Freezing Your Eggs with Dr. Stephen B. Mooney

Podcast Transcript

Kate Kaput:

Hi, and thank you for joining us for this episode of the Health Essentials Podcast. My name is Kate Kaput, and I'll be your host. Today, we're talking to Reproductive Endocrinologist Steven B. Mooney about freezing your eggs. American women are waiting longer than ever to have children, and many of them are choosing to freeze their eggs during their most fertile years with the hopes of improving their chances of being able to get pregnant later in life. Dr. Mooney is here to talk to us today about the ins and outs of freezing your eggs. Dr. Mooney, thanks so much for being here with us today.

Dr. Steven B. Mooney:

Thank you, Kate. I appreciate the opportunity to speak on the topic and look forward to the discussion.

Kate Kaput:

We're always glad to have you. So I'd like to start out by asking you to tell us a little bit about the work that you do here at Cleveland Clinic, and what kind of patients do you typically see?

Dr. Steven B. Mooney:

Yes, I'm a reproductive endocrinology and infertility specialist physician here at the Cleveland Clinic. There are seven or eight of us total in the REI division. Each of us sees individuals or couples who are seeking future fertility, experiencing surgical fertility problems, genetic fertility problems, are interested in OSI or sperm cryopreservation and the full range of services also including recurrent miscarriage treatment.

Kate Kaput:

Got it. So a lot of important topics that you guys cover. We're thrilled to talk to you today about freezing your eggs, which has become more and more popular. So can you start out by giving us a little bit of an overview about what it means to freeze eggs, what does that term refer to generally?

Dr. Steven B. Mooney:

Sure. The term egg freezing has more recently been coined. Originally, we added the term OSI cryopreservation. It was very stuffy, scientific terminology, OSI being the equality of the egg or the equal of the egg, and cryopreservation being the scientific or medical terminology for freezing. It probably confused some people in the lay literature as they read articles online or in a magazine in the waiting room. So I like egg freezing better because I think everybody understands, what are we trying to do? There's someone's egg, and we like to freeze it. Why would we like to freeze it? So that we can preserve future fertility in the situation where we're not ready to achieve pregnancy in immediate circumstances.

Kate Kaput:

Got it. That seems like a much more straightforward term than OSI cryopreservation, which I can almost fairly say.

Dr. Steven B. Mooney:

Me too.

Kate Kaput:

So you said that this is something that people might use when they're not quite ready to have a baby yet. Tell us about some of the reasons that someone might choose to freeze their eggs. What are some of the most common personal reasons that you hear for this process?

Dr. Steven B. Mooney:

Yeah, when I've been to lectures and read journal articles and study on the topic, some authors will separate these out into five or 10 different reasons. But many of them can be coalesced together, essentially, if a woman or a couple is not yet ready to achieve pregnancy in their current situation. This could be a litany of things. This could be a female with no partner. This could be an individual who has a professional track in her career that just doesn't allow the time and the commitment for having a child at this point in time, it could be a financial circumstance. But what really happens is, is many of these things are entangled or intertwined, and they're happening all at the same time, maybe someone's not currently partnered and the finances aren't quite maybe what they want them to be and their careers, not real where they want to be. So OSI cryopreservation or egg freezing is something that is worth looking into at that point in time.

Kate Kaput:

Is it correct, too, that there are some treatments, some medical treatments that can impact your fertility, and so there are some folks who might be preparing to undergo, say chemotherapy, who want to undergo freezing their eggs to ensure that they preserve their fertility.

Dr. Steven B. Mooney:

Yes, there are benign conditions and there are also malignant or cancerous conditions that could affect fertility. So, for example, say, a person has kidney disease or multiple sclerosis or lupus, or some other type of condition in which a physician needs to induce a type of remission with medications that aren't consistent with being pregnant. But also there might be an individual diagnosed with a neoplasm or a cancer have to undergo some sort of surgical treatment or chemotherapy treatment, and this won't allow for pregnancy at the current time either. In both cases, the individuals may want to freeze eggs in order to benefit from them in the future.

Kate Kaput:

I know that other folks who might wish to preserve their fertility are individuals who are going through a gender transition. Can you tell us a little bit about that?

Dr. Steven B. Mooney:

Yeah, absolutely. So individuals who are gender transitioning oftentimes want to have all of the same capabilities that every other individual or any other couple has in their reproductive choices. So if an individual is transitioning such that say, an individual is transitioning from male to female and is going to be using certain hormonal medications in order to make that transition take place. Those medications oftentimes severely impact the sperm count, for example, and the same features can play in the reverse.

