“I’m Continuing My Egg Freezing Cycle Even Though Some Doctors Say Not To”
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It’s no surprise that many women are putting off parenthood right now after seeing how anxiety-producing being pregnant during a pandemic can be. According to a recent survey on the state of fertility in 2020 by Modern Fertility and SoFi, 31% of women surveyed have changed or delayed their fertility plans due to COVID-19, citing access to prenatal care and financial reasons as their main concerns.
Others are deciding to freeze their eggs in order to have children at a later time – but they’ve run up against a roadblock: guidelines released by the American Society of Reproductive Medicine in mid-March calling for the suspension of new treatment cycles.
Although the ASRM has since updated their initial guidelines, many clinics have put new fertility treatments, including ovulation induction and egg retrievals, on pause in compliance with social-distancing guidelines. Other fertility clinics that practice in hospitals have shut down in order to preserve personal protective equipment and hospital space for medical staff fighting COVID-19.
But some women can’t afford to wait.
For Chelsea K. from San Francisco, putting off her egg freezing could mean kissing goodbye her dream of becoming a mom one day, due to an already extremely low ovarian reserve. “I’m 28, single, and not trying to conceive anytime soon; because my mom and grandmother went through menopause early, the same could likely happen to me,” Chelsea says.
Chelsea’s level of Anti-Mullerian Hormone, or AMH, a hormone that indicates the number of eggs that are in the ovaries, is currently at .45. The number that’s compatible with fertility is at least .7, or preferably over 1, explains Kaylen Silverberg, M.D., a reproductive endocrinologist at Texas Fertility Center. For a 28-year-old, the AMH level would ideally be closer to 2.5, Dr. Silverberg says.
Since Chelsea’s egg production is naturally lower, her doctors have said she needs to undergo at least three retrieval cycles to have enough eggs that survive the deep freeze for one child down the line. So far, she’s only completed one, in January 2020. Her second cycle, scheduled for March, was put on hold once the pandemic hit. She tried to push back, she says, but the clinic pushed off her appointment.
“When my second cycle got canceled because of the shelter-in-place [orders], it was pretty devastating. I was anxious because I had no idea when restrictions were going to be lifted, and it’s tough to tell how quickly you’re going to run out of eggs,” Chelsea says. Waiting for the pandemic to blow over completely could mean waiting until she has little to no ovarian reserve left.
The problem is, it’s near impossible to set an “expiration date” on your egg freezing viability, Dr. Silverberg says. Because doctors can’t exactly estimate how long a patient has before her ovarian reserve deteriorates, they (in normal health circumstances) urge them to get their fertility plans, like egg freezing, embryo freezing, or IVF, in order as soon as they have a fertility consultation and realize a need.
Clearly, these aren’t normal circumstances — but where do they leave women like Chelsea who feel a pressing need for fertility treatment?
Should You Freeze Your Eggs Right Now – and Can You?
Luckily, ASRM relaxed their recommendations slightly in late April, noting that “infertility is a serious disease that requires treatment in a timely manner.” The reproductive group is now suggesting that clinics carefully assess starting to offer fertility treatments again on a case-by-case basis, according to the prevalence of COVID-19 in their area.
That meant Chelsea’s clinic was able to prioritize urgent cases for women about to undergo chemotherapy, women in their 40s, and women with low ovarian reserve — so she rose to the top of the pile. Her clinic confirmed her second egg retrieval for the end of April, and she decided to continue with her egg freezing, even though San Francisco’s stay-at-home order had been extended until the end of May.
But at the end of the day, ASRM’s guidelines are just suggestions. Clinics are able to call the shots (no pun intended) when it comes to treating patients, as long as they do so in a way that’s safe.
Dr. Silverberg’s private clinic has chosen to continue all treatments, while taking precautionary measures like adhering to social distancing guidelines in the office. His practice has been open about the fact that they disagree with the ASRM’s original recommendations to stop fertility treatments, because of the urgency of so many women’s fertility cases.
It’s worth noting though, that not every case is urgent, and for these women, it’s still best to stay home to prevent the spread of the virus.
Some states, including New York — which has had the highest rate of COVID-19 transmission in the U.S. — have maintained that fertility care is an essential service. However, when such services must occur is to be decided between a patient and clinical provider, according to the executive order issued by Governor Andrew Cuomo.
That means it’s ultimately up to clinics to decide how they choose to operate during the coronavirus pandemic. “We chose to finish our existing, ongoing treatments in March and then suspended the initiation of any new IVF cycles or egg freezing cycles,” explains Lucky Sekhon, M.D., and ob-gyn and infertility specialist at Reproductive Medicine Associates of New York in New York City.
However, she says her clinic hasn’t put egg-freezing consultations on hold because of the time-sensitive nature of preserving fertility (she's conducting them via telemedicine calls). “The earlier one freezes their eggs, the more likely they are to get a higher quantity frozen in a given cycle, and a higher proportion of those eggs will be genetically normal, or good quality, and capable of resulting in a successful pregnancy in the future,” Dr. Sekhon says. A 2017 study found that if you freeze 10 eggs between ages 30 and 34, there’s a 69% chance you’ll have at least one child from that bunch of eggs (the study authors also created a calculating tool based on age and number of eggs you’re freezing). That’s why getting enough cycles in to produce as many eggs as possible is crucial and urgent for many women.
So, if the pandemic has changed your pregnancy plans and left you unsure about the future, there are still ways to continue with egg freezing — and many experts agree it’s a good idea. Especially if time is of the essence for your case, you may have to seek out a private clinic in order to get started while social distancing guidelines are in place (especially if you used to get ob/gyn care in a hospital), Dr. Silverberg says.
Chelsea’s resolve to keep her egg-freezing process going resulted in four more eggs retrieved at the end of April – she is hopefully just one more cycle away from having enough eggs to have a baby someday. She’s grateful to have gotten the conversation about her fertility health started when she did, especially because the world is so uncertain right now, she says. “I was lucky enough to be able to make these decisions to help out my future self when I’m at a point where I’m ready to start a family.”
The coronavirus pandemic is unfolding in real time, and guidelines change by the minute. We promise to give you the latest information at time of publishing, but please refer to the CDC and WHO for updates.