Latest / The Home of Fertility with Liz Walton & Helen Zee / Egg Freezing And Fertility Preservation Explained Clearly With Dr Kaushi from City Fertility

Transcript

Egg Freezing And Fertility Preservation Explained Clearly With Dr Kaushi from City Fertility · The Home of Fertility with Liz Walton & Helen Zee

• 0:05
  SPEAKER_02: Welcome back to the Home of Fertility.
• 0:09
  SPEAKER_02: Today's episode is part of the City Fertility Education Series.
• 0:15
  SPEAKER_02: The Home of Fertility.
• 0:17
  SPEAKER_02: And this is created in partnership with City Fertility.
• 0:21
  SPEAKER_02: Together, we are bringing you a series of conversations designed to answer some of the biggest questions people have about their fertility, like IVS, family building, and of course reproductive health.
• 0:35
  SPEAKER_02: So whether you are beginning to explore your options, whether you're already navigating fertility treatment, our hope is that these conversations leave you feeling more informed, more empowered, and knowing you are not alone.
• 0:53
  SPEAKER_02: So now, let's welcome today.
• 1:01
  SPEAKER_01: Hello, all you beautiful beings out there.
• 1:04
  SPEAKER_01: Good morning, good afternoon, good evening, wherever you are in the world.
• 1:08
  SPEAKER_02: It's a beautiful welcome to you to this space, the home of fertility, with Liz Walton.
• 1:14
  SPEAKER_02: And today, again, I get to speak to another amazing, beautiful person.
• 1:20
  SPEAKER_02: And today we're talking with Dr.
• 1:22
  SPEAKER_02: Caushi.
• 1:24
  SPEAKER_02: Welcome, Dr.
• 1:25
  SPEAKER_02: Caushi.
• 1:25
  SPEAKER_02: How are you today?
• 1:27
  SPEAKER_03: I'm well.
• 1:27
  SPEAKER_03: Thank you, Liz, for having me.
• 1:29
  SPEAKER_02: Very excited to be on this podcast today.
• 1:31
  SPEAKER_02: You have two kinds, you're two kinds.
• 1:33
  SPEAKER_02: I think I'm the one that's excited.
• 1:35
  SPEAKER_02: So I love it when I get to speak to doctors because their knowledge is obviously far beyond mine.
• 1:39
  SPEAKER_02: And I learn so much by asking all of these great questions.
• 1:44
  SPEAKER_02: And today we're going to talk about egg freezing and fertility and preservation.
• 1:52
  SPEAKER_02: So it's going to be an absolutely awesome topic.
• 1:55
  SPEAKER_02: But first of all, who is this amazing lady called Dr.
• 1:59
  SPEAKER_02: Kauchi?
• 2:00
  SPEAKER_02: Well, let me share her bio.
• 2:02
  SPEAKER_02: So, known as attentive and caring, which I already get from just chatting to you through the screen, that loveliness that you just sort of purvade there.
• 2:11
  SPEAKER_02: Dr.
• 2:12
  SPEAKER_02: Caushi provides a really individualized and holistic approach.
• 2:17
  SPEAKER_02: Holistic approach, sorry, getting overexcited, to patient care to help you achieve your fertility goals.
• 2:24
  SPEAKER_02: Her passion for helping patients achieving their dreams of parenthood is reflected with her exceptional patient care.
• 2:31
  SPEAKER_02: Dr.
• 2:32
  SPEAKER_02: Caushi graduated with a Bachelor of Medicine degree from the University of Southampton in UK, oh, awesome, Southampton, not far from where I'm originally from.
• 2:41
  SPEAKER_02: And after many years of further study and practice, she became a fellowship of the Royal Australian New Zealand College of Obstetrics and Gynecologists.
• 2:51
  SPEAKER_02: Well done.
• 2:53
  SPEAKER_02: During this time, she also undertook a Master's of Reproductive Medicine at the University of New South Wales.
• 2:59
  SPEAKER_02: Dr.
• 3:00
  SPEAKER_02: Cowshi has undertaken an additional three years of sub-speciality training and is currently completing her certificate in reproductive endocrinology and infertility.
• 3:12
  SPEAKER_02: Wow, that sounds amazing.
• 3:15
  SPEAKER_02: Actually completed, Liz.
• 3:16
  SPEAKER_02: Yeah, this is an old bio.
• 3:20
  SPEAKER_02: We need to tell people.
• 3:25
  SPEAKER_02: This is the highest recognised qualification for fertility specialists in Australia and New Zealand.
• 3:31
  SPEAKER_02: So uh just many, many congratulations and well done, you.
• 3:36
  SPEAKER_02: Dr.
• 3:36
  SPEAKER_02: Cow, she is the strongest advocate for research and education.
• 3:40
  SPEAKER_02: She has authored several publications and is a conjoint lecturer at the University of New South Wales.
• 3:47
  SPEAKER_02: With a keen understanding of the challenges and choices individuals and couples face, she provides a safe and supportive environment where patients can make informed decisions about their fertility journey.
• 4:00
  SPEAKER_02: Her approach is grounded in open communication and collaboration, ensuring that her patients are active participants in their care to ensure their choices and that they are aligned with their goals.
