This Changes Everything - Egg Freezing and ART

January 9, 2007 - Tuesday
1:06 PM to (EST)
Guest Speakers: Gad Lavy, MD
New England Fertility Institute

Categories
Egg Donation • Egg Freezing • Fertility • IVF • PCOS

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Corey_Whelan	Hello and welcome to tonight's American Fertility Association's on line educational session. I am Corey Whelan, The AFA's Director of Development and your moderator this evening. Tonight's chat is about egg freezing and assisted reproductive technology - possibly the largest potential breakthrough that we have seen in ART. We are very, very lucky to have Gad Lavy, MD as our speaker tonight. Dr. Lavy is the founder of the New England Fertility Institute, based in Stamford and Hamden CT. Dr. Lavy is more than qualified in this area and is one of the most respected voices in reproductive medicine today. We look forward to welcoming him and hearing your questions tonight.
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Scandia	Hi, I know the doctor isn't here yet but for when he arrives, Dr. Lavy, I am 23 years old, I have pcos so I don't ovulate regularly. I am currently in a relationship but don't plan to marry this year or next year (at least I don't think so!). Is egg freezing something I should consider and is it expensive? Thanks.
Dolores	Hi Dr. Lavy. Can you tell me, do you have to be very young to freeze your eggs?
Dr._Lavy	Good eveneing Scania: Single women who are in their mid to late thirties should consider egg freezing due to the expected decline in eg quality. At your age this is not an issue (at least for most people). Your PCOS should not be a consideration.
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denise-va	hello
Dr._Lavy	Dolores: You need to be under 40 and have a normal FSH in order to be considered a reasonable candidate for egg freezing. These are our criteria but may vary by clinic. The point is that you want to make sure that the eggs that are frozen are of good quality.
denise-va	Thank you for your time Dr. Lavy! Please tell us about the new technologies in egg freezing/ thawing and how these may be beneficial to those of us who are currently in TX vs. those women needing to delay pregnancy for various reasons.
Dr._Lavy	Egg freezing is appropriate for those women who wish to delay pregnancy. If you are in treatment currently and have a partner, you should use the more conventional methods of IVF.
Corey_Whelan	Dr. Lavy, how long do frozen eggs last before they lose their viability? Is there a decline annually?
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Dr._Lavy	In general frozen cells (sperm, embryos and eggs) do not lose their viablity over time.
Dr._Lavy	You can keep the cells frozen for a week, a month, a year or 10 years and expect the same survival and viability.
Corey_Whelan	welcome terbo02. Please don't hesitate to ask Dr. Lavy any question you may have
terbo02	When undergoing IVF, why would one choose to freeze eggs instead of embryos?
Dr._Lavy	Hi terbo02. You would not freeze eggs while undergoing IVF. Egg freezing is intended for those who wish to delay pregnancy and is scheudled as a separate procedure.
Dr._Lavy	The advatage of egg freezing is that the eggs do not need to be fertilized before they are frozen.
Dr._Lavy	Candidates include women who are concerned about reproductive aging, those who are about to undergo surgery that may affect their ovarian function or be treated with chemotherapy.
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Caitlin	Dr. Lavy, I know that this is a new technology. Truthfully, how long does it take before we really really know that no long term effects to the baby will result?
terbo02	Would one freeze eggs though, when undergoing IVF in hopes that when they are thawed, they would survive better than thawed embryos? Just curious:)
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Dr._Lavy	No. At this time survival of frozen embryos is better than frozen eggs.
Corey_Whelan	Welcome Olivia and Niksherman. Dr. Lavy is on board to answer any questions you may have.
terbo02	Thank you Dr. Lavy:)
Corey_Whelan	Hi Silvia, didn't notice you arriving!
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mruss	My understanding is that the freeze/thaw process needs to be perfected in order for clinics to readily offer egg freezing to patients. How long before we can see an increase in success rates?
Dr._Lavy	Long term effects are difficult to judge. IVF technology is still relatively young. We are still learning about the effects of ICSI and of PGD. At the moment there is a small database of children born after egg freezing that does not indicate a potential problem. We have experience with PGD after egg freezing and find no increase risk
Corey_Whelan	Welcome Victoria.
Dr._Lavy	Currently the techology allows to freeze eggs and expect good survival, good fertilization and no increase in chromosomal abn. None of the methods we are currently using including IVF ICSI aND PGD have been perfected but they do provide a reasonable chance of success. The same is true for egg freezing
niksherman	What is the longest length of time that an egg has been successfully frozen?
Dr._Lavy	We are currently developing a egg donor bank as well. This will allow easier access for patients to egg donors. This is another exciting application of egg freezing
Dr._Lavy	Hi Niksherman: I mentioned earlier that cryopreservation allows cells to be frozen for indefinate periods of time. That holds true for eggs as well as embryos and sperm
Dr._Lavy	In general with any new technology it takes some time before its proper indications are established. We are currently trying to best understand who will benefit most from this technique.
