Latest / The XX Lab / What Women Aren't Told About Freezing Their Eggs | Kristen V. Brown #26

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What Women Aren't Told About Freezing Their Eggs | Kristen V. Brown #26 · The XX Lab

• speaker-0: If you're a woman somewhere in your 20s or 30s, chances are you've gotten on your social media feed something about freezing your eggs. And most of us, you probably ask yourself whether or not this is a good idea. And the promise is incredibly appealing. The idea is you freeze your eggs now, you buy yourself some more time, and then you can give your future self more options. But how much security does egg freezing actually buy you? Today's guest is going to talk to us about this. Who is it? It's Kristen V. Brown, a journalist whose work has appeared in the New York Times, The Atlantic, and many other publications that you have likely read. Her reporting on the fertility industry became the Bloomberg audio series Misconception. And in the course of making it, Kristen ultimately decided to go through the process herself. Today we talked about what she learned during the process, both as a reporter and as a woman making this decision for herself. We get into what egg freezing can realistically offer. What women often aren't told before they begin, and why the decision is so much more complicated than simply freezing your fertility in time. We also talk about something I found particularly fascinating, and that is that reproductive technology has given women more choices than previous generations had. But at the same time, having more choices also means that we have more decisions to make. And oftentimes we're made these decisions with surprisingly little information about what the future holds. This is a conversation about what egg freezing can do, what it can't do, and what women should know before deciding whether this is the right decision for them. I can't wait for you to listen to this conversation with Kristen B. Brown. This is the XX Lab. I'm Dr. Sarah Hill. Let's get started. Kristen V. Brown, welcome to the XX Lab. speaker-1: Thank you for having me. speaker-0: I'm really excited to talk to you because I've been a long admirer of your work. You are a journalist, and your work has appeared in outlets like the New York Times and The Atlantic. your work has also been the basis of a four episode audio series that was held on Bloomberg's prognosis, and it was called Misconception. And in this series, you reported on your own intimate journey into the business of fertility. And I just wanna start by talking to you about what inspired you to start that series. speaker-1: Before the pandemic, I went through a really bad breakup. And you know, as I entered the pandemic, I was 33, suddenly single, getting a roommate for the first time in a decade, looking at my friends who were getting married, some were starting to have kids. I'm just like, here I am moving backwards. And of course, at this moment in my life. The fertility ads started to appear in my feed. This is, 2018, 2019, 2020. This was peak fertility ads, where if you were a woman of a certain age, you could not open social media without somebody trying to convince you you needed to freeze your eggs. And for me at this particular moment in time, I mean, it was a really tough message to hear, but also very Persuasive. I didn't know if I wanted kids, but I also hated the idea that I could miss out on this opportunity. And so I started digging into it, you know, personally, but also with the zeal of a reporter. I think if you're a healthcare reporter, you approach any question about your own health, like it might be the world's biggest story, right? And so as I started digging into it and really asking myself the question of is this worth it? What will I wind up with at the end? I just realized that these were actually really tough questions to answer, that there wasn't an easy, yes, you should go for it in this situation, you shouldn't in this situation. And then when I ultimately decided to do it, was actually which was actually after we already started making the podcast. Originally I just conceived of making a podcast that looked at this, you know, huge, massive growing fertility industry and how it was shifting. And then the course of doing this. what became formal reporting, I decided I would freeze eggs. And yeah. And and of course, once I started down that path, I thought it would only be fair to share my own story with the world. Since so many people always share their stories with me. speaker-0: One of the questions that everybody wants to know is the same question you were asking, and that is, is it worth it? Right. When it comes to freezing your eggs, it's obviously I'm not inexpensive. And a lot of people want to know do is this something that makes sense for me? And after spending all of the time that you spend reporting on it and then ultimately going through the process yourself, what do you believe the answer is? And is it going to be the same for everyone? speaker-1: Definitely not the same for everyone. It's such a complicated calculus, right? For me, I actually think the number one factor that led me to do it was when I looked into the finances of it. I found that my employer at the time, Bloomberg, they would foot most of the bill. It actually still wound up costing more than I thought it would. I thought it would be close to free, and nothing ever winds up free. I still wanted to pay a couple thousand dollars. But for me, yeah, the math was the biggest. thing like the the financial math, right? But there were things I didn't consider, right? I had kind of fallen for the messaging that it would be, you know, no big deal. I'm somebody who does pre-world pain. Needles don't bother me. I was like, you know, the finances are the hard part. But actually it was really hard on my body. And at the end of the cycle, I said to my now husband, you know, I don't care how many Eggs wiggle, I'm not doing this again because the math had changed for me. It was no longer just about the finances, it was