• 4:14
  SPEAKER_02: Well, I love that.
• 4:15
  SPEAKER_02: So a lady speaking my own language, because it, you know, it is really good to get that um doctor and that really you know hears you and sees you.
• 4:27
  SPEAKER_02: So I love hearing that.
• 4:28
  SPEAKER_02: So thank you so much.
• 4:32
  SPEAKER_02: So let's get on to our wonderful topic of egg freezing.
• 4:35
  SPEAKER_02: And look, egg freezing, it's huge.
• 4:38
  SPEAKER_02: You hear about it everywhere, and you know, there's always that topic, when to freeze my eggs, when should I?
• 4:44
  SPEAKER_02: And it's it's a it's an increasingly popular opinion and topic for individuals who are wanting to preserve their fertility.
• 4:52
  SPEAKER_02: I wish I'd known when I was trying, because I didn't realize about it then.
• 4:58
  SPEAKER_02: So whether it's driven by medical needs, personal circumstances, fertility um preservations offers more choices for family planning and for future family planning.
• 5:08
  SPEAKER_02: So, what we're going to chat about in this episode is explore how egg freezing works, um, who may benefit from it, and the realistic expectations and what they look like, the factors that people should consider when deciding whether fertility preservation is right for them.
• 5:24
  SPEAKER_02: So, what is, let's start with what is egg freezing, and then why are most people exploring fertility preservation today?
• 5:35
  SPEAKER_03: So, good question, Liz.
• 5:37
  SPEAKER_03: I mean, simply put, egg freezing is sort of a woman's way of going.
• 5:42
  SPEAKER_03: I'm just going to pause my biological clock to freeze my eggs in its current age and quality.
• 5:50
  SPEAKER_03: And I think that's really important.
• 5:52
  SPEAKER_03: Um and so what people don't realize through the process of egg freezing is that it is an IDF cycle at the end of the day.
• 6:00
  SPEAKER_03: Um, it's um still involves injections, it's still evolved a lot.
• 6:05
  SPEAKER_03: We try to simplify it, but it's still a 10 to 12 day process where we can stimulate the ovaries, grow as many eggs as we can, and then um you have to have a surgical procedure under an anesthetic to treat those eggs.
• 6:20
  SPEAKER_03: Um and it's a 10-minute day case procedure, and then those eggs are frozen in time.
• 6:24
  SPEAKER_03: Um, and the current technologies advance so much that we have excellent um freezing techniques called vitrification.
• 6:32
  SPEAKER_03: Um, so most eggs survive really well in this current day and age with egg freezing.
• 6:39
  SPEAKER_03: So I think that's what egg freezing at large is, but it's gained a lot of traction because it offers women choice in their fertility.
• 6:50
  SPEAKER_02: It is, it's offering a lot of choice, and um now I'm aware with more of my clients and also friends and family, you know, as well as, you know, for me, I've got uh, you know, I'm I'm an older mum with a younger daughter, so a lot of my friends' children are actually talking about this, and you know, what should they or shouldn't they, depending on what's going on?
• 7:13
  SPEAKER_02: So it's it's it's really, really interesting.
• 7:17
  SPEAKER_02: So out of that, then who is the person that should consider egg freezing?
• 7:22
  SPEAKER_03: Well, it really depends because when you categorize egg freezing, I kind of look at it as purely elective purposes or medical needs.
• 7:32
  SPEAKER_03: So if you're looking at someone purely for elective purposes, it's because they want to navigate life with their own timeline, they're not partnered or you know, to pursue a career, or they're just not ready to have a baby yet.
• 7:44
  SPEAKER_03: So they just want the option of freezing eggs, it's not a guarantee, but it provides that option.
• 7:50
  SPEAKER_03: Or it could be for someone where they're on treatment that could potentially insult the ovary and reduce that ovarian reserve.
• 7:58
  SPEAKER_03: Because as females were born with all the eggs that we'll ever have in our lifetime, and then they set natural age-related attrition.
• 8:05
  SPEAKER_03: So if you're on any chemotherapy, for example, or any medication, or even endometriosis which requires surgery, these things can potentially impact your encounter ovarian reserves.
• 8:17
  SPEAKER_03: So the sort of patients prior to embarking on any of any of those treatments would benefit from having a fertility preservation.
• 8:27
  SPEAKER_02: Yeah, absolutely.
• 8:29
  SPEAKER_02: There's all sorts of good reasons.
• 8:30
  SPEAKER_02: And I know uh another one where um women are, you know, they're just not too sure about you know their partner as well, you know.
• 8:41
  SPEAKER_02: They're and so I know a few ladies and a friend of mine as well.
• 8:44
  SPEAKER_02: She hasn't got a partner, um, but there's just so much going on.
• 8:49
  SPEAKER_02: So she's choosing to freeze her eggs now, just so that she's got some, you know, for for later on, depending on what's going to go on.
• 8:56
  SPEAKER_02: So I found this really, really interesting.
• 9:00
  SPEAKER_03: Yeah, a lot of patients that I also see, you know, who come, they they're partnered, but they're not ready to have a child.
• 9:09
  SPEAKER_03: Then there's an interesting discussion of egg freezing versus embryo freezing.
