Questions to ask your Fertility Doctor before your Egg Freezing Procedure

Questions to ask your Fertility Doctor before your Egg Freezing Procedure

Are you considering egg freezing? Make sure you know the answer to all these questions before you move forward. Go into it with your eyes wide open. My patients will be guided through everything listed below. If you’re not my patient, make sure you’re informed!

• What are the steps to determine if I am a candidate for egg freezing?

In order to determine if you are candidate by me, Dr. Aimee’s office, we take a look at your fsh, estradiol, AMH, antral follicle count and age. We take all the data points and then give you a percentage chance of pregnancy for pregnancy using your frozen eggs.

• What is the average FSH level for someone my age?

Your doc can show you charts demonstrating pregnancy rates for patients at your age with your FSH levels.

• Is FSH more important than age?

Over the age of 40, there’s no such thing as “having the FSH level of a 25 year old.” Your age is more predictive of egg quality than your FSH level. Your FSH level however will guide your doctor and give her the info she needs to tell you whether she thinks you are a good candidate for egg freezing.

• FSH Testing
  • Is FSH test reliable? FSH levels are their lowest in the first several days of a woman’s menstrual cycle. The levels fluctuate from one month to the next.  The normal cycle to cycle fluctuations in FSH levels can be very confusing and frustrating to many women. Our fertile potential tends to be defined by the highest levels seen. For example, if a 40 year old woman has a day 3 FSH level of 14 one month and another day 3 FSH level of 7 the next month, you can’t ignore the 14. Meaning, the level of 14 seems to tell the story about what’s going on with her fertility.
  • Regular testing needed?   Aimee likes to track fsh  and estradiol levels over time because she feels that it may give a woman an idea about what is going on with her fertility
  • At what time in cycle does testing occur (day 3)? It is not a fasting test and can occur cycle days 1-5 .  We say “day 3” only because that’s how most studies are done: looking at a woman’s levels on the same day each cycle.
  • What is a good FSH range for fertility? Every lab runs their hormone assays slightly differently. An FSH level of 12 in one lab may not be equivalent to what it may mean from a fertility standpoint in a different lab. It is so important to ask your IVF doc about your FSH levels and what they mean about you.
  • How high is too high? I have had patients achieve healthy pregnancies with high FSH levels. Ask your doc what they think.
  • If FSH results are high, is there anything one can do to lower?  Science hasn’t given us the tools your fertility doc needs to turn bad eggs into good eggs and tools to give a woman more eggs than she already has. The FSH level is simply a diagnostic guide that tells you what your chances are for pregnancy. It’s then up to you to make the personal choice regarding whether the chances are good enough for you to take the next steps to try to freeze your eggs.

• Related to elevated FSH,  what supplements do you recommend? I recommend: fish oil, coQ10, Vitamin D if deficient, and a host of other supplements based on a patient’s individual profile.  I also recommend acupuncture.
• What is the most current/successful egg freezing technique?  Vitrification is the egg freezing procedure of choice. It decreases risk of damage to the eggs.
• Do you have patients who have done egg freezing? How many? Ask your doc about their personal experiences in their patients with egg freezing.
• Do clinics have age and/or FSH cut-off levels for egg freezing? Be sure to find out after you learn about your levels whether your local clinic will take care of you. There are clinics that don’t offer egg freezing based on a patient’s age and FSH levels.
• What injections are involved? Ask your doc about the protocol they would consider for you. I individualize all my protocols based on the patient’s age, antral follicle count and fertility indicators. My goal is to get mature eggs in the safest way possible.  This is usually done with fertility hormones that will talk to the ovary such that more than 1 egg will grow. Every woman’s potential number of eggs to be retrieved is different and the antral follicle count tends to be a predictor re: how many eggs a patient could grow in any given IVF cycle.
  
• What are the side effects of the injections?
  • Are they significant enough that one won’t feel like going to work? You can work as you’re taking your meds to get you ready for the egg retrieval. Ask your doctor about their exercise recommendations. Egg retrieval procedures are done under close monitoring by an anesthesiologist. It is similar to a pelvic ultrasound while asleep. You will wake up crampy and may need some pain meds. Some patients need to take pain medications after the retrieval.  You need someone to drive you to and from the procedure and stay with you after you get home.
  • Are there any long-term side effects? (i.e.  cancer, since they are hormone injections?) You have to talk to your doctor about the long-term side effects in your situation. For example, if you have fibroids, endometriosis or a family history of breast cancer, your doc may alter how they approach your cycle and what they recommend for you.
  • What are the risks of the procedure? Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications of an egg freezing procedure. Ask your doc if you’re at risk of OHSS and what checks and balances they have in place to prevent you from getting sick. We watch patients very closely by doing frequent monitoring ultrasounds. We use medications that will prevent patients from getting sick from OHSS.

• What is the safety profile for the procedure? As with all surgery, pain and bleeding is a risk. Your doc will review all the necessary consent forms that should speak to the surgical risk of egg retrieval.
• Are eggs harvested able to be evaluated for quality? The embryologist handling your precious eggs will take a look at the appearance of your eggs. They will describe the appearance of your eggs. Pay attention to whether they see a grainy cytoplasm, and smooth endoplasm reticular vacuoles (aka SER vacuoles). Understanding your egg quality at the time of your freeze will guide you regarding your chances using your eggs in the future and whether you should consider perhaps another cycle with a different protocol hoping for better quality eggs.
• Is there increased risk for birth defects from eggs that have undergone this procedure? The largest study to date published in October 2014 shows no increased risk of birth defects in babies born from egg vitrification.
• Is ability to carry a baby to full term also related to age? Valid scientific data suggests that as a woman gets older, her risk of pregnancy complications also increases. Talk to your doc about the pregnancy complications that you should be looking out for at your age.
• Where are eggs stored? We ship eggs to be stored with Reprotech. Reprotech has a the best reputation for long term storage. Ask your doc about how the storage process works.
• How long can eggs be stored?   Studies have not shown any long term risk associated with storing eggs long term.

Information on Dr. Aimee’s blog is not meant to replace important and valuable information that you personal doctor has for you. As always, talk to your personal physician about what’s best for you always! Hope this info helps.