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Corey_Whelan	Dr. Lavy, what do ethicists have to say about egg freezing?
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Dr._Lavy	Ethicists are divided about egg freezing as they are about any of the ART procedures. There are in my opinion less ethical concerns about freezing eggs than about freezing embryos.
Dr._Lavy	Eggs and sperm are the same in that regard and sperm banks have been around for a long time.
Dr._Lavy	Even those who oppose embryo freezing on the grounds that these embryos may be abandoned later on, should not object to egg freezing
victoria	Is egg freezing available internationally, or solely in the US?
Dr._Lavy	Hi Victoria: Egg freezing is available in other countries. Some of the pioneering work has been done in Korea and Singapore.
terbo02	Hi again! Are eggs graded before they are frozen and if so, do they remain the same grade when thawed?
denise-va	Dr. Lavy, do some of the advancements in freezing / thawing eggs have potential to improve the freezing / thawing of embryos? Or are we basically using the same methodology?
Dr._Lavy	The grade of the eggs does not change following the freeze/thaw cycle. However, on occasion an egg can be damaged and become non-viable following the freeze. As technology improves fewer eggs are lost.
Dr._Lavy	Currently our survival rates after egg freezing are 80-90%
terbo02	That is excellent. Thank you so much for your time!
Dr._Lavy	Hi Denise: We are using the same methodology. The egg cell is much more dificult to freeze due to its size and the charachteristics of its membrane. New freezing media (fluids) had to be developed for that purpose.
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mruss	Are you concerned that too many young women will be drawn to the financial benefits of donating their eggs without really understanding the long term implications of their decision to donate?
Dr._Lavy	That clearly will help improve the success of embryo freezing
denise-va	Great - the sooner the better!
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Dr._Lavy	Hi mruss: We provide intensive couseling to those young women who wish to donate their eggs and provide them with the information about potential long term effects of their donation.
denise-va	I always thought that embryos tended to decline in quality after the freeze - it sounds like the eggs are not declining so much. Is the thawing done the same way, or again are we learning things about egg thawing that will help embryo thawing?
Dr._Lavy	Denise: the success with frozen embryos has improved dramatically over the past several years. The success with frozen embryos is currenlty very close to that of fresh embryos
denise-va	As someone currently in IVF TX, are there any questions to ask my RE around these new technologies that might improve my personal success rate?
Dr._Lavy	If done properly freezig of embryos does little to damage the cells. The reason for the lower sucess with frozen embryos cycles has to do with the fact that the embryos that are frozen are generally not the best embryos. Those are transferred on the fresh cycle.
denise-va	Makes sense.
Dr._Lavy	Again, Egg freezing is not intended for those who are currently undergoing IVF.
denise-va	Are there any other patient controllable factors that you have found to be beneficial to the freezing of eggs beyond what we already know about health and diet etc.?
Dr._Lavy	No more than what we already know are the predictors of IVF success. Age, FSH, ovaerian response etc. Clearly lifestyle also plays a signficant role as you mentioned.
niksherman	one of my biggest interests with this topic is the use of this technology for cancer patients. I apologize for the late inquiry (if this has already been addressed I am sorry). Do these patients have to undergo an IVF type preparation? has there been any success with ovary freezing?
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Dr._Lavy	Hi niksherman: freezing eggs for cancer patients prior to therapy is clearly one of the most exciting aspects of egg freezing. Ideally, IVF stimulation should be given to increase the chances of a good egg yield.
Dr._Lavy	However, in many cases this is not possible due to the nature of the underlying illness. Egg retireval wihtout stim is possible. The results with ovary freezing are not as good due to the fact that the eggs are not stimulated and therefore not mature
niksherman	thank you
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Dr._Lavy	In addressing the overall success with egg freezing one has to realize that in most cases the procedure is perforemed for the purpose of delaying pregnancy. Therefore those eggs will be frozen for awhile. It will take some time to get the data for survival and success.
Dr._Lavy	We are threfore actively trying to address this issue by studying the survival, fertilzaation and chromosomal complement of frozen eggs
terbo02	If a woman is childless, but in the future, would like children, at what age would she consider freezing eggs?
denise-va	I'm curious what is being done to "market" (I mean that in a good way) these technologies to appropriate audiences. Women delaying due to cancer TX and the like I suppose may get counseling from their physicians before they begin, but women simply delaying because they aren't yet in the right place of a relationship I would think are more likely to be trying not to get pregnant and not thinking much about how to do it later. People seem not to think about fertility until they need it!