• 9:14
  SPEAKER_03: And I always say to my patients, if you freeze your eggs, that is for you.
• 9:20
  SPEAKER_03: When you do embryo freezing, that belongs to both of you, which is for the future of both.
• 9:25
  SPEAKER_03: But if anything were to happen to that relationship, you cannot then use those embryos.
• 9:30
  SPEAKER_03: No, good point.
• 9:32
  SPEAKER_03: So I often say, especially when I see a lot of cancer patients, you know, cancer does a lot of things to relationships.
• 9:38
  SPEAKER_03: There's a lot of emotional, physical strain there.
• 9:42
  SPEAKER_03: And so I often encourage patients to also consider freezing their eggs, even if they've been married for years sometimes, it's worth looking at that because that's the only option before they embark on treatment and potentially have no result after their treatment.
• 9:59
  SPEAKER_03: But it's just something to consider.
• 10:01
  SPEAKER_03: Absolutely.
• 10:04
  SPEAKER_02: Yeah, no, absolutely.
• 10:05
  SPEAKER_02: It's all these things to consider.
• 10:06
  SPEAKER_02: And so um, how does, you know, we all age, and I know we're told sort of get older eggs and these these things.
• 10:14
  SPEAKER_02: So what does affect um egg quality um and those future success rates?
• 10:21
  SPEAKER_02: And what would be, you know, what would be the ideal age?
• 10:25
  SPEAKER_02: Um I suppose now, you know, in 2026, mid-2046, that's a good time to freeze your eggs.
• 10:33
  SPEAKER_03: Yeah, so I'll answer that in two parts.
• 10:36
  SPEAKER_03: So when we're looking at what influences egg quality, age is your biggest independent risk factor.
• 10:43
  SPEAKER_03: And what do we mean by equality?
• 10:45
  SPEAKER_03: You can't measure it.
• 10:47
  SPEAKER_03: It's not like a test to measure your egg count.
• 10:49
  SPEAKER_03: It's an age really at a decline in quality because as women, we have all the eggs that we're ever going to be born with, and the longer those eggs are out there for, the more poor making mistakes within embryos.
• 11:04
  SPEAKER_03: So that's what determines quality.
• 11:06
  SPEAKER_03: So at the age of 30, 30% of the eggs that you release will generate embryos that are chromosomally abnormal.
• 11:17
  SPEAKER_03: That's 65%.
• 11:19
  SPEAKER_03: So it's a very big disparity in the age spectrum.
• 11:24
  SPEAKER_03: And then smoking, um, you know, obviously any extra um medications and things that can also impact um air quality as well.
• 11:35
  SPEAKER_03: And then we're seeing a lot about endocrine disruptors in the environment as well that can potentially impact me.
• 11:43
  SPEAKER_03: So these are all things that we need to be mindful about.
• 11:47
  SPEAKER_00: Yeah.
• 11:47
  SPEAKER_03: And so when we're trying to obviously we can't override the biological plot, but when you're looking at increasing, most of the studies say it's economical to do it up to the age of 35 to 37.
• 11:59
  SPEAKER_03: Beyond that, you're going to need more than double the number of embryos or eggs that a 20 year old 30-year-old would need to have a more than 50% chance of having a line birth down the track.
• 12:12
  SPEAKER_03: So if you're 40 and considering increasing, you're going to need at least 40 eggs to have a more than a 50% chance.
• 12:19
  SPEAKER_03: And we know that the ovarian reserve of a 40-year-old is going to be low, that they're going to have to do more cycles to get to that number.
• 12:27
  SPEAKER_03: But that's not very realistic.
• 12:30
  SPEAKER_03: And financially, that's not a very realistic option either.
• 12:34
  SPEAKER_02: Yes, I suppose then.
• 12:36
  SPEAKER_02: Absolutely, gosh.
• 12:37
  SPEAKER_02: Me falling pregnant naturally at 46 after years of trying, I feel like, oh my God, it really was such a miracle.
• 12:44
  SPEAKER_02: 100%.
• 12:45
  SPEAKER_02: And you know, what a wonderful story.
• 12:48
  SPEAKER_02: Yeah.
• 12:49
  SPEAKER_02: Thank you so much.
• 12:50
  SPEAKER_02: Well, it was this that's given me this huge passion, you know, of wanting to wanting to, you know, have all this information and share it.
• 12:58
  SPEAKER_02: So with egg freezing, what what does, you know, what is that process?
• 13:04
  SPEAKER_02: What does the egg freezing process involve?
• 13:07
  SPEAKER_02: And what should patients expect?
• 13:10
  SPEAKER_02: You know, what is that journey for them?
• 13:12
  SPEAKER_03: So I say it's about 10 to 12 days.
• 13:14
  SPEAKER_03: And for some patients, it it averages out to about two weeks, depending on how well or how quick they respond.
• 13:21
  SPEAKER_03: Yeah.
• 13:22
  SPEAKER_03: It so you've got to take over your body's natural ovulation.
• 13:26
  SPEAKER_03: So you will be on injection to try and block that from happening.
• 13:30
  SPEAKER_03: Nowadays, we can actually replace that with a tablet um that helps.
