The Center for Fertility Preservation™

at Pacific Northwest Fertility

Director: Dr. Julie Lamb, MD, FACOG

At The Center for Fertility Preservation, we are committed to offering the most advanced fertility preservation options for both men and women. The choice to preserve your fertility may result from a personal decision to delay pregnancy, or perhaps you have been referred to us by your oncologist following a cancer diagnosis. Egg freezing, in particular, is an empowering choice for women today who want to keep options open for their future.

For Female Patients

Egg Freezing is available for patients who wish to delay childbearing for any reason. A cancer diagnosis has historically been the most common motivation for women chose to freeze eggs, but as success rates have improved and costs decreased, many women are now choosing to freeze their eggs as an effective means of postponing childbearing for other reasons. Fertility decreases with age beginning at 30, and by age 40 the chances of spontaneous pregnancy are less than 50% of what they were at age 30. In general, egg freezing is best for women under age 38 who have a reassuring egg supply (ovarian reserve), but every woman is considered as an individual, and patients with low egg supply may benefit even more from egg freezing.

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Embryo banking involves a similar process for fertility preservation for patients who prefer to freeze fertilized eggs (or embryos). This is often the patient or couple that is starting their family at an advanced age (>35) but their family building goal is more than one baby. Pregnancy success rates change so much between ages 35 and 42 (lower egg number and more abnormal eggs) that it makes sense to consider freezing embryos for future children, as success rates are based on the age of the egg at the time it was frozen, not the age of the uterus at the time of implantation.

Why Pacific NW Fertility?

It is essential that patients consider where they are doing their fertility preservation. At Pacific NW Fertility, we are committed to providing the most cutting edge technology. We have expertise in the most up to date freezing technique, called vitrification, for embryos, and we have more experience with frozen eggs than most IVF embryology labs in the United States. Egg freezing is considered a relatively new IVF technology, but at Pacific NW Fertility we have been freezing eggs with this highly successful technique since 2009. Most clinics offer egg freezing, but very few have taken the next step to optimize the process to produce the highest success rates possible from frozen eggs. We have been successfully thawing frozen eggs, fertilizing them with sperm, and helping patients build their families for many years now with frozen donor eggs. As of March 2017, Pacific NW Fertility celebrated the more than 300 live births from eggs frozen at our clinic.

Please schedule a new patient consultation so we can help you figure out if egg freezing is right for you. If you have further questions you can schedule a free 30-minute consult with one of our providers or email us directly at eggexpert@pnwfertility.com.

For Male Patients

Sperm freezing may be done for several reasons: cancer patients preparing to undergo radiation or chemotherapy (treatments which potentially destroy sperm production), patients who are electing to have a vasectomy but wish to have sperm stored, and patients who are expecting to be unavailable at the time of insemination and wish to store sperm for their partner’s use.

Fertility declines with age, even for men. Fertility potential does not usually decrease as drastically for men compared to women, but older men have fertility issues as well. Many men are freezing sperm at younger ages to keep options open for the future. Ask us about this opportunity for you.

Please contact the Andrology Lab at 206-515-0002, or by on-line message, for more information about fertility preservation for men.

Although freezing sperm and freezing embryos (fertilized eggs) have been available for years, egg freezing is a relatively new option for those who wish to delay for fertility.

Once a woman has decided she is ready to be pregnant, the frozen eggs can be thawed and fertilized with sperm. The resulting fertilized eggs (or embryos) are then tested and transferred to the woman’s uterus, one at a time.

The first baby born from a frozen egg was in 1986. At best estimate, there have now been thousands of babies born from frozen eggs, and in 2012 it was declared no longer experimental by women’s health expert groups.

Egg freezing may be used by women who wish to delay childbearing for any reason. One of the most critical times for egg freezing is in the setting of a cancer diagnosis. Treatments for cancer such as chemotherapy and radiation often damage eggs and result in infertility. Depending on the cancer diagnosis and recommendations from a woman’s oncologists, she may choose to freeze eggs before undergoing cancer treatment in order to preserve her fertility.

