For a really long time, I have thought very hard about the biological clock and how it affects people in their dating lives. The way that if we’re panicked because we think that our goal of having children is suddenly threatened by our timeline and we think that we’re not going to meet someone in time, that can be a disaster in our dating life. It can affect us in all sorts of ways, both conscious and unconscious. It can make us live in fear and anxiety, that is not going to happen. It can make every day that we don’t meet someone and find a serious, committed relationship seem harder and harder. It can affect our energy on a date.

When you go on a date and there is a nervous energy, when there is a sense of, “I need you for this,” that creates so much power in the other person’s hands and it robs us of our power in the situation. It robs us of the power to have standards about how we’re treated. It robs us of the power to walk away if the situation isn’t right. And it risks us settling for something that we shouldn’t be settling for. I wanted to create a conversation that could help anyone in this position to get their power back, their personal power in the situation, so that they could get back to a place of peace, where they can make good decisions and make it much more likely that their goal of having a family happens.

So I invited two really wonderful people to the conversation who are far more educated than me when it comes to fertility and the issues that not just women face, but people face in these areas. I think you’re really going to enjoy this. I hope that it sparks a conversation that maybe you’re not having in your own life or that you just haven’t been able to find out there in the online world, and I look forward to your feedback on it. Without further ado, I present to you this podcast on the biological clock.

I have with me today, Dr. Ioana Baiu, who is a general surgeon at Stanford and a former pediatrician. She obtained her medical degree and a master’s in public health from Harvard. Her professional interests are in women’s health healthcare administration and she uses writing as a tool for advocacy. She also wrote an article called “Freezing the Future” about her own journey with egg freezing, and I’m really excited to talk more about that.

Alongside her, we have Dr. Serena Chen. Dr. Chen is a director for the Division of Reproductive Medicine at Cooperman Barnabas Medical Center in Livingston, New Jersey, and the Institute for Reproductive Medicine and Science with several locations throughout New Jersey and New York. She graduated from Brown University and Duke University School of Medicine, trained in gynecology, obstetrics, reproductive endocrinology, and infertility at the Johns Hopkins Hospital. She is a clinical associate professor at Rutgers New Jersey Medical School in Newark and Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey. That is all a mouthful. But so happy to have the two of you here. I was very excited just to get people who live in this world in one way or another, either through personal experience or through their professional path to weigh in on this subject. Hello to both of you.

Hello.

Thanks for having us. Hi.

It’s my pleasure. Well, I suppose I’ll keep this open between all of us and feel free to just jump in where you see fit, because I won’t always know where a question is best directed, but I think that I’d love this to just be a very casual conversation between the three of us and to try and get somewhere interesting with it. Could you help educate me, firstly, on fertility in general and what the windows are in 2022, 2023 for people right now? Because I understand some of the data out there is more historic in terms of what fertility windows are. What is it right now for both women and men?

In general, we know that age is one of the most powerful factors that impact fertility, your general health impacts fertility, but age is a powerful factor. People come in all the time and they’re like, “Please, test my fertility. I want to find out what’s going on.” Yet, we can tell a lot without any testing, just like looking at your general health, looking at risk factors like smoking, which is negative for fertility and things like chemotherapy, and then your age and the younger you are, once you go through puberty, the more fertile you are.

Honestly, mother nature really wanted us to have our 10 kids by the time we turn 25 and then die of exhaustion by 35, I think. Today’s society doesn’t really fit with that plan. We do consider we have these arbitrary designations, advanced maternal age 35, advanced paternal age 40. We do see there’s some data on higher risks of things like fertility issues, miscarriages, birth defects above those ages, but it’s not like you fall off a cliff. And there is some variation between people, but age does mean a lot when it comes to fertility. There really is a biological clock, in other words.

Given everything you know about the statistics, when you’re dealing with women in your own life, women that you care about, who you are thinking they’re coming to you for advice and saying, “By what point should I really get a move on?” What age are you telling them? Because obviously there’s always going to be a range and that range is going to fluctuate for different people. But have you gotten to a point where you go, “There’s an age in my mind as a fertility doctor that I think by that point people really do need to start taking it very seriously?”

Well, I feel like there’s a lack of information and education, which is why I’m so glad that you’re talking about this and that really little tiny girls from the beginning should understand their reproductive health. They should understand how to get pregnant and how not to get pregnant and what are all the ways they can keep themselves healthy and be proactive about it from contraception to things like preserving your fertility.

Meanwhile, we spend a lot of time trying to prevent pregnancy and then we forget to tell people about the impact of the decline in fertility. I feel like everybody should know about it from a very young age. That way if you have risk factors like family history of early menopause, you have surgery on your ovaries, or you need chemotherapy, or you’re a smoker, or you have a very high BMI or you have some risk factors to your fertility, you can go in earlier and talk with your doctor about it.

But if you’re everything no risk factors at all, everything’s perfectly healthy, then I really want people to start thinking about it around 30 and getting information and maybe having a good connection with a good doctor, who’s going to support them to preserve their fertility and understand the finances and things like that. Because really fertility preservation should be covered for everyone, not… Right now, our medicine is a little bit misogynist and biased against women and this is considered a women’s problem and elective and it’s really about the whole human race. It affects men and women, it affects families, and affects the economy, too. We have high rates of infertility and a declining birth rate. That’s an impact on the economy.

