Dr. Lorne Brown:

By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose. Today on the Conscious Fertility Podcast I have back Dr. Areiyu Zhang. We did an episode on donor egg cycles and today we’re going to be talking about egg freezing. So many of you are familiar with Dr. Zhang, but if you don’t know her, she is a reproductive endocrinologist at Olive Fertility Clinic. And she also, you do some teaching or mentoring over at UBC as well, do you not? I

Areiyu Zhang:

Do, yeah. I teach some residents and fellows at UBC on a regular basis and give some talks there.

Dr. Lorne Brown:

And when I was looking at your bio, because I see you regularly at the clinic, but it’s neat when you go read somebody’s bio, you get to learn a little bit more. But I didn’t know you had a background in fertility and psychology. I

Areiyu Zhang:

Did. I, well, I minored in it in undergrad, so I really enjoyed physiology, but I also liked learning about why people do the things they do, like the behavioral aspect of things. So I really enjoyed psychology, social psychology. So I decided to put a bit more focus and do more courses in that in undergrad, but I’ve always had an interest in it.

Dr. Lorne Brown:

Well, it’s a good skill set, especially with our topic because there’s the whole physiological aspect of doing egg freezing. There’s a lot of biology science behind it, but there’s a huge psychological component too. So this is a great skills to have when you’re talking to those that are wanting to freeze your eggs.

Areiyu Zhang:

I think so too. Yeah.

Dr. Lorne Brown:

Good. Well, we’re going to dive in. And so egg freezing is different from embryo freezing, and I just thought we’d kind of go through all the gamuts. So the kind of common questions that I get at my clinic over at Accu Balance when they’re seeing us, and obviously we’re always referring them to you, the ones that are doing the egg freezing, but can you share the kind of who’s using egg freezing? What is the population that’s coming to you? They want to freeze their eggs

Areiyu Zhang:

As people are getting. Society is changing, right? And people are waiting longer to have kids and people are focusing more on their careers and on their education. And even people in relationships are finding that having kids right now is not right for them. We all know how crazy the housing market is in Vancouver and all these reasons. And they’ve done surveys where people look at how many kids do you think is ideal and how many kids do you actually intend to have? And they find there is a discrepancy. So I think people out there are maybe intending to have multiple children because of life circumstances or things or finding it’s not possible to complete a bigger family as they had originally hoped. So there’s kind of two camps. Some people who want to increase their chances of having a bigger family, two or three children down the road, and then they freeze eggs well in advance of that. And lots of people who don’t have a partner who haven’t found the right person yet to have children with. So we do see a wide range of people and folks are also coming in younger, which I find is nice too. We used to see more people in their late thirties and finding a trend. Now people are coming in in their early thirties, which is great as the world’s getting out. And I think more employers are recognizing the need for it.

Dr. Lorne Brown:

And then there’s the emergency group where I think it really started the egg freezing for those that get a cancer diagnosis where they take out their eggs. But you’ve shared that people are coming out to use it as fertility preservation because they want to delay having children for career or whatever their situation is, or they don’t have a partner yet, and so they want to be able to have these eggs later on to have a child with that partner.

Areiyu Zhang:

Exactly. And there’s lots of other reasons too. For example, if people have endometriosis or they’re at risk of losing a good portion of their eggs through ovarian surgery or people who are about to have, like you said, emergency treatments for cancer, that’s another role for egg freezing.

Dr. Lorne Brown:

So I want to talk about our two groups. We have those that are coming in where they’re in the reproductive age that you see the best success rates for egg freezing. And so those would be people in their twenties and early thirties. And then what’s quite common still is where people are coming later in life in their late thirties, early forties looking to can I freeze my eggs? And I wanted to talk about both those camps because I think very different statistics and it’s not equal with everybody.

Areiyu Zhang:

Exactly. I think there’s a fine balance with egg freezing too, and that’s where you do find some of the psychology coming into this is it is great to freeze your eggs as early as you can biologically speaking. That’s when we’re at our optimal egg quality. But of course the younger we do it, I suppose the higher the likelihood that we may not ever have to use those eggs. So it’s the delicate balance between when is the best time for you. The younger you do it, you may be spending a lot of money that you may not necessarily be in a financial spot to pay. And then also you may not actually need them if you realistically think you’ll find a partner in the next couple of years. And also the younger you actually do start trying to conceive the higher the odds that you would have success and never need to use the eggs also.

So it’s very individualized for someone. And on the other end of the spectrum too, as people are getting older, they may find that their need to freeze eggs is higher, but then the actual success rate is going to be lower because of the decline in egg quality that comes with older ovaries. So you do have to recognize that the longer you wait, you may need to end up doing multiple cycles to collect the number of eggs that would have given you the same amount of chances as half the number of eggs from when you were younger.

