Welcome to another episode of The Egg Whisperer Show! I’m Dr. Aimee, and today I’m thrilled to be joined by the incredible Dr. John Jain, a board-certified reproductive endocrinologist and pioneer in the field of fertility. With over 20 years of experience, including a decade as a professor at USC, Dr. Jain has been at the forefront of egg freezing research and now leads Santa Monica Fertility, where he’s dedicated to helping patients build families through cutting-edge science and compassionate care.
In our conversation, we dive deep into the realities of fertility and pregnancy over 40, the science behind egg and sperm quality, and the emotional journey of third-party reproduction. We discuss the myths and misinformation that often surround fertility, the importance of being informed, and the options available for women and couples, including egg donation and surrogacy. Dr. Jain shares his expertise on how to navigate these choices, what to look for in a donor or surrogate, and how to advocate for yourself as a patient.
In this episode, we cover:
- The impact of age on egg quality and fertility rates for women over 40
- Why IVF is not a magic solution, and what it can and cannot do
- The role of sperm quality and male factors in fertility, including epigenetics
- The truth behind celebrity pregnancies and common misconceptions
- How egg donation works, including donor selection and success rates
- The process and considerations for surrogacy, including for LGBTQ+ families
- Tips for choosing a reputable egg bank and what to expect from the patient experience
Resources:
- Santa Monica Fertility: https://santamonicafertility.com/
- Santa Monica Fertility Egg Bank: https://santamonicafertility.com/egg-donor-egg-bank/
- Santa Monica Fertility Surrogacy Agency: https://santamonicafertility.com/surrogacy/
- Join Dr. Aimee’s IVF Class by clicking here
- Get Dr. Aimee’s Fertility Essentials and Supplement List
Full Transcript:
Dr. Aimee: I am so excited, I have a rock star of a fertility doctor on, Dr. John Jain.
Hi, John. Thanks for joining me today.
Dr. John Jain: Hi, Dr. Aimee. It’s good to be here.
Dr. Aimee: We’re going to talk about something that is near and dear to my heart, especially as a woman in her 40s, and that is fertility and pregnancy over 40. Of course, there is no better person to talk about this than you, because you run one of the most successful egg donor banks.
When I say egg donor and over 40, don’t feel like I’m giving up on you. Not just a bank, but also an agency in terms of running egg donors through fresh cycles, and one of the best that I have ever seen in my entire life in the entire world, so I applaud you.
Thank you, John. I just had to start off by saying that.
Dr. John Jain: Thank you. We’ve had some great success together, you and I.
Dr. Aimee: It’s been really special for me to be able to refer patients to you because I know they’re going to be in really good hands when they see you.
Welcome to the show. I’m super curious, why did you decide to go into fertility?
Dr. John Jain: Great field. Isn’t it? Both you and I made the right move, I think. Back when I was in residency in the early ‘90s, I felt like a kid in a candy store. It’s such a great field. There’s OB, there’s high risk OB, there’s gynecology, and all of the women’s health fields. Then there was reproductive endocrinology, and it was innovative and exciting and technologically cool.
I actually just saw it sort of blossoming into a real remarkable science and being able to build families. I was really interested in how as professionals we’ll be able to improve childhood health through embryos. Thirty years later, it’s kind of coming true. We can do a lot more to help patients become parents and build families, and of the cool invitro stuff, molecular genetics, I think it’s still a phenomenal and wonderful field to be in. That’s how I picked it, and I’m glad that I did.
Dr. Aimee: It’s really fun. It obviously comes with its challenges, of course, but I agree with you. Thank you for sharing that.
Tell us about Santa Monica Fertility and tell us what made you start your own practice.
Dr. John Jain: You alluded to the fact that I was at USC for quite some time. We don’t really hit our stride until we leave fellowship and get out and practice. I spent some extra time in academics, and I’m really happy that I did. When I was there, I did a lot of work on egg freezing, which was very novel at the time in the early 2000s. One of the first clinical trials actually in the world and had babies, it was pretty exciting.
Then I actually created the first donor egg bank in California, way back in the day, maybe before its time. It was that egg freezing technology that led me out of USC. I built Santa Monica to do that, to offer egg freezing to women who wanted to freeze their own eggs and to pursue donor egg banking. Now, we’re talking almost 20 years ago. Today, we talk about egg freezing and women are like, “Yeah, I want to freeze my eggs,” as sort of commonplace.
Did you know that in 2009 I did the national debate at the American Society of Reproductive Medicine, and my side was that women should be allowed to freeze their eggs if they’re consenting to do so. That was contentious at the time. Speed ahead 12 or 13 years later, and now it’s commonplace because it does work and it’s a great thing.