also about the physical toll on my body. So I think that there's a lot of different things to consider, right? There's your finances, there's your stage in life. How old are you? I've recently seen on Instagram a lot of people talking about freezing eggs in their 40s, right? You might get a lot of eggs in your 40s, but it's very unlikely that they're gonna be high quality eggs. Doesn't mean you have a 0% shot of getting a kid out of those, right? But the odds get less and less as you get older. At the same time, if you do it when you're 20, you're actually gonna go need to go back and use those eggs? Also, probably not, right? So I think it's this really personal and complicated decision where everybody has to sit down and ask themselves, can I afford this? How much do I want kids? Where am I in my life now? Where is my egg quality at in life? Obviously, we don't really know what makes a quality egg, but we have some ways that we can kind of like begin to assess this question really poorly. And I think you just have to think about all these things. I should say one thing that maybe has changed the math for me retrospectively. So I'm actually currently pregnant with one of these embryos that was made from one of my eggs. But I also asked my question, did we wind up just using these embryos because they were there? Did I really need to go through the second half of IBF? So I think that it's just a really tough question to answer. And everybody has to take into account, you know, their pain tolerance, their finances, their relationship status, their life trajectory, and really evaluate what matters to you. And, you know, don't believe it's a walk in the park. No matter what what advertising you get because it's different for everyone, but I don't think anybody would describe it as a walk in the park. speaker-0: So when you're considering this for your own life and trying to make the decision about whether or not this makes sense for you, some of the things that a person might consider, as you noted, is the price tag. And then one of the things that you said is that the price was higher than what you were originally anticipating. And I'm wondering whether you can walk us through some of the costs that people don't really anticipate, because I think that Sometimes when women are being presented with a number about what this is going to cost them, it's the egg retrieval only. It's not necessarily the medication that's going to be required and it's not necessarily the storage. And so what are some of the the hidden areas of cost that women should be asking about as they're first just trying to fact find and understand what the actual costs are. speaker-1: Right. So first of all, it's different at different places, right? Some clinics do offer you a more transparent kind of package deal, right? And if you do have coverage, a lot will depend on, you know, how much is medication covered, these kinds of questions. So you really have to dig in to your individual policies and you know, call your benefit provider if you have these benefits and ask. And if you don't have the benefits, be very clear with a clinic, you know, have them outline like All of the potential costs, which include drugs, which include the cycle, which include storage. And storage is a big one, right? Because as I have found, so I wound up actually freezing embryos, not eggs, because halfway through the process of deciding to do eggs, the person I was with and I decided, you know, we were serious enough to freeze embryos, and they have a higher rate of success. So, what I was gonna say about storage is that costs. Can go up every year. And there's not really anything you could do about it, right? If the rent on your apartment goes up, you can move apartments, but it's harder to move your eggs, right? That's a big one to think about too. And for younger people considering freezing, how long are you gonna be freezing them? In the five years that my embryos have been in storage, the cost has gone up $300 a month, I think, right? Started a thousand and is now like $1,300. speaker-0: So it's thirteen hundred dollars thirteen hundred dollars a month. speaker-1: Yeah. This is New York City. sorry, a year. A year. A year. speaker-0: Okay, here I was like Yeah. I'm like that's more than rent on my first apartment. speaker-1: For no year. Sorry. Sorry. Yeah. So, but it's gone up by $300 annually in the five years since I've frozen. For me, the big surprise cost, because we froze embryos instead of eggs, was PGTA testing, which is when they look at the chromosomes of your embryo and try and assess whether they're normal or not, which can detect things like Down syndrome in an embryo, right? So you don't risk transferring an embryo. That you may wind up wanting to terminate later. I was 36 when I froze. And if you're over 35, clinicians generally recommend that you do it. There's some controversy there. But, anyways, I thought that it would be covered because I was old and it was not. And I fought that bill for a long time and eventually I I gave up. But that wound up taking the price tag from like a couple hundred dollars to a couple thousand dollars. So that was the big blind spot for us that I had just not thought about the PGTA testing at all. I just assumed it would be covered. speaker-0: And so you were saying that some women's insurance companies will cover this. so this is something that if like a woman is considering freezing her eggs and thinks that she's, you know, egg freezing curious and wants to go and talk to somebody about it, is the first phone call if she does have health insurance, maybe to call her health insurance provider and just look into it. Because I assume that I mean, I I would assume that most do not, but I, you know, I'm in the dark ages, because I had kids, seventeen years ago for my youngest. And so it's been a hot minute since I've considered maternal health benefits. speaker-1: Yeah, so it really depends on the fertility benefits offered by your healthcare provider. In my case, they didn't cover egg freezing per se, but