It’s really very much a global issue, but not everybody should freeze their eggs. I really feel like this is… Everybody should have access to egg freezing and everybody should get information about egg freezing and it should be covered if you want it, but you should be able to make that decision for yourself. I don’t feel like anybody should feel pressured to do it, but I want everybody, by the time you’re 30, if you haven’t had kids and you want to have a family or you think you might, because things change throughout life, you should have that, you should be thinking about that option and understanding it. I don’t know. That’s a long question.

No, it’s-

A long answer to your question.

It’s a wonderful context setting for this whole conversation. So, it’s great. Dr. Baiu, you went on that path yourself of egg freezing. What was the age that you began thinking about that as an option for you? And what made you go for it at the time that you decided to go for it? What was the deciding factor that pushed you into that camp from continuing to wait?

That’s a great question. I’m originally from Europe and I feel like priorities are a little bit different. I never imagined that I would consider this as a possibility. I’ve thought about having a family and when I was in my 20s, I’d heard of people doing this. When I was a pediatrician, we would have, like Dr. Chen said, you’d have patients who are diagnosed with cancer at a very young age, so you start talking about fertility preservation with them, but that just somehow feels like a very separate type of situation. So, I always imagined that I would just have a family and not ever have to think about this or consider it.

I think once I turned 30 is really when it started hitting me that there’s a little bit more time pressure. Of course, we discussed and I think unfortunately, in 2022, this is still a major problem. It’s financially prohibitive for a lot of people. It’s one thing to say, “Sure, I’ll take the leap of faith and go through the process,” and I know it’s going to be emotionally and physically draining to go through it and it’s really pushing your body to an extreme in some ways, but it’s also you have to then consider the financial aspect of it. It’s not just wanting to do it, it’s can you actually afford to do it?

And it’s I understand anywhere between six and $10,000 for the full-

It’s usually a lot more.

That’s a tremendous amount. Yes.

Yeah. I think the one thing that I didn’t realize is, and I think this is why it’s important to talk about these kinds of things and be open is that depending on the age of which you do it and how healthy you are, where shape your body is in, we often need more than one round. We often will talk about it’s 10, 15, $20,000 per round, but the majority of women end up needing more than one round. It really just adds up each time.

The fact that that’s considered an elective and not covered makes it an unbelievable financial commitment for most people.

Yes.

It is, yes.

And it really should be covered, but that’s kind of a radical idea. The idea that you brought up, Matthew, of every woman should think about it, I think is something that women physicians or physicians in women’s health, specifically in fertility medicine, we believe that. But that is not an idea that’s widely accepted at all. I just wanted to mention that Dr. Baiu is actually, she looks perfectly healthy and beautiful, but she’s very high risk for infertility, because she’s a physician. It’s just ironic that we’re in this field that puts us at risk, at significant risk.

Could you explain that to me?

In general, the general population risk for infertility, and this is really only, we’re only talking about cisgender, heterosexual population. I mean, obviously there’s the whole LGBTQ population, transgender males should consider freezing eggs also. But in the physician population, the numbers seem to be at least double of having trouble having babies. One in four women physicians, and if you look at the surgery population, Dr. Baiu is specifically a general surgeon, that may be as high as one in three. We don’t understand it very well, but probably the lifestyle, the training, a lot of it is age, the delay in childbearing. But we are seeing this in a lot of different surveys of physicians. I really think we are putting our future physicians at risk and yet we’re not supporting them by providing coverage is something that I’m working on at Rutgers. It sounds like Dr. Baiu is also working on at her institution that hopefully those are things that we can change.

That’s not just a product of them having kids later than others because of their schedules and because of the years of training and so on. You’re saying it’s also related to stress factors in that profession and just the general wear-and-tear lifestyle of the hours, the scheduling?

That’s what we think. We don’t know for sure. There’s so much in women’s medicine and reproductive medicine that we do not understand well, because there’s a bias in terms of research dollars and just the way research is carried out that most studies are done in men. So, we don’t have a lot of really strong data. But yes, that’s what we think, not just fertility issues, but we do see, especially the surgical specialties, have much higher pregnancy complications.

I think, Matt, regardless of if you’re a physician, a surgeon, whatever profession you may be, I think we can all say in 2022, at least in America or Western Europe, I always say that social biology is out of sync with human biology. People just don’t have children when they’re 18, 19, 20, right away, the majority, the age of which people have children is getting further and further delayed. It doesn’t matter, again, what your career is or what your career priorities are, in general, we are delaying this more and more. Automatically, your risk of infertility is going to increase.

I’ll say that there is a study that was published a couple of years ago looking at surgeons, and again, like Dr. Chen said, just the thought that maybe the work hours, the stress may impact things, so it’s hard to know is it being a surgeon or is just any high-stress career going to impact you? Anecdotally, I’ve done two cycles of cryopreservation and I have friends who’ve, again, done multiple cycles. In all the cases that I’ve spoken with, whenever one of us had done it, while we were on a very difficult work-life balance situation, when you’re working 24 hours in a row, and then you’re working 100 hours a week, the risk of success was significantly lower than when you are able to take time off and focus on yourself and you’ll be a little bit more relaxed and really be in the best possible condition you can and where you can actually have higher yield. Deciding when you’re going to do this matters, I think, because you can’t just randomly pick a date, it really is worth thinking and planning it so that you can have the highest yield you can.

I get different stories from different people, some of whom say it’s extraordinarily difficult on the body and others who said it was fine and it was a fairly fast process. Could you talk us a little bit through just the procedure in general so that any woman out there who is listening to this has an accurate idea of what they actually will have to go through as a process if they’re considering egg freezing?