Kate Kaput:

Got it. So lots of reasons why people might want to freeze their eggs. Talk to us a little bit about age. Is there an ideal age for freezing your eggs? Is there an age at which you're considered too old to freeze your eggs?

Dr. Steven B. Mooney:

Well, anybody who knows much about the fertility game knows that with respect to the possibilities of time, and circumstance, the younger, the better. Of course, probably if I had to pinpoint an age somewhere between the early 30s, and the mid-30s would be the perfect age to cryopreserve or freeze eggs, simply because there's still ovarian reserve or a stock of eggs remaining in the ovaries from which to gather the eggs and also the quality of those eggs, genetically, it still remains intact.

Kate Kaput:

So say that you've decided to freeze your eggs, walk us through the process, what goes into it? What are the steps that the process actually entails?

Dr. Steven B. Mooney:

Yeah, like most fertility services or most fertility circumstances, it involves consultation with qualified physician. So that's usually a reproductive endocrinology infertility specialist. It also involves assessment of ovarian reserve. Sometimes this is the anti-mullerian hormone or the FSH or the combination, also, AFC or antral follicle count could be performed using sonogram or ultrasound. Then there are some other things that need to be done just because of FDA regulations, such as infectious disease screening, and it's really, regardless of the patient's previous or current sexual history.

From that point, then, it becomes planning the cycle from a calendar point of view, taking medications to cause eggs to develop. The egg development is typically monitored using ultrasound. Let's say, an individual would stimulate for maybe 10 days duration prior to being able to withdraw or retrieve those eggs. During that timeframe, she might undergo three ultrasounds in a 10-day timeframe, roughly at three-day intervals in order to see the development of the eggs during the process.

The egg retrieval process or the egg withdrawal process is an outpatient procedure performed with anesthesia. It's done so with an anesthesia because a needle, the same caliber that we draw blood with is passed through the tissue of the vagina and into the ovary. Of course, this wouldn't feel good on any day within any individual's point of view, and really from a physician and safety standpoint, we just need the patient to remain still so we could safely visualize the eggs on ultrasound and withdraw them without harm, or losing any egg along the way.

Kate Kaput:

Are these the same steps in the IVF process or are those two kinds of patients going through the same processes?

Dr. Steven B. Mooney:

Yeah. At this point, up to the point I just described, it's nearly identical, meet with a qualified physician specialist, have a discussion about the risks, benefits, indications, alternatives, likely outcomes, potential failures of egg freezing or IVF in the other aspect, and through the required testing, make a plan, get it on the calendar, start to undertake the plan, and go from that point. But essentially to this point, yes, almost identical to IVF.

Kate Kaput:

OK. So when all is said and done for the process of freezing your eggs. How long does that whole process take, everything you just meant right up until your eggs being frozen, how long are we looking at there?

Dr. Steven B. Mooney:

Well, the beauty of it is, is it can be really performed at a breakneck pace for some individuals. So say, for example, a young woman is referred to me and her diagnosis is unfortunately cancer, such as lymphoma or some other type of cancer in which her oncologist wants to start chemotherapy nearly immediately. Essentially, we can start stimulation medications after the appropriate counseling and after the appropriate informed consent and all of the things that you would expect in excellent medical care are undertaken.

We can perform the stimulation and egg retrieval in a matter of days. So, for example, let's say that we got the formalities taken care of properly, and then the person started on their medication to make the eggs develop and mature, three days of medication, let's get her ultrasounded. Another three days, let's get ultrasound. Then maybe another two or three days and then egg retrieval. So really, if you count those up, you're talking about probably 10, 11, 12, 13 days. From the time we started the medication to the time the eggs were out of the ovaries and then the laboratory for freezing.

Kate Kaput:

So tell us a little bit more about the egg retrieval process. I know that you said it's done under sedation. What else can you tell us about what that procedure entails, recovery time, et cetera?

Dr. Steven B. Mooney:

The egg retrieval process is done under sedation, and in fact, it's done under a full anesthesia. The difference is, is that the anesthetic is such that we can use an oxygen mask to maintain the patient's airway while she's sleeping, instead of having to have endotracheal tube or an intubation. So despite the fact that the patient would be fully asleep under general anesthesia, there is a less involved technique in order to maintain the airway, which is better for patient recovery in a quicker fashion.