they covered IVF. And because egg freezing is really just the first half of IVF, the codes were covered, right? When they put them into bill insurance. The codes for everything except actually physically freezing the egg were covered in the process, right? So it really depends on your insurance. There's lots of employers that offer standalone fertility benefits, like carrot is one, right? So you really just have to investigate what options you have. And some some states require fertility coverage. I think most of that doesn't extend to egg freezing at this point, but perhaps in the future it will. You know, I in France they they currently cover women freezing their eggs. there's just a study I haven't read it yet that came out that's trying to assess How that's working, right? So in some countries they they do offer some coverage, but here it mainly comes down to your fertility benefits from your employer. speaker-0: Right. So it's worth looking into find out about the storage facility and the cost for that. Because you were saying that yours has increased pretty dramatically f year over year. Do they offer any sort of promise with that? Like if you go to freeze your eggs, do do you is is it commonplace for them to offer you? Like this is the rate for the you know, first five years, like we guarantee that it won't change, or is there any conversation around that at all? speaker-1: sure there are some clinics to offer that I haven't I haven't come across that. speaker-0: One of the other things that you mentioned that you found to be surprising just in your own experience was how much harder it was on your body than what you were expecting. Because I think that a lot of women, when they're considering whether they want to do this or not, are mostly sticker shocked more than anything else, where they look at the price tag and that seems to be the biggest hurdle in because they see that as the biggest hurdle. I think that we oftentimes discount the impact that it might have on us physically, right? Thinking that, that's the easy part, right? Is just being able to have my body do this. I'm wondering if you'd be willing to share a little bit of your own experiences and that of of women that you talk to in in your years of reporting about the physical experiences of preparing to have eggs harvested and then having eggs harvested. speaker-1: Yeah, so it's funny. I just interviewed a woman who had a very similar experience to me. she works at a company that that almost fully covered it. So she decided I'd she'd do it anyways. Even though she actually thought she probably doesn't want kids, she was like, the benefits here. I might as well use it. And she told me that after having done it, she'd just done it, that she felt so naive that she just hadn't thought at all about what it physically entailed. And, you know, that. Cost, the cost to the female body. And, you know, when you think about what physiologically happens when you freeze eggs, right? You're taking these drugs. The drugs make you mature more than one egg at once, right? In a typical cycle, we have just one egg, right? That that makes it through the whole process. I mean, sometimes there's more than one, right? Twins, as you get older, it's more likely that you'll have multiples, but Typically you have one egg that matures each month. And then if you get pregnant, that egg becomes a fetus. If you don't get pregnant, you get your period, right? In freezing, they're trying to up your odds. So you take these hormone shots that mature as many eggs as possible, right? From the group that has been recruited to potentially mature. So that can be, you know, five eggs for one woman. It might be 20, 25, 30 eggs for another woman. But the ovaries are not meant to mature that many eggs at once, right? There's not room in there for them to get that big. So your ovaries swell to the size of very juicy lemons, right? With all these ripening eggs, right? Like your body is literally ripening. And that's uncomfortable because unlike, say, pregnancy, which is meant to accommodate, you know, your womb. expanding for a baby, your body is not meant to accommodate your ovaries swelling to the size of lemons. And for me, that was the worst part. You could just feel like I felt like there wasn't enough room in my body. Like if I wasn't standing up or laying flat down, I literally felt like I was a balloon that would pop. It just it just was like this this just feels wrong. It doesn't, you know, something is something is off because it's just not something that our body does naturally, right? And I think for me that was that was the worst part. A lot of people have very emotional reactions to the drugs. Some people go into ovarian hyperstimulation. I think I probably had a mild form of that. I got quite a lot of eggs for my age. And ovarian hyperstimulation, very rare to have very medically problematic version of it, but it does happen. You can lose your ovaries if if it goes that way. So it's not, there's no medical procedure that is zero risk and egg freezing is certainly a low risk medical procedure, but it is not a zero risk medical procedure. So in addition to just being physically uncomfortable for the, two weeks that you're doing the procedure, it has these risks of long-term consequences as well. speaker-0: So is one of the long term consequences of did you call it ovarian overstimulation? speaker-1: ovarian hyperstimulation syndrome. So that's basically yeah. So ovarian hyperstimulation syndrome is basically, your body responds too well to the drugs and makes a lot of eggs, which sounds great, right? You're going for as many eggs as possible, but there is such a thing as as too many eggs, and your body can have a hard time coming down from that. And in some women, it can lead to more long term problems, such as in very, very rare instances, even losing Europe. speaker-0: Got it. And so you said that the main time like the timeframe of discomfort, like the primary timeframe of discomfort is about two weeks. Is that right? speaker-1: It's about how long people