I’m happy to talk about it as a patient and maybe Dr. Chen can give her professional opinion, but I think I’ll start saying that I am a surgeon. I’m used to working with my hands, I’m used to working with syringes. The day I got home and then just spilled everything on my dining table and there were just these hundreds of syringes and all these bottles that you had to mix micrograms of medications and you had to be very careful what goes in the fridge, what you give when and what time every single hour mattered. It was overwhelming and I think that’s just something that if you know it’s going to be overwhelming or it can be overwhelming, then it’s a little bit easier to just prepare yourself for it.

Everybody’s a little bit different and there are a lot of different regimens. I think part of the reason why many women end up doing more than one cycle is that the first cycle, often you’ll try a kind of formula of a variety of hormones and see how your body reacts. Then based on that experience, your physician will then decide on the second cycle how to tweak things around, what to change, what worked when, and so you can have a more successful second cycle.

I know everybody’s a little bit different and some people will have more side effects than others. I think the first time I went through it, it was fairly minimal. I just felt bloated but didn’t really have any emotional ability or anything else that was significant. Really the hardest part was the recovery after the retrieval of the eggs, which I didn’t expect. I thought once I’m done with the shots, celebrated, this is over, the procedure is done. Then it was really the week after the retrieval that was very difficult.

Particularly, the second time around when I did it, we essentially just tried to have an even higher yield and so pushed things even closer towards the limits, towards the extreme so to say, and I had some complications afterwards. It’s very rare to get ovarian hyperstimulation syndrome. It’s essentially when you’re just stimulating ovaries so much that you can have some hormone imbalances. I felt pretty ill after the retrieval. It took me a couple of weeks to recover and really feel like I’m back to normal. That’s something that I didn’t expect. I thought the actual giving myself the injections was going to be the toughest part, but it turned out to be the recovery afterwards, where I had . . . You have belly full of ascites and felt just really heavy and very fatigued. It’s hard to breathe, so on and so forth. It’s a rare complication, but it’s certainly something that you have to think of.

How long does that one round of the procedure take in total?

It took me about 10 days. It depends a little bit on your health and your physiology and what you decide with your physician. I thought what was extremely interesting and helpful was that you can control and manipulate things to the hour. I was happening to be a trainee at that time. I was a resident, I was a surgery resident, I had very narrow breaks and times when I would say, “I could come between this hour and that hour.” So, we were able to schedule everything around a very tight schedule. You have to give yourself the medication at certain times, like the day before the retrieval, I had to wake up at 3:00 in the morning, because it had to be exactly so many hours before the procedure. But the whole thing takes about 10 days.

Then the recovery, it took long after that?

The first time around, it was just the, I don’t know, three, four days. The second time around was a couple of weeks.

You’re now, you’ve done your second round, you’ve been through this process twice, correct?

Yes.

Having been through it twice. Has your view on whether it’s worth doing changed at all? Do you still feel like ultimately it’s entirely worth it because of the option that it’s given you? Or has the calculation changed now that you’ve been through it?

No, I think it takes the pressure from making that decision. I think this is what’s changed. Because without it, you feel a little bit of a rush and stress of, “Oh my goodness, what if I don’t have a family now, will I be able to have it later? Will there be more complications?” Obviously, the health of your eggs matters and it’s affected by your age. The older you are, the different the quality of your eggs is going to be, so the younger you are when you freeze your eggs, in some ways, the healthier embryos you may have.

On that, one of the questions I wanted to ask is, is there a expiration date on those eggs? If you had it done at 25, do they become less viable over time or no?

Yeah, the answer is no. Yeah, once you freeze, that is the technology today, it’s called vitrification, it just became widely used maybe about 10, 15 years ago and it’s literally pressing the pause button. Eggs are full of water, so it was challenging to freeze them, much more challenging than sperm. We’ve been freezing sperm really well for decades and decades. But eggs have been really tough because they’re very complicated. There’s lots of organelles and water and things like that, because the egg is responsible for all the cellular functions in the first three days of the embryo’s life. Whereas the sperm is just like a little DNA missile.

Freezing that big cell was really difficult and the first frozen egg baby was in 1981, but then there are no frozen egg babies through the ’90s, then we figured out how to do it much better. Now a lot of people are freezing eggs because the pregnancy rates are much better. And a frozen egg once you thaw it behaves almost exactly the same way as a fresh egg, although the shell is a little bit harder. So, to get the sperm to fertilize, you do have to inject the sperm into the egg with a process called ICSI, intracytoplasmic sperm injection.

But the eggs, you should put them in your will, because you don’t want crazy people doing things with them after you’re gone, because they are definitely going to be around for longer than you are. There was just that incredible news story with the babies that were born after being frozen for 30 years. That is a much older technology. Those babies are alive and well and healthy. We think the current technology is even better than that now.

But it is a numbers game. You do need, you usually need multiple eggs and that’s why Dr. Baiu is talking about doing multiple cycles. Although, I would say, most of my patients do just one retrieval, because ultimately I would love for people to have 18 to 21 eggs in the freezer. That’s about a 95% chance of having one healthy baby on average, depending upon your age. You need more if you’re older, maybe less if you’re younger. But a lot of this is about no regrets, because even if you have 100 eggs, you might not necessarily have a baby from those eggs. I do have a patient who froze over 100 eggs, 10 retrievals, and is very happy now with her donor egg baby. I have a patient who was only able to freeze one egg and has a little boy from her one frozen egg.