It’s interesting, I came to Santa Monica Fertility, we froze eggs for women, then I built the egg bank, and now we’ve metamorphosed into a third-party reproduction center. We focus on donor eggs, both fresh shared cycles, an egg bank, and surrogacy, and we put it all together with the medical care, an integrated practice. Patients find it less stressful, and the success rates speak for themselves. It’s a nice way to practice, we get a lot of babies, and that makes me really happy.
Dr. Aimee: Truly. I get a lot of really positive feedback about the experience that patients have as well.
Let’s talk about fertility and chances for a woman who is 40. I see patients a lot of times that are over 40, and a lot of them don’t know what the pregnancy rates are. I’ll ask them a question like, “What do you think your chances are at 45,” and they’ll say 50%. It’s just so hard for me because I’m such an annoyingly positive person, it’s hard for me to be like, “Actually, it’s more like slim to none.”
In your own words, what do people need to know about fertility rates and natural conception when they’re over 40?
Dr. John Jain: First of all, don’t change your annoyingly positive way, it’s a good thing.
I think understanding fundamentals is the best. If someone understands why someone is saying something is best. For me, when I work with women 40 and older, I try to impart on them one simple fact, and that is egg quality.
It all starts with the egg. Eggs have 46 chromosomes. They have to get rid of 23 to make room for the sperm. If they don’t get rid of 23, then the fertilized egg has the wrong number and it doesn’t work. That’s it. That’s pretty easy for most people to get their head around.
The egg makes mistakes at all ages, but after 40, 90% of the eggs make a mistake. At 45, almost 100% make a mistake. Okay. What if I take this herb and this supplement and I cut out sugar and I cut this out, are my eggs going to get better? The answer is no, we can’t change the eggs. But we can get more of them, that’s called IVF. If we can get more out of the body, maybe we can find a normal one.
I’ve found that when I tell patients about that underlying factor, that it’s just nature and at 40 it’s better than 41, it’s better than 42, by 43 and 44 it’s really getting pretty bad, I think they get it. It doesn’t mean that they shouldn’t try. But with that piece of information, and then understand that IVF is not magic, it just gets more eggs out of the body, but it doesn’t help the eggs. I think those two pieces of information I’ve found to be very useful to patients.
Dr. Aimee: Right. IVF is magic when it works. I don’t think people realize that if you look at live births across the board for all comers, most of the time it actually doesn’t work. If you take every single person that does IVF in this country every year, less than 50% will actually take home a baby, and that’s really hard. I think when you’re over 40, if you were to choose between cycling yourself, depending on your situation, versus an egg donor, obviously that will take you up closer to not 100%, but a lot higher.
What about men and women, do men see the same rate of decline when they’re over 40 as women?
Dr. John Jain: The answer globally is no. Men can father children well into their 40s, 50s, 60s. But here’s what’s missing; we don’t know because all of the research has been on women. Yes, the egg factor and the egg quality is a big deal, that’s the driver.
But I have found my own research that the semen analysis, the gold standard of sperm, does not tell us the whole picture. For the listeners, the semen analysis is a microscopic exam of the sperm, looking at the count, the swimmers, called motility, and the shape, called morphology. If it looks good, you’re good to go. Most guys get a pass.
But remember, the sperm cell is like a delivery truck. It’s bringing DNA, that’s the package, and DNA gets into the egg and makes the embryo, and that’s what matters. Things like advancing paternal age change the DNA. Bad habits, if you drink a lot, you smoke a lot, you’re sedentary, you don’t exercise and you don’t take vitamins, you’re going to change the DNA, and yes, it will affect embryo outcome and maybe pregnancies.
That’s the piece of information that is lost. I did some research in my egg donation program and saw that it’s real, it’s called epigenetics. All those bad things I was talking about, they influence how the DNA works through what is called epigenetics. I tell my male patients they have to kick in here, take those vitamins, behave themselves. Don’t take testosterone, by the way, that’s a killer. You have very little to do compared to your partner, if you’re a heterosexual couple. That’s all we can do today, and I do think it’s a real miss in our field, a real oversight.
Dr. Aimee: I agree. I love that. Guys, behave yourself, please. There are so many celebrities out there, and I can think of so many names of women over 40 who have had babies. They’ve made it so hard on us as doctors because they mislead our patients so often. What are some of the options? Not to speak about what they’ve done, but what are some of the options that a woman who is over 40 should be considering when it comes time to conceive?
Dr. John Jain: To further your observation about celebrities and those in the public eye, I think the idea is if you’re rich and famous you know the special doctors, maybe you know the Dr. Aimees of the world, who can get you pregnant. Right? Unfortunately, the ovaries of celebrities don’t know how special they are.