Egg freezing may also be a choice for women who are not ready to have children, but who may want that option in the future. Fertility decreases significantly with age, and women who want to store their eggs for later use can improve their chances of a successful pregnancy and healthy baby. Egg freezing is an empowering choice for women today who want to keep options open for their future.

Egg freezing may also be used in the setting of a donor egg/recipient IVF cycle. In cases where a woman is unable to conceive with her own eggs, she has the option of using donor eggs. Typically the donor is 21-31 years old and in peak fertility. The traditional method for a donor egg/recipient IVF cycle is to match a recipient with a donor and sync their menstrual cycles with medication so that when the donor’s eggs are ready to be retrieved and fertilized, the recipient’s uterine lining is ready for the resulting embryo(s). This matching and syncing process can take weeks to months, but with frozen egg the donor’s eggs are available and ready whenever the recipient is ready.

There are many other medical reasons to freeze eggs including: severe endometriosis, ovarian surgery, diminished egg supply, prior ovarian cyst, BRCA 1-2 mutation carriers, transgender transition to male, just to name a few. Some patients prefer egg freezing over embryo freezing due to religious or ethical issues with freezing embryos that remain after a traditional IVF cycle. We have more history (over 40 years) and experience with embryo freezing in the field of reproduction, but once an egg is fertilized with sperm, it cannot be unfertilized. Egg freezing keeps more options open for the future.

The process for egg freezing is similar to a traditional IVF cycle and takes approximately 2 weeks. In these two weeks, a woman takes gonadotropins to stimulate the recruitment of multiple eggs in the ovaries and when the eggs are ready, they are retrieved in a simple procedure called an egg retrieval. Gonadotropin hormones are the same hormones women make every month to recruit one egg and in IVF we are simply giving a higher dose to recruit more than one. Women take the shots subcutaneously (right under the skin) every day (we teach you how to do it) until the egg retrieval. The stimulation part of the cycle is often preceded by 2-3 weeks of birth control pills to prepare the eggs for recruitment but your protocol will be customized to fit your needs. Eggs are retrieved and frozen immediately. Once the woman is ready to conceive, the eggs are thawed and fertilized with sperm. The resulting embryo(s) can be genetically tested and then transferred into her uterus, usually one at a time.

Although egg freezing provides an excellent option for women to take charge of their reproductive potential, the process isn’t for everyone. Freezing eggs is an opportunity but it does not guarantee a baby in the future. Also, the success rates and efficiency of the process are tied to how many eggs you can produce and there is variability between patients. For example, a patient with low egg numbers may have to do more than one stimulation cycle to get an optimal number of eggs frozen. The process should always be carefully considered. It is always a good idea to meet with a reproductive endocrinologist and learn more about what it would look like for you. Sometimes it takes years for a woman to get up the courage to come in and learn more, but in fertility every year counts, so let us help you learn more about your fertility and decide if egg freezing is right for you.

1. Initial Consultation

The first step for those considering fertility preservation is a consultation with a provider at Pacific NW Fertility. A complete medical history is taken as we get to know you as an individual. We discuss age and how chances of pregnancy success change over the fertility window. We discuss testing and the process of IVF. The egg freezing process begins with IVF (In Vitro Fertilization) so that multiple eggs may be produced for freezing. In general, the older you are at the time of egg freezing the lower the chances of pregnancy and the higher number of eggs recommended to freeze. The best predictor of how many eggs can be collected per cycle is the ovarian reserve, measured by both ultrasound and blood work. The ultrasound is often done as part of this initial consultation.

2. Ovarian Reserve Testing

Women considering egg freezing will first undergo a series of fertility tests to assess their reproductive potential and so their doctor will be better able to counsel the patient about the number of eggs expected for freezing. This can be done prior to initial consult if desired. These tests include: FSH and estradiol done on cycle day 3 (third day of your menstrual cycle) and AMH done anytime in your cycle.