We do not have complete control over the future. A lot of this is about really making a very informed decision for yourself that you feel good about, so you can sleep at night, have no regrets and like Dr. Baiu said, and I think you have said, Matthew, that you’re taking some pressure off yourself, you’re turning down the sound of that biological clock a little bit, because you feel like you’ve made a good decision for yourself and if you decide, “I’ve gotten all the information, this is not for me.” Hopefully, you could also feel like, “Okay, I made an informed decision, that’s not for me.”

What is the success rate of egg freezing when it actually comes time to use the eggs? What’s the percentage?

There are some calculators out there and tables that give you general ideas. If you’re, let’s say, healthy and less than 35 years old, 35 or less, and these are healthy normal eggs, I would say every half a dozen eggs would give you maybe one or two nice embryos, and each embryo is about a 50% take home baby rate. That comes out to being eight to 21 eggs being about a 95% take-home baby rate, which is really difficult, because either you’re pregnant or you’re not, you’re not 95% pregnant or 50% pregnant. It’s hard to know, that it can vary widely.

But those are good general numbers for the United States, good programs in the United States who are experienced with egg freezing using the current technology of vitrification. I feel like most doctors across the country will give those kinds of numbers. If you are over 40, then the numbers can vary widely and some people feel like once you turn 43, you probably, you might need over 100 eggs to make a baby. Not that anybody’s ever done that, but those are extrapolations of data where people try to calculate things to give people an idea of what the pregnancy rate would be.

It strikes me that it must be a very, very difficult decision for so many people to do this, because you are having to do it often at a time where it’s a very preemptive, proactive measure if-

Well, obviously, I see a biased population, I do see people are not necessarily positive they’re going to freeze their eggs, but I feel like everybody really wants the information. I think most women, a lot of women are very proactive about their health. Guys, not as much. But women seem to be very proactive about their health and very curious about the process. A lot of the issue is the money. That’s hard. Some people don’t like needles and things like that, but the lack of insurance coverage is a big barrier. Also, Dr. Baiu and I are both on the coasts, where there’s a lot of IVF programs that are really good. The middle of the country is definitely a lot harder. There’s just not as many IVF programs in the United States as there are in, say, Europe.

Because I know we had one of our podcast listeners who wrote in, I think she was 42 and she decided at that age to do IVF and it was successful and she sent in a picture of-

Oh that’s wonderful.

… her and her baby, which was lovely. But one of the comments that she made, and I’m curious to know what your thoughts on this are, and of course to some extent her view is based on the fact that it worked for her to wait that long and then to have IVF. But she suggested that these treatments are a billion-dollar industry that obviously benefits a lot from people doing egg freezing. Her point was that there’s the window for women is often exaggerated in an attempt to get a lot more people buying into these treatments.

Yes. That’s why it has to be no regrets. We can’t say everybody should freeze their eggs, because everybody shouldn’t freeze their eggs and nobody should feel pressure to do that. It is a billion-dollar industry and people… I’m near New York and in New York, there’s this company that’s famous for riding around in yellow trucks testing people’s AMH levels and telling them, “Oh my god, your AMH doesn’t look good. You need to freeze eggs right now.” That’s not really a great way to go about it.

Now, having said that, I will tell you, as a reproductive endocrinologist, I’m board certified, an OB-GYN and reproductive endocrinology and infertility, and all the OB-GYN female physicians all want to freeze their eggs and really feel strongly that it is a good, proactive reproductive health thing to do. For our residents, we try to just get it covered and find free drugs for them and things like that, because we feel like we want them all to freeze their eggs if that’s something they want.

So, you see experts who are taking care of patients and living this every day and really seeing the power of this technology, we really believe in our own technology. Yes, there is a billion-dollar industry and I don’t think people should be pressured and fearmongering is not good, because by the way, AMH, everybody thinks AMH predicts fertility and it doesn’t, just because your AMH is low might mean you would have a low response to fertility drugs, but it does not mean you are going to be infertile. Honestly, we’re not very good at predicting that.

I think people, it has to be a very personal decision and you have to have a conversation and get a real evaluation with a board-certified reproductive endocrinologist who has experienced freezing eggs. And you should never feel pressure. If you feel pressure to freeze your eggs, you need to find a second opinion. No one should feel that kind of pressure.

The thing is . . .

You’re getting me worked up, Matthew.

No, I mean, I’m happy with doing this. I don’t mind worked up. I’ve been doing what I do for 15 years now and it’s been a subject that has, it’s felt important to me for a very long time. As a man in my 20s, I didn’t feel too confident in wading in on the subject. But the truth is, for a long time, I was dealing with women where the elephant in the room was that they were on dates trying to find an amazing partner at the same time as trying to make this life goal a reality for themselves-

So difficult.

… of having a family. That’s two really difficult things that you’re trying to do together. It’s hard enough just to find someone who you would want to spend your life with, without the pressure added of being on a certain timeline. And these women, in knowing that there’s this thing that they want so badly, what was really sad to me for a long time was I saw them behaving as if they had no leverage and there was something that in their minds they had to have this other person for and therefore it was almost as though every date subconsciously, or just in a way that they never vocalized, they felt like they were coming to the negotiating table from a place of no power.

That was, for me, what started me feeling like, even if I’m coming to this from a biologically ignorant place, I know the pain that I’m seeing day in, day out in people and I can see the bad decisions that they’re making because they’re acting out of fear, not out of a place of certainty and a feeling of control and confidence.