From the standpoint of the retrieval process and a transvaginal or internal ultrasound is inserted once the patient is fully asleep, and on the ultrasound screen, we can visualize the egg follicles, which almost looked like a modified cluster of grapes, black ovals, black circles, and there is a biopsy guide on the ultrasound visualization aspect and the needle passes through that biopsy guide.

So basically I can use my eye/hand coordination to see the egg follicles, gently go through the tissue of the upper vagina, and into the ovary, into the egg follicle, and then vacuum or aspirate those eggs from the follicle into the test tube, and hand off to the laboratory so that they can check for the presence of the egg and the Petri dish. Of note, in IVF, this process was called test-tube baby, but never in this process is the baby in the test tube. It might be more like Petri dish baby, but it's only the eggs that's in the test tube.

Kate Kaput:

You know what? That's good to know. I've actually always wondered about that. So helpful. So let's get into the science, then, of how exactly the eggs are frozen after that process. There's gentrification or flash freezing, and then the traditional method of slow freezing. What do each of these methods entail, what are they, and what are the pros and cons of each?

Dr. Steven B. Mooney:

Yeah, vitrification has really revolutionized our field. I've been in the field for nearly 25 years, and during the start of my career, vitrification really was not a clinical process in the human medicine world. It was used in other species and bovine, or ovine, or equine freezing, but not in humans. So when my career started slow freezing or sequential freeze was the technique in play.

The problem with this technique is that ice crystals form through this process and ice crystals are the enemy of cell membranes. In other words, ice crystals, if you can imagine what an ice crystal would look like under a microscope, they're almost jagged, like little sharp edges, and when those ice crystals form and expand, they can puncture cell membranes and when the cell membrane of the egg is punctured, the egg is probably going to not make it through the freeze and thought process, simply because the egg is one single large cell, as opposed to, for example, an embryo, which is made up of a multitude of cells.

So vitrification like I say, has modernized and revolutionized our field. Vitrification really involves being able to pick up the embryo in a very small wire loop. So the best way for someone to imagine this is, think of the circumstance where a child has a ring and a bit of soap solution, and they're going to, "blow bubbles." So think of that ring and how you can dip that ring in the soap solution and that liquid will create a film, and it will stay present in that ring until someone forces it out by blowing on it and, "making the bubble."

Of course, in the embryo lab, we don't blow on this. We simply use the little tiny ring and it has fluids in the surface tension, and we can put that in the Petri dish and literally pick up a single embryo and hold it in that little film, and then that little film containing the embryo can be flash frozen over liquid nitrogen vapor placed in a vial and then placed into a liquid nitrogen tank and frozen for essentially eternity without ice crystal formation. So it's crazy amazing how it's revolutionized things in our industry.

Kate Kaput:

That's really amazing, and I think that's a really helpful analogy for people who might not necessarily have a science-minded brain. When did this start to become the norm? How long have we been seeing vitrification as the standard way of egg freezing?

Dr. Steven B. Mooney:

Yeah, at least for the last 10, 12, 15 years. So it's been around for quite some time in the techniques have been perfected, and nearly every laboratory in the world that performs IVF can do this technique with great fidelity.

Kate Kaput:

Are there other factors that can impact the success of egg vitrification aside from just the type of freezing that is done, lab conditions, things like that?

Dr. Steven B. Mooney:

Yeah. Lab conditions certainly can play a role. I think from a consumer or a patient standpoint, it would be important back during the consultative phase of this process of just getting an idea of how many egg freezes, and quite frankly, how many IVF cycles does a given clinic do? There's an axiom in our field that basically clinics and IVF laboratories should stick to what they do a lot of just because it's sort of the practice makes perfect scenario where if I were someone who was seeking egg freezing, I probably would not want to go somewhere where they say, "Yeah, we did a couple of those last year," as opposed to the practice across the street who has performed 200 in the past year. It doesn't always mean the practice with the numbers is necessarily guaranteed to be better. But you certainly want a practice and an IVF laboratory where the experience is abundant, and one less thing to worry about when it comes to this intricate process.

Kate Kaput:

That makes sense. How many eggs are ideal to freeze? Can you try freezing your eggs more than once to increase the amount of eggs that you have in storage?

Dr. Steven B. Mooney:

A circumstance exists where it would be ideal to freeze as many eggs as possible. However, we're oftentimes limited by the number of eggs available based on ovarian reserve, patient age, and other medical circumstances. So if you take, for example, a patient whom is, let's say, 35 years old, and that patient has 10 eggs. At 35 years old, the average patient with 10 eggs is probably going to have somewhere around a 70% chance for live birth from a frozen egg.

