Clinic Q&A: Talking Egg Freezing with RMA of CT

by Jon Ward

Dr. Shaun Williams Reproductive Endocrinologist RMACT Fertility Doctor CT Reproductive Medicine Associates of Connecticut is a fertility clinic with three locations in Connecticut and two in New York. Shaun C. Williams, M.D., a fertility doctor with RMA of CT, recently answered questions about egg freezing in Connecticut and New York.

How long has your RMA of CT been performing egg freezing?


RMA of CT has been performing egg freezing since 2010.

Who are you offering egg freezing services to? What types of patients?

We work with patients who have different reasons for freezing eggs. Some patients have been diagnosed with cancer or other medical conditions that require medical treatment that has the potential to damage their eggs and ovaries.

We also work with women in good reproductive health who are not ready to have a family and therefore elect to vitrify, or freeze, eggs. The American Society for Reproductive Medicine (ASRM) recently determined that the freezing and thawing of egg cells is now a proven method for preserving a younger woman's ability to have children, removing the technique's "experimental" label which has been in place since 2008.

What does your clinic consider the optimal age for egg freezing?  Do you have a cut-off age?

Fertility cannot be determined by one number — not a woman’s age, not even one test result. That is why we like to determine the best fertility plan for each patient individually. As is true with all available treatment options, a woman’s best chance to conceive using her own eggs is during the early part of her reproductive life. Just as pregnancy rates following IVF begin to decline after age 35, so too does the likelihood of success when frozen eggs are thawed and used during an IVF attempt. The “ideal” age for egg freezing is when eggs are the healthiest, between the ages of 18 and 24. However, not many individuals have the forethought or resources to consider this option at this early age. But women who understand that pregnancy chances decrease rapidly after 40, being able to preserve eggs between the ages of 35 and 40 may give them a better chance to conceive in the future if the circumstances for pregnancy are not yet appropriate.

To help understand what an individual’s likelihood of success would be, we take into consideration many factors, including:

  • A woman’s reproductive history
  • Her family members' reproductive history, and
  • Evaluations of current ovarian function, such as hormonal markers (FSH, AMH) as well as ultrasound determinations of egg quantity (antral follicle counts)


The process of egg freezing is relatively quick — typically, egg retrieval occurs during the menstrual cycle of the month following a patient’s first visit. After a patient has completed a consultation with a fertility specialist and had all of her questions answered, she can start preparing for egg retrieval. First, the patient will have an ultrasound of her uterus and have blood tests taken, including FSH, which is taken on day 3 of a woman’s menstrual cycle. During the next three weeks, the patient will take birth control pills and fertility medications. By her next menstruation, she is ready for egg retrieval. It is especially important for cancer patients or anyone delaying medical treatment to understand that egg retrieval will take place about three to seven weeks from her first doctor’s appointment.

Although we do not have a cut off age, a woman’s reproductive health and her chances of having a successful pregnancy decrease significantly after 35 years of age. We counsel our patients based on this clinical data and the results of her diagnostic testing.

Once eggs are frozen, where are they stored?

We store vitrified eggs on site at our location in Norwalk, CT. Our embryology lab is extremely sophisticated, with continuous monitoring, security and power source.

How long do you feel eggs can be stored safely?

There is not enough clinical data to know exactly how long vitrified eggs will remain viable, but it generally thought that they will last many, many years. The vitrification process freezes eggs without crystallization, so theoretically they could be viable indefinitely.

Is there a cut-off age that you recommend for women to have eggs thawed, fertilized and transferred in a cycle?

Women who have eggs stored should monitor their reproductive health regularly and maintain good health overall. Before eggs are transferred, patients should undergo diagnostic testing, including a pelvic exam and assessment of her uterus. ASRM recommends that patients who are over 45 years old should have a more thorough evaluation, including an assessment of heart function and risk of pregnancy-related diseases. Above the age of 50, women should consider using a gestational carrier (or surrogate) during advanced treatments.

Has your fertility clinic had live births from frozen eggs?

The number of patients who are interested in freezing their eggs has been relatively small compared to other fertility treatments; however, we are encouraged by the positive results that these patients have had. RMA of CT currently has a patient who is pregnant from eggs that she froze a few years ago, and I have personally been involved in over 70 pregnancies using frozen eggs, both from donors and fertility preservation.  