Dr. Lorne Brown:

So I’m going to share with you how I sometimes discuss this with our patients. So they go into see you equipped with asking really good questions. And so sometimes it works well that you don’t have to do the general well, you’re always doing the general discussion. And we’re going to do general things here today. Actually, I’m going to tangent for a second. This is a general discussion and I’ve heard you say it before and I just want to reiterate it, that it’s individualized. You do need to have a consult to find out what is your best protocol, how many eggs you need to freeze for the probability. And I’m going to emphasize the probability of having a live birth. A few things that I have found are you, when I see the patients and talk to them, some of them are under the idea that they freeze eggs and those are all babies, future babies. And that’s misleading because, and they think of them like IVF, like I’m freezing eggs, like I’m freezing embryos. And those have very different success rates. So not all eggs turn into live births, right?

Areiyu Zhang:

Correct.

Dr. Lorne Brown:

And that’s why you need, as you said, you need how many do you need to freeze in order to have a live birth? So when the individuals come and see you, sometimes when they look at the stats and see things on the internet, on Google and on the internet, they’re just saying they’re talking about how many eggs they got frozen. All the women are sharing. But really the important data is of those eggs frozen, how many turn into live births? And I would imagine still at this time we got a lot of frozen eggs, but not a lot of the majority of those eggs probably haven’t been used to create babies yet.

Areiyu Zhang:

Exactly

Dr. Lorne Brown:

Right. So there’s still a lot of unknown still, right?

Areiyu Zhang:

There is totally. And when you have them as eggs, you just really don’t know what the quality is until it’s time to come back and freeze and thaw them and use them. And so I say for any one individual person, no matter how many eggs they have for them, it’s going to be zero or a hundred percent. But you have these probabilities that guide you and say, well, the younger you are, the more eggs you have frozen, the better the odds of success. But still it’s never going to be a guarantee. And so some people choose to do multiple rounds just to collect more eggs, but at the end of the day exactly, you don’t really know what’s going to happen to them. Just the whole inefficiency of biology that you need so many eggs to result in an actual baby because recognizing not every egg survives the thaw.

And even if it survives the thaw, it may not fertilize with the sperm. And of course the sperm plays a factor in all of this too with regards to the quality of the embryos that you make. And then the likelihood not every embryo will also result in a live birth. So there’s attrition every step of the way. And all we have is computer modeling to tell us what are the odds because truly not a ton of people have come back to use their eggs. And especially for some of our older folk, there’s not a lot of data on the actual success of people freezing their eggs over their forties because many people haven’t come back yet and there’s not many people doing it

Dr. Lorne Brown:

And you shared. So people are doing this for hope and it’s a strategy. So this is not a guarantee, it’s a strategy because if you’re in a place where you’re not able to have a child, you don’t have a partner, whatever your life situation is, you’re not ready to start your family. And as you shared, a lot of the younger women that come in their late twenties or early thirties that froze eggs, they’re not going to have children until later. And they just wanted to know that they have the opportunity if there’s whatever the issues are that they have some eggs that they can use, like you said, a lot of them don’t end up using those eggs because they end up finding somebody and through intercourse they have a natural conception in birth. But that was their plan actually when I see them, they’re like, I hope I don’t use these eggs.

I’m doing this just in case. So that is really an insurance policy. So that’s not a failure in a sense that wasn’t a bad thing for that person. They literally said, this is going to let me sleep at night. This is a backup plan and I hope I never have to use these eggs. I hope I’m going to be in a relationship or when I’m ready to have a child, I’ll be able to do this through natural means without having to thaw eggs and use them. So those people, that’s their plan and that’s what you’ve seen as well. They don’t actually use those eggs.

Areiyu Zhang:

I think of it as an option. It’s like a backup option if plan A, which is finding your partner and trying the regular way is not working. And it may even be someone’s like plan B, plan C, plan D for example, if when the time comes, they could also turn to regular fertility treatments like IVF at the time when they’re actually ready to start their family. And then if that doesn’t work, then move into using their frozen eggs. So they have lots of other options too beyond just automatically going to father eggs. So I think as an insurance policy, yes and no in that when we buy insurance, we want to know for sure there’s going to be a payout. But this is kind of just one other thing you can think about using and especially as people get older, I like to weigh it against what is the alternative.

