This profile is brought to The Layers Project Magazine through a partnership with Extend Fertility.
(1/5) “Thinking About Fertility”
“For many years egg freezing was considered experimental. The technology just wasn’t that good. Too many eggs would get lost in the process. With low success rates, it was only worthwhile for women about to lose their fertility, like young women undergoing chemotherapy. The experimental label meant it could only be performed with a special ‘research protocol.’ Since then the technology has dramatically improved. In 2012 the American Society for Reproductive Medicine removed the label, which meant the process could be available to a broader group of women. The concept of ‘Egg Freezing’ as we know it today is really only about five or six years old.
When they revised the guidelines, I was a resident and just matched for fellowship. It was a huge deal. Around the same time, new research showed that a blood test might be able to give more accurate information than ever before about a woman’s fertility. All of sudden there was this potential to really shift the way we thought about fertility.
I am passionate about helping women understand their fertility. Whether they are single or married, it is so important to understand the basics of our biology and that our fertility is not something that we can ‘always’ rely upon. It doesn’t need to be scary. Truthfully, it is scarier to think about all the choices we make without realistic knowledge of our fertility. Our perceptions of fertility influence so much of our most important life decisions. Women have to decide on schooling, career paths, promotions…these all lead to equations in our heads that inevitably include reproductive goals. How many women feel pressured about relationships because of perceptions about their fertility? How many couples are hesitant to have another child but are concerned that ‘time is running out’? We don’t even realize how often the ‘biological clock’ becomes a consideration in our major life decisions. It’s human nature, but most of the time these decisions are made without actual facts.”
(2/5) “Having It All”
“Sometimes I feel like the women of my generation were served this dream of ‘having it all’: the career, the children, the balance…but no one gave us the proper knowledge to biologically plan for it. How many women assume it won’t be a problem to have children in their late 30’s or early 40’s? And that just isn’t the reality for many women. As doctors, we haven’t done a good job counseling young women about the effects of age on fertility. Talking about it takes time. Time that most GYNs don’t have during a routine visit. Too often the topic is rife with sexism and paternalism. It’s the ‘oh you’re young, you’re fine’ type talk. Or that it is ‘too complicated’ and ‘let’s not get them worried about it’. Granted, it is not easy. The conversation is complicated and nuanced and is different for everyone. But does that mean we shouldn’t trust women to get accurate information and use it to make appropriate decisions about their futures?
The number one reason women come to freeze their eggs is not career related. It’s that they haven’t found a partner with whom to start a family. It is as true in the religious community as it is in general society. For most women, being in my office is very much ‘Plan B.’ Considering egg freezing often means coming to terms with your deepest vulnerabilities, with recognizing that life hasn’t turned out quite as planned. For a religious woman, the issue is so much more intense because of the value placed on having large families. Having a large family takes time. And without an early start, biology eventually catches up. You get to a certain age and the risk of infertility goes up each year, whether you’re trying for your first or your fifth.
I see young religious women who are still looking for a partner or who are in the process of divorce. They really want children, often more than just one or two, but it could be years before they even get started. Egg freezing gives them more options should they run into challenges down the line.
Egg freezing is already becoming a part of the conversations of young religious single women and men and it will only become more commonplace.”
(3/5) “Taking Control”
“A year ago I gave a lecture about egg freezing at an Orthodox synagogue on the Upper West Side. It was really well attended, by both men and women. Egg freezing was a new fresh topic and people just weren’t talking about it much. The lecture got a lot of positive feedback. People were excited to learn about the cutting edge technology that they were just starting to hear about. So much seems to have changed in just one year.
Before the lecture I asked a shadchan/matchmaker whether she was hearing about egg freezing in her work. She said ‘The women are talking about it amongst themselves, but the men have no idea.’ Now I hear stories of men specifically asking if a woman has frozen her eggs. My patients tell me they talk about egg freezing at their Shabbat meals, that they take a break from the meal when someone needs to take their injections. Young Orthodox women are coming into my office with their friends. There is a lot of camaraderie and support around egg freezing. Many young women want to be emissaries for egg freezing. They are purposefully public about their fertility journeys. They want to let other people know about this opportunity and to make sure that this process isn’t stigmatized.