And so to put this conversation in a slightly different gear, I want to present to you my crusade and then for you to tell me what you think, how you think women should be thinking about it from your expert knowledge. Because I have only ever… I’m happy to wade in ignorantly and make mistakes for the purposes of giving women more control and getting them to have conversations that they’re otherwise wouldn’t be having. And I’m a bit of a control freak myself. So, if I was a woman, I know my nature would be to try to control the situation as much as I possibly could. And if I knew there was an option out there that could buy me a lifeline in some way, if it could extend the window, if it could give me a backup plan, I would want that if for no other reason than, then when I was on a date, I could, if it worked, great, and if it didn’t work, ultimately I don’t need you.

My publisher, Karen Rinaldi, who is a staunch feminist and a very, very formidable woman, we were walking along the street in New York one day and, I’m 35 now, I must have been 24 at the time, because it was when I was publishing my first book. I said to her, “What do you say to women who are at risk of making really bad decisions about who they end up with because they’re in a rush? It’s also not to mention it’s just changing their energy around a person and it’s making them accept less than they deserve, they’re lowering their standards, they’re accepting bad behavior, all because they want this goal to happen.” Her view was, “If you know this is a life goal of yours and that it is something you really, really want to do, why would you rely on a man for that? Why would you give a man power in that situation?” This was someone who ended up having her own children with a partner, but she was more than ready to do it on her own if that didn’t happen.

I suppose I put it to you, how important do you think it is? I know that you say that it’s a personal decision for everybody and maybe I need to, for a moment, remove the financial issue, because I think that’s its own barrier. But if you remove the financial variable and control for that and just say, do you believe personally that in order to give themselves that power and sense of control and to make better decisions that people in their early 30s, do you lean towards they should do it rather than they shouldn’t do it?

I lean towards they should definitely think about doing it, but I think I’m biased.

What do you think, Ioana?

I’m going to use a phrase that you used in your other podcasts when you make the difference between settling for something or settling on something. I think just to bring it to your point is I feel like when you’re feeling that pressure and the stress that you’re running out of time, that’s when you risk settling for someone just because you’re running out of time as opposed to settling on someone because they’re the right person and it’s the right time, and now you’ve taken this other variable out of the equation.

I do think it’s a personal decision. I do lean towards, I think you should consider doing it, get your data, get your facts and talk about it, because that doesn’t cost you anything. Then you can make a more informed decision. But I do think it empowers you at the end of the day to set your own schedule and empowers you to take control of your body, to make your own decisions and to just control your own biology to a certain extent. It’s not that if… First of all, there’s no guarantee, as Dr. Chen said, but also just the fact that you’ve done it doesn’t mean that you are now obligated to have children with someone or on your own. I mean, the only downside, and not to bring it back to the finances, but the only downside is that once you’ve done it, you do have to pay every year for those eggs to be frozen. It’s not like once you’ve done it, it’s a done-

How much is that roughly?

It depends on the place. I’m sure I think, in my place, is something between 600 and $1,000. It’s not-

A year, a year.

It’s something, a year. Yeah, every year.

Yeah, it’s significant.

A year.

Yeah. It’s something that you just at some point if you’ve decided, “Okay, I’m definitely not going to do this,” then you can stop paying for it, presumably. But you always have that option open as long as you’re willing to do it. I do think it empowers you to make a decision later and it just in some ways kicks the ball down the court, then you can make that decision at a later time if you choose to.

Ioana-

Then the other thing that I’ll-

Oh, please.

Well, I was going to say just one other thing, because I have had friends who’ve done this, there is a difference between freezing your eggs and freezing embryos. I think that that’s something that it’s worth thinking about, as we discuss relationships or marriages and people who decide to have children, I do have friends who’ve frozen embryos and then ended up breaking up with that person and they never actually had eggs frozen.

I hadn’t thought of that.

Yeah, we have to talk about that, because there’s a little bit of a patriarchal attitude in our field with many programs or maybe just an archaic attitude that looking at old data, that it’s better. No, it’s patriarchal. It’s really patriarchal saying it’s better to freeze embryos. We have more data on frozen embryos, because it’s been around for longer. But for long-term future storage, if you are not ready to have a baby right now, you really shouldn’t be freezing embryos, honestly.

I do have people embryo-banking, where they have one baby and they want to have two or three babies and they’re already like 38 and they’re doing IVF anyway, so they want to store some embryos. I think that’s perfectly reasonable. But for somebody who’s really not ready to have a family yet, to do this, to do embryo preservation as fertility preservation really does not make sense. Dr. Baiu is absolutely right. We’ve seen some really terrible cases where people are stuck with these embryos. Once we put the sperm in there, we can’t take it apart. And to tell somebody, “Oh, the pregnancy rate’s a little bit better with frozen embryos.” That’s a little bit of a myth. If you are at a good program that’s doing a good job of freezing eggs, it’s not better. It’s really almost exactly the same.

People do that because they’re already in a relationship, but neither one of them is ready to have children and it therefore is preserving a child that you can have with this person. Is that correct?

Right.

Those are the circumstances under which you would do it?

No, I’ve even seen people saying, “Yes.” And with this idea that somehow medically freezing embryos is better, but it’s not. It’s potentially a huge disaster. I mean, we have over a 50% divorce rate in this country.

Yeah, yeah, yeah.

So, you’re flipping the coin like, “Am I going to be able to use these embryos or not?” It’s always better to freeze eggs. By the way, now that Roe v. Wade has been overturned, the frozen embryos take on even more of a risky proposition. We do not know what is going to happen with all of this legislation in the wake of Roe v. Wade. People are proposing some really crazy things. And it’s much better to have frozen eggs than to be dealing with frozen embryos in long-term storage. I wouldn’t be purposely making embryos that you are not ready to use.