For example, we know that the data for egg quality is not good in women in their forties, and we often discourage someone from freezing their eggs in their forties just because the quality of the eggs is more uncertain. But at that point it’s really a discussion of like, well, what are your alternatives? Right? Because if you mildly don’t see yourself like a partner until you’re in your mid forties or at that point if you really are trying to get pregnant naturally, then your own natural success rates are so low at that point that the really viable alternative is to use someone else’s eggs at that point. And for a lot of people, that’s unacceptable or they don’t want to try that first. So I think well at least having your 40-year-old eggs is maybe more acceptable to you than automatically going to donor eggs, say at age 45 if that’s all you’re left with. So it’s a weighing of your options at the time. So you may be between, you’re not comparing them between your eggs from when you’re 20 that ship and sail, but now you’re trying to weigh your own alternatives.

Dr. Lorne Brown:

Yeah, again, it’s strategy. We’re looking at risk and probability and that’s why it’s so individualized. I want to share because I want to talk about the population that is still more common coming in, in their late thirties, they thought career or family would happen and then it hasn’t happened and now they’re looking to freeze their eggs. And I’ll share with a mutual patient that we had that she was 40 and she wanted to have another baby. So Sherry had a child and that relationship had dissolved, so she wasn’t a relationship, has a child much older and she wanted to have another baby and she’s 40. She came to us to do preconception care. So she heard about our nurse’s soul before you plant the seed of a hundred days of preconception. And then her plan, which she did, was to freeze her eggs at 40 and she consulted with you guys and she knew the probability and risk, she just did one freeze.

Although based on her age you guys shared how many numbers would be recommended for live birth. But this was how she was doing her assurance and a happy ending. She’s like the 20 year olds, she never got to use her. She froze. I think she got to freeze somewhere around nine or 10 eggs for herself. And again, statistically when you guys look at your stats, that’s a low number to turn into live birth. But she ended up meeting somebody and they were able to have intercourse and at 41 she got pregnant and ended up having another baby. So again, same thing. It was just like, I want another baby, I’m going to try and do this. And again, she was aware of the odds and the risks and the chances and it gave her opportunity, it brought her anxiety down that she had that on ice, those eggs and she ended up needing to use them.

Areiyu Zhang:

I think you make a great point that how many eggs you get from a round of egg freezing is in no way predictive of your ability to get pregnant naturally. And so I see a lot of people, especially younger people, check their egg reserve and it gives them unnecessary anxiety because they think, oh, this is a test of my fertility, my egg reserve is low, I’m not going to do well with egg freezing. And so I also will have trouble getting pregnant. And those things are not related to each other. One doesn’t predict the other. So even if you have not many eggs frozen from one round doesn’t necessarily mean you’re less fertile. It’s just a numbers game. When we look at checking your anti malian hormone to look at your egg reserve, that helps us predict how many eggs we would get, but it doesn’t predict how likely it is you are to spontaneously get pregnant if you just start trying

Dr. Lorne Brown:

And when you do the egg freezing. So just the process. So in Canada, here in Vancouver, you need to get a referral to Olive and then you guys would run some basic testing before you do any egg freezing to help with the consult. So you mentioned the ovarian reserve. This is the quantity test, not the quality test. Age is kind of the quality test. How old are you? And then quantity tests, you guys do the an and hormone test. So that’s a blood test you guys usually do on day three FSH. And do you guys still do the ultrasound for an antral follicle count just to get a

Areiyu Zhang:

Sense of these? Yep, still do that. Ultrasound for antral follicle count day three SSH, we’re finding that the A MH is a way better test than the day three FSH. And also you can do the A MH at any point in your cycle, unlike the day three FSH. So it’s a lot more sensitive. So we tend to use the A MH mostly to look at,

Dr. Lorne Brown:

So the tests aren’t very invasive. So if somebody, they get this testing done and then they come to you with that information and that lets you know you’ll look at their age. There’s the whole planning of how many children you plan to have, right? It’s one child, two children, three children. And then based on their age, you can share, and I think you have a calculator on the Olive website under the egg freezing section. I’ll see if I can even bring that up. It’s just a general thing based on age. So again, I’m just going to share with people because we’ll put this video up as well. This is a podcast audio, but we will put the video up on the Olive website. There’s an egg freezing calculator and in that calculator then if somebody was 39, it gives you the percentage. And

Areiyu Zhang:

I haven’t played with this calculator on the website, but we do have one if you were to come in for a consult, we do have one that predicts live birth and I think it might be pretty similar. Similar.

Dr. Lorne Brown:

So you get your workup, you get a sense of your reserve, then you guys do the full history and then you can give them a sense of based on their age and other factors, how many eggs ideally they would freeze in order to get a live birth. And based on the ovarian reserve, again, this is the quantity. It doesn’t mean it’s one cycle. It could take 2, 3, 4. And here’s where life can be cruel. As you get older, you need many more eggs in order to have the probability of live birth. But as you get older, you end up getting usually less eggs each retrieval. So the older you get, you’re going to need many more retrievals. And that’s where life can be cruel. So somebody’s at 40, which is not a great age to freeze, 20 is a better age than at 40, but this person who’s at 40 that’s looking for options, they can’t be 20 again.

