a missed opportunity, right?
• 15:05
  SPEAKER_00: Yeah, so I mean the lifestyle will influence both egg quality and I guess her health in pregnancy.
• 15:10
  SPEAKER_00: So risk of miscarriage would be the would be the factors.
• 15:14
  SPEAKER_00: But her egg, her egg won't change in its quality.
• 15:17
  SPEAKER_00: The problem is if she's freezes at 32 and she comes back and she's 39, and the eggs that she froze when she's 32 don't achieve a pregnancy, she's now missed the opportunity that she would have had at 37 or 36 uh to try and conceive at that stage, and she's gonna deal with um her biological age and the reality, the realities of that.
• 15:39
  SPEAKER_00: Absolutely, lifestyle is important when we're thinking about pregnancy, about the health of pregnancy.
• 15:45
  SPEAKER_00: And many of the conditions that we see in reproductively older women are because we all have um increasing lifestyle-related issues as we as we're getting older.
• 15:56
  SPEAKER_00: Uh be that increased risk of of diabetes or hypertension in pregnancy, uh, we see that in reproductively older patients.
• 16:06
  SPEAKER_01: Yes.
• 16:06
  SPEAKER_01: Yes.
• 16:07
  SPEAKER_01: Thank you.
• 16:09
  SPEAKER_01: So let's move it on to a fuller picture of the cost associated if uh a person does come in and is interested in egg freezing, um, and the care that you and Thrive Fertility offer to a patient.
• 16:27
  SPEAKER_00: Well, I think that I think that an important thing when you're when you're speaking about the cost, uh, and perhaps that's not always um acknowledged, is there's the cost of the actual egg freeze, which is what's happening now currently.
• 16:38
  SPEAKER_00: Um, and then there are ongoing costs, and that's why I'm surprised that your that your patient wasn't aware of that.
• 16:44
  SPEAKER_00: But will be ongoing costs of storage, clinics are gonna are gonna charge a storage fee.
• 16:49
  SPEAKER_00: And then ultimately, uh, if um the woman is wanting to use her eggs, it's gonna need to go through a thaw.
• 16:54
  SPEAKER_00: So eggs frozen have to be uh have to be thawed, and then a fertility treatment to fertilize those eggs.
• 17:00
  SPEAKER_00: So the eggs can't just be combined with sperm.
• 17:04
  SPEAKER_00: We would then need to actually do a process where we call it XE injecting the sperm into the eggs to assist that fertilization.
• 17:11
  SPEAKER_00: So there would be the initial, the ongoing storage, and then the fertility treatment around utilizing those eggs.
• 17:20
  SPEAKER_00: Um and and I think that those are often hidden or not made transparent or upfront uh when women are thinking about these options.
• 17:30
  SPEAKER_01: Yeah, yeah.
• 17:32
  SPEAKER_01: And also the change in costs as time goes on.
• 17:36
  SPEAKER_01: Like, you know, you you are in in any field, like we've got uh inflation and there's an increase um in costs and other procedures and research that then gets uh that is available.
• 17:51
  SPEAKER_01: And so you know, people don't realize that they can do all this extra testing and it's gonna cost X amount of dollars and all the rest of it that that comes through.
• 18:01
  SPEAKER_01: You really do need to be front of mind in knowing that you have got eggs and this is part of your family planning and your reproductive story.
• 18:13
  SPEAKER_00: I I agree with you.
• 18:14
  SPEAKER_00: I agree with you.
• 18:15
  SPEAKER_00: So so certainly if you're going through the effort of freezing your eggs, that that is a proactive decision to take.
• 18:21
  SPEAKER_00: Uh, but it you it should then be that you continue to revisit your fertility goals uh um on a regular basis.
• 18:30
  SPEAKER_01: Yes.
• 18:30
  SPEAKER_01: Yeah, yeah.
• 18:31
  SPEAKER_01: And this is why I I wanted to mention um that potential client that came on with a foundation.
• 18:38
  SPEAKER_01: I mean, I just had to get all the history in one go with a dilemma.
• 18:42
  SPEAKER_01: She she literally was having a uh, you know, uh quite a strong response to her reproductive story not being played out in this lifetime.
• 18:55
  SPEAKER_01: And so, you know, without needing to go into why I didn't get the letters and where were you, moving from home to home.
• 19:04
  SPEAKER_01: But ultimately it is a re it can be a form of reproductive trauma when you have this notion of your story, and we speak about this in somatic therapy and reproductive trauma, in that we're we've have been conditioned from a young child in what our reproductive story is going to be.