If you take that same person, and she's 35 years old and she ends up having 20 eggs retrieved, that increases her chance for live birth to probably around 90%. Of course, I don't want any of the statistics I'm using to be thought of as applied to any individual patient. It's just trying to give an example of what does it mean to have a certain number of eggs, and what do I mean when I say, the more, the better? Because essentially for a lot of young women who are freezing their eggs, the more eggs they have, the greater likelihood that they're approaching a 100% chance for a future pregnancy.

Kate Kaput:

OK. So say that you've frozen your eggs and the time has come when you want to start to try to get pregnant. What happens next? Where do you go from there?

Dr. Steven B. Mooney:

Yeah. So again, like before, we have consultation, and then we discuss, what does all of this mean? Of course, we presume that when the individual is ready to thaw their eggs and use them, there is going to be a sperm source. So many times, that is, that the individual is now partnered, or the individual has gotten to the point in her life where she's decided to not achieve pregnancy partnered and donor sperm would be selected and utilized.

So essentially the egg has to be thawed. Thaw rates for vitrification are thought to be somewhere between 80% and 90%, and then the thawed egg has to be fertilized. It can be fertilized through conventional, in vitro fertilization where the sperm and egg are simply placed in close proximity to one another in the Petri dish and allowed so-called nature to take its course, or there's the ICSI technique I-C-S-I intracytoplasmic sperm injection where a single perfect sperm swimming in perfectly shaped is injected into the proper location of the egg to obtain fertilization.

Once the sperm is in the egg, it would be the next day that fertilization would be checked. There are certain visual parameters through which the laboratory can determine that the egg fertilized normally, and then the fertilized eggs, now embryos, are allowed to grow in the culture media in the Petri dish. The culture media is the solution that is specially made for the embryo to grow in. The embryo grows in laboratory for the next five to six days. We grow them for five to six days in the laboratory, in the Petri dish, simply because in human reproduction, that's the ultimate stage of embryonic development. Embryo development is what's called the Blastocyst stage. Once the embryo reaches the blastocyst stage, it either has to be transferred into the individual's uterus in order to conceive, or it has to be frozen because current techniques don't allow for further development in the Petri dish.

Kate Kaput:

OK. So what happens from there? It's been monitored for a little while and then what's next?

Dr. Steven B. Mooney:

Yeah. So again, depends on what our pre-planning has been with the patient. If the pre-planning has been to monitor her uterine lining or her endometrium, so that we know that it's ready and receptive to achieve the pregnancy, we could do what's known as a fresh embryo transfer. This simply means that the embryos that have grown out to the fifth day and become blastocyst. The leading or the best one of the class, can be selected for transfer. That embryo transfer occurs. Unlike the egg retrieval, the patient is not under anesthesia for this procedure, the patient is awake. A speculum is inserted vaginally, similar to a Pap test or an annual exam technique. We visualize the cervix, and using a flexible hollow catheter under ultrasound guidance, we transfer the embryo into the endometrium and the uterine lining for potential pregnancy.

The opposite of that would be a frozen thawed embryo transfer, and I know this sounds a little crazy because you think like, "Well, the eggs were frozen. Now, we thawed them. Now, we're going to fertilize them. Now, we're going to freeze them again." But there are certain circumstances in which that would be necessary. So let me give you a couple, one circumstance would be if the individual wanted to perform genetic testing of the embryo. Genetic testing of the embryo involves a biopsy, or taking a few cells from the part of the embryo known as the trophectoderm. The trophectoderm is the portion of the embryo that becomes the placenta in the membranes of the pregnancy, not the portion that becomes the fetus, or the embryo, or the baby. Those cells can be analyzed for chromosome, normalcy, or abnormalities, but that currently takes approximately 10 days to two weeks to return a result.

Remember in our previous part of the discussion, we know that the embryo can't sustain itself in the laboratory greater than five days. So, since there's a discrepancy between when the result would be available and when the embryo has to make a decision, so to speak, we would freeze that embryo after the biopsy awaiting the results so that we would be able to determined that, "This particular embryo is genetically normal. Yes, it's the one we want to transfer." At that point in time, having prepared the patients uterine lining properly for implantation. We would thaw the embryo and do the transfer technique.