• 13:34
  SPEAKER_03: It's called progesterone, a different type of progesterone called prometrium.
• 13:38
  SPEAKER_03: And that actually is a daily tablet that you take to block ovulation.
• 13:42
  SPEAKER_03: And that way you can control the cycle and you take daily hormone injections to stimulate the ovaries.
• 13:49
  SPEAKER_03: There are so many nuances in the protocols that we use.
• 13:53
  SPEAKER_03: But um, like I said, this is the beauty of fertility, it's so evolving.
• 13:58
  SPEAKER_03: We now have an injection which can replace seven days worth of a daily injection.
• 14:03
  SPEAKER_02: Wow.
• 14:04
  SPEAKER_03: It's so important that you take a single injection that can last seven days, bring the patient in for a blood test, and now ultrasound process the response.
• 14:12
  SPEAKER_03: And they may or may not need an additional two injections.
• 14:15
  SPEAKER_03: So you get through the whole process with a tablet and one injection or potentially three injections in total, which is a really um, it's I think it's come a long way in terms of egg freezing.
• 14:29
  SPEAKER_03: So it's called a progesterone trying to ovarian stimulation protocol.
• 14:34
  SPEAKER_03: And a lot of us fertility specialists have employed this technique, and it really reduces the injection burden to a woman, it reduces the psychological burden and also financially, because not all egg freezing is self-dust.
• 14:49
  SPEAKER_02: Yeah, yeah.
• 14:50
  SPEAKER_02: Wow, I mean, that's changed heaps.
• 14:52
  SPEAKER_02: I know for me, and look, for me, it was IVF, but I know, like you say, it is an IVF process, all the injections and the different um medications I had to take.
• 15:02
  SPEAKER_02: So that was, you know, starting around 2006.
• 15:04
  SPEAKER_02: So this sounds so much better.
• 15:07
  SPEAKER_02: That is awesome.
• 15:08
  SPEAKER_02: Awesome.
• 15:10
  SPEAKER_02: And so with that, knowing you know, the the the egg freezing um and the fact that it's now condensed so much, what does um how many eggs should someone I suppose aim aim to freeze?
• 15:27
  SPEAKER_02: And like I know I can remember wanting heaps of eggs, and I only like remember got four or three or two.
• 15:34
  SPEAKER_02: But obviously, if someone's younger, you say, like you say, you're 35 to 37.
• 15:39
  SPEAKER_02: How many eggs should someone aim to freeze?
• 15:42
  SPEAKER_02: What's the optimize?
• 15:44
  SPEAKER_03: Yeah, so there's actually um, I mean, I'll I can give basic steps, but um basically at the age of 30, if you have about a dozen eggs, you've got a more than 50% chance of having uh live birds because that's the end point when you think also depends when someone asks how many eggs.
• 16:05
  SPEAKER_03: I often say, How big a family are you looking at?
• 16:09
  SPEAKER_03: You want a football team, so that would determine that.
• 16:12
  SPEAKER_03: Um 15 to 20 eggs if you're about 35 or so, and then beyond that, you're probably looking at 20 plus eggs after that.
• 16:20
  SPEAKER_03: Yeah.
• 16:22
  SPEAKER_03: To that question, UNSW has now come up with the um Australia's first age freezing calculator.
• 16:29
  SPEAKER_03: So um you can actually it's available to the public.
• 16:33
  SPEAKER_03: Um and essentially you plug in your values.
• 16:38
  SPEAKER_03: So you say how old you are, you would state how many um, you know, um eggs you would like to how many cycles of IVF you would like to undertake.
• 16:49
  SPEAKER_03: So if you say I only want to do one IVF cycle, this is my age, it will work out for you how many eggs you could potentially get, it would work out for you how many of those eggs could translate to an embryo and then potentially your pregnancy rate and the success of that.
• 17:08
  SPEAKER_03: So um I think it's a really handy tool.
• 17:10
  SPEAKER_03: Um it's useful for a clinician but also helpful for a patient to gauge and get an idea of that.
• 17:17
  SPEAKER_02: So this episode is part of the City Fertility Education series on the Homer Fertility in partnership with City Fertility.
• 17:29
  SPEAKER_02: More people are exploring fertility preservation these days, whether it's because of their age, their health, personal circumstances, or simply because they want to understand the choices that are available to them.
• 17:43
  SPEAKER_02: But egg freezing isn't a guarantee of future pregnancy.
• 17:47
  SPEAKER_02: It's an option that may provide greater reproductive choice and understanding timing, egg quality, the freezing process, and realistic expectations is a huge important part of making an informed decision.
• 18:04
  SPEAKER_02: CityFertility offers fertility preservation services and a specialist advice to help people understand whether egg freezing may be appropriate for their individual circumstances or not.
• 18:18
  SPEAKER_02: You can learn more at cityfertility.com.au.
• 18:22
  SPEAKER_02: Now, let's get back to that fabulous conversation with Dr.
• 18:25
  SPEAKER_02: Kelchi.
• 18:32
  SPEAKER_02: I like that.
• 18:33
  SPEAKER_02: I wonder how long has that been um available?
• 18:41
  SPEAKER_03: Really?