The statistic is still true. If you’re 45 years old, your eggs are prone to that mistake I talked about, they’re prone to poor egg quality, and the chance that you’re going to have a baby from your eggs is really low, no matter how famous you are.
Of course, some say, not just celebrities but others, “I froze my eggs when I was younger,” or, “I made embryos when I was younger.” Yes, okay, that does happen. It doesn’t happen that much, but it does happen.
One more point from when I’ve been asked this before. I think they’re just trying to protect their baby. They are the mother, and they want to tell the child at the right time that they came from an egg donor, so I get that.
But you’re absolutely right, it is misinformation, or at least it’s inferred as misinformation. Women over 40, it’s important to realize that there is, unfortunately, a time window. If you’re a heterosexual couple and you’re not pregnant within 6 months, you have to get a workup to make sure you’re not missing something. If the sperm is bad, for example. Then the goal of treatment is to get more eggs in a given month so that you can find the normal or the good quality egg, and have a baby. You have to take shots to make multiple eggs and do artificial insemination, or you take shots to make a bunch of eggs and then do in vitro fertilization.
All roads kind of lead to increasing the odds, and that’s what is important, as soon as you can after 40.
Dr. Aimee: Are you on Twitter? No? I do a thing called quote of the day. Do I have your permission to actually quote you? “The ovaries of celebrities don’t know how special they are.” I think that’s a really good one to make the point that the 50-year-old who is having a baby and makes it look like it’s so easy, and she’s a celebrity, she’s still a 50-year-old. That’s hard for me to see because patients literally come to me, “Dr. Aimee, I know you’re an amazing doctor. I want what she had. I know if any doctor can do it for me, it’s you.” I’m like you’re 50 years old, I’m going to introduce you to Dr. Jain.
Your work is great. Talking more about your work as far as egg donation, how does it work?
Dr. John Jain: It’s a hard decision for women, you’re giving up on your eggs. I always tell patients you have to try with your eggs as far as you can or as much as you need to, that’s your journey and only you can define when you’re ready to move on. Sometimes somebody has been told it’s time, but it’s a hard decision.
I also tell my patients when they tell me, “I’m ready for egg donation,” I say, “Actually, you’re not ready for it, you can’t be ready, but intellectually you’re ready because you want to give birth and you want to be a parent, and that’s okay.” I find that’s an important partnership that way.
When it comes to choosing a donor, these are women in their 20s. In my egg bank, we’ve done all of the homework, as have other egg banks. That’s the genetic screen, the medical screen, the psychological screen, the liability, all of those things. With egg banking, it’s even better because the eggs are already in the bank. The patient and her partner just need to focus on what they like.
They have some choice because they’re giving things up, too, so they get some choice here. It might be the ethnic background, it might be height, eye color, athleticism, academic prowess, whatever it might be, they have a choice on that. All other things being equal, that’s what they look for. Sometimes they look for a donor that’s maybe been proven or had babies from their egg donation, although first time donors work just as well.
That’s really the process, getting the emotional and psychological readiness for it and then picking the donor they want. Then when they pick a donor, they pick a number of eggs based on their goals, because we can correlate the number of eggs to the number of blastocyst embryos. Those are five-day-old embryos that are made from the eggs. From eight eggs, we can normally get three blastocyst embryos, which we freeze.
Then every time we transfer one of those embryos, our success rates are about 65-70% baby rate, nationally it’s about 50%. If it doesn’t work the first time, they get a second transfer, and 90% of those people have a baby. That’s how it works for us. Then if they want to see the sex of the baby, that can also be done, and a variety of things like that.
That’s sort of the big picture is their readiness, the selection of the donor, the selection of a number of eggs, and build their family.
Dr. Aimee: I love that. That’s very easy to understand. I have to tell people, not that I want people to think that these results will be seen everywhere, but for any patient that I’ve referred to you and that you’ve taken care of over the years, I think we’re at 100%, every transfer has led to a healthy pregnancy and baby. I just think that shows the quality of the work that you do there. Thank you for that.
What about surrogacy? You talked about how your clinic is doing third-party parenthood, the whole thing from egg to baby, and you now have incorporated surrogacy. Can you tell us a little bit about that?
Dr. John Jain: Sure. We have gestational surrogates. The old traditional type of surrogacy where the surrogate provides the egg, we don’t do that, nor do many people really do that.