              One of the other reasons other than genetic testing would be some women whom stimulate vigorously with the medications for in vitro fertilization and egg maturation will actually undergo a mild process called ovarian hyperstimulation, OHSS. In those individuals, it's recommended that they don't become pregnant immediately in order that their ovaries can return back to a normal size from the enlarged size that they became during the stimulation. Even if we had previously planned a fresh embryo transfer, we change that plan and freeze the embryos so that the individual can return their ovaries to normalcy and not become ill from the OHSS circumstance.

Kate Kaput:

So let's set expectations a little bit. Talk to us about the likelihood for success of eventually it's achieving a pregnancy after you've frozen your eggs?

Dr. Steven B. Mooney:

Yeah. Kate, like most of the discussions in the reproductive realm, the likelihood of success hinges greatly upon the patient's age. If we compare two individuals, say one individual is 30 years of age, and the other individual is 40 or 42 years of age. Even if those individuals are able to freeze the same number of eggs, the likelihood of successful live birth pregnancy in the individuals is greater in the 30 year old than in the 40 or 42 year old. It simply plays upon the fact that certain things are finite and known in this equation. One of them is that with time, the number of eggs will decline with age. But remember, in my example here, I said, both of these individuals have the same number of eggs, therefore embryos decline in genetic normalcy with time as well.

              So the 30 year old individual has a much lower likelihood of having a genetic abnormality, and the genetic abnormalities, of course, lead to lower chance for pregnancy and greater chance for miscarriage. So it's really difficult to blurt out a statistic, or just say a certain number of giving someone what to expect from this, and that's why way back in the beginning, when we talked about having a consultation with a qualified provider, it's because we should look, there's actually sort of a nomogram, if you will, where it plots the number of eggs versus the patient age. You could start with the age of 30 and go all the way through the age of 45. If you have 10 eggs, this is your live birth likelihood. If you have 15 eggs, this is your live birth likelihood.

              It comes back to a question, I think we touched on earlier, are there circumstances where an individual would undergo more than one stimulation or more than one retrieval? The answer is absolutely. Say, we're comparing the two individuals of which we began speaking in this segment, the 30 year old versus the 40 or 42 year old. It may take the 40 or 42 year old, two retrievals, or even three to obtain 10 eggs compared to the 30 year old who may get them in one retrieval. So success is defined here in many, many ways. I know the ultimate answer is we want to live birth, but I think these numbers in this question have to be individualized.

Kate Kaput:

Just like everything else in medicine, that makes a lot of sense. So how long are frozen eggs viable and what happens to unused eggs?

Dr. Steven B. Mooney:

Well, frozen eggs and frozen embryo, for that matter, are essentially viable forever. They're frozen at ridiculously low temperatures. Something like minus 196 Celsius. I mean, numbers that we can't even fathom in our everyday life. So all cellular processes stop, and for this reason, I think... maybe someone out there knows even different, I think that there have been embryos that have been thawed and have led to live births. The embryos were 20 or 25 years old. So there's no reason to think at this point, based on what we know, that eggs couldn't be frozen for that duration of time as well. Clearly, that's not a duration that most individuals are going to utilize. Most individuals are probably going to utilize their eggs within three to five to 10 years’ time, and so there should be no worries whatsoever about that timeframe in keeping the eggs safely frozen.

              When it comes to what happens with unused eggs. Of course, these eggs are not the property of the IVF laboratory or the institution. These eggs are the property of the individual from whom they were retrieved, and it is that individual's choice as to what happens. So I've had situations where an unpartnered individual wants to try to get a better insurance with regard to her future fertility and she freezes eggs. Then, as life would have it, she meets someone and they develop a relationship, and they decide that they're going to be together and have children. They achieve pregnancy without using the eggs that she froze. Then here she has these that she never ends up needing to use. So some individuals might choose to discard these eggs. Some individuals might choose to donate them to an institution where there's a institutional review board-approved study performed relating to eggs, and some may choose to donate them to another individual known or anonymous, so that that individual could utilize those eggs that are essentially unused at this point.

Kate Kaput:

That's really interesting. I never thought about that part, that those frozen eggs could end up being donor eggs at some point. You talked a little bit about ovarian hyperstimulation syndrome. Are there any other risks associated with freezing your eggs?

Dr. Steven B. Mooney:

So, like we talked before, the risks really fall under the same risks that we see in the IVF process. So ovarian hyperstimulation is something we look out for and we try to prevent also risks of anesthesia. Although, thinking about anesthesia, our patients are typically young and healthy. Remember, we're talking about individuals who are between teenagers to 50 years old, let's say, and so, with most people being in their late 20s to early 40s. So healthy individuals typically do well under anesthesia. So even though theoretically anesthesia risk. Those risks are very low in the type of anesthesia, and the type of patients we're talking about.