With the recent change in ASRM’s classification, we anticipate more women being interested in vitrification.

What is the price range for freezing eggs, and what does that range cover?

Freezing eggs at RMA of CT costs about $10,000. This includes cycle monitoring, retrieval and lab fees, anesthesia and cryopreservation of oocytes for the first year.

Cancer patients should also look into their options through Fertile Hope, a non-profit that provides information and resources for cancer patients. Fertile Hope runs a program called Sharing Hope, which works with companies and clinics to arrange for discounted services and donated medications for eligible female cancer patients.

What are the reasons a woman would NOT be a good candidate for freezing her eggs?

Before any of our patients puts time and resources into freezing their eggs, we conduct diagnostic testing to ensure that the patient and her eggs are healthy. This testing tells us if a woman’s ovarian reserve is healthy and if she is a good candidate for egg vitrification. Basically, a woman’s likelihood of conceiving with frozen eggs is no better than her current likelihood of conceiving with IVF. If factors are identified that may indicate a lower likelihood of success with a fresh IVF cycle, these factors still apply when the eggs are thawed. The likelihood of success in the future must be weighed against the cost of the treatment to determine if this process is right for a woman to consider.

What is the most exciting aspect of ASRM lifting the experimental label? How do you think this will change the face of fertility treatment?

ASRM’s decision and the recent advances in vitrification can enable patients to fulfill their family dreams in the future; however age is still an important factor to consider. This Practice Committee of the ASRM based their decision on a report titled “Mature Oocyte Cyryopreservation,” which examined nearly 1,000 published papers. The report urges caution, stating: “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing. Patients who wish to pursue this technology should be carefully counseled.”

By lifting the experimental label, we hope that more women will consider freezing eggs as part of their family planning in their 20s. This change in thinking could open the door for many patients who delay having a family. This also allows more options for choosing donor eggs through frozen donor egg banking, similar to the prevalent and well accepted use of donor sperm through donor sperm banks. This can allow more women to pursue pregnancy through oocyte donation at a lower cost.
 
What should a woman look for in a clinic that does egg freezing?

First and foremost, ask what types of certification the practice has for its embryology lab and doctors. I recommend working with board-certified reproductive endocrinologists.

The most advanced form of egg freezing is called vitrification, and it has the greatest success rates. Ensure that any practice you are considering working with is experienced with the vitrification process, which involves cooling eggs to a very cold temperature very rapidly. The antiquated method of “slow-freezing” is still used by many clinics for embryos and sperm, but this method is unacceptable for egg freezing.  And be sure that the vitrified eggs are stored on-site through a system that is protected with back up power and 24-hour monitoring.

Contact us by clicking here if you are interested in egg freezing.

Thank you to Fertility Authority for conducting this interview.

Topics: reproductive endocrinologist, Fertility Treatment, RMACT Doctors, Egg Freezing

CCS Breakthrough Technique Identifies Genetic Embyro Abnormalities

by Grant Speer

Norwalk, CT (January 11, 2010) – Reproductive Medicine Associates of Connecticut (RMACT) recently participated in a breakthrough study titled "A Prospective Randomized Controlled Trial Demonstrating Significantly Increased Clinical Pregnancy Rates Following 24-Chromosome Aneuploidy Screening: Biopsy and Analysis on Day 5 with Fresh Transfer," which was led by Infertility Specialist Richard Scott, M.D. and Nathan Treff, Ph.D., of Reproductive Medicine Associates of New Jersey (RMANJ), an affiliate of RMACT.  

About the Study

CCS Comprehensive Chromosome Screening Embryo ScreeningThis study, which earned the top research award from the American Society for Reproductive Medicine (ASRM) in October 2010, examined technology that is the first and only fully validated system to reliably evaluate all chromosomes in a small biopsy obtained from an embryo during in vitro development. This is the first and only prospectively randomized trial showing real benefit from Pre-Implantation Genetic Screening (PGS) and RMACT is the only fertility practice in New England to offer it.  

