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Later, Baby: Will Freezing Your Eggs Free Your Career?




There comes a point in every childless woman’s life, usually around 35, when the larger world becomes very interested in her womb. Friends and family inquire about its health, asking why it’s not being utilized, when it will be, and then: Will it even work? For those who do want children, the pressure can be crushing and counterproductive. “I found myself going on dates thinking, is this marriage material? Is this? Is he? It was exhausting,” says Dr. Suzanne LaJoie, an ob-gyn in Manhattan. “When I was in med school and residency, all my friends were having babies.” She went through a breakup in her mid-30s and started to worry she wouldn’t be able to have a child of her own. So in 2007, at age 37, she paid $10,000 for a round of oocyte cryopreservation, more commonly known as egg freezing. “I just wanted to take the pressure off,” LaJoie says. “Men don’t have a biological clock, and I felt like it leveled the playing field a bit.”

LaJoie fits the typical profile of an egg freezer: They’re great at their jobs, they make a ton of money, and they’ve followed all of Sheryl Sandberg’s advice. But the husband and baby haven’t materialized, and they can recite the stats about their rapidly decreasing fertility as a depressing party trick. For LaJoie, now 45, it was demoralizing to see friend after friend get married and have kids, while she was stuck at the hospital without romantic prospects.

“You feel bad about yourself, like you’re the odd man out, and somehow you’ve messed up on your path,” says Sarah Elizabeth Richards, who spent $50,000 freezing several rounds of eggs in 2006 to 2008 and wrote a book about the experience, Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It. “By freezing, you’ve done something about it. You’re walking taller; your head is held higher. And that can pay off in both your work and romantic lives.” Richards, now 43, is dating someone promising and says she’d like to thaw her eggs in the next year or so. She’s also at work on a new book and plans on finishing it before she tries to get pregnant. “Egg freezing gives you the gift of time to start a family, but it’s also, like, here’s how many years I actually have left for my other goals—what can I do with them?”

LaJoie got married soon after she froze (she told her husband about it on their very first date: “I was upfront and said, ‘This is my plan.’ He was, like, ‘OK!’ ”) and had her first baby naturally at 39. A few years later, after briefly trying fertility drugs, she thawed her eggs. The implantation worked, and her second son is 2 years old. “If I’d had kids when I was a resident, I wouldn’t have been able to spend any time with them—I was working a gazillion hours a week,” she says. “Now I can bring my 5-year-old to kindergarten every day.” In a 2013 New York University study of 183 women who’d frozen their eggs, 19 percent said they might have had a child earlier if their workplace had been more flexible.

The egg freezing generation, those latchkey kids of glass-ceiling breakers, were taught “that you create your career, and then everything else falls into place,” says Lauren, a 34-year-old lawyer in Los Angeles who froze her eggs in January and, like many of the women interviewed for this article, declined to reveal her full name in a national magazine for fear of staying single forever. “But now I know it’s not as easy as that.” Work hard, put off kids, and you might find yourself at 40 hearing a fertility doctor deliver the bad news. According to a 2008 analysis of data from the National Survey of Family Growth, among women 40 to 44, there are equal numbers of those who are childless by choice and those who would like to have children but can’t conceive.

Not since the birth control pill has a medical technology had such potential to change family and career planning. The average age of women who freeze their eggs is about 37, down from 39 only two years ago. (“Desperation level,” as Brigitte Adams, a marketing director at a Los Angeles software company who froze her eggs at 39, puts it.) And fertility doctors report that more women in their early 30s are coming in for the procedure. Not only do younger women have healthier eggs, they also have more time before they have to use them.

Read more: http://www.businessweek.com/articles/2014-04-17/new-egg-freezing-technology-eases-womens-career-family-angst#p1
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Assessment of corifollitropin alfa for assisted reproduction: a review study

Introduction:
Corifollitropin alfa, a fusion product of recombinant human follicle-stimulating hormone (rFSH) with a hybrid beta subunit C-terminal peptide of human chorionic gonadotropin, plays a similar pharmacologic role as traditional rFSH, but with a longer half life. Clinical applications of corifollitropin alfa in assisted reproductive realm have reported that it stimulates multifollicular growth for 7 days with the same safety and ovarian response as rFSH administration. In 2003, the first report of live birth using corifollitropin alfa stimulation was released in Netherland. In 2010, European union approved corifollitropin alfa in its market, and then Taiwan approved the release of corifollitropin alfa in 2013. To assess the outcomes of corifollitropin alfa in following embryo development of IVF program, including fertilization, good embryo formation (culture to the day 3), and blastocyst formation (culture to the day 5), we analyzed the results generated from the cases stimulating by long-acting rFSH (L-rFSH, corifollitropin alfa) and by traditional rFSH (T-rFSH) shots in this study.