But if you break up with that person, that embryo, can it be legally used?

Yeah, it could be legally used if both parties agree, but-

But would need sign-off from both parties?

 . . . there’s some horrible court cases where people are fighting and fighting and fighting. The lawyers are benefiting, but nobody else is fighting over embryos.

But does it sign-off by both parties? In other words-

It does, but people change their minds. We have a case in New Jersey where this woman had cancer and froze embryos with her fiance and they drew up legal documents that said, “In the case of divorce, she would be able to use these embryos to conceive.” They broke up, she survived her cancer, she got ready to use her embryos, he changed his mind, they had a legal agreement, he changed his mind. And he could easily have won, because there are, depending upon the judge and the situation, most cases rule that you cannot force somebody to procreate against their will. But this judge said that this was her last chance to have genetic children and I think ultimately she won the lawsuit. But it was a lot of pain and suffering.

This is perhaps down the rabbit hole a little bit, but I’m finding this a little bit . . . This is kind of fascinating, because I’d never even considered that eventuality. Does-

Oh, Matthew, there’s so many rabbit holes in reproductive medicine. We could talk.

Right. I’m just quickly learning that. In that sense, if she’s choosing to go ahead and he’s saying, “I don’t want this.” Does he, in the same way of normal pregnancy, does he have an obligation there?

I think the judgment was he did not have to pay child support. But if she has a child, he’s got a progeny out there.

Got it. Wow. How fascinating.

Yeah.

That’s a really interesting distinction. Ultimately, even if you are in a, relationship having your eggs frozen rather than an embryo frozen, it’s still a version of greater options, which I hadn’t even considered.

More flexibility.

Yeah, yeah, yeah. Wow.

More options. Yes. Matthew, you’re 35 and I tell all my guys, I would like them to either finish their family by 40 or maybe freeze some sperm by 40, because there is theoretically some increased risk, not as much as women, but some increased risk to the child with older dads. Some of that can be addressed by you being super healthy, but some probably not. Banking sperm is much easier than banking eggs. If you have that option, there’s tons of great sperm banks around that will store your sperm. That’s something that I want I would like men to think about, because I am, as a fertility doctor, seeing more and more first-time dads significantly over 40 and having more fertility issues and being more at risk of having kids with issues because of advanced paternal age. When you have an older wife and an older sperm that in some ways adds to the risk and adds to the infertility risk.

Yes. Yeah, it’s a great example of the ways men aren’t actually in . . . I think so many men aren’t even in the conversation of their own fertility. There is, I think, an assumption amongst so many men that it’s women who have these issues, it’s not men who have these issues. Which is something that I suspect a lot of men find out too late that they have their own factors at play.

Ioana, and if this is too personal a question, feel free to tell me and we can edit this out, but I’m curious as to how far your internal planning has gone. If you don’t meet a person by a certain time, have you decided that you would do this on your own? If for any reason, as an additional kind of eventuality, it didn’t take, I don’t know what the right term for that is, but if it didn’t, have you considered that you would adopt or you would go a different route? I’m curious how many different ways you’ve played out the scenarios in your head that have given you comfort or just you haven’t gone there yet?

No, I think it’s a great question and the answer will vary depending on who you ask, because it’s a very personal decision. For me, I wanted to have the option open and I decided that I would only do this if I were able to have a family with somebody else. I wouldn’t want to do it. I wouldn’t want to raise a child alone or have somebody else’s child that I didn’t know or wasn’t you know. . . This doesn’t mean anything though, I know women who’ve done this exactly because they wanted to be empowered to have children with or without a partner. I think that’s perfectly fair. Some women wanted to, you know . . . Didn’t matter if it was their own egg or somebody else’s and would be open to adoption.

Some other women I know, and this was actually somebody asked me this, I don’t think a lot of people know this, but you can also donate your eggs to couples who are infertile or who’ve not been able to either go through the process of IVF or they have and they weren’t able to fertilize. So, there are some options where you can potentially give your eggs away or to friends or homosexual couples if you have friends who actually are looking for something like this. There’s really many things, many different directions you can go with this. It’s really just a completely personal choice.

With this technology, you have given people the option to, as you said, Matthew, to totally separate the search for a partner from the family-building part. You can separate if you want and you don’t have to do it in the traditional order. You can have the baby first and find the partner later if that’s what you want. All those kinds of things.

Ioana, speaking to that have, when you have decided that for you the blueprint is either that you find someone or you choose not to have children, has the not having children thing been something that you have, you feel that in any way you’ve already made peace with if it doesn’t happen? Or has the kind of urgency that you perhaps would’ve felt earlier just been transferred to later by freezing your eggs?

Yeah, I think it took the pressure off. I think my theory is that I personally would want to have a family with somebody that wants to have a family. I think it makes a big difference if you’re in a relationship where you are both on the same page. I don’t think it’s a decision that it’s not been cemented in my mind and it could still very much go either way. I haven’t settled on one side or the other. It’s given me options essentially that I didn’t have before.

Yeah.

No, we don’t want people . . . We want to take pressure off people, but we don’t want them to delay too long, because as you get older, it does become harder to carry your baby and you do have higher risks in pregnancy like diabetes, high blood pressure, things like that, as you get older, which can be somewhat addressed by a very healthy lifestyle. But that is something to think about as well.

At what age do you see those things really starting to kick in, in a significant way?