So they’re just looking, what can I do? So at 40 they would have to freeze many eggs which require many retrievals. And that’s what I just want to share with the listeners. It’s not like you just go in, freeze your eggs and it’s good. And whenever you choose to thaw, you’ll have a baby. One is you may have to do multiple retrievals to get the number of eggs for a probability of a live birth. And then they’re not not making embryos with these. So not every follicle will have an egg when you retrieve it. Not every egg will be mature and then those are frozen. When you decide to make a baby, you go back to the IVF process, you thaw the eggs, inseminate with sperm, has to grow out to be a blasis, transfer has to implant, make it to blood tests, ultrasound, live birth, there’s so much as you said, attrition. And so that’s why there’s got to be a lot of numbers because at age 40 the genetic issues, the not being normal, these eggs could end up not being normal embryos, so therefore not make it to live birth. That’s why you need more with age that I summarize that accurately.

Areiyu Zhang:

Yes, exactly. That’s exactly it. And the kicker is that too, there’s a lot of unpredictability with this as we try to give you a realistic prediction of how many eggs you might get from one round. But at the end of the day there’s no way to actually know exactly how many you get without trying out the medications and just seeing how your ovaries respond. And it may be different month to month for the exact same you, your A MH won’t have changed much. You’ll maybe be a few months older, but it’s a different month and in every given month, the number of eggs available to us changes a little bit. Even if we change nothing about your medication or the protocol of egg freezing, we might get eight eggs, one cycle, 12 eggs, another cycle. So it is really hard going into this to try to set expectations for someone when they’re coming in for their first consult is while recognizing there’s a lot of error, not error, but there’s just variability in trying to predict a person’s response based on just two numbers, really your age, your A MH, it’s not perfect.

And sometimes we overshoot or we undershoot the prediction and that can be really disappointing for some people when they don’t respond the way that they’re A MH predicts necessarily. But also it doesn’t mean that that’s going to be the case for every single cycle. Sometimes we have a cycle where we don’t do as well as we thought the next cycle we do way better. It’s a bit random. Sometimes it feels that way. So it is a tricky thing to try to counsel. How many eggs would you expect? So we tend to give a range recognizing that month to month it’s different, especially for some people who are on the birth control pill for many years. It can make your A MH falsely low. We talk about things like that with them.

Dr. Lorne Brown:

I want to unpack that a little bit just because I can hear a panic and people what makes it falsely low temporarily and then after a couple months it’ll come back up. So I think what Ari was saying is that if you come right off the birth control and test your A MH, it may not be an accurate reading. You need to retest it again a couple of months later. Not that it stays artificially that

Areiyu Zhang:

Not that

Dr. Lorne Brown:

It stays low,

Areiyu Zhang:

Right? It’s not that the birth control pill gives you a lower a count, it’s just that if you were to test your A MH while on the pill and if you’ve been on the pill for many, many years, it’s going to give you a reading that might not be reflective of your true egg reserve. It might be lower than what it actually is and make people panic. But really if they were to come off the pill, let their ovaries wake up a bit and bounce back, it might find your A MH increases and a personal experience with this where my A MH came back four times what it was when I was on the pill. So recognizing that this one number makes people change their life goals and their decisions sometimes. So at the end of the day, it’s still just a number. It’s affected by many things like your ethnicity and your weight and even being on things like hormonal birth control. And at the end of the day, it’s not a prediction of your chance of getting pregnant naturally. But yeah, it just helps us give a better ballpark of how many eggs we might expect if we were to stimulate them. But even that is a prediction and it changes month to month.

Dr. Lorne Brown:

And then quality is an important issue. And I’d like to talk a little bit about things that can damage the quality because this is key. So if you’re a smoker, it can impact your A quality, the environment, and the endocrine disruptors. So oxidative stress, I call that body rest can damage it. So you are looking to do things to reduce that, things that can damage it and things that can improve the environment that your follicles and eggs mature. And we’ll talk a little bit more about that and that’s where we talk about a good diet lifestyle. It was making me think of a professional basketball player, LeBron James, because most professional athletes, you don’t see too many professional athletes at age 40, right? So it’s kind of like that fertility journey. There’s a cutoff in the forties, but yet he is unique in this way because at age 39 or 40, he’s still dominating.

