Lately, so many women are talking about whether or not to freeze their eggs for the future. But we often don’t dive into that future: what happens when it’s time to thaw them and make a baby? That was the topic of my
It’s a good idea to look out for yourself because your eggs are precious and you only get one chance to thaw them
When I first started throwing egg freezing parties in 2014, I did so because I wanted to empower women (and men) about their fertility. (See The Egg Whisperer Is On A Crusade To Make People Aware Of Fertility Issues And Solutions)
Too many women in their late 30s and 40s were coming into my office struggling with fertility and wishing they had known more about it when they were younger. Had someone told them to get their fertility levels checked and to consider the option of preserving their eggs they most certainly would have. My main lesson is simple: age is the number one factor that affects fertility. The older we get, the more the quality and quantity of our eggs decrease, and this begins most dramatically after the age of 35.
Time to Thaw: What the F?
Egg freezing is IVF without the F. You go through a standard cycle of In Vitro Fertilization in which you take hormone shots that stimulate the growth of eggs. A doctor like me then extracts your eggs through a simple surgical procedure, and I work with an embryologist to preserve your eggs in liquid nitrogen until you’re ready to use them. (See article, Mysteries of the IVF Lab Revealed) Multiple studies show that frozen eggs are yielding successful pregnancies and healthy babies.
So the big question is what happens now that you’re ready to use your eggs? In other words, what are the steps towards fertilization (or as I like to say, what the F?)
When it comes to human biology and thawing your eggs there is no such thing as a 100% guarantee.
Step 1. Locate Your Eggs
It’s time to locate your eggs and make a plan for how to transport them to your fertility clinic. They may be in storage at your fertility clinic, or if you froze your eggs five or six years ago, perhaps they’re in long-term storage. Either way, make sure you prepare the clinic or your fertility doctor of your plan. Check to see if they need a media kit, which is the fluid that the lab uses to thaw your eggs. A good lab will take care of this step for you, but it’s a good idea to look out for yourself because your eggs are precious and you only get one chance to thaw them. Make sure to seek out the safest situation possible and make sure that the lab you’re working with understands the protocol of how your eggs were frozen because that determines how they get thawed.
Step 2: Decide if you want to unfreeze all your eggs.
Let’s say you have 20 frozen eggs. Maybe you thaw five at first and leave the rest frozen to see what happens. Having unused embryos means different things to different people, so really think through this. Maybe your relationship isn’t as stable as you would like it to be, so perhaps you don’t want to fertilize all your eggs with your partner’s sperm and save some eggs for later, just in case.
Step 3. Complete Your Preconception Testing
If you go to Tushymethod.com, you’ll learn more about this mnemonic that focuses on diagnosis before treatment. It’s a new first step for every fertility patient, even if you’ve already frozen your eggs, which will ensure you are taking the right path and have the highest likelihood for a healthy pregnancy and baby.
What is the TUSHY Method?
“T” in TUSHY stands for tubes (the fallopian tubes).
Make sure that you’ve checked to make sure your fallopian tubes are clear. Well, you don’t need them to be clear when you’re doing IVF with thawed frozen eggs, but if they are blocked, you could be at a higher risk for an ectopic pregnancy.
“U” in TUSHY stands for an ultrasound of uterus.
Maybe you had an ultrasound two years ago, but I recommend doing it again to make sure that your uterus will be receptive to an embryo.
“S” in TUSHY stands for semen analysis.
Every pregnancy is 50% egg and 50% sperm. Learning about your partner’s or donor’s sperm health is essential before you thaw your eggs. You know all too well the challenging steps that you went through to freeze your eggs. Now that you’re ready to have a baby, you don’t want to learn that your sperm source should have gone through a sperm fitness challenge before fertilization. Once your eggs are thawed, you don’t want any surprises. If your a partner or sperm donor is older, then you want to know if their sperm is healthy. You want to see if they’re smoking or drinking because this can damage sperm. Look at DNA Fragmentation. (See article, Does Your Man Have a Biological Clock?) I’ve heard too many stories of women who have thawed their eggs and found out that their sperm source wasn’t strong enough. If they had known, they would have waited, so don’t find out the hard way.
