New York fertility doctor Alan Copperman, M.D., is co-director of Reproductive Medical Associates of New York (RMANY), as well as Director of the Division of Reproductive Endocrinology and Infertility, and Vice-Chairman of the Department of Obstetrics, Gynecology, and Reproductive Science at Mount Sinai Medical Center. He recently answered questions about egg freezing at RMANY.
How long have you been performing egg freezing?
We began to experiment with egg freezing in mouse models nearly a decade ago. Once we were comfortable with our technique and success rates, we began to freeze eggs in women under an IRB protocol. We were fortunate in that three of the first four women who used frozen eggs at RMANY achieved pregnancies, and since that time, several hundred women have come and electively frozen their eggs.
Who are you offering egg freezing to? What types of patients?
I would break down the two groups into medical and elective. Women who medically freeze their eggs may be undergoing chemotherapy for cancer and thus want to preserve their fertility or may be undergoing a different medical treatment for a chronic condition that could theoretically compromise their egg quality, or the treatment could delay childbearing. For those women who are freezing their eggs for social reasons, they are usually in their 30s and are single and would like to preserve the opportunity to reproduce when they are ready.
What does your fertility clinic consider the optimal age for egg freezing? What are the other criteria? Do you have a cut off age?
We know that a woman is born with all the eggs she is ever going to have in her lifetime. In her 20s, 90 percent of the eggs are normal, and by the time she is in her 40s, 90 percent of the eggs are abnormal. So, clearly the earlier that we freeze a woman’s eggs the better reproductive potential these eggs have. This must be balanced by the fact that many women in their 20s will ultimately not need to use the frozen eggs. In general, we are seeing more and more women in their early 30s. I believe that this is a group that we can easily help. We have had a few pregnancies in women in their 40s, however, we know that the success rate appears lower in this age group.
Once the eggs are frozen where are they stored?
The patients can either have their eggs stored in an external storage facility or more likely in our locked monitored room at our main office at 635 Madison Avenue. These eggs are stored in liquid nitrogen containers and are checked on daily. We have temperature sensors and motion detectors, and we are confident that the frozen eggs are extremely safe.
How long can these eggs be stored safely?
We know that sperm and embryos can be stored safely for decades, and we have no reason to believe that eggs are any different. If an egg is normal and the freezing and thawing process go well, these eggs will be fine for extended periods of time since they are essentially metabolically inactive at −196 °C. In other words, once a healthy vitrified oocyte is in liquid nitrogen, it should be safe, and prolonged storage will not compromise its viability.
Is there a cut-off age that you recommend for women to have eggs thawed, fertilized and transferred in a cycle?
The American Society of Reproductive Medicine uses the age of somewhere between 50 and 55 as a guideline for egg donation. As far as using the patient’s own eggs, I think that for now many programs will be following that guideline. I would recommend any woman over 45 to see an internist and a maternal fetal (high risk) specialist to make sure she is medically cleared prior to attempting to become pregnant
Has your clinic had live births from frozen eggs?
Yes. We have had many women successfully conceive after freezing their eggs.
What is the price range for freezing eggs, and what does that range cover?
Some patients have insurance coverage for parts of the egg freezing, but I have seen that out-of-pocket expenses range from $10,000 to $15,000. I always recommend that patients speak to a financial counselor in our office to find out specifically what their cost would be.
What are the reasons a woman would not be a good candidate for freezing her eggs?
We first look into health of the individual and then at the health of her eggs. We find that patients who have emotional support of others do well in the process. They have to be able to come in for frequent monitoring, which includes blood tests and ultrasounds. Potential patients need to understand the physicial, emotional and financial costs of a cycle and that there is no guarantee that the eggs produced will be viable. Young women with good ovarian reserve do much better than older women with diminished reserve. That being said, for a good candidate, the process of freezing eggs can be emotionally empowering and can create opportunities for achieving parenthood that were not possible a few short years ago.
What is the most exciting aspect of ASRM lifting the experimental title and how do you think it will change the face of fertility treatment?
I am excited that ASRM has rethought their position. We know that we have been able to help many women preserve their fertility and go on to have healthy children. I believe the publicity surrounding this new position statement has helped improve awareness and acceptance of the technology and that an increasing number of women will pursue this option with many more obstetricians and gynecologists becoming aware of it. I look forward to a near future where we can analyze the DNA of young women and best determine who is at risk for early ovarian compromise and who would best benefit from egg freezing. I also look forward to having the costs come down and for insurance coverage to improve so that egg freezing will be accessible to more women.
What should a woman look for in a fertility clinic that does egg freezing?
I would look for a clinic that has performed this procedure before, particularly with successful results. I believe that the doctor should be very involved in the patient’s treatment and that a center should be responsive to meet any and all emotional and clinical patient needs.
Click here if you are interested in egg freezing, and we will will put you in contact with RMA of New York or a fertility clinic near you!
February 14, 2013
Posted by Leigh Ann Woodruff