The key here is he’s not dominating, he was when he was 20 or 21 or 25, but he is much better than the 35 and 34 year olds in the league. But one thing interesting about LeBron is he treats his body like a temple. So for at least the last decade, the trainers, the diet, all the therapies he does, so he’s been able to maintain the physicality, right? I’m sure when he was 19, 20, like most of us, abused his body, but at a certain point he really took care of it. And that’s where I love this nurse as solo, the hundred days of preconception. Now again, he did it for a decade. So really for those that are listening and you’re in your early thirties, if you’re smoking stop and excessive drinking, stop. But this whole idea of adequate rest, deep sleep, exercise, stress reduction, things that can increase blood flow to your system, the diet and lifestyle, this can say something and I was using LeBron James, the professional basketball player because not all 40 year olds are equal.

And so we see this with him. He really took care of himself. So there’s things you can do to take care of yourself on a cellular level. And I also want to share though, oh, so that means at 45 you can fix it. No, I don’t think LeBron James is going to be playing basketball at 45 still, even though he’s done well, he’s taking such good care of his body that it is true that at 40 years old there are women that can conceive easily at 40 years old if somebody came and we’ve had people come to my practice at 50 and I’m like, no, I don’t think I can. It’s beyond in Chinese medicine, beyond the reproductive span. And in western medicine, the same thing. And in the NBA, we don’t have 50 year olds, but if you’re in your early forties, some of you biologically may be really in your forties.

What happens is a lot of the people we see come to us with fertility issues, although chronologically they’re in their early forties biologically, they’re in their late forties or fifties. And so the goal is can we have you biologically as young as possible, which is as young as your chronological age, so we can get you biologically 40, then that’s reproducible. But if you’re 50, the best we can do is 50. So this is me going on a tangent just saying that really take care of yourself as much as you can, but even if you do, age is still a factor. So LeBron James is not going to be playing in the NBA, probably at 45, even though he takes care of his body like a temple and he has the money to do that, but he’s definitely extended his life to 40 in the NBA very well. So I wanted to talk about things that can impact it. So if somebody’s thinking of egg freezing regardless of age where they want to talk to a clinic like yours and also work with a clinic like ours where we’re supporting the health of the cells, if somebody has endometriosis that can impact egg quality and quantity, I believe, correct?

Areiyu Zhang:

It can. Yep, certainly, certainly. Especially if you’ve had surgery on your ovary already where we worry that when there’s been surgery done to remove c ovarian cyst for endometriosis that it’s maybe removed some of the normal ovarian tissue with it also and you risk damaging your ovarian reserve with that. So anyone with a history of ovarian surgery might benefit from a chat. Smoking is a particular bad one. Cigarettes on egg quality and PCOS, it’s hard to know. PC os people with PCOS tend to have higher egg reserves and actually with egg freezing, that’s usually a good thing and we will always wonder, does it mean their egg quality is poor? But I think science is still not convinced of that being a certainty. So it’s not necessarily a bad thing if you happen to have a lot of eggs or a high ovarian reserve, it doesn’t automatically mean your eggs are poor quality. But certainly PCOS is associated with lots of medical conditions that can impact egg quality. For example, if you have diabetes,

Dr. Lorne Brown:

Yeah, diabetes disorders, which goes with, because you’re saying if you have high ovarian reserve, that doesn’t mean anything quality issue. But with PCOS, which often can have a high ovarian reserve, there’s some hormonal inflammation and metabolic disorders. So there’s those factors that I think potentially, I think of a woman that came to us after she had done I-V-F P-C-O-S, she doesn’t ovulate on her own at all. So sometimes even with ovulation drugs, she wouldn’t ovulate. Hence that’s why she went into an IVF. Her first transfer was chemical and the second was not successful and she came to us like, can you help balance my hormones? She knew she had high androgen levels and she just thought for uni receptivity, can we help balance her hormones? She was overweight, lots of acne, bloating, and depression. And so we worked with her over four months and over those four months she lost close to 20 pounds.

We don’t do any calorie counting, but once you change the diet and bring down inflammation, weight tends to kind of fall off naturally in a healthy way because I’m not a fan of big restrictive diets when you’re trying to reproduce, it’s not great. Her acne went away during this whole process. She said hair had changed, her mood was good, and her digestion had improved. Remember, she’s never ovulated on her own and not even with ovulation drugs. She ovulated naturally and got pregnant naturally and she had her baby. But when we shared, I said our medicine, Chinese medicine is holistic, so I can’t just focus on your uterus, it will focus on the whole body. And so if it’s doing well, we should see some of these signs and symptoms change. If she did, and if it’s able to regulate your hormones, you may ovulate again or start, she goes, well, I never have.