• 18:42
  SPEAKER_03: Um it was um brought up by Georgina Chambers, who's sort of pioneered this process because she's pioneered the your IV of success website where you can look at IV of success rates across clinics.
• 18:53
  SPEAKER_03: So the sum part of that is an increasing calculator, which I think is really instrumental and provides patients as a platform which is well researched, you know, where they can actually plug in their values and just get an idea.
• 19:05
  SPEAKER_03: Then you can come see a fertility specialist and have more of a discussion about, you know, your future planning.
• 19:13
  SPEAKER_02: Oh, I love that.
• 19:14
  SPEAKER_02: And that just really gives more um, I suppose, control for that person and understanding what they need and what they want.
• 19:21
  SPEAKER_02: So that can be what an awesome tool.
• 19:24
  SPEAKER_02: Really, really good.
• 19:26
  SPEAKER_02: So, what would be, you know, when we're on this journey, and that might be that person's choice for whatever reason.
• 19:33
  SPEAKER_02: So, what would be some of the biggest misconceptions about egg freezing or things that they might not realize?
• 19:41
  SPEAKER_03: I think the biggest misconception, which you know, if people ever come to use their frozen eggs down the track, is that they think it's an insurance policy or a guarantee.
• 19:51
  SPEAKER_03: And I hate that word because it is a it is an option for your future fertility, but it is not a guarantee.
• 20:00
  SPEAKER_03: Because frozen eggs, I mean, as I said, the technology is great.
• 20:04
  SPEAKER_03: Most of the eggs do survive the freeze thaw process, but generally only about 90% do.
• 20:10
  SPEAKER_03: So if you had 15 eggs to begin with, you're probably already just from pouring those frozen eggs, you're down to about 13 already.
• 20:18
  SPEAKER_03: Then you've got to inseminate with sperm.
• 20:20
  SPEAKER_03: Not all 13 is fertilized with sperm.
• 20:22
  SPEAKER_00: Yeah.
• 20:23
  SPEAKER_03: Maybe 10 might.
• 20:24
  SPEAKER_03: And then after that, you've got to follow it up to day five, which is the absolute milestone for an embryo.
• 20:29
  SPEAKER_03: And then you'll have a few that sort of drop off.
• 20:32
  SPEAKER_03: And so then you might end up with only one or two embryos.
• 20:35
  SPEAKER_03: And depending on the genetic makeup of those embryos and the metabolics can help those embryos, there's a you know, 50, 45, 50% chance of implantation.
• 20:46
  SPEAKER_03: So there's a real attrition, and I think that's really important for patients to understand when they're looking at utilizing the strozen eggs.
• 20:55
  SPEAKER_03: I feel like one of the biggest misconceptions is people having freezing down and they go, Yeah, I'm sorted.
• 20:59
  SPEAKER_03: Yeah, my future for family plans are sorted.
• 21:02
  SPEAKER_03: It's not a guarantee, it's an option.
• 21:04
  SPEAKER_02: That's not a guarantee.
• 21:05
  SPEAKER_00: Yeah.
• 21:06
  SPEAKER_02: Yeah, it's not necessarily so.
• 21:08
  SPEAKER_02: And you know, it's just so huge, and it's a lot for the body to go through too.
• 21:13
  SPEAKER_02: So yeah, that's again, it's good to be aware.
• 21:15
  SPEAKER_02: That's the biggest thing we can do is be aware.
• 21:20
  SPEAKER_02: And so for patients um that are considering fertility preservation or freezing the eggs, what is the factors that they should discuss with a fertility specialist um so that they should be, again, aware before making this decision?
• 21:39
  SPEAKER_03: So I think often most patients have done their testing with their GDP before they come to you.
• 21:46
  SPEAKER_03: Okay, yeah.
• 21:47
  SPEAKER_03: And so often they'll come.
• 21:48
  SPEAKER_03: And I think the first thing is don't fret about the result, especially if your AMH is low.
• 21:54
  SPEAKER_03: I have patients who come here, they're in tears because they're worried about their fertility.
• 21:59
  SPEAKER_03: And It's really important when it's looking at egg grazing to understand what does my AMH or my ovarian result need.
• 22:06
  SPEAKER_03: It does not reflect your ability to get pregnant at all.
• 22:09
  SPEAKER_03: Well, actually, in fact, proof of that.
• 22:13
  SPEAKER_03: You say AMH of four, but you still manage to conceive naturally, then all it takes is quality.
• 22:18
  SPEAKER_03: It's one good egg that would give you that guarantee.
• 22:22
  SPEAKER_03: So that's really important to factor in when they're coming to see a specialist to try and understand what my ovanium reserves mean for me and what actions do I need to take out of this.
• 22:35
  SPEAKER_03: Okay, so if my reserve is 12, is that good?
• 22:38
  SPEAKER_03: Is that appropriate for my age?
• 22:40
  SPEAKER_03: Because it's an age-made switch.
• 22:42
  SPEAKER_03: Do I need to act on it now?
• 22:44
  SPEAKER_03: Am I okay to hold off family planning for the next five years?
• 22:48
  SPEAKER_03: So these are the sort of discussions patients need to be thinking about.
• 22:51
  SPEAKER_03: And of course, discuss family.
