Online Health Chat with Jeffrey Goldberg, MD
September 10, 2013
Although many women today often delay starting a family, their biological clocks keep ticking. The longer women wait to become pregnant, the more challenging it can be. Now women have the opportunity to freeze their eggs for use when they are older and the timing is better. It also allows women undergoing chemotherapy or radiation treatment for cancer to preserve their fertility by banking their eggs.
Egg cryopreservation is the process of freezing eggs for future use. This alternative to embryo preservation allows women to preserve their fertility by banking their eggs. Whether eggs are frozen or fresh eggs are used, the results of in vitro fertilization are the same in terms of delivering healthy babies.
The technology of egg cryopreservation has advanced the options women have for fertilization, whether because of timing or to allow for improved health before starting a family.
About the Speaker
Jeffrey Goldberg, MD is Head of the Section of Reproductive Endocrinology and Infertility in the Women’s Health Institute at Cleveland Clinic and professor at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is also the director of the Reproductive Endocrinology and Infertility at Cleveland Clinic. Dr. Goldberg is board-certified in obstetrics and gynecology and subspecialty board-certified in reproductive endocrinology by the American Board of Obstetrics and Gynecology. His clinical interests are advanced endoscopic surgery, microsurgical tubal anastomosis, in vitro fertilization, and reproductive endocrinology. His research interests include endometriosis, reproductive surgery, and in vitro fertilization.
Dr. Goldberg completed his fellowship in reproductive endocrinology and infertility at The Ohio State University, in Columbus, following his residency in obstetrics and gynecology at Emory University, in Atlanta. Dr. Goldberg received his medical degree from The University of Medicine and Dentistry of New Jersey, New Jersey Medical School in Newark, N.J.
Let’s Chat About Fertile in the Future: Egg Freezing
Moderator: While many people associate infertility treatment with in vitro fertilization there are other fertility services available. In vitro fertilization generates a great deal of media attention, but most patients can be effectively treated with simpler means than in vitro fertilization.
Cleveland Clinic fertility centers provide the full range of state-of-the-art services for the diagnosis and treatment of infertility, including in vitro fertilization. Patients are seen in a caring environment, where the major emphasis is not only technological excellence, but also on accessibility, personal attention, and emotional support.
Jeffrey_Goldberg_MD: Welcome to the cryopreservation web chat. Cryopreservation is also known as egg freezing. Thank you for joining us today. I appreciate your time and look forward to answering your questions.
zippymelissa: What tests can be performed prior to the procedure to determine if egg freezing is a viable option?
Jeffrey_Goldberg_MD: The best predictor of success with egg freezing, and any infertility treatment for that matter, is the age of the woman. Fertility rates progressively decline starting in the early 30s and the risks for miscarriage and birth defects rise. That is the rationale for freezing eggs from women who are in their 20s and early 30s for later use when they are in their mid-to-late 30s or 40s. There are several tests to check ovarian reserve, which is a reflection of the number of eggs remaining as well as response to stimulation with fertility drugs. Women with low ovarian reserve can expect to recover fewer eggs per retrieval, but may still want to consider freezing eggs since there is a concern that they may go through menopause earlier.
Samantha: I am on a career path where I want to wait to have children. I am concerned with my prospect of fertility down the road. Is cryopreservation come with an age limit—meaning is it better or more viable if a woman is younger?
Jeffrey_Goldberg_MD: Absolutely. Women should ideally bank their eggs in their 20s and early 30s to assure the best possibility of success.
Effect of Endometriosis on Eggs
abrahaml: How does endometriosis affect a woman's ability to freeze an egg and the likelihood that it will be useful later in life? I am 28 years old and have been on Lupron® depot (leuprolide acetate) for two years for the treatment of endometriosis.
Jeffrey_Goldberg_MD: Endometriosis may reduce the number of eggs available per retrieval cycle as well as reduce the chance for pregnancy after the eggs are thawed, fertilized and transferred.
Effects of Chemotherapy on Eggs
DH31: I will be undergoing a double mastectomy and was wondering if I should look into this option for future fertility concerns. I am mostly concerned about chemotherapy for the breast cancer and what it might do to my eggs.
Jeffrey_Goldberg_MD: The concern with chemotherapy is that it can lead to early menopause. This was the original use for egg freezing. Now that it is successful, it has been made available for women who want to electively freeze their eggs for social reasons. After chemotherapy, the patient would need to wait until they have been in remission for several years before they could attempt to conceive. The frozen eggs are not aging during this time.
zippymelissa: If we determine this is something we would like to pursue, what is the first step—specifically for an out-of-state patient?
Jeffrey_Goldberg_MD: Prior to freezing eggs, the woman will need to meet with an infertility doctor to discuss the process and chances for success. An in vitro fertilization (IVF) nurse will review how to administer the fertility drug injections (given like an insulin shot with a tiny needle under the skin) and the patient will need blood work for sexually transmitted diseases as required by the FDA. Monitoring during the cycle with ultrasounds and blood work can be done locally. Our IVF lab and storage facility is located in our Beachwood office. The main number to call for an appointment is 216.839.3150.
JoanieV: Does overstimulation of the ovaries during a treatment cycle have any long-term negative effects? I am wondering because this happened to me the last time I went through in vitro fertilization. I am in the unexplained category of infertility.