Surrogates are women under 40, healthy, have their own children, no obstetric problems or problems, they’re healthy with no medical problems. They’re hard to find. There’s a real shortage in the country. Some of the big agencies have a year backup. We have our own surrogates that are for our patients and for close friends and doctors that we know, present company included. We prescreen our surrogates so they’re ready to go.
Basically, women who cannot carry the pregnancy because it poses a risk to their life, for example if they have medical problems, or a risk to the child’s life, are candidates for surrogacy, as are women who have tried fertility treatments that haven’t worked. The surrogate does not have a genetic link to the child, that’s the egg and sperm provider. They do, however, nourish the child, nourish the fetus, so it does matter that they’re healthy and live a healthy life during pregnancy.
At the end of the day, they’re disconnected genetically. California doesn’t always have the greatest rules, because at 21 or 22 weeks, the hospital gets a court order saying when that baby is delivered, it belongs to these people, they’re the parents and they’re the only ones on the birth certificate. Now other states have really favorable laws, so getting that out-of-state surrogate is not a bad thing, especially in these virtual days where people can follow pregnancies virtually.
Dr. Aimee: What about for gay men, how does it work for them?
Dr. John Jain: We actually have a lot of gay clients because we’re kind of built for their needs. Gay guys have the sperm, oftentimes they have two sources of sperm, but we have the eggs and we have the surrogate, and we have the medical care.
Just like any other couple or single person, they pick the eggs, we create the embryos, and the surrogate carries it for them. We also work with HIV-positive men who are undetectable with the virus. That has been shown, without question, to be a non-transmissible state. We really pride ourselves in being a full-service package to that community, who encounter bias and prejudice, and have a lot of understandable anxiety in going through all of these steps. We have an integrated program that we work with them frequently on.
Dr. Aimee: Patients have so many options out there when it comes to egg banks now, more than ever. If you were someone who was looking through options, what kind of things should a patient be looking for when picking an egg bank?
Dr. John Jain: For us, we only take 2% of the donor applicants and we prescreen everything. We have to really believe in the donor, her reliability, and her genetic and medical history. Then we know all of the donors, we’ve met them, and I did the care of the donors. So, when we speak to our intended parent candidates, we speak from the point of an in-house program.
Some of the larger banks don’t have that. They bank the donor eggs in one place and ship them to many different places. I don’t think that’s a negative per se, because someone is going to get healthy eggs and the cost might be affordable, they might be in a small town in a smaller state and that’s all they have, so that’s great, they have a family and that’s all good. But the experience is important and the trust is important.
We also build in the plan to have backup embryos as part of what we do. We almost universally have extra embryos so that we can do another transfer if the first one doesn’t work, and we do that for no cost. That’s how you get that high level. The first one might be 65-70%, but the second up to 90%. Patients also get nervous if they only have one embryo.
I spent a lot of time when I built the program thinking about the anxiousness in the patient experience and how does someone feel better and more confident, and these are some of the factors that are built into the experience.
Dr. Aimee: Is there anything else that you want to add and share with our followers today?
Dr. John Jain: I think it’s something you also profess, and that is good information. There’s so much misinformation out there, whether it’s the lay public or medical doctors. I think patients just have to ask questions and not become victims of the information.
Yes, your friend may have taken CoQ10 and she got pregnant, but it doesn’t mean that’s the case for you. You may not need to cut out sugar and alcohol and caffeine, you may not need to have a restricted diet. Pick and choose what feels good for you, realizing that nothing is going to change the egg, but it might change how you feel.
On the other side with doctors, I so frequently see patients who really don’t know what they did. I find that kind of appalling because it’s not helpful, really, and it doesn’t feel good. I encourage patients to just ask the questions, “Why are we doing this? Is this going to really change the management? How is this going to help me have a baby?” I think the number one message that I have is to just be informed and ask questions, both in the lay public and otherwise.
Dr. Aimee: Exactly. “Who is my doctor going to be that day?” You and I are unique in that. I joke that there’s three people that work here, me, myself, and I, you’re going to get one of us.
How can people find you and your clinic?
Dr. John Jain: It’s easy, it’s just Santa Monica Fertility.com, and it has a link to our egg bank and it has a link to our surrogacy agency. We are people that pick up the phone here. Not to say that automated systems don’t work, but that’s what we do. Give us a call, send us an email, get a contact sheet, and we’re happy to talk to you.
Dr. Aimee: Who doesn’t love going to Santa Monica?
Dr. John Jain: That’s right. It’s a wonderful place.
Dr. Aimee: Thank you, John. Thank you for making my patients parents. Thank you for all of the work that you’re doing pushing our field forward. I really appreciate you.
Dr. John Jain: Thank you for today and thanks for the trust in the program. It’s been great working with you, Aimee.