I go, I know, but let’s see if we can help put you into balance, basically put it in general terms. And that’s what happened to her and she was just going to get ready to do her frozen transfer the next month, but she was able to ovulate. So when I think of PCOS, I think not that we’re not certain we need to do research, so this is speculative, but I think if you have the metabolic disorder and we see a lot of the signs like the acne, the herem and you’re not ovulating or very delayed, I would suspect that that environment may not be optimal, at least for egg quality. So it could impact it. It doesn’t mean it’s going to impact it that it’s not going to be good quality. Just saying take that same person where they don’t have the disorder, they would have probably even better quality.

So I still like to see those signs and symptoms disappear even before we do a transfer just because we’re always looking at that environment, hence nourishing the soil to support the egg. We peak fertility potential. So endometriosis, PCOS, and then if somebody’s very overweight or very underweight, that can impact their fertility and other health conditions probably. And if you’re on lots of medications. So these are things where come to see somebody like you at Olive, you get to help them and see what’s going on, when to freeze, how much to freeze and just kind of get a really good picture and you’re going to do the blood test, you’ll do the antra focal count because it really has to be individualized is what I guess I want to share is that’s been my understanding. You can’t just go to a website and look at a calculator and think that’s what I need to do. They really need to talk to you to find out possibly how many retrievals will be needed, how many eggs in order to have a live birth and then bring it in your love for psychology. There’s that component too.

Areiyu Zhang:

And we also talk about alternatives to egg freezing at every discussion. How open would someone be, for example, to try to get pregnant soon with say, using a sperm donor or making embryos with a sperm donor as the other? Can

Dr. Lorne Brown:

We talk about that?

Areiyu Zhang:

Yeah, we can

Dr. Lorne Brown:

Their goal is to have a child because some of them don’t realize that some of them are in a relationship and they come saying, I want to do egg freezing, and they’re not aware that they can have an embryo with a partner. That’s a rare case, but that has come into our practice like you’re married or you find have children with him, they were told by somebody at work that they should freeze their eggs and embryo freezing is a higher success than egg freezing for that same individual because you now have an embryo, so you have a better prediction. So help me word this. If somebody freezes their eggs versus that same person creating embryos at the end of that egg freezing or embryo freezing, you would be able to give them a better prediction of live birth, correct?

Areiyu Zhang:

Yes, because we know how embryos behave when we thaw them. The number one thing is they will survive the thaw way better than eggs will embryos 99% of the time. So once you have the embryo frozen, you can be reasonably confident that that embryo will survive the thaw. Whereas eggs, it’s closer to maybe 80-90% for survival. And then you’ve already known that that egg has passed through all these hurdles to become fertilized, to become a good enough embryo that can be frozen in the first place. And so the embryo, once you already have it there, you’ve already passed all these hurdles that whereas if you had 10 eggs, you don’t know how many eggs would’ve died off in that process already. So once you have the embryo, we also know that we have way more statistics on just live birth rate per embryo because we’ve done many, many embryo transfers.

So we can pretty confidently say in general, if you are under 35 when the embryo was made, the pregnancy rate is about 60%, whereas with an egg, it’s a lot more uncertain. So I like to say making embryos just gives you more insight into the fate of your egg upfront while we’re young enough to do something about it. For example, we make no embryos, or if we make a bunch of embryos and we test them genetically and let’s say they’re all genetically abnormal, then we would know that now while we’re young, while we have the ability to do something about it, versus if we just froze the eggs 10 years later, we’re close to 50 let’s say, and then we find out we make no embryos or they don’t get us pregnant, then they’ll really have no alternative at that point. I got

Dr. Lorne Brown:

To ask you a question and it’s a tangent, but I don’t want to forget because it’s the most common question I got. I just got it in my clinic this week. So she’s come to me and she wants to freeze her eggs. She’s not in a relationship and she’s 35 and she wants to transfer them as soon as she can because she’s over 35. I’m almost, she’s going to be over 35. Can you share with the audience that the aging of the ovary is different from the aging of the uterus? So once you have embryos or eggs, because you just said they transfer at 50, and I am hearing this woman saying, I can’t transfer my embryos at 40 because I’m 40, they won’t work because I’m 40, but she froze ’em at 35. Can you kind of talk a little bit about that?

Areiyu Zhang:

Yeah, so you’re right. Our uterus does not age the same way the eggs do. And we could carry a pregnancy well into past menopause age, even in our early fifties perhaps. But at that point, for many people, the egg quality is not there. So as long as they’re using younger eggs, they’ll have the same chance of pregnancy as the younger egg. And so you could transfer an embryo no matter how old you really are, but it’s the chance of getting pregnant dependent on how old that egg was? Because that egg age speaks to the quality of the embryo, which predicts the chance of actually getting pregnant.

Dr. Lorne Brown:

So it’s not the age of the woman or the individual. When embryos transferred, what was the age when the embryo was created or the egg was created? Yes, sorry, the egg was frozen or the embryo was created. That’s the key. How old was?