are taking the drugs. For me, I feel like I was really uncomfortable for a week, which doesn't sound like a long time, right? in retrospect, I'm like, why was I such a baby about it? But when you're when you're living it, you're just like, God, why did I do this? speaker-0: Right. yeah, the idea of being able to like and I think you probably saw saw me like grimace. I could imagine myself feeling my ovaries and it would be so upsetting to me. Like the idea of just like feeling these heavy ovaries, like I I I feel like that would be like, like that's just too much, you know, like too much internal s sensation for me and and that it would be not pleasant. Not pleasant for me. It's not pleasant. Yeah. And so you have that. So you're going through that period where you're producing all these eggs, maturing all these egg follicles. And then after that you go in to have them harvested. And is that something that is done? Are you awake? Or do they put you partially to sleep? Like how does that work and what is the level of discomfort there? speaker-1: It really depends on the clinic whether they, put you under anesthesia or not. In my case, it's I I was under anesthesia. I didn't feel anything. I woke up and felt like I just had a really great nap. So I would say the procedure in my case was not strenuous, but you know, different women have different experiences and different responses to anesthesia, right? So I mean, again, this is a medical procedure. You're doing something to your body that it does not naturally do, and then you're getting a Outpatient surgical procedure. All of these things come with all sorts of risks attached. And then, you know, you add on to this the risk that for all of this effort, you might not have anything to show for it, right? You know, I think the best study to date said that it was just out of NYU found that about 40% of women who went back to use their eggs wound up getting, you know, a live birth out of it. Depending on who you are, that might sound like a lot, it might sound like a little. That number goes. Up the younger you are, down the older you are. But then you also consider that many women, most women, don't even go back to use your eggs. That was just among the women who actually went back to use them. Most people wind up not wanting or or needing them. So it's like you could go through all this pain and discomfort, not get any eggs that are viable, get eggs that are viable, and then when you go to fertilize them, wind up with no embryos that are viable. Or just never go to use them at all. In which case, again, this is why this is such a personal choice. Cause at the end of the day, would you regret that you did all that and didn't use them, or didn't get an embryo if you did go to use them? Or would you feel like you're just glad that you gave it your best shot? Right. So I think this is why it's such a personal decision, because I think that how somebody views that data, views those success rates. Is so different from individual to individual. speaker-0: Yeah. And when you look at like I I I did a little bit of research, poking around on different internet threads like Reddit and looking at see seeing what people are talking about when it comes to egg freezing. And it seems like a lot of it is a question of managing regrets and managing like the possible regret that you do all of this stuff to your body, you incur this large financial cost, and then ultimately you don't end up using the eggs, and then you just waste all this money and you and you created all of this. A physical stress on your body. and then of course there's the other regret, which is that you didn't do that. And now, you know, your reproductive years are beginning to eclipse and and it's looking a little bit less promising in terms of the outcomes for you, even if you freeze your eggs now. Right. And as you were doing research into this topic, was there any research on which of these types of regrets tends to happen more frequently than others? speaker-1: So there's not a lot of study of regret and egg freezing patients. I think the one good study I found found only 12% of women regretted it or something. And in my own reporting, even the women who didn't use them, most of them do say they were glad that that they did it. even if they wind up not wanting to use them, not needing to use them. But I would I would counter with something that I've been thinking a lot about, actually. You know. That the egg freezing technology even exists. It means that we all actually have to make a choice about whether or not to use it right. Fifteen years ago, if you were 30 years old and hadn't found the right partner or didn't feel in a good financial position to have kids, there was no choice to make, right? you just went on with your life and let it unfold. And maybe you winded up needing IBF later, maybe you adopted later, but there was no choice to make in that. Position. but nowadays the every woman has to opt in or out. Even if you don't do anything, that is a choice, right? So in some ways, these technologies have created this kind of burden of choice for women, where you have to, at a certain point in your life, think about whether you want to opt in or out of this and whether you'll regret it or not. And the mere availability of these technologies has created this situation, I think, in which people Start to feel almost like this is actually the only path to have a family. I have to do this so that I can later have a chance, you know, of having a family. But you know, people who struggled with fertility have built families in all kinds of ways since the beginning of time, right? back in the day, it would have been that your brother had 10 kids and didn't need all of them. So you just took one. You know, more recently, before the advent of IVF, adoption was really the only answer, right? Which isn't. Easy are, people who say adoption is easy, clearly have not looked into all the hoops you have to jump through for adoption. But I think that the existence of these technologies has created this false sense