“This technology will revolutionize reproductive medicine,” said infertility doctor Mark Leondires, M.D., Medical Director of RMACT and Lead Physician for RMACT on the Clinical Study. “The purpose is to identify the best embryos for a healthy pregnancy.  By selecting chromosomally normal embryos without damaging them, pregnancy rates were dramatically increased to more than 90 percent and miscarriage rates were lower compared to the control group. This data is historic in its nature and implications.”

Sustained implantation rates were 75 percent in the study group, much higher than compared to 56 percent in the control group.  Clinical pregnancies, which are a typical result of genetic abnormalities, were significantly lower in the study group (60 percent) than versus the control group (92 percent).

“Our goal is one embryo, one healthy baby," said Dr. Scott.  "So, the driving force behind most of our research is to assess reproductive competency to better predict which embryo will most likely produce one healthy baby.  This is the first study of its kind that has shown dramatically improved clinical pregnancy rates with blastocyst biopsy, 24 Chromosome Aneuploidy Screening and fresh embryo transfer.  Though similar screening technologies are being marketed, none have been validated through the critical studies, culminating with a randomized clinical trial, which provides this high level of medical evidence.”  

The procedure starts when a couple goes through In Vitro Fertilization (IVF) Treatment with intracytoplasmic sperm injection (ICSI); the embryo is then grown to the blastocyst stage and a small biopsy of five to 10 cells is taken from the embryo on day five to six days of life. The biopsy sample then goes through computer analysis to identify any abnormalities among the chromosomes.  This process identifies chromosomal disorders such as Down syndrome before the embryo is transferred into the female patient’s uterus. This error rate of the technology is less than one percent in more than 4,000 embryos tested.

What separates this technique of Comprehensive Chromosomal Screening (CCS) from other PGS processes is that the embryo is able to grow for five or six days, allowing the cells to split and the chromosomal analysis to be more accurate.  In addition, since the technology can be used to find small breaks in chromosomes and even single gene disorders it defines itself as the most robust and reliable technology for evaluating pre-conception embryos available.  RMANJ has previously shown 24 chromosome analysis technology to be significantly more reliable than other existing methods.  However, with this latest clinical study, the new technology has been improved because it no longer requires freezing embryos for weeks before thaw and use.  The breakthrough is based on a shorter timeline, which has better results; the same comprehensive screening is conducted within hours instead of days.  It is the first technology of its kind that allows for assessment of blastocysts and still enables a fresh embryo transfer, which generally has a higher success rate than freezing embryos.

The study included patients seeking IVF who were less than 43 years old and had no more than one prior failed IVF cycle.  The control group underwent routine care and typical screening methods, whereas the study group underwent biopsy of the blastocyst and CCS on day five.  
 
In a related retrospective evaluation presented with this research, the study shows that this new technology dramatically decreases the occurrence of abnormal pregnancies such as Down or Turner syndromes.  This technology will allow women in their late thirties and forties, who normally have a high risk for genetic abnormalities, to nearly eliminate these risks and thereby maximize their chances for a successful pregnancy with in-vitro fertilization.  CCS represents a major step forward in helping patients have healthy pregnancies and thereby allowing them to choose a single embryo transfer to minimize the risk of twins.  

“A singleton pregnancy is the safest for mother and baby,” stated Leondires.  “This technology will allow couples to choose a single embryo transfer without jeopardizing their chance for success.  It is truly an amazing advance which will change the landscape of reproductive medicine in the future for both patient and physicians.”  

Infertility affects 7.3 million Americans and for 20 percent of infertility patients the cause is unknown, according to The National Infertility Association.  Through 24 chromosome aneuploidy screening, fertility doctors can determine which embryos are normal, increase healthy pregnancies while at the same time reduce the number of miscarriages.  The technology will transform reproductive medicine and instill confidence in transferring only one embryo, leading to fewer multiple gestations. In addition, for patients who have had several miscarriages, it can enable them to make informed decisions about their next steps, such as working with an egg donor.

About RMACT
Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility.  With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including IVF, egg donation and preimplantation genetic diagnosis (PGS). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies.  RMACT’s IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://www.RMACT.com.


Topics: PGD, ASRM, News, CCS - Comprehensive Chromosomal Screening, Embryo, Fertility Treatment, Egg Freezing