Areiyu Zhang:

Yeah, how old the egg is your biggest predictor.

Dr. Lorne Brown:

But there are some risk factors, but not so much the uterine, it’s just your older kidneys, older liver. When you’re in your late forties carrying a pregnancy, there’s risk. Is it more risk of hypertension, diabetes, or there’s just

Areiyu Zhang:

Other risks? Yeah, there’s still other risks. So it is not totally the same as getting pregnant in our twenties and early thirties. As we get older, there will be risks of having diabetes and pregnancy, high blood pressure, preeclampsia needing a c-section. All these risks go up gradually as we get older. If we’re carrying a pregnancy, it is a stress test for the body, but the actual pregnancy rates are maintained more or less. And the miscarriage risk too is dependent on the age of the egg.

Dr. Lorne Brown:

So I want to repeat this. This is a very common question. So the uterus doesn’t age like the ovaries, and so you can transfer and have a similar pregnancy rate as the age of the embryo, not the age of the uterus. So if you transfer at 48 and the embryo was frozen at 35, it’s a 30 5-year-old pregnancy in that sense, pregnancy rates not a 50-year-old pregnancy rate. And there’s risk factors with aging pregnancy, but it has nothing to do with the fertility side of it, the embryo or the uterus. It’s just a risk factor with aging. And pregnancy is stressful on the body, but the pregnancy is the same. And again, another reason why smoking, drinking, not sleeping, doing things, if you’re conceiving later in life, is just be as healthy as possible. Going back to my LeBron James basketball player, take care of your body because pregnancy can be stressful on it.

That was our tangent. Going back to the strategy of, so there’s other strategies like making embryos. So if somebody at 40 came to you and they’re single, because this is a real scenario in my practice and they want to freeze their eggs, they don’t have a relationship yet. This is where you’d have the discussion because the egg freezing may not turn into an embryo because what we were talking about is, and we were comparing egg freezing to an IVF, like an embryo, the egg freezing, it’s a similar procedure as an IVF for embryo. You’re doing the same stimulation you do retrieve. Now you have all these eggs. So if it’s an egg freezing, you freeze those eggs. If it’s an IVF making embryos, you now inseminate those eggs and then over five days you watch if they fertilize and grow and there’s attrition. So this is where it’s different because if you freeze all those eggs, you don’t know which ones are going to turn into embryos and which ones will not make it. But if you do an embryo, make an embryo, you now have new data because you now know how many embryos you got to freeze and you have much more data and experience knowing how those embryos turn into live births. And you also can do some genetic screening on those embryos to see if there’s any abnormalities or not.

Areiyu Zhang:

Exactly. The process is exactly the same for eggs and embryos in terms of the medications you’re taking, the ultrasounds, and the whole process. It’s just what happens after the eggs come out? Do we freeze them right away or do we fertilize them? And the main difference is that, yeah, once you fertilize them, you see how your eggs behave and how many embryos you create, and that can give you a bit more of a concrete, something to hang your hat on if you’re really wanting more of a reassurance that yes, I could have a realistic chance of a baby without these eggs is see how many embryos they make. And you could even then do genetic testing on the embryos. And that’s one of the main issues as eggs get older, is they tend to make more genetically abnormal embryos. So then you could purposely screen your embryos, and if you do have a normal one, that is one of your highest probabilities of getting a baby.

And some people behave better than their age based predictions. Some 40 year olds, maybe you’ll make all your embryos genetically normal, which tastes great. It might be worthwhile to know that or the opposite is true. So then you can make some other contingency plans. But I get asked a lot like, which is better, eggs or embryos? I mean there’s no better or worse is kind of like what’s right for you. Some people are not open to using a sperm donor if you don’t have a partner. And that’s the crux of freezing embryos is you need to know where your sperm is coming from and that’s where it’s important to do some soul searching and just see what you want to do.

Dr. Lorne Brown:

The probability though, embryos, you have a better prediction from embryos than from egg freezing. But like you said, these are why it has to be a one-on-one discussion, consultation to find what your needs are. If you’re single at 40 and you’re open to sperm, then at least you know you have donor sperm, then you can make embryos and then you have a better idea of the probability of a live birth than if you just froze the eggs. But it comes down to there’s no perfect way to do this. Unfortunately, there’s no guarantee and no perfect way. It’s individualized. And what I wanted to share and bring up here at this part of our chat is just to find a balance because there’s a lot of hype on the internet. Egg freezing is the answer. You freeze your eggs, you preserve your good, now you get to do whatever you want for the rest of your life.