Jeffrey_Goldberg_MD: Overstimulation of the ovaries usually occurs to a mild degree after using injectable fertility drugs. Multiple cysts develop in the ovaries and resolve on their own within about two to four weeks. In more severe cases, it can potentially be life-threatening with risks for kidney failure, fluid collection in the lungs and blood clots. These patients require hospitalization until the condition resolves.
dot.chewie: How many retrieval cycles are needed? What are the long-term risks from fertility drugs?
Jeffrey_Goldberg_MD: About 10 to 20 eggs are typically recovered per cycle so two or possibly three cycles may be needed to get the desired 20 eggs in storage. Millions of women have used these fertility drugs for over three decades with no risk beyond overstimulating the ovaries during the treatment cycle. It must be kept in mind that being childless increases the risk for several cancers such as breast, ovarian and uterine.
Egg Harvesting Procedure
atgb007: Can you please describe how eggs are harvested? Where is the ultrasound located?
Jeffrey_Goldberg_MD: The eggs are harvested using a vaginal ultrasound probe with a needle in a procedure room in the office. There is no cutting or surgery involved. The procedure takes about 15 minutes and is done under anesthesia, so there is no discomfort. Patients are ready to leave within an hour.
Egg Cryopreservation: Freezing, Thawing and Use
NaNaNa: Is egg freezing safe? Can it cause any harm to my eggs?
Jeffrey_Goldberg_MD: Egg freezing is a fairly new treatment option so there are no long-term data, but there is no increase in miscarriage or birth defect rates. The concern with trying to conceive later in reproductive life is that the risks for miscarriage and birth defects are dramatically higher, if the woman is able to conceive at all.
London: How many eggs need to be frozen in order to assure a woman that she can use them to conceive?
Jeffrey_Goldberg_MD: We recommend having about 20 eggs in storage.
atgb007: Do most women freeze unfertilized or fertilized eggs? Do some women do both?
Jeffrey_Goldberg_MD: If they have a partner they want to have a child with, women may freeze fertilized eggs. Unfertilized egg freezing is used when there is no partner, and they don't want to use a sperm donor. Some women going through in vitro fertilization will elect to freeze both fertilized and unfertilized eggs for religious reasons if they want to avoid the possibility of having excess frozen embryos that they wouldn't use.
London: What is entailed in thawing and using the eggs?
Jeffrey_Goldberg_MD: The lab thaws the eggs in the lab, inseminates them using the partner’s (or donor’s) sperm, then cultures the fertilized eggs (now called embryos) for three to five days before they are placed in the cavity of the uterus (womb) using a narrow, flexible catheter. The transfer only takes about three minutes and feels like a Pap smear.
London: Does a doctor at Cleveland Clinic do the fertilizing and implanting of the egg(s) once it has thawed?
Jeffrey_Goldberg_MD: The embryologists thaw and fertilize the eggs then culture the embryos in the laboratory. An infertility specialist physician then performs the embryo transfer.
London: What risks are involved in freezing, thawing, and utilizing the eggs?
Jeffrey_Goldberg_MD: The only risk to the woman is overstimulating her ovaries with the fertility drugs during the egg collection cycle. In that case, the ovaries develop multiple cysts that may cause discomfort until they completely resolve on their own in a few days. Very rarely, it can be severe enough to require hospitalization. The only obstetrical risk is for multiple pregnancy, if more than one fertilized egg is transferred to the uterus.
London: What happens to a woman's unused eggs?
Jeffrey_Goldberg_MD: They may be donated to another woman, donated for research or discarded.
London: What are the costs associated with freezing eggs—both current and long term?
Jeffrey_Goldberg_MD: The cost to collect the eggs (including anesthesia), freeze them and store them for one year is $6600. Cleveland Clinic employees and women undergoing cancer treatment get a 50 percent discount. In addition, the medications required to stimulate multiple eggs to mature is approximately $2800 per cycle. The annual storage fee beyond the first year is $400. The cost to thaw and fertilize the eggs, and then culture and transfer the embryos (and freeze extra embryos) is approximately $3700.
London: Will insurance pay for any or all of the costs?
Jeffrey_Goldberg_MD: Insurance will typically pay for the ultrasounds and laboratory work for monitoring the cycles, since they are diagnostic tests. However, they usually don’t cover anything else except the medications depending on the policy.
atgb007: What is the cost for Cleveland Clinic employees?
Jeffrey_Goldberg_MD: Cleveland Clinic employees get a 50 percent discount.
Moderator: I am sorry to say that our time is now over. Thank you, Dr. Goldberg, for taking the time to answer our questions today about infertility and egg freezing for future use.
Jeffrey_Goldberg_MD: Thank you for your participation in today’s webchat on egg freezing. I appreciate all of your questions, and it was a pleasure chatting with all of you.
If you would like to set up a consultation with a Cleveland Clinic Fertility specialist, please call 216.839.3150 (for women’s services) or 216.444.5600 (for men’s services). You can request an appointment online.
For More Information
On Cryopreservation and Fertility
Cleveland Clinic fertility specialists offer several options to preserving fertility.
On Cleveland Clinic
Cleveland Clinic fertility experts provide the full range of state-of-the-art services for fertility preservation as well as the diagnosis and treatment of infertility, including in vitro fertilization. Patients are seen in a caring environment, where the major emphasis is not only technological excellence, but also accessibility, personal attention and emotional support. We have locations throughout Northeast Ohio for your convenience.
Cleveland Clinic's gynecology program is ranked third in the nation by U.S.News & World Report and is the top ranked in Ohio.
On Your Health
MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: firstname.lastname@example.org.
A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.Reviewed: 09/13