• 22:53
  SPEAKER_03: If someone says to me, I want three kids, and they're already now 37, then you get a reward.
• 22:59
  SPEAKER_03: But if they're 30 and thinking three kids, then you've got a bit of time.
• 23:03
  SPEAKER_03: And also, only 10 to 12 percent of uh patients in Australia have come back to use those frozen eggs.
• 23:10
  SPEAKER_03: Really?
• 23:11
  SPEAKER_03: Most of them have frozen their eggs but gone on to concede naturally.
• 23:16
  SPEAKER_03: Right.
• 23:17
  SPEAKER_03: So they that's the other factor they need to take into consideration because you're having to pay long-term storage for these frozen eggs.
• 23:24
  SPEAKER_03: It is an out-of-pocket cost, especially if you're doing it purely for electric purposes, so you're not getting that Medicare subsidy.
• 23:32
  SPEAKER_03: Yeah.
• 23:32
  SPEAKER_03: So you need to take into account the financial implications of it as well, what it needs for your doctor.
• 23:37
  SPEAKER_02: Yeah.
• 23:38
  SPEAKER_02: Yeah.
• 23:39
  SPEAKER_02: Wow, yeah.
• 23:40
  SPEAKER_02: I didn't think about that.
• 23:42
  SPEAKER_02: Of course, there's they might not need the eggs if they fall pregnant naturally.
• 23:46
  SPEAKER_02: Absolutely.
• 23:47
  SPEAKER_02: So if I was somebody, and I wasn't sure, um obviously imagine myself a lot younger, you know, and I wasn't sure whether freezing eggs was the right choice for me.
• 23:57
  SPEAKER_02: What advice would you give somebody like me that's considering, you know, egg freezing?
• 24:03
  SPEAKER_02: But I just like, oh, I don't know if it's right for me.
• 24:05
  SPEAKER_02: I'm not sure.
• 24:05
  SPEAKER_02: What am I doing?
• 24:07
  SPEAKER_03: Well, it's such an individualistic decision.
• 24:10
  SPEAKER_03: But if you've got, you know, in front of you, you've got a normal NH.
• 24:16
  SPEAKER_03: The first thing I would say is, yep, it's an A, it's a number, but does it reflect your ability to get pregnant?
• 24:22
  SPEAKER_03: That's the first thing.
• 24:24
  SPEAKER_03: Second thing is what are your reproductive goals?
• 24:27
  SPEAKER_03: Like, are you partnered?
• 24:28
  SPEAKER_03: Are you thinking kids in two years?
• 24:30
  SPEAKER_03: Where are you with your career?
• 24:32
  SPEAKER_03: Have you bought a house?
• 24:33
  SPEAKER_03: Those are other factors that come into the conversation as well.
• 24:36
  SPEAKER_03: Yeah.
• 24:37
  SPEAKER_03: So you want to make sure where they are in their lifeline.
• 24:41
  SPEAKER_03: Some people just want to go traveling and enjoy life and put resource.
• 24:44
  SPEAKER_03: So I often say to them, if you don't think that you're going to look at pregnancy in the next five years, but you don't want the pressure of having to, you know, tie yourself down just because you haven't been partnered or you haven't kicked all the goals, then you can potentially undertake one cycle and just, you know, it kind of eases the burden for them and they don't feel so stressed about meeting one online or going and buying a house straight away.
• 25:13
  SPEAKER_03: They can achieve all those life goals in their own timeline.
• 25:16
  SPEAKER_03: And therefore, that's what their egg freezing does.
• 25:18
  SPEAKER_03: It just reduces their burden a little bit for them.
• 25:22
  SPEAKER_03: But if they say to me, Oh, I might potentially look at you know pregnancy in the next two years, then I actually say, Well, look, you know, your reserve's good.
• 25:32
  SPEAKER_03: It's there's no family case, no major concerns to say that it's going to drop off the perch, you know, in two years' time.
• 25:40
  SPEAKER_03: Yeah.
• 25:40
  SPEAKER_03: Provided everything else looks good, we can hold off and we can revisit things in about two years' time.
• 25:46
  SPEAKER_03: If it gives you reassurance, we can recheck the ANH in another year just to make sure they are on a holding pattern and everything looks good.
• 25:53
  SPEAKER_03: And then that they're happy with that as well.
• 25:56
  SPEAKER_03: So just depends on the individual and where they are in their life plans.
• 26:02
  SPEAKER_02: Yeah, it really is such an individual choice, isn't it?
• 26:05
  SPEAKER_02: And we've all got different lives that we're leading, and you know how to how best to, you know, create that legacy and what's the best thing to do.
• 26:14
  SPEAKER_02: So absolutely.
• 26:16
  SPEAKER_02: So what would be the other like fertility preservation options that exist that is say beyond egg freezing?
• 26:26
  SPEAKER_02: What else is there?
• 26:28
  SPEAKER_03: So we talked about embryo freezing.
• 26:31
  SPEAKER_03: That is an option as well.
• 26:33
  SPEAKER_03: So embryo freezing translates better to clinical pregnancy rates than embryo.
• 26:39
  SPEAKER_03: Because when you're creating embryos, the eggs and the sperm are you know brought together and you fertilize them and you get create the embryo and it's frozen straight up.