Materials and Methods:
Study Cohort I—General patients


A total of 252 cycles were recruited since December, 2012 to September, 2013. There were 91 cycles (average age: 34.9 y/o, range from 28-42) using L-rFSH stimulation (14 cycles with single shots and 77 cycles with T-rFSH supplements), and 161 cycles (average age: 34.9 y/o, range from 23-40) using T-rFSH stimulation, which was set as the control cohort (Table 1). The patients with polycystic ovarian symptoms were excluded from the study cohort. Number of antral follicles, number of retrieval oocyte, hormone levels after stimulating, number of mature oocytes(MII) after retrieving and the fertilization rates were compared between the two groups. Then the good embryo rate (GER) of day3-culture and the good blastocyst rate (GBR) of day5-culture were determined from each group.



Table 1



Study Cohort II—Oocyte Donor Cohort
A total of 89 oocyte donating cycles were recruited since December, 2012 to September, 2013. There were 64 cycles using L-rFSH stimulation, and 25 cycles using T-rFSH stimulation, which was set as the control cohort. The same parameters associated with embryo yield were also compared in these two groups.

Treatment Protocol Design
To assess the more friendly protocol to the IVF cases, we designed a protocol with fewer injections based on the traditional rFSH short protocol and the corifollitropin α in GnRH antagonist protocol. The modified protocols were displayed in Figure 1.


Figure 1

Statistics
Statistical evaluations were carried out using nonparametric Student’s t test with Welch’s corrections. The statistical software, prism (http://www.graphpad.com/scientific-software/prism, GraphPad) was administrated in the data processing.

Results
Although the number of antral follicles showed difference between L-rFSH recipients and T-rFSH recipients (10.16±0.44 vs. 8.39±0.31, p<0 .01="" font="" nbsp="">

After oocyte retrieving of L-rFSH recipients and T- rFSH recipients, number of MII oocytes (11.16±0.69 vs. 9.52±0.50, p=0.03), maturation rates (75.8% vs. 78.31%, p=0.16) and fertilization rates (78.72% vs. 77.12%, p=0.26) were no different. In following cultural results of embryos, GER of day3 (61.32% vs. 58.22%, p=0.24) and GBR of day5 (60.39% vs. 57.36%, p=0.21) also performed the similar outcomes from the two groups (Figure 2).


Table 2 General IVF case

After oocyte retrieving of L-rFSH recipients and T- rFSH recipients, number of MII oocytes (11.16±0.69 vs. 9.52±0.50, p=0.03), maturation rates (75.8% vs. 78.31%, p=0.16) and fertilization rates (78.72% vs. 77.12%, p=0.26) were no different. In following cultural results of embryos, GER of day3 (61.32% vs. 58.22%, p=0.24) and GBR of day5 (60.39% vs. 57.36%, p=0.21) also performed the similar outcomes from the two groups (Figure 2).



Figure 2

In the oocyte-donor cohort, the group stimulated by corifollitropin alfa also displayed similar ovarian responses and clinical outcomes in the following embryo culture (Table 3, Figure 3).


Table 3 Oocyte donating cycles


Figure 3

Discussion:
Based on the efficiencies of controlled ovarian stimulation and embryo culture, no significant differences were observed between the recipients of L-rFSH and of T-rFSH. Due to the long lasting effect of corifollitropin alfa, a more patient-friendly option with reduced injective frequencies could be applied to the overseas cases or cases afraid of injections (Table 4, Table 5).


Table 4 Frequency of Injection


Table 5 Cost List

(The study has been published in 2014 Annual Meeting of Taiwanese Obstetrics and Gynecology Society)

References:
1.    A comparison of long-acting FSH versus daily FSH did not show evidence of difference in effect on overall live birth rate or OHSS in 2335 IVF participants (Cochrane Database Syst. Review, 2013)
2.    Long-acting rFSH and short-acting rFSH treatment protocols provided equal success rates of live birth and cumulative pregnancy
(Boostanfar et al., Fertil Steril 2012)
3.    Treatment of poor ovarian responders with corifollitropin α  in a GnRH antagonist protocol results in low pregnancy rates, similarly to conventional stimulation with a short agonist protocol
4.    (Polyzos et al., Fertil Steril 2013)









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It's bitter-sweet to have a baby



Looking at the genuinely sweet smile on my baby's face, 
I just felt indescribable joy. 
If I didn't feel the warmth from this tiny thing, 
I would think that I was still in my dream.


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