that if you don't do this, you will miss out on building a family. And I think that that is something that women should think about. How much does having genetic children matter matter to you? Right. That's that's also part of part of the math. And I think. That it's a disservice to women that we feel like if you don't do this, you can't have a family. speaker-0: Yeah, I think that in a lot of ways, the re all of our reproductive technology has created all these decisions that humans never had to be confronted with ever. And even like birth control, you know, because parenting used to be something that was a default if you like to have sex. If you were heterosexual and liked sex, there was never a question about whether or not you were going to be a parent for most humans, for most of history. It was just a the a byproduct of the fact that you were in a sexual relationship with a member of the opposite sex. And now parenting is opt-in and for the first time in history. And so I think that it's like it's something that I don't know that our brains are used to reasoning about. And I think that things like freezing your eggs, it it gives somebody something that they can do that can feel agentic, where it feels like you have some power over what happens next and you're allowing to take steps in that direction. But again, you know, it it does raise some of the questions that you ask, which is, you know, is is this necessary? speaker-1: choice is good, right? I'm glad we have these options. But I wonder whether women feel forced into making a choice. I mean, even and and the choices create sort of like a cascade of decisions, right? So my husband and I froze embryos. We were very lucky that with one cycle we got four Euploid embryos, right? So four that were chromosomally normal, which was good because I would not have done it again. And then last year when I was 39, I got pregnant right away. I had a miscarriage. And then as soon as there this miscarriage happened, I felt like I had another choice I had to make. Do I keep going with my old eggs or do I use these embryos and go through, the second half of the IVF process, right? So if we didn't have those embryos, we'd have just kept kept going. And you know, I probably would have. Gotten pregnant eventually, right? I can't really say that for sure, but that was just that's my witchy sense that I would have gotten pregnant eventually. But but all of a sudden I was faced with this choice. Do I spend more money? Do I put my body through more to give myself the best chance at the quickest path to chromosomally normal pregnancy, right? So it's like there's just these cascades of decisions once you opt into the assisted reproductive technology. space, which isn't necessarily bad, but it's definitely a bigger physical and emotional burden. speaker-0: And one of the things that you had mentioned that I want to to follow up on now is talking about embryo freezing and talking about IVF and the differences between embryo freezing, egg freezing, and then IVF. Because I think that sometimes people assume that you freeze your eggs and then it's you're kind of done. And can you speak a little bit about what all is involved? So you've gone and froze your eggs. Now what happens next if you wanna have that materialize into a baby? And what is the probability that that's going to end up successful? speaker-1: Right. Okay, so let me just start by saying eggs are really amazing, right? They're the biggest cell in the human body. I mean, they have the machinery that powers early development. They're just a really probably the most amazing self. Maybe this is a biased perspective, but eggs are amazing. But they're also really fragile, mostly because they have a ton of water in them. And think about when you freeze. things that have a lot of water in them, right? lettuce does not freeze well. So this makes eggs particularly vulnerable to the freezing and thawing process. Even with our new technology, such as the way we do it now is a process called vitrification. It's much better at preventing ice crystals from forming, which are what damage the egg when it freeze and thaws, right? So you they basically replace the water in the egg with this other, you know, liquid That makes them less vulnerable to issues when you freeze and thaw. But you are introducing another step to the process, right? So if you were to freeze an embryo, right, they're gonna take your eggs, they're gonna fertilize them right away, and then they're gonna take these, you know, multi-celled embryos that are just much more structurally sound, and they're gonna freeze those and then eventually thaw them, right? So you have this multi-celled thing that just fares better in the freezing and thawing process. With eggs, you freeze the egg, right? And then you eventually thaw it. There's some eggs that are inevitably lost in the thawing process because, you know, even with our fancy vitrification technology, we just like can't prevent all of the things that could destroy an egg in that process. And then you fertilize it, right? They might not all fertilize. Even the ones that fertilize then may not make it To, day five, which is usually the stage at which they would either transfer an embryo or freeze it again, right? So egg math is really depressing because there's all of these stages of development that are really, really complicated, right? It gives you a lot of respect for, you know, that that it ever works out because there are all these stages that really so many things have to go right in order for an egg. To become a baby, right? Because even after you get to a day five embryo, does it implant in the womb? If it implants, does it turn out to, you know, go through all the developmental stages? there's some lawsuits right now over PGTA technology, which is the technology that assesses chromosomal normality of an embryo, which is supposed to give you the best shot at having a normal baby, but It even that isn't a hundred percent, right? You can take this perfectly healthy looking normal embryo and transfer