              When it comes to the actual egg retrieval, as I mentioned, we're using a needle and we're doing it under ultrasound guidance. But we are inserting that needle through the tissue, the upper vagina, and into essentially the body cavity where the ovaries are. So there is the small risk of puncture of an internal structure, bowel, bladder, uterus, cervix, blood vessel. Those risks are less than 1%, but they have been recorded in time, and over time to have happened in the world.

Kate Kaput:

Then, let's talk a little bit about... I don't know if I would call it, the emotional risk, but certainly there's an emotional side to freezing your eggs. Just like there is to undergoing IVF. How can this process weigh on individuals and couples who undergo egg freezing and how can they find support throughout the process?

Dr. Steven B. Mooney:

Yeah. All of these decisions and all of these processes way heavily on individuals and couples. I think many individuals who are unpartnered or who are pursuing professional goals, or feel like there's not enough time to commit or not enough finances to commit, are already feeling stresses of life, already feeling stresses of decisions, already questioning, even in their own mind and with respect to their family and friends, "Am I doing the right thing? Is this what I should be doing? Is this what's meant for me?" On top of that, we've talked through this discussion of how many uncertainties there are, even though the techniques are good, and even though numbers can look good? The bottom line here is, there's no guarantees. So there's always going to be mental and psychological anguish when it comes to these decisions.

              I think I mentioned previously in a discussion that there's an organization known as RESOLVE, resolve.org. It's a fertility organization that if you were to look at their website and peruse their offerings, a lot of mental health services. But more locally, every fertility program typically has licensed psychologists. Sometimes psychiatrists who are, let's say, on staff, or very close to staff in order to support patients through their journey. So there's no question that family members, friends, significant others, those of us that we know there are acquaintances that have gone through these processes before. Those are very important for us. But at the same time, sometimes a third party individual, such as a mental health professional, or someone you meet through a group on RESOLVE are very beneficial in the process of support.

Kate Kaput:

So really just finding support wherever you can from the people in your own life, and maybe looking a little bit externally to some medical assistance.

Dr. Steven B. Mooney:

Yeah. Everybody's different. Some people wouldn't dream of talking to a counselor. Other people wouldn't dream of, of joining a group online. But vice versa, some people would see it differently. So absolutely, it's individualized. I think the important part to know is that there's a multitude of circumstances and services available. If people aren't having luck finding them, then just like everything else, just ask, and if not me, someone near me, or works with me can point in the right direction.

Kate Kaput:

Sure. Lots of options out there, and just figuring out what's the best method of support for you. Dr. Mooney, is there anything else that we haven't discussed today that you think is important to this topic? What else might folks need to know about freezing their eggs that we haven't talked about yet?

Dr. Steven B. Mooney:

I think the most important things relating to this topic are that the techniques, the scientific and medical techniques such as stimulation of the ovaries, retrieval of the eggs, vitrification or freezing of the eggs are quite excellent. 80% and 90% vitrification survival rates. Once the egg that's been vitrified is thawed, maybe 70 or 75% fertilization rates in many circumstances. So these are really top notch numbers. However, I think it's also important to know and have eyes wide open going into the process that even these good numbers that are well above 50% don't guarantee a future pregnancy.

              There are circumstances that sometimes an individual can't foresee in embryo development, genetic abnormality, circumstances related to miscarriage that we didn't even know about because we'd never been pregnant before. So I would think that while there are some practices in some entities that almost market this process as a guarantee against a future, no partnership, or getting your professional goals in order... I just don't like the idea that we can think of this as a guarantee. It's simply not a guarantee. Albeit a good option for many people. Albeit safe and effective for many people, unfortunately not 100% guaranteed.

Kate Kaput:

Got it. Thank you so much for that important caveat. Thank you so much for being here with us today and for speaking with us on this important topic.

Dr. Steven B. Mooney:

You're welcome. It's a pleasure to speak on the various topics of reproductive endocrinology and infertility, and I love to be invited back.

Kate Kaput:

To find an Ob/Gyn or to schedule an appointment with Cleveland Clinic Women's Health. Please visit clevelandclinic.org/women, or to discuss fertility concerns with our fertility center specialists, please visit clevelandclinic.org/fertility. You can reach both departments by calling 216-444-6601. Thanks so much for joining us today.