• 26:48
  SPEAKER_03: Whereas with egg freezing, there's an extra layer where you have to store the eggs, they have to survive, then you inseminate with sperm, then you create the embryo.
• 26:55
  SPEAKER_03: So there's an added layer of stress which you wouldn't have with embryo freezing.
• 27:00
  SPEAKER_03: So that's why they translate better.
• 27:03
  SPEAKER_03: Then we do see patients um who go through um sperm preservation, you know, if they're gender transitioning or oncology patients, we can do sperm freezing, that remains an option as well.
• 27:18
  SPEAKER_03: Um sometimes for um, especially these the other options, freezing are largely for cancer patients, but we can sometimes do um ovarian tissue freezing.
• 27:30
  SPEAKER_03: Really?
• 27:31
  SPEAKER_03: Yep.
• 27:32
  SPEAKER_03: So for example, if I have a patient who doesn't have the luxury of time to do an IVF cycle and she needs to start her cancer treatment pretty quickly, depending on the type of cancer, of course.
• 27:46
  SPEAKER_03: You can do keyhole surgery where you can take um sort of a 10 10 millimeter, sort of one and a half centimeter strip of the outer part of the ovary.
• 27:56
  SPEAKER_03: It's called the cortex, and you freeze that and then down the track, and she goes on, has her cancer treatment, comes back now wanting to, you know, have a child, yeah, you know, they can't conceive naturally because of her treatment or the need of her treatment, and then you can put that tissue back into her pelvis.
• 28:17
  SPEAKER_03: Wow, and then try and stimulate it to grow some eggs.
• 28:21
  SPEAKER_03: And it's been done.
• 28:22
  SPEAKER_03: I think uh there are about in Australia, I think across we've probably got worldwide, there's good maybe about 250 cases now.
• 28:30
  SPEAKER_03: Yeah.
• 28:30
  SPEAKER_03: Wow.
• 28:32
  SPEAKER_03: Um it used to be experimental, but it's no longer experimental.
• 28:36
  SPEAKER_03: So that's another option of fertility preservation or variant tissue freezing.
• 28:41
  SPEAKER_02: Wow, that that that's amazing.
• 28:44
  SPEAKER_02: Wow, that's really interesting to hear.
• 28:47
  SPEAKER_02: Um, gosh, that's blown my mind.
• 28:49
  SPEAKER_02: I think that's amazing.
• 28:51
  SPEAKER_02: And so um what else?
• 28:54
  SPEAKER_02: Um, we've gone through a lot of our questions here, but is there anything else regarding, I suppose, egg freezing and um, you know, preserving what's the best thing to preserve our fertility that you would like to share?
• 29:11
  SPEAKER_03: Well, it's always tricky, isn't it?
• 29:13
  SPEAKER_03: Because it's it's the biggest question, Mark.
• 29:15
  SPEAKER_03: You have, you know, you've been asked, you go, I'm healthy, I'm fit, I exercise, I'm you know, I follow a good diet, I've got a regular cycle.
• 29:24
  SPEAKER_00: Yeah.
• 29:25
  SPEAKER_03: And you don't know until you go into that rabbit hole of testing.
• 29:30
  SPEAKER_03: You don't know.
• 29:31
  SPEAKER_03: Um and and I think that's the um misconception with that AMH.
• 29:37
  SPEAKER_03: You know, it's so I think it's important, but it's also, you know, when you're getting it done, you worry because you're like, oh, but the chances are these are the very people that would conceive naturally without any issues.
• 29:50
  SPEAKER_02: Yeah.
• 29:51
  SPEAKER_03: Um and the AMH is just almost academic.
• 29:53
  SPEAKER_03: So I think it's just um important to, you know, my take-home message there is by all means do it to be informed.
• 30:02
  SPEAKER_03: Yeah.
• 30:03
  SPEAKER_03: Definitely don't fret over the result if it's on the lower end or you don't understand what it means.
• 30:07
  SPEAKER_03: Discuss it with the specialist because that taking it out of context is the problem.
• 30:13
  SPEAKER_03: And now there's a lot of um sort of other um, you know, I think products that are out there when you can do testing for AMH without a doctor necessarily giving you a form.
• 30:25
  SPEAKER_03: Um, which, you know, I think it's good that patients have access to all of this and it's good for them to be informed about their reproductive choice, but the interpretation of the results, see a fertility specialist is my um take all for that.
• 30:38
  SPEAKER_02: Yeah.
• 30:38
  SPEAKER_02: Oh, I love that.
• 30:39
  SPEAKER_02: Yeah.
• 30:39
  SPEAKER_02: So with the information that you're given, do your best to, I suppose, advocate for yourself and go and find out the information that's right for you instead of getting too, I suppose, stressed and anxious about it, isn't it?
• 30:53
  SPEAKER_02: Absolutely.
• 30:54
  SPEAKER_03: And always I love it when a patient comes to me with a list of questions because then it's like, ask, ask, ask, ask.
• 31:01
  SPEAKER_03: Because often what happens, you come to the concept, you're not they go away and they're like, oh no, I never asked them all this question.
• 31:07
  SPEAKER_03: They're sort of like coy about that process.