it to the womb. And it can have developmental issues still, right? So it's just like the math is really depressing, and there's nothing that we have figured out how to do yet. And I suspect there will not ever be anything we can do that can take away all of the chance of this very highly complicated. procedure that is human reproduction, right? We're just like not very efficient at reproduction as people. And so that is a big part of why egg freezing has the success rates it does. So there's just a lot of things that that have to go right. But the other thing I would say is that when you see the odds, right, they may not apply to you. You could be better or worse. Those are all averages. You know, in my case, we had 16 eggs, they became four Euploid embryos and the first embryo I transferred became, what is now a fetus growing inside of me. That defies the odds, especially at the age I was at. it was way better than I would have ever expected or hoped for. So it's also important to remember that as depressing as the odds are, their population level statistics, and as an individual, that might not really mean anything for your situation. speaker-0: Right. So I think that one of the things that people do want to do is obviously get the odds stacked in their favor. And there are some different things that do impact the odds of success. And one of those that you already talked about is age. And one of the questions that I often hear from women, like when women are in their 20s and early 30s, like they're wondering, is this too early? Sh is it too early for me to be thinking about freezing my eggs? And then you'll have women in their late 30s, early 40s who are asking. Is it too late for me to be freezing my eggs? And is there a sweet spot if they're considering having their eggs harvested and frozen, that they should consider doing that? speaker-1: This is such a personal question because when you're 22, you obviously have a way better shot of having more normal eggs than when you're 32. But when you're 22, you also have way less of an idea of what your life is gonna look like. You're probably less financially stable. You're also probably a decade or more out from using those eggs, which means a lot of years of paying storage with the rent going up every year, right? So I think that there is a balance, you know, no I I often hear from reproductive endocrinologists, the younger the better, but you should also consider whether you think you're in a position where you'll go back and and use them, right? So I think that it really again comes down to this individual decision. You should look at what you want your own life trajectory to look like. You know, if if you are 24 entering med school, that's different than a 24-year-old with a study boyfriend who she thinks she might marry in the next two or three years, right? Those people have have a different different calculus to assess their. speaker-0: Mm-hmm. And when considering the age thing, I've actually got some stats from that study out of NYU. And what they were finding is that the overall live birth rate from frozen eggs was about 39% resulted in live births. And that was overall. And that's similar to what you find if you do IVF with fresh eggs, so non-frozen eggs. But they found that the statistics were actually different depending on when women froze them and how many they froze. Right. And so they found that the numbers, even though they were 39% overall, were 51% for women who froze their eggs when they were younger than 38. Right. So that's a pretty significant increase. And then they found that they were 70% for those who froze when they were younger than 38% and froze 20 or more eggs. Right. And so that seems to suggest that age may be important, right? The number of eggs that you harvest seems to also be important. Does that seem consistent with? Your experiences both with yourself and your conversations with fertility doctors. speaker-1: But the truth is that people's reproductive systems mature at really different paces. consider menopause, right? Some people go into menopause in their early 40s, some people go into menopause when they're almost 60, right? And the aging of our reproductive system has the same kind of variation when you talk about what your egg quality is doing at any given time. So the reason you want more is because you want a better shot at quality eggs. So the older you are, The less chances of having quality eggs. So the more eggs you might want. But at the same time, not every 36-year-old is the same. So again, this is part of what's so frustrating of trying to assess the value, is we don't have good tools to say your egg quality is, you know, the egg quality of a 32-year-old. Yours is that of a thirty eight-year-old. We just don't know, right? We actually don't even really know what makes a quality egg. All of these things we have, age or your AMH level, it's a hormone that they measure to try and assess the quantity of follicles in your ovarian reserve, right? These are really bad proxies. And really at the end of the day, we have no idea whether you are gonna behave a thirty two year old if you're thirty-six or a forty two year old. And it's really frustrating, but that's that's part of what makes this all so so risky when you're trying to assess whether it's right for you or not. That it's it's just a gamble. speaker-0: For a minute about AMH, which is anti-malarian hormone. And the this level is oftentimes measured and is used as sort of an indicator of a person's egg quantity, right? And this is because it is correlated with egg quantity, but it's not perfectly predictive of it. And if you have a higher AMH, that's generally related to having a higher egg reserve. If it's lower, it's related to a lower egg reserve. But As you noted, it's not perfect. and in in the, you know, science world, we know that this isn't perfect. And there's a lot of discussion in research papers about how this isn't actually necessarily a good mark of natural fertility. Why does the industry keep using it the way that it does? And do you