Sep 12, 2019

Interview Transcript

Dr. Jones: So you're 34 and the clock is ticking and you haven't met Mr. or Mrs. Right yet and you want a baby someday but not now. What are your options to protect your eggs because you can hear them getting older in your body?

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: So women around the world have been told they can have it all, and although I may not get agree with that completely, there is a time when you make babies and there's a time when you build your career. But, in fact, the making babies and chief career building tends to overlap, and sometimes we put something off and what gets put off, as we're learning about the increasing age of women having their first child in this country, is the baby making. But your eggs are getting older and what are you going to do to save them?

In the studio today with us is Dr. Joe Letourneau, who is a fertility preservation specialist and reproductive endocrinologist at the Utah Center for Reproductive Medicine. Thanks for joining us, Joe.

Dr. Letourneau: Thank you for having me.

Dr. Jones: So a 34-year-old is really looking for her next big job and she hasn't found the honey yet, but she wants to have kids someday. She's got your name. She knows you're the fertility preservation guy. What are you going to tell her?

Dr. Letourneau: That's a very common presentation that we see in our clinic now, and it's becoming more common. We've certainly become more sensitive over the years to the idea that women are building their families later. There is an intersection with, you know, family timing and ovarian and an egg physiology that that can be important. And the way it can manifest is that, you know, achieving a pregnancy becomes incrementally slightly more, you know, difficult with time.

One thing that I like to tell patients is that there's not really a fertility cliff. I think there must be many websites on the internet to suggest there is a fertility cliff where you're fertile one day and then not the next, and it's really a gradual change with time. But for some people if they anticipate many years elapsing before they plan to build their family, it may make sense to consider freezing their eggs. Essentially freezing them in time with a higher reproductive potential that they may have at their current age and that they may have in the future.

Dr. Jones: So is there a time when you're too old to save your eggs?

Dr. Letourneau: Age is quite predictive of a quality for women in one way in particular and that's having a normal number of chromosomes. The way that I like to frame this for patients is to, one, give them an understanding of how many eggs there are in the body at a given time and, two, what percentage of those eggs are normal.

So at birth, average women are born with about 1 million eggs, and by puberty there are around 300,000. It turns out that the egg comes in a unit with something called the follicle, and the follicle is what provides support to the eggs so that it can become fertilized. It also helps to regulate the menstrual cycle and provides estrogen. So the absence of follicles is what defines menopause, which is typically around age 50 or 51. So there is a decline from the start of puberty in the early teens until age 50 of about 300,000 eggs down to the end of the egg supply.

Interestingly, in this time, only 400 or 500 eggs will be ovulated or released from the ovary because, as humans, we release one egg per month because it's difficult to raise a human baby. So most eggs in the ovary are actually not released. Most of them are sort of selected for or against in a way that we don't understand well and many of them die off.

Each month, the egg that is released has a certain probability of being normal or being abnormal. And the normality of it I'm really talking about the chromosome number. If the chromosomes that come out are abnormal, the embryo that may be created will be missing some of the instructions for it to grow.

Most typically that manifests in the absence of a pregnancy. Occasionally it manifests in an early miscarriage, and more rarely it manifests as chromosomal abnormalities that the baby may have at birth. But really most commonly these chromosomal abnormalities make it hard to become pregnant. These go up with time raising pretty steadily, but rather rapidly in the late 30s and early 40s, and that's really what drives age-related fertility concerns. So freezing eggs earlier results in more normal eggs.

Dr. Jones: So ladies, as you're thinking about planning your life, understanding that women plan and God laughs. But if you're thinking about planning your life, there are some options about freezing your eggs, but you should know what's available and decide what's right for you. And thanks for joining us on The Scope.

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