They start, I think, we start to be able to measure it a little bit over 40, but we usually stop doing embryo transfers at around age 50, maybe up to 53, 54. It varies by program, but in general, in the United States, the age limit is around 55 for getting people pregnant. Once you had 43, 44, usually people are, if they don’t have their own frozen eggs that they froze earlier are usually using donor eggs to conceive. But in terms of maternal health, we stop around early 50s, because of those risks.

When you say embryo transfer, that’s the term referring to implanting the embryo in the subject?

Yeah.

Okay.

I mean, they have, like in India, I know they’ve done some transfers to people in their 60s, but there was a very upsetting case a couple years ago where the woman, she died soon after the baby was born, when she was in her 60s. Because your heart, it really impacts your heart. We do have to think about that, not to torture people, but we do have to think about that.

Then I think I do want people to . . . Hearing Dr. Baiu’s personal experience, I think really helpful, I would say that I think, as a surgical resident, probably, squeezing it in between cases is tough and that does probably lead to more side effects. Because I think if you can make your schedule really light and you can give yourself enough time to get extra sleep and naps when you need it, because most people need that and drink at least two to four liters of water a day, most people really tolerate this process very, very well.

Just to add another layer of complexity there, depending on how you’re planning on doing this, whether you pay for it on your own or go through the insurance company. I think, in general, the advice is that you would always try to have a natural fertilization. So, you’d always try to have a child naturally. Just the fact that you have your eggs frozen or your embryos doesn’t mean that that’s automatically you decide to have a child, and this is your go-to, I think. Recommendations are still that you try to do it and if not then go through a serious of steps.

Because you might not need them, yeah.

Exactly.

But that’s interesting to me, because I would’ve thought from everything that’s been said that if you are 39 and trying to conceive, but you have eggs frozen and you had those eggs frozen at 30, then there’s potentially less risk of complications with younger, with eggs that you retrieved when you were younger than at 39. Am I completely wrong about that? In other words, is there a greater risk of complications by using your eggs at 39 than at 30?

You’re right and you’re wrong. There’s a lot of things to think about, but it’s costly. You’re doing an extra cost, you’re doing an extra procedure to thaw your eggs and inseminate them and put them in. The vast majority of IVF babies are really healthy, but there is a slightly higher reported birth defect rate for IVF babies, 8% instead of the normal 5%. We think most of that is because most of the data is from infertile people. But we don’t know for sure we are growing embryos in a dish and a frozen-thawed embryo transfer, we are seeing slightly higher rates maybe of high blood pressure in pregnancy, things like that, is that an IVF effect.

It’s nothing crazy. We feel like most people do really, really well. But yes, there’s a risk of miscarriage and things like that when you’re conceived 39 and it’s really up to the patient. But a lot of people think, “Okay, the eggs are a backup plan. If you don’t get pregnant on your own easily, then we use those.” Because we think of them as a type of fertility treatment. But you don’t have to do it that way, but yes, that’s pretty typical.

Firstly, I really appreciate all of this information, because this has without a doubt been the most useful conversation I’ve ever had on this subject. I feel so much more educated on this side of it than going into it. It’s funny, I made a glib comment not so long ago that I felt like I was coming from an uninformed place of saying, “Well, surely, everyone should do this. Why would you not do this?” I mean, finances aside, obviously. I said, “If you had the money, why wouldn’t you do this?” I had a couple of emails back from people saying, “Well, let me tell you why.” I quickly realized how uninformed I was.

But what’s interesting about everything that’s been said here is that while I feel like there’s much more energy and cost and just the effects of the process are much more dramatic than I perhaps realized, I don’t know that it changes how I feel about the whole thing, because I still feel like I’m inclined to say, if there was a woman in my life that I love and she got to her early 30s and knew without a doubt that having a child was something she wanted to do or she felt like there was a good chance that at a certain point she would end up wanting a child, I would want her to have the personal leverage of having created options despite the process and the cost.

It’s very sad to me that some people will never be able to do it because of the cost. I totally agree with you, Dr. Chen, that the idea that this is solely a women’s issue is unbelievably ignorant and there is an inbuilt misogyny to that and to not having it be something that’s covered. I’m with you on that.

Yeah, let’s work on that. Because we passed some egg-freezing laws in New Jersey and there’s nine states that have mandated coverage for egg-freezing for cancer patients. But I think you should continue to say controversial things, because at least we keep the conversation going. Right? I love that you’re having us here to talk about it, because the more people hear about it, I think it’s an educational process. That’s something hopefully we can motivate some people to learn more about their reproductive health and at least have a conversation with the doctor, so they can make this decision for themselves. I do want people to know that’s like such a striking image, Dr. Baiu, what you said of the syringes all over, it does seem really scary, but it is all relative. We’re talking about having a baby. Having a baby is much, much more physically demanding and riskier medically than doing egg freezing. There are risks to everything, but for a healthy woman, egg freezing is really relatively low risk.

I’ll say one other thing, Matt, and this is, again, just from anecdotal and experience of just having friends have done this. The pressure can be tremendous from a partner. I mean, I have friends who’ve gone through the process because they felt pressure from their partner. Sometimes, that’s a decision that’s mutual and can be made by both people. Sometimes, there is that sensation that the woman has to go through a process that can be painful and distressing because her partner really wants to have a family at some point. So, I do think that’s-

Is the pressure that, let’s say, he wants a family at some point, but he doesn’t want it now and that’s the pressure that he’s saying, “I want the option of us doing this and you have to go and freeze your eggs so that we have the option later on?”