Dr._Lavy	Anyone over 35 should consider freezing their eggs. Of course the decision needs to be individualized.
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Dr._Lavy	Denise: You are absolutely right. We are working very hard on educating not only potential patients but also physicians who are not aware of this new technology. You may be surprised how many cancer docs are not recommending freezing eggs sperm or embyos to their patients.
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Dr._Lavy	Educating women about their fertility potenial is another great challange. In my opion this should start in highschool or college. Too many women delay childbirth because of careers only to realize later that they have missed the boat.
k_blumenfeld	Hi Dr. Lavy, can you please address the 40 age cut-off. I assume that this age 40 is an average, meaning that there are women who will have problems at age 35, while others will have few problems with eggs at 45. Rather than rely on a general cut-off of 40 at your clinic, do you have plans to work with women that meet all the criteria for egg freezing, other than just being over 40?
denise-va	That's a shame. I thought of that because of a friend who underwent TX for testicular cancer. I wanted to suggest it to him (knowing how it feels to be faced with infertility), but it seemed out of place with a not very close friend who is thinking about saving his life first and foremost. If his Dr. didn't suggest it, this very young man who has been cleared of cancer may now have the terrible plight of infertility.
Dr._Lavy	Hi K: of course. These are just guidelines. We always evaluate people individually and will offer treatment to women who do not satisfy the criteria if they appear to be good candidates and understand the stats.
k_blumenfeld	Hi Dr. Lavy, thanks. Do you have a site to direct me to, to determine what is the range of criteria to be deemed a good candidate? Thanks.
Dr._Lavy	you can check our web site nefertility.com or call the office
k_blumenfeld	Will do. Also, how long does the process take, from prepping the woman's body for the egg extraction, to extraction?
Dr._Lavy	Approx 6 weeks
k_blumenfeld	What medication is administered?
Dr._Lavy	We generally use the same meds as we do for standard IVF. The idea is to try and retrieve as many viable eggs as possible.
amccloskey	Are the medications shots, oral, or both?
Dr._Lavy	Mostly injections :( Mostly subcutaneous shots (small needles and under the skin)
k_blumenfeld	Sorry for being a novice in this area, but how many treatments does a patient undergo, on average, and is the extraction procedure done in the office or in a hospital. Also, do you know if insurance may cover this procedure, if it is not for reasons relating to cancer treatments?
Dr._Lavy	The exact regimen of drugs is custom tailored to the individual patient
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Dr._Lavy	The exctraction procedure is done in the office using vag ultrasound and sedation. Insurace coverage varies by company and by state.
k_blumenfeld	Thanks. Have you implanted thawed eggs that were then fertilized, into a surrogate mother?
Dr._Lavy	We have recently achieved our first pregnacy using frozen eggs. The eggs were retrieved from a donor, frozen, thawed, fertilized and transferred to a recepient.
terbo02	Hey K, as a patient of Dr. Lavy's, I must say that he is a miracle worker and the most compassionate Dr. I have ever met.
denise-va	Checked out the web site - wonderful to see that you are planning the documtary. The awareness will help us all.
Dr._Lavy	::blush
Corey_Whelan	guys, just want to give you a heads up that we are at the five minute mark.
Dr._Lavy	thanks
k_blumenfeld	Congratulations, Dr. Lavy, on the pregnancy! I reside in NJ near NYC. Do you have colleagues that have clinics closer to my locale? Also, once my eggs are frozen, and then I decide to use them, does my age matter that much for implanting them into me? Over the past few years, there are stories of women giving birth in their 50's etc.
Dr._Lavy	once the eggs are frozen the chances of success are the same if they are implanted when you are 40, 45 or 50.
Dr._Lavy	Please call my office I will be happy to refer you to a local doc
denise-va	Dr. Lavy...thanks so much for your time tonight. I'm sure you have other things you could be doing.
Dr._Lavy	Thank you all for being here. I wish you luck.
k_blumenfeld	Thanks. Will call your office for referrals.
Corey_Whelan	Dr. Lavy, thank you so very much for all of your amazing wisdom on this topic. You are truly helping a whole generation of women move ahead!!!!
k_blumenfeld	Ditto!!!
Corey_Whelan	also, thanks to all of you who participated tonight.
Dr._Lavy	Thank you Corey for moderating this session.
Corey_Whelan	my absolute pleasure
marionk	when will the transcript be posted
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Corey_Whelan	I believe tomorrow.
Dr._Lavy	Good night all.
Corey_Whelan	folks, our time together is officially at an end. Thanks again to all of you. Thanks again, Dr. Lavy to you and to your amazing staff
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Corey_Whelan	sweet dreams and good luck to all!
marionk	Thank you Dr. Lavy for an excellent session
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This Changes Everything - Egg Freezing and ART

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