• 19:26
  SPEAKER_01: It gets shape-shifted.
• 19:28
  SPEAKER_01: And then when the reality comes and we're later on in life, we're face to face with that, whether it's you know plays out like we thought it would, or whether we're taken through the gauntlet of a lot of um uh you know, heartache to get to get to that point.
• 19:44
  SPEAKER_01: Yeah.
• 19:45
  SPEAKER_00: I think the freezing is is a double-edged sword.
• 19:47
  SPEAKER_00: I think I think that it offers, I think it offers women autonomy control over their reproductive potential.
• 19:53
  SPEAKER_00: Sometimes it's placing an additional burden on women.
• 19:56
  SPEAKER_00: So it's like, oh, now you have to do this other thing.
• 19:58
  SPEAKER_00: So I think I have concerns about that as well.
• 20:01
  SPEAKER_00: Uh and and then there's a then there's a kind of an overarching concern, which it means, which is that it then takes the conversation of trying to build a family off the table because you've got the eggs frozen, so you can ignore it when actually there is still a biological uh uh clock ticking and a need.
• 20:18
  SPEAKER_00: And if you know building a family is important, it shouldn't be ignored uh uh um into the future forever.
• 20:26
  SPEAKER_01: Yeah, because I'm sure that we've both seen in our personal in our individual practices that uh women and women can go and uh do egg freezing as that opportunity, um, you know, not have a partner that could be one reason, uh thinking that they are uh they've got subfertility issues and diagnoses, and then there is a new partner that comes along, and there might just be a natural conception, and so that goes ahead, that goes ahead, and then that egg freezing just gets left behind, right?
• 21:05
  SPEAKER_01: There is a there is uh there's a lot of psychological nuances that that that do get to play out.
• 21:14
  SPEAKER_00: That's possibly not that's possibly a good outcome.
• 21:17
  SPEAKER_00: If they if they don't, if if she is able to achieve a pregnancy without utilizing the frozen eggs, yeah, so much the better.
• 21:22
  SPEAKER_00: There is a conversation uh in Australia at the moment about what to do with unused frozen eggs.
• 21:29
  SPEAKER_00: So certainly that that is uh an ethical discussion, that is a uh um I guess a societal um you know discussion about how how to utilize these eggs that are that are not how to best use them if they're not being utilized.
• 21:46
  SPEAKER_00: Yeah.
• 21:46
  SPEAKER_00: Um and there are some people that are even talking about the concept of uh donating unused uh eggs that were frozen for for couples who are unable to achieve a pregnancy.
• 21:58
  SPEAKER_00: Yeah.
• 21:58
  SPEAKER_00: And it's certainly something something.
• 22:00
  SPEAKER_00: uh that's a consideration obviously that has to be done when when that's deemed appropriate and with with you know the correct consent um i think i think a lot of the uh um issues that women who froze the eggs did not have that as their intention and so the difficulty is to change their intention or their expectations around the eggs yeah there's lots of little conversations that we can sprout off isn't there definitely correct are there any other last takeaways that we uh wish to explore and discuss around egg freezing estimators and calculators yeah I mean I think I mean I think that it's important that it's coming to the debate more more more often and more openly I mean like the the University of New South Wales calculator really just brings the discussion I think it's a useful tool and starting point um I'm happy to have that be a a lead that brings patient to have patients to have a more detailed thought and assessment i i don't want people to be doing unnecessary procedures i don't want people to feel that they have to do procedures investigations or surgery uh if it's not required but I think that you would want to be informed so you want to have a uh a realistic assessment about your own situation that is personalized and then make an informed decision about what's right for you and do that understanding what in this case egg freezing is offering and what it's not.
• 23:30
  SPEAKER_00: And in that context if a patient is well informed I I'm hoping that we can get the best outcomes.
• 23:36
  SPEAKER_00: I do believe that it does provide women with increased agency and autonomy and control over their reproductive potential which I think is important as long as it doesn't create an additional burden um you know that that's that's the balance that we're trying to find.
• 23:53
  SPEAKER_01: Beautiful and something that you would explore in that consultation with your patient.
• 24:00
  SPEAKER_00: Yes yes there are people that it's appropriate to be doing egg freezing people that it's that it's that it's not appropriate for various reasons uh and I would have an honest conversation with them about that.
• 24:12
  SPEAKER_01: Wonderful thank you so much for your time and presence and your wisdom doctor really appreciate it.
• 24:21
  SPEAKER_00: All good lovely chatting thank thank you Eleanor thank you for everything that you do thank you too