think that it's just because I mean it's essentially all just reading tea leaves where nobody actually really knows what what somebody's, you know, possible future fertility is and that we're just All grasping at straws, and it's the best thing that we've got. speaker-1: It's definitely the best thing we've got. It's really the only thing we've got at the current moment, right? And I wouldn't say that AMH is useless, right? If you are struggling with fertility, if you're struggling to get pregnant and your AMH is low, that can give us a clue as to why you're struggling to get pregnant, right? So I feel like AMH is best deployed as a diagnostic tool for people struggling with infertility. But I would also say that I'm hopeful that we'll have better. tools in the future. There are a lot of scientists who are really working right now to understand ovarian biology in depth. And we're starting to understand that egg quality isn't even the only factor, right? And that there's many things that contribute to egg quality. The stiffness of your ovaries, right? The fibroticness that can play a role in it. You know, is it's possible that even how stiff your ovaries are make it hard for the, the Egg to get out of there and be ovulated. The structure of the blood vessels, we're starting to really understand that so much in the ecosystem changes with age. And not just in the ovarian ecosystem. There was just a study out this year that kind of overturned the dogma that all that matters is egg quality because it found that there was a cutoff where for 49-year-old women, even using donor eggs for younger women, they had lower live birth rates, which suggests That there's something going on in the uterus too that plays a role in the success of pregnancy. So there's a lot of scientists who are right now are really, really working to understand the intricacies of ovarian biology, of uterine biology, and put together the pieces in a way that hopefully will one day give us better assessment tools, you know? But we're not there yet. All we have is AMH and it really just can't tell you very much, unfortunately. speaker-0: So I want you to imagine a listener is considering going in for a consult for egg freezing. And what are some questions, like maybe if there's like two or three questions that she should ask before she makes a decision about whether this is the place where she should be harvesting her eggs or whether she wants to be doing it at all? Well speaker-1: Before I even made an appointment at a clinic, I would go on over to the federal database that assesses, how successful clinics are. And I would look at a clinic success rate. And I would not only look at its overall success rate, but I would look at its success rate for people my age, right? So a clinic that takes on women over 40 might have a lower success rate than a clinic who'll only take on people, in their 20s and 30s, but that data is skewed by sort of like the difficulty of the problem they're tackling. So the first thing I would do is look at, you know, the federal database where you can see clinic success rates. And then I would pick one that seemed like it was doing a pretty good job for people in my particular situation. And then when I went in, I would ask them again about their success rate, you know, ask them how they're how they're doing it, ask them about their lab. I think a lot of people don't realize that the lab is actually the most important part of a lot of fertility procedures, right? it's not just how many eggs they get, but it's how do they manage to sort of like get them out of the follicular fluid. How good are they at freezing them? There's there's a lot that happens in the lab that you don't have insight into in a patient as a patient. So I would really, really ask questions about the lab, which you can also assess with help of that federal data. speaker-0: So with that federal database, can you tell people where they find that? Is that something that's found on the CDC website? Is it I think that there's a database on it's called the SART, the Society of Assisted Reproductive Technology. They have a database, I believe, that that is searchable. speaker-1: So the CDC has an assistive reproductive technology website. And if you go to that, if you just Google art success rates, CDC will take you to a website where you can click into a state and look at the success rates for every clinic in your state. Not every clinic reports to the CDC. I definitely would not go to a clinic that does not comply with the federal rules that they report. 'cause it's one of these things where they're supposed to report, but there's no consequences if you don't. The vast majority of clinics do report. So definitely would start with are they reporting to the federal government? And then look at how those success rates compare to some of their competitors. speaker-0: How should a person know whether or not a success rate is good? what would be a good success rate? Or is there a benchmarking that women should know about in terms of don't go somewhere unless they're producing at least X percent success rates with live births? speaker-1: No, I think you just have to compare it to other clinics in the area who are seeing people in your age range. I don't think that there's a benchmark. And and and and just keep in mind that the success rate is low. it will be low across the board for all of these fertility procedures. And the data at this point, you can't see people who are just doing egg freezing. It's not broken out like that. You can see people who are freezing. different kinds of things for later. You have just look at the overall picture of how they're doing with their fertility treatments. speaker-0: Another thing that you had recommended is that you ask questions about the lab. Are there specific questions that they need to be asking? Do they need to see the lab? is there some success metric that people need to be asking about with respect to the lab? speaker-1: I think the best way to assess the lab is really by looking at the success rates, right? But