And I think it’s a little oversold. And so I want to talk on that side of it just saying there’s risk to it, there’s cost to it, and there’s no guarantee. Then all the media people poo poo the IGF clinics doing egg freezing and saying it’s too popular, too many people running to it and they don’t know. I want to take the other side of it, like how fortunate we are that this technology exists because 50 plus years ago we weren’t able to do this. And so we are able to help preserve fertility for many individuals that we could not have before. And people because of a cancer diagnosis or just because of their situation, life situation, they’re able to now have children later in life. And so you can look at it from both sides. This is where it becomes individual. So when I see the overhype, yeah, it can be overhyped, but also when they really get upset with clinics doing this, I’m like, this is such a blessing to have this technology.

If it was all free and no side effects, yes, but that’s like everything in life. I wish if everything was perfect and easy, yes it would be better, even better. But I just want to share that there’s a balance here and everybody has to look at their life situations, their needs and get a consultation. So you can talk to your local clinic if you’re in Vancouver or Olive and just find out if you’re a candidate for egg freezing, what does that even mean? What your probabilities are, learn what the risk factors are, learn how many eggs you may need to freeze, what the probability of life birth rate is. Or maybe you’ll find out that making embryos is an option for you, or maybe you’ll find out that learning more about donor eggs and there’s another option for you to parent. And so there’s so many things available to you and Google, Dr. Google gives us some great information, but a lot of people come to my practice thinking this is what they need to do because an influencer said Do it this way and that worked for them, but you got to find out how it works for you. So that was my little speech at the end just because I see sides of it Areiyu, where some people are coming in saying, is it really this good? And then some people are criticizing it. I feel there’s no judgment on it.

Areiyu Zhang:

Yeah, it’s an option. It’s not the be all and end all. You’re so right. You can’t really just set it and forget it. You still have to keep in mind that this is just one thing you have frozen, but it’s not necessarily going to guarantee anything. But it does take the pressure off for a lot of people where you feel like they’ve bought themselves a bit of time. And if you’re not, whether you’re in a relationship or not, it gives you the most reproductive flexibility to decide what you want to do with your eggs

Dr. Lorne Brown:

Later on. It gives you hope and just gives you information so you don’t have false hope because until you have a live birth, there’s no guarantee. That’s the thing. So if you freeze your eggs or if you freeze embryos, it’s just increased your probability. Keyword here is probability of a live birth. It hasn’t guaranteed it. And that’s what life’s about. Knowing this and then making your decision when you put yourself through a procedure like egg freezing and the cost and the emotional part of it, you just want to be as knowledgeable as possible going into it. And then there are people that are going to go through this that are going to get a live birth from this, and there’s going to be people that are going to do this, like you said at the very beginning, that will never need to use this. And they’re okay because they didn’t want to use it, they did it. So they just had a little bit of hope and reassurance that there’s another chance for them later in life if needed. Appreciate that. Is there anything else you wanted to share about egg freezing before we wrap up?

Areiyu Zhang:

No, I think we’ve covered all the really important things.

Dr. Lorne Brown:

So going back to LeBron James basketball player, he treated his body like a temple. And this is the integration side with Olive as well. At Acubalance, we like to look into diet, there’s supplements to support your health and to help optimize your egg quality. We also use acupuncture, low level laser therapy, meditation and spiritual practices or stress reduction practices, just a holistic approach to bring the inflammation down, lower oxidative stress, improve mitochondrial function. This is our goal to support the egg and sperm quality so you can be at your peak fertility potential for your age when you go through any of these procedures. So that’s our holistic integrative approach. Are you, thank you. Again. Check out her donor egg talk as well. There’s a good connection or relationship here with these two talks. So I think it’s a nice one to listen to.

It’s one of the ones we did earlier in the first season with Dr. Zhang. And then I hope this was helpful regarding egg freezing. And again, you can talk to your medical doctor to get a referral to Olive and also on the Olive website under egg freezing, they do have a little calculator to give you some predictions based on your age for egg freezing. And again, it is a general calculator. General means not you because there is no average human being. There’s just you, but they’ve taken all the averages and worked this out. So it’s just to give you an idea. But please do talk to your reproductive endocrinologist to find out more specifics for yourself. Are you, thank you very much for joining me today and sharing these clinical pearls. I really appreciate it.

Areiyu Zhang:

Always a pleasure chatting with you, Lauren. Take care. Hey,

Dr. Lorne Brown:

You too.

Speaker:

If you’re looking for support to grow your family contact Acubalance Wellness Center at Acubalance, they help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility, acupuncture, and naturopathic medicine. Download the Acubalance Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to Acubalance dot ca. That’s Acubalance.ca.

Dr. Lorne Brown:

Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That’s Instagram, Lorne Brown official, or you can visit my websites Lorne Brown.com and Acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.