• 31:09
  SPEAKER_03: And I'm very like, you know, please ask away.
• 31:12
  SPEAKER_03: Um, and I often like my patients emailing me because they, you know, and they'd be like, and this and this, and then it's absolutely fine.
• 31:18
  SPEAKER_03: But I think it's good when they do their research and come to you.
• 31:22
  SPEAKER_03: It makes the discussion a lot more productive, yeah.
• 31:25
  SPEAKER_03: Yeah.
• 31:26
  SPEAKER_02: Yeah.
• 31:26
  SPEAKER_02: So I think with that, what I'm hearing is have your questions ready.
• 31:31
  SPEAKER_02: Bring all of your questions because um, you know, I suppose that's so helpful for you because then you know what's going on for them and it allays any of their stresses and worries and woes.
• 31:42
  SPEAKER_02: Hey.
• 31:44
  SPEAKER_03: Absolutely.
• 31:44
  SPEAKER_03: Because I think even you know, with egg freezing, there's so many nuances to it.
• 31:49
  SPEAKER_03: Like patients understand at the time when you speak to them, but once they've done the process, yeah, they went, Well, what do you mean?
• 31:56
  SPEAKER_03: I only got eight eggs.
• 31:57
  SPEAKER_03: The scan said I had 12 follicles.
• 31:59
  SPEAKER_03: What happened to the other four?
• 32:00
  SPEAKER_03: And it's like, but not every follicle results in an egg.
• 32:03
  SPEAKER_03: And you know, on scan, you can't tell if there's an egg until you look at the fluid under a microscope.
• 32:09
  SPEAKER_03: So it's just going through all those little steps.
• 32:13
  SPEAKER_03: It's really, really important.
• 32:15
  SPEAKER_03: Yeah.
• 32:16
  SPEAKER_02: Find that interesting.
• 32:18
  SPEAKER_02: So interesting.
• 32:19
  SPEAKER_02: So I suppose let's sum that up.
• 32:21
  SPEAKER_02: Egg freezing, look, it's it's just an amazing modern thing that can happen now that's really important for fertility preservation.
• 32:29
  SPEAKER_02: And the option can provide greater reproductive choice and flexibility.
• 32:35
  SPEAKER_02: And so then understanding this option for egg freezing, it it, you know, I suppose it empowers the individual, the person that's on the journey.
• 32:43
  SPEAKER_02: And that means they can make better informed decisions for their own reproductive future, you know?
• 32:52
  SPEAKER_02: Yeah, yes.
• 32:54
  SPEAKER_02: Awesome.
• 32:55
  SPEAKER_02: Awesome.
• 32:56
  SPEAKER_02: So is there anything else that um, you know, I suppose one last home, bring your bring your questions, always have your questions, advocate for yourself.
• 33:06
  SPEAKER_02: You don't have to stress with any of the um, I suppose, information, for example, like low AMH, you know, come and talk to your specialist and support yourself to, you know, keep your worries uh at bay.
• 33:20
  SPEAKER_03: Absolutely.
• 33:21
  SPEAKER_03: Um, you know, I think and and also, you know, it's really important to be supported through this process or surround yourself with a lot of positivity and a lot of advice because that's really important as well.
• 33:34
  SPEAKER_03: I think the mindset is so important in this journey.
• 33:37
  SPEAKER_03: So really important to do that as well.
• 33:41
  SPEAKER_02: So um thank you, thank you, thank you so much, Koshi, for this time, taking your time um to chat to me today, because I know you're all so busy and um just sharing your thoughts, your knowledge with egg freezing preservation.
• 33:58
  SPEAKER_02: And I'm really, really grateful.
• 34:01
  SPEAKER_03: Thank you.
• 34:01
  SPEAKER_03: Thank you for having me.
• 34:03
  SPEAKER_02: It's a pleasure, absolute pleasure.
• 34:04
  SPEAKER_02: And with that, beautiful listeners, remember to bring that list of questions and also to have your support network.
• 34:12
  SPEAKER_02: It is so, so important.
• 34:14
  SPEAKER_02: And thank you so much for being there and listening today.
• 34:18
  SPEAKER_02: And with that, lots of love and thank you so much, Kauchi.
• 34:22
  SPEAKER_00: Thank you.
• 34:23
  SPEAKER_02: All right, lots of love.
• 34:24
  SPEAKER_02: Bye everyone.
• 34:29
  SPEAKER_02: Thank you for joining me for another episode of the City Fertility Education series, which is on the home of fertility.
• 34:38
  SPEAKER_02: This is created in partnership with City Fertility.
• 34:43
  SPEAKER_02: I do hope today's conversation has given you something extremely useful to take away.
• 34:49
  SPEAKER_02: Perhaps it's a better understanding of your fertility.
• 34:52
  SPEAKER_02: Maybe it's a new question with simply more confidence in knowing what your options might be.
• 34:59
  SPEAKER_02: Because sometimes one conversation can be the thread that leads you to the information support.
• 35:06
  SPEAKER_02: Or next step that's right for you.
• 35:09
  SPEAKER_02: If you'd like to learn more about city fertility and services today, of course, cityfertility.com.
• 35:32
  SPEAKER_02: Thank you so much for the first time.