Essentially. Essentially. I mean, this is . . . I’m talking, I’m thinking of some friends who’ve had a very similar situation. The one thing that I do think it’s really worth mentioning is that we’ve talked about the success of egg freezing and you go into it and let’s say you have all the money and all the support that you want. Sometimes, it is luck and you can be healthy and young and you might not get the yield that you are hoping or might not get any yield. I know women who’ve taken this very personally and just felt like this was a personal failure, that they weren’t able to freeze their egg despite going through the motions, going through the efforts, choosing a great fertility doctor, paying the money, doing all of it, and then just not being able to do it.

All of a sudden, they’re faced with this reality that’s pretty tough to take in when you weren’t expecting, you were thinking that you’re doing this because you want to be proactive and you want to save an option and all of a sudden you realize you can’t do that. It can be emotionally hard on some people and it’s just something that it’s worth thinking about. Again, I think a lot of it, it’s personal, but I think just being informed and making an informed decision is critical.

It’s much more than a decision about a medical procedure. You’re really talking about making a decision about your life, really. Because all those things come into play in that decision.

But in a way, you are also doing the opposite. You are giving yourself, you are just keeping doors open in life. To not do it is also a decision about, there’s a potential decision about the future. And I have to assume that if someone’s yield wasn’t what they thought it was, that is a reflection of their fertility anyway, correct?

Mm-hmm.

Right.

You’ve learned something.

It may just be . . . Yeah.

Right. To that extent, in a way, you’re learning something painful, but you are only learning something painful that you would’ve learned anyway down the line. Right? You’re just learning that earlier.

Right. I think, yeah, it just hits people sometimes hard if they’re like 30 and all of a sudden you’re realizing, “Oh, this is happening and I can’t do it and I don’t have that option saved.” And it’s just making you wonder, “Is it too late? Have I waited too long?” It can be emotionally-

But I would’ve thought almost that if you delayed it another five years, you would only increase that feeling of, “I should have done something sooner.” I feel like the person who does it at 30, they’re already being a very proactive person. I would hope that people would try at least to feel that message of actually, “What I did was an incredible thing. It may not have worked, but I’m the kind of person who took action and I had no control over whether that action was, aside from some of the factors that maybe I can have some control over, ultimately, it’s my body we’re dealing with.” I would hope that people would be incredibly proud of themselves for having taken a very proactive step, even if that proactive step didn’t pay off the way that they wanted it to.

Ultimately, it’s still information. I feel like, hopefully, from this call, I’m hoping that so many people listening, men included, feel like this is just information. I mean, even for me, it’s given me a sense of urgency about just having some key internal and couple conversations with my partner in just making, deciding what the plan is and what options are in front of us. I think that even for me, it’s been really educational in that respect.

I think you’re right about all of that. I think you’re right. People should feel good about themselves for even having the conversation or listening now, you are getting more educated and that is empowering. The more education you have about your body and your health, you can make a difference, even though sometimes the outcomes may not be what you want, but you are making a positive difference. Absolutely.

Even feeling that fear, because these conversations are kind of scary, but even feeling that fear of, because you’re treading in deep water all of a sudden thinking about all of these things. I feel like even the fear is a reflection of progress, because it means you’re having the difficult conversations. You’re no longer putting them off. The sooner you are having difficult conversations within yourself, the sooner you’re bringing about the piece from having resolved them one way or another, whatever the outcome.

What you mentioned about feeling proud that you’re doing something, I feel like once you embark on the train and you decide you’re going to do this and you follow the steps, there are things that are outside of your control. So you just have to remind yourself that you’ve literally done everything you possibly could. You literally have done your best, you’ve pushed your body as hard as it possibly could get pushed, and whatever the result is, it’s the result and it’s not because you’ve done something wrong or because it just, it’s really, I think it’s important not to beat yourself up and just be proud that you’ve done it and no matter what your yield is or what your result is, the important thing is that you’ve taken that decision and you’ve thought it through and you tried.

I agree.

I thank you so much to both of you for joining me today. It’s been lovely talking to you both and you have such a lovely way of sharing the information that I just feel really grateful. There were any number of people that we could have had join us on this subject, and I’m really, really glad it was the two of you.

Thank you.

Thank you. I’ll leave it with one other thing just to keep it out there is just don’t go through this alone. I do think it makes a tremendous difference to have friends or family know that you’re going through this, because it is hard. I think it was so nice to have somebody that could pick you up after, on the day of a procedure, drop you off and pick you up and get you home with good food and celebrate the fact that you’ve done this incredible thing and it’s over. I think it makes a tremendous difference to not be lonely in it.

100%, I totally agree.

Lovely. Well, thank you both and please stay in touch and if you’re ever listening to anything I’m doing and you think I’m missing something crucial, please know that your opinions are always welcome and I’d love to hear from you.

Well, I’m subscribed now, Matthew.

Thank you so much.

I will be listening.

Very good. Thank you both. Take care.

I just wanted to say thank you for watching this. If you’re a woman, I hope that this helped and I hope that it gave you much-needed information. If you’re a man, I hope that this gave you much-needed information, and I hope that it created a sense of perspective and empathy about what women go through in this area. I would love to hear from you all on this. Leave me a comment. Feel free to reach out and message us on Instagram or by email, but just let us know what this meant to you, because I want to continue having these kinds of conversations. I think they really matter, and I think they’re going to make a big difference to a lot of people’s lives. Thank you for watching and I’ll see you in the comments.