Egg Freezing for Endometriosis: Should she rush - Tomer Singer, MD

Should women with endometriosis freeze their eggs at a young age?

Key Points

Information about the presenter: This presentation is by Dr. Tomer Singer, M.D., FACOG, MBA, a fertility specialist, and the medical director at Shady Grove Fertility in Manhattan, New York. Dr. Singer’s presentation is titled “Egg Freezing for Endometriosis: Should She Rush” and is about the timing, quantity, and financial properties of egg freezing in patients with endometriosis.

Highlights:

• Egg freezing is a very powerful tool that allows women to store their eggs to be used in the future when they are ready to have children.
• Egg quality and quantity are higher when women are younger. The best age to freeze eggs is early to mid-’20s for women with endometriosis, and before age 34 for women without the disease.
• There is no correct number of eggs that need to be frozen but the chance of a live birth increase with the number of eggs, with 15 eggs leading to an 85% chance when a woman is younger than 35.

Importance:

• Patient education about endometriosis is paramount to ensure that young women with symptoms of endometriosis are aware of their options for egg freezing.
• Egg freezing for women with endometriosis should be regarded as a medical necessity rather than an elective procedure and be covered by medical insurance.

Remarks:

• Egg quality and quantity decrease with age. In women with endometriosis, the decline is faster, hence more likely to need more cycles of egg freezing and IVF when they are trying to conceive.
• Egg freezing, or the process of removing eggs from a woman’s ovaries and freezing them to be used in the future, should be done in their early 20’s, before endometriosis advances and healthy eggs can be obtained.
• It is very important to find a fertility specialist that knows endometriosis and an endometriosis specialist that knows fertility, in order to decide the best time to retrieve eggs for freezing. 
• Anti-Müllerian hormone (AMH) levels are very helpful in assessing ovarian reserve and to predict how many eggs will be obtained during each egg retrieval.
• Even if the women have the same AMH, a lower number of eggs are obtained from patients with endometriosis compared to a woman without the disease.
• Egg freezing is no longer experimental as of October 2012 according to the American Society of Reproductive Medicine. Therefore, insurance companies should cover patients with endometriosis for egg freezing. 
• Risks associated with egg retrieval are low and include bleeding, infection, injury to neighboring organs such as bowel, bladder, and blood vessels especially in women with endometriosis.
• The pregnancy rates with frozen eggs versus fresh eggs are equivalent. 
• Egg freezing is not a true insurance policy and although the higher the number of eggs that are frozen the higher the chances of live birth, no number of eggs can guarantee a live birth.
• The cost of egg freezing includes hospital, medication, storage, and embryology fees, as well as the cost of office visits, ultrasounds, lab work, egg retrieval, and anesthesia. Some insurance companies may cover these costs for women with endometriosis and this should be pushed.

Lay Summary

In this presentation, Dr. Tomer Singer, a fertility specialist and the medical director at Shady Grove Fertility in Manhattan, New York talks about egg freezing and its importance for women with endometriosis. He emphasizes the importance of having an endometriosis surgeon and reproductive endocrinologist who work together when caring for a woman with endometriosis.

He moves on to explain the process of egg freezing stating that it is very similar to in vitro fertilization (IVF) minus the sperm.  It involves consultation with a fertility specialist who reviews the patient’s medical history and discusses the process. This is followed by a physical exam, pelvic ultrasound, and laboratory work. The consultation with the fertility specialist includes ovarian reserve and hormone testing.

Following consultation, ovarian stimulation takes place. This involves the patient self-administering fertility drugs for about 10 days. During this time, she is monitored with blood tests and pelvic ultrasounds. The next step is the trigger shot, which triggers natural ovulation and helps egg maturation. Thirty-five to 36 hours after the trigger shot, the egg retrieval step takes place. Eggs are retrieved through the vagina under anesthesia. The procedure takes 15 to 30 minutes. Patients spend one hour in the recovery room following the procedure before being discharged. The retrieved mature eggs are then frozen through a process called vitrification and can remain frozen until the patient is ready to use them. 

The best age for egg freezing is early to mid-’20s and six to eight mature eggs are necessary for a good chance of life birth according to Dr. Singer.

In the second half of his presentation, Dr. Singer talks about how the eggs are used when the patient is ready to have a baby. 

The eggs are thawed in the laboratory and injected with sperm. The fertilized eggs are then grown in the laboratory for three to five days and transferred into the uterus. Embryos can be biopsied before transfer to determine whether they are genetically normal. 

Dr. Singer concludes his presentation by saying that egg freezing should be regarded as a medical necessity rather than an elective procedure and covered by medical insurance. 

Research Source: https://www.endofound.org/egg-freezing-for-endometriosis-should-she-rush-tomer-singer-md?pop=mc