“H” in TUSHY stands for hormone testing.
Before you transfer, it’s vital to check your hormones to make sure your body is ready for a pregnancy. This includes your thyroid and prolactin because abnormal thyroid function and high prolactin levels can cause miscarriage and pregnancy complications.
“Y” in TUSHY stands for your genetic profile.
Prior to creating embryos from your frozen eggs, you want to make sure that both you and your partner are genetically healthy. You want to do a carrier screening, a reproductive genetic profile and a cancer screening.
Step 4: Complete Your Infectious Disease Labs
Even if you know that you don’t have any sexually transmitted diseases, these tests are part of the basic protocol before your transfer. The tests you get will depend on the state in which you live, but most states require these labs to be done within two years of your embryo transfer to make sure that you’re not carrying any diseases that could affect your baby’s development. Most fertility clinics will coordinate the blood draw for you by working with a local lab or a lab of your choice.
Step 5: Implantation Testing
I recommend implantation testing to everyone before they transfer. It isn’t just something for patients to do after they’ve had a failed transfer. It’s something that you do upfront to ensure your best chance for pregnancy with these eggs. The ERA test tells you exactly when your uterine lining is ready for the transfer by telling me how many hours of progesterone that you need to be on before the transfer.
It’s the equivalent of the Evite that tells you the exact arrival time for the “embryo party” in your uterus. If your embryo arrives too early or too late, it won’t stay for the party and implant. If your uterine lining isn’t ready, your embryo has nowhere to sit. If the lining is what is known as post-receptive, then the embryo won’t settle in comfortably either. Basically, it’s a mock IVF cycle in which you take meds as if you’re going to transfer but then you don’t. Instead, we do an endometrial biopsy and study the lining of your uterus.
Note: There are still times when an embryo may not implant despite doing the ERA test, which is why last year I started to offer patients the Receptivadx test. It tests for a hormone known as BCL6 that can point to endometriosis, which could impact implantation.
Step 6: Make Embryos
After your eggs are thawed, it’s time to make embryos. This process is the job of the embryologist. Some eggs get fertilized by putting a drop of sperm on them. This happens with fresh sperm from your partner or unfrozen donor sperm. Some are injected with the sperm in a process called ICSI, where the embryologist hand selects one sperm to inject inside the egg. Fertilization starts immediately even though we can’t see it for another 18 hours.
Do You Want to Do Genetic Testing on Your Embryos?
I always show my patients photographs of a fertilized egg, a day three embryo and a blastocyst, which develops around day five. The reason why it’s important to see these stages is because it’s the point where you can decide if you want to do genetic testing, which is a way to find out if an embryo has a balanced set of chromosomes or not. It’s important to know that this test is just about chromosomes and it can’t predict many genetic diseases, so that’s why it’s also essential to do carrier screening to see if you and your partner or donor sperm have shared genetic mutations.
Some people think that when you say genetic testing, it means you can learn everything about your embryo. We’re not there yet. We can’t tell your child’s height, their eye color or their IQ. All we can know is whether the chromosomes are balanced in a way that you’ll have a higher chance of pregnancy and a lower chance of miscarriage. And even a genetically tested embryo has a 75 % chance of implanting because nothing is guaranteed. When it comes to human biology and thawing your eggs there is no such thing as a 100% guarantee.
Step 7: Decide Whether You Want to Transfer Fresh or Frozen Embryos
When you’re ready to implant your embryos, you go on hormones for a couple of weeks. First, estrogen then overlapping with progesterone. You have the choice to transfer an embryo without freezing it first or to freeze it and then get your body ready for the transfer. The answer depends on how many eggs you have and how old you were when you froze your eggs. We also look at the viability of your eggs after they are unfrozen.
The information that you get from the egg freeze report is invaluable. When I do an egg freeze for a patient, I always tell them what I think about their egg viability. You want to know this because if you found out when you thawed the eggs that they didn’t look as good in the beginning, you might feel pretty disappointed that you didn’t have a chance to do another egg freeze. So ask yourself these questions: How many kids do I want? Do I have enough embryos for my future family? Even if you’re using your frozen eggs, maybe there’s still a chance for you to go through another IVF cycle or egg freeze if you need too.
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