I would ask things like, is the lab on site? Where will my eggs be stored? Right. Some places don't have their own labs, right? So if it's not that clinic's lab, where where is it? Right. I don't think most places would let you see the lab. It's hard to even get a lab tour as a reporter, but it would be nice if they gave you lab tours. speaker-0: So is the question then about is the lab on site and then 'cause I would assume that it that that the ideal situation would be that the lab is on site, the freezing facility is on site, and so that way there's fewer opportunities for mistakes. Is that correct? speaker-1: Yeah, although a lot of places are are moving their their storage facilities off site at this point, especially if say you're a New York City clinic and you don't want to give up your Manhattan rent for for egg storage, especially as clinics get sort of like larger and larger banks of of this stuff. But but yeah, I mean like how secure is it? I mean, recall a couple of years ago that case in Alabama. That kicked off a personhood debate in the state where a hospital patient just wandered into a lab and somehow got access to the cryo storage and dropped someone's embryo. you want to make sure that there's good security for the lab. And then the other thing that I would actually ask is you've probably heard a lot of stories in the news about mix ups where people wind up giving birth to the wrong baby after they go through IBF. I would also ask about what kind of system they use to keep track of the embryos. How are they doing it? Is it is it an electronic system, which is the gold standard where there's a barcode on every embryo and you're scanning it every time you do something? So that's another good thing to ask about. speaker-0: And I wanna close by asking you a little bit about what your thoughts are on what's happening on, for example, social media. Right. So a woman is in her thirties or late twenties and all of a sudden the ads start coming in, right? About freezing your eggs and freezing your eggs and freezing your eggs. And do you think that all of this is exploiting women's deepest fears? Do you think that it is making them aware of a real risk? Do you think that it's a little bit of both? Like what the what do you think about what's happening culturally with respect to the conversation about egg freezing? speaker-1: Yeah, it's funny. So so in your 20s and 30s, you get the egg freezing ads. And then I just turned 40 and I started getting the hormone therapy ads. It's like it never, it never stops. It just goes from one thing to another. So what I would say is that it's amazing that we're at this point where we have these options that do allow us to not extend our fertility, right? Because it can't promise that, but but allow us to feel like we have a fallback. plan, a break the glass in case of emergencies situation that that could help you potentially if you have trouble starting a family down the line, right? It's amazing we have these options that generations before never had. And it's amazing that we're talking about these things and that women are now educated about them, right? I think it's incredible that the the average, you know, 30 something Has this familiarity with her reproductive biology. Because when I was 33, I think I had never once before about my biological clock in any meaningful way. I think it's great that women are educated. But I do think that you can very quickly go from education to fear-mongering, especially in a time and place where many of the companies that are Out there offering this stuff are companies, right? Private equity backed, venture capital backed. We should always be suspicious of people who are trying to sell us things on the internet, right? So I think that it's a little bit of both, right? We're at this moment where women have incredible choice, incredible opportunity, but that comes at a cost, which is being made to feel at every moment like. Your biological clock is about to just expire in the next 10 minutes and you better hurry up and do something about it. Right. And the truth is always somewhere in the middle. So I think that when you're trying to assess for yourself whether these technologies will be meaningful and useful to you, it's important to try and, you know, push all that out of your mind and really just think about what matters to you and your life. speaker-0: I think those are really great words to end on. Is there anything that we didn't talk about that you think is important for women to know as they're considering the thought of do I freeze my eggs, do I not freeze my eggs? the fertility conversation we have with ourselves? speaker-1: Yeah, I think that it's important to understand how little we know about female reproductive biology. It really is, mostly unknowns. There's, you know, we know some broad strokes things, right? Like that are that our eggs decrease in quality with age. But like we don't even know why that happens or why does it happen at a different pace for a different woman, right? So I think it's important to keep in mind that. When when you read about these things, when you think about doing them for yourself, it sounds like, we're in this kind of age of scientific wonder where science can stop time in the female body, but that's not where we're at. We're at a point where we barely understand the basics of the female body. And we have this really crude intervention that can sometimes help some women, right? And I'm optimistic that with the research that's happening right now, we will in the next 10, 15, 20 years know so much more about the female body and maybe develop interventions that are more foolproof. But at the current moment, we just really don't know a lot. speaker-0: Thank you so much for your time. I'm sure this was incredibly useful to everyone who's listening. And where can people find you and learn more about your work? speaker-1: My name is Kristen V. Brown and that's also my handle on all social media. So look me up. speaker-0: All right, awesome. Thanks so much. speaker-1: Thank you.