54. Egg Freezing: Facts Over Fear

In this episode of Cycle Wisdom, Dr. Monica Minjeur discusses the growing trend of egg freezing, particularly for women facing social pressure or fear-based decisions. She unpacks the procedure, its potential downsides and questions the over-reliance on lab values like AMH as indicators of fertility. Dr. Minjeur also highlights how Restorative Reproductive Medicine offers holistic alternatives to preserving fertility, empowering women to make informed decisions without fear.

Transcript

Monica: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I am so glad you're listening today. On today's episode, we're going to be talking all about egg freezing, which is also called oocyte cryopreservation. Now this has become a much more common topic in recent years, especially in women who aren't quite ready to start a family yet, but may be concerned about their age and what this may mean for their fertility in the future. I'm going to talk about what egg freezing is, as well as a brief overview of the process. I will also share why I think too many young women are being talked into this invasive procedure based on lab values and data alone. And finally, I will share with you ways that restorative reproductive medicine can help all women to preserve their fertility at any age so that you are not just relying on a predictive model to make decisions based in fear. Now, I want to give a little disclaimer today and the first piece of this is that I am not intending to offer any medical advice. I am specifically going to be talking today about personal or social reasons to delay childbearing. I'm not going to be getting into any details regarding egg freezing for cancer with chemotherapy or pelvic radiation or situations requiring removal of the ovaries that should be made in consultation with your medical professional. Today's episode is primarily to give you some details in regards to egg freezing so that you don't make decisions based in fear or those that will be made by poor medical judgment. So let's get started with a story about a past client of mine who we'll call Heather. Now Heather was a bright young woman who came to see me just as she was finishing up her family medicine residency. At the time, she was 29 years old and did not have a partner. She knew that someday she wanted to try and have biological children, but she wanted to wait until she was married and she hadn't met anyone yet. During her medical school training and residency program, she heard about egg freezing and had some lab work done to check her ovarian reserve. She was told that at 29 years of age, she had the ovaries of a 45 year old based on her lab testing, and that she should freeze as many eggs as she could over the next few months if she ever wanted to be a mother. Now, as you can imagine, the fear factor set in a bit, and Heather was really worried about the term, you will never be a mother. She advanced her expected timeline by 15 years by what this medical professional said to her, and she had this personal and emotional journey she went through of deciding whether single motherhood is what she should do, whether she needed to hurry up and try and pursue a relationship, and all these ideas flashed through her mind. Now, this medical advice was given to Heather by a physician who had done an ultrasound test as well as a lab test called AMH or anti Mullerian hormone. Now this particular lab test is often used as a marker of ovarian reserve, however, I'm going to talk a little bit more later in this episode about why this is actually not a great marker for someone's ability to get pregnant at any point in time. So Heather came to see me because she wanted a second opinion. She was planning to go through with this and she just wanted my advice about what to do. And so when we talked through what her options were. At that time, her biggest barrier was the financial piece. She just didn't have the financial means to go through the process of egg freezing, and she came to me for this second opinion. So in the meantime, while she was trying to decide what was going on, we got her started with charting her cycles. I ordered some additional labs and we worked together to optimize her cycles to restore and maintain her ovarian function. We made some changes with her lifestyle. We made some adjustments with her supplements and we did start on some medications to help preserve her ovarian reserve and her fertility. I'm happy to say that Heather has had regular follow ups over the years and three years later has showed that she has stable lab levels without further decline in her AMH level and she still is ovulating on a regular basis showing good signs of ovarian function. In the long run, we were able to avoid any unnecessary procedures of egg freezing, as well as bypass the cost of the procedure itself, as well as the long term storage costs. More importantly, we were able to help empower Heather to make a decision that would be best for her and help to preserve her fertility for the future. So let's talk a little bit about what egg freezing is, and typically this is done through a reproductive endocrinology or an in vitro fertilization clinic. The first step is typically checking some lab work done, as was the case with Heather, as well as an ultrasound and a means to try and assess the fertility and ovarian reserve. Then, you give your body hormones to suppress enormal menses, as well as additional hormones to stimulate lots of follicles and eggs to mature. As you go throughout your cycle, you have frequent checks of your hormone levels as well as ultrasound, and then when the timing is right, you give yourself another megadose of hormones in order to trigger the release of those eggs. Once the trigger shot is done, you're scheduled for a surgical procedure to retrieve the eggs. During that surgical procedure, a needle is advanced through the vaginal wall to get to the ovaries, and it helps to remove the eggs and suck them up through that needle. These eggs are then put through flash freezing procedure in liquid nitrogen at sub zero temperatures so they don't form crystals. From there, the eggs can be preserved or frozen as long as you need in liquid nitrogen tanks. Now at the time of this recording in 2024, freezing eggs has only been around for about four to five years, so it's not really known what the long term implication is for freezing