The Science

FSH (follicle stimulating hormone) and estradiol are indirect measure of ovarian reserve. As part of the body’s normal reproductive cycle, a hormone called FSH recruits eggs to grow in the ovaries. High FSH levels in a woman indicate that the body is working extra hard to grow eggs, which can be an indication of low egg numbers in the ovaries. This is called diminished ovarian reserve or DOR. A lower (or normal) FSH value indicates a greater potential for creating a substantial number of eggs for freezing.

Women having their FSH levels checked must have it done on day 2 or 3 of the menstrual cycle when the eggs are being recruited. Estradiol is also measured at the same time as a means of making sure that the FSH level is truly indicative of ovarian reserve. Estradiol comes from the granulosa cells surrounding the growing oocytes and this hormone actually suppresses FSH once oocyte growth has started. So if FSH is measured on day 3 and estradiol is already at a high level, the FSH value will have started to drop and will not be an accurate measure of ovarian reserve. A lower estradiol value suggests that oocyte growth has not yet started and we would therefore expect FSH to be at its highest level. The highest level for a given patient is what the test aims to measure, and measuring estradiol at the same time makes sure that we get that number.

Antral Follicle Count (AFC) is another way we evaluate a patients reproductive potential. Oocytes grow inside follicles, and the small developing follicles that exist in the ovary are called antral follicles. An antral follicle consists of an egg, several layers of estrogen producing granulosa cells that surround the egg, and a small pocket of fluid (or cyst, called a follicle). Antral follicles in the female ovary viewed with an ultrasound scan can indicate a woman’s potential to produce multiple eggs for freezing. The higher the AFC, the higher a woman’s potential to produce an adequate number of eggs to be harvested and frozen.

Anti-Mullerian Hormone (AMH)
is a hormone produced by the ovarian follicles. Measurement of AMH hormone levels likewise serves to assess ovarian reserve. A higher AMH count indicates higher ovarian reserve and thus greater fertility potential and higher number of eggs likely yielded from an IVF cycle. Because it is not dependent on where a woman is in her cycle, it can be an easier test to obtain and interpret. Please note that if you have been on birth control pills for over one year that your AMH can appear lower than it may be off birth control pills.

3. The Egg Freezing Process

This process involves steps similar to In Vitro Fertilization (IVF), beginning with a series of fertility enhancing medications to produce multiple eggs and then retrieving the eggs.

Fertility medications

The first step in this process is to generate multiple eggs for retrieval. The patient’s physician will prescribe fertility medications to stimulate follicle growth and produce multiple eggs. Medications are injected subcutaneously (just beneath the skin) with a very fine needle. As always, our staff will counsel and instruct our patients on this process and are available throughout the entire process. This phase of treatment lasts approximately 10 days.

Ultrasound monitoring and lab tests

A patient’s physician will monitor them on a regular basis to assess follicle growth and the number of eggs they are producing. When eggs are determined to be mature and ready for retrieval, the patient will stop taking the fertility medication and receive one injection of hCG, a hormone that prepares eggs for ovulation. The hCG shot brings on the final phase of egg maturation, allowing the eggs to separate from the surrounding granulosa cells. The eggs would be naturally ovulated about 40 hours after the hCG shot, but we remove the eggs from the ovaries with a fine needle 4 hours before the predicted time of ovulation.

Egg retrieval procedure

This is a painless and relatively brief procedure, during which your doctor will use ultrasound guidance to gently retrieve eggs from the ovarian follicles. You will be under sedation throughout the procedure. The retrieval is performed in our clinic and takes approximately 10 minutes; patients are able to resume normal activity shortly after the sedation has worn off.

Egg preservation

The retrieved eggs are preserved through a rapid freezing process called vitrification. The eggs remain frozen until they are needed. The eggs may be kept frozen indefinitely so it is critically important that patients maintain annual contact with the clinic so we know the eggs have not been abandoned.

The first thing I put in my baby's baby book was a pasted in sheet of paper showing that we were pregnant, from PNWF.  Below it I wrote, "Mom and Dad worked HARD for you." We deserve it even more, I say. Because the baby that comes from PNW Fertility and their crew of helpers is one loved baby. That is a pretty amazing legacy to be able to tell that kid someday.

Morgan
Pacific NW Fertility Patient

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