There really is no reason it should be stigmatized. Yes, it is hard from an emotional perspective to begin this journey. I see women who are ill, who just broke off their engagements, whose marriages are dissolving. But even in the absence of a crisis, women are not always excited to freeze their eggs. It is hard to grapple with the reality of, ‘This is not where I thought my life would be at this point.’ Many women find strength in being able to say, ‘No, this isn’t where I thought my life would be, but much of this is not within my control. Here I have an opportunity to do something which allows me to take some control.”
“There are two aspects of our fertility that are affected by age: egg quantity and egg quality. We are born with all the eggs we’ll ever have, millions of them in fact, and eventually we run out and go into menopause. Where we are in terms of our egg supply is one piece of the fertility puzzle. Often, the more profound impact of age on our fertility has to do with the quality of our eggs- the likelihood that any individual egg could go on to produce a healthy baby. Over time, errors accumulate in the DNA and more and more eggs become unable to produce healthy babies.
We like to compare ovaries to gumball machines. When we’re young our ‘gumball machines’ are full. Plus, almost all of the eggs/gumballs are healthy and just a few are not. We’re basically set up for fertility success. As we age, not only do we have fewer total ‘gumballs’- most of the remaining eggs are unhealthy. Just like a gumball machine, each month a single egg is released at random. The time it takes to conceive and risk of infertility increase with age because the proportion of unhealthy eggs goes up with time. For women trying to conceive in their late 30’s and early 40’s there may be many months where the egg they’re working with is not going to be able to produce a healthy baby.
Egg freezing preserves a group of eggs with a higher proportion of healthy eggs than you might otherwise have at the time you are trying to conceive. Ultimately, it serves as a hedge against your future risk of infertility. If you find yourself needing infertility treatments in the future, the chances of success are directly related to the age of the egg, not the person.
Since we can’t test the quality of an egg, you need to freeze a lot to have some confidence that you can have a baby with them in the future. How many of your eggs are healthy depends on the age at which you froze them. How many eggs you can produce depends on your individual egg supply. Some women are born with a lot of eggs and others are not. A blood test and ultrasound can not only evaluate your egg supply compared to other women your age, we can estimate how many eggs you might produce in a single egg freezing cycle.”
(5/5) “Investing in Your Future”
“Freezing your eggs can be a huge emotional and financial investment. Extend Fertility was started to make egg freezing accessible to more women. Typically egg freezing is done at a fertility clinic, where the focus is on couples experiencing infertility. It can be intimidating and expensive, which turns women off from even considering the option. The beauty of Extend Fertility is that it is geared specifically to women who want to proactively preserve their fertility. We really value knowledge and education. We provide a fertility assessment and consult with the doctor at no charge. We want every patient to be able to have an in-depth conversation about her results and what they mean in the context of her age, life circumstances, and goals. And by lowering the cost, to about half the market rate, we can make it within reach for so many more women.
I feel so fortunate to have ended up at this position. It came together very fortuitously. Extend Fertility is the vision of my friend and colleague, Dr. Josh Klein. Last summer, when I felt like I wasn’t maximizing my potential, I reached out to him for some career advice. He spent 45 minutes giving me great practical suggestions to improve my current situation. Then he asked if I would consider joining him. I honestly didn’t even know they were looking. It didn’t take very long for me to realize that it was the right move. The rest is history.
I think doctors are ‘fixers’ by nature. I’m blessed with ample opportunities to use my skills and knowledge to fix problems. But sometimes it’s in the moments of uncertainty that we find purpose. Reproduction is surrounded by so much uncertainty, despite the fact that it is a ‘natural’ process. And when circumstances don’t turn out the way ‘nature’ would dictate, it is devastating. As doctors, we won’t always know the solution, or even if there is one at all, but there is something very powerful in being there to help someone take that first step forward.
At its core, egg freezing is founded upon uncertainty. I truly believe the more knowledge we have about our own biology, the more we can embrace uncertainty and create opportunities to have options in the future.”