eggs. Embryos have been frozen for about 10 years or so at this point in time, and when you're ready to use them, this needs to be re implanted via in vitro fertilization. At this point in time, freezing eggs has a clinical pregnancy rate estimated about 5 12 percent per egg. I want to let that number sink in a second. Around 10 percent of the time, each egg is going to actually result in pregnancy. The potential side effects of egg freezing include mood swings because of the medications, bloating, headaches, nausea, and then after the procedure, cramping, pain, and soreness. As of this time, the cost is anywhere from 5, 000 to 10, 000 per cycle of egg retrieval, plus the medications that you're using, which can range anywhere from 2, 000 to 7, 000 if your insurance does not cover them. Storage for those eggs can range anywhere from 500 to 1, 000 per year. So let's talk a little bit more going back to that lab test that we talked about in Heather's case and that's the AMH level or the anti Mullerian hormone. So this is a blood test that's been done and it's been created to estimate the success of how well your body can produce follicles or eggs in response to receiving high doses of hormones. to stimulated ovulation during an IVF retrieval. Now, this normal range for what the lab level should show is numbers that have been decided on based upon the success of egg retrieval and subsequent IVF procedures. The normal range is dependent upon your age and levels decrease as you get older, but in general, from the time that you're 20 to 40, the typical range can be anywhere between one. to three. If you have elevated numbers, that can actually reflect concern for possibility of PCOS or other anovulatory dysfunction. So the levels become less reliable in regards to your actual ovarian function. However, I want to clarify that AMH is not a marker of how many eggs you have left in your body, nor is it actually an accurate reflection of your ovarian reserve. And the reason I say this is that the number does not correlate with your ability to ovulate or get pregnant in any particular cycle naturally. So, despite the normal ranges of 1 to 3, I have actually personally had a patient conceive with levels of AMH as low as 0. 05 and have other colleagues in my same field that have positive pregnancies in patients with levels as low as 0. 05. 0. 02. Now these levels are significantly lower than what is considered normal and they are significantly lower than even what many IVF clinics will consider reasonable to attempt ovulation stimulation in order to retrieve eggs. The way we're able to have success with these low AMH levels is by optimizing ovulation as well as any other factors surrounding that ovulatory event to ensure optimal levels of hormones during development of the follicle and to prepare for subsequent natural fertilization and implantation. So part of the reason that I am so passionate about this is that oftentimes Egg freezing is approached from the medical community with significant fear tactics, as was the case that we saw with Heather. Women are told, you'll never be a mother. You have the ovaries of a 45 year old. Maybe you'll never find the right partner. Do you really want to wait for that? You shouldn't put your career or education first. You really don't have time for that. Or my very least favorite, your biological clock is ticking. First of all, fear is no way to live your life. Please don't ever, ever let a doctor or relative or friend talk you into any medical decision you make out of fear. Always get a second or a third or a 17th opinion. Listen to your instinct. Trust your intuition and be empowered to ask more questions. In these cases, what does it look like to be a mother? What if I can't carry children of my own? Does this mean that I must have biological children in order to still be a mother figure? What will happen to these eggs 10 years from now? What further advances will we have in medicine even a few years from now that aren't even on my radar anymore? Why is this doctor pushing so hard to try and encourage me to have egg freezing? Might there be some underlying motivator that is encouraging them to push me in this direction? Is there perhaps a more natural way that I would be able to evaluate further my ovary status as well as my ability to carry children in the future? So I would propose a better way forward, and this can be done through restorative reproductive medicine. And yes, I do check AMH levels. However, I also look at a myriad of other lab values. charts, charting signs, listen to your symptoms and talk more about your lifestyle habits, your life plans, and how you want to move forward with preserving your fertility. Very importantly, we also are evaluating for other underlying cause that may be causing your AMH levels to decline. So specifically, I often find autoimmune dysfunction. Thyroid dysfunction in chronic stress, whether that's from lack of sleep, excessive exercise, poor physical habits, or social or emotional stress as a cause that is continuing to make that AMH decline too quickly. The treatment then is going to be dependent upon those underlying causes that we find. So whether that's lifestyle modifications, dietary changes, treating underlying inflammation, treating autoimmune disease and thyroid dysfunction. All the while we are wanting to look to balance your hormones and monitor labs for stability over time. That way, when it's time to get pregnant, whenever that is for you, we will work together to optimize all the factors to improve your success with pregnancy. So don't be talked into egg freezing just based on fear. Please know the facts. Please know that just because you have a lower AMH level does not mean that egg freezing is your only option. For Imagine if, rather than being scared into thinking you needed to freeze your eggs, you were empowered to understand what your labs mean about your overall health. Now, let's work together to use those findings and correct the underlying medical concerns to improve your health and promote fertility when the time is right for you. If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic. com, to schedule a free discovery call with me, and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in the Cedar Rapids, Iowa area, or telehealth visit if you live in the state of Iowa, Illinois, or Minnesota. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.