Egg Freezing for. Your Future. Specialists in Reproductive Medicine & Surgery, P.A.

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Egg Freezing for Your Future Specialists in Reproductive Medicine & Surgery, P.A. www.dreamababy.com

Egg freezing can be a game changer for women 40 years of age and younger. It has tremendous potential for women who are faced with a cancer diagnosis, as well as those who want to delay childbearing. These women can now preserve their fertility, potentially stopping their biological clocks until they are ready to start a family.

What is oocyte cryopreservation, or egg freezing? Oocyte cryopreservation (OC) is a procedure where a woman s eggs (oocytes) are frozen (cryopreserved) for future use. It is commonly known as egg freezing. More than 1,000 children have been born through OC. 1 In 2012, the American Society for Reproductive Medicine, the leading professional organization for the reproductive medicine field, announced that the procedure should no longer be considered experimental. 2 Who qualifies for and who may benefit from egg freezing? Women between the ages 13 (puberty) and 40 years old will be considered for OC with informed consent or signature of a legal guardian. Patients must be healthy enough to undergo light sedation. Good candidates, who will be evaluated individually, are: 1. Women wanting to delay childbearing may freeze their eggs for use in the future when their natural ability to reproduce would otherwise be reduced. 2. Women with upcoming pelvic surgery or medical treatments that could result in the loss of ovarian tissue or eggs are candidates for OC. This includes women with benign diseases (i.e., ovarian cysts, endometriosis) as well as cancer. 3. Women at risk for early menopause because of their family history or genetic reasons may also consider OC.

What risks does egg freezing pose? The medications used in the ovarian stimulation process and during egg retrieval are used universally around the world. There is no data for humans that indicates that the medications have long-term complications. The risk of the egg retrieval procedure itself at Specialists In Reproductive Medicine & Surgery, P.A. (SRMS) is estimated at one percent or less. Are children conceived through oocyte cryopreservation normal? Approximately 3.5 million children have been created through IVF worldwide and the children are generally as healthy as those conceived naturally. 6 Although studies are ongoing, there does not appear to be an increase in the rate of birth defects or chromosomal abnormalities in children born from cryopreserved oocytes. 7,8,9

What are the successful live birth rates following egg freezing? Success rates for live births are dependent upon the age at which you froze your eggs, the number frozen, the survival rate following thaw, the number successfully fertilized as well as the number and quality of embryos eventually transferred to your uterus. Each patient will receive a consultation estimating the overall chances for future success. Based on recent studies, success rates are likely to be similar to in vitro fertilization (IVF) using fresh oocytes. 4,5 How much does it cost? SRMS has been quite careful to accurately calculate the costs for the OC process. Costs are available in detail in the Download Center on the website. Your insurance policy may cover all, part or none of the fees involved. There is a 20% reduction on charges billed by SRMS for a second egg retrieval procedure.

Women needing egg freezing because of a cancer diagnosis may qualify for financial assistance through LIVESTRONG s Sharing Hope program and through Verna s Purse. Contact SRMS for more details. Ferring Pharmaceuticals also offers free medications through their Heartbeat Program to women with a cancer diagnosis needing egg freezing. To apply or for more information about Ferring s Heartbeat program, please visit: heartbeatprogram.com. How do I get started? 1. Please review the on-line OC information located within the Download Center on the SRMS website, DreamABaby.com 2. Schedule an initial consult with an SRMS specialist who will review your medical records as well as obtain a history and physical examination. 3. You will have a pelvic ultrasound and lab studies will be performed to determine your ovarian reserve. 4. For approximately two to three weeks, your ovaries are prepared with daily hormone injections given just beneath the skin. SRMS monitors your progress with periodic pelvic ultrasounds and blood tests. 5. You will be given intravenous (IV) light sedation where you will be asleep and breathing on your own. The doctor will then retrieve your eggs using a slender needle placed through the walls of the vagina and into the ovaries under ultrasound guidance.

6. Mature and healthy oocytes will be cryopreserved in liquid nitrogen for future use. 7. Depending upon your age and the number of oocytes cryopreserved, it may be ideal to undergo a second procedure to essentially double the number of cryopreserved oocytes. 8. Once your OC/egg freezing procedures are completed, the cryopreserved oocytes will be transferred to a long-term storage facility, located out of the region, for safekeeping. 9. The cryopreserved oocytes may last for years, decades and perhaps even longer. It has been confirmed that there are no differences in live birth rates between oocytes thawed and transferred after 48 months compared to those thawed earlier. 3 References: 1. Rodriguez-Wallberg KA, Oktay K. Recent advances in oocyte and ovarian tissue cryopreservation and transplantation. Best Pract Res Clin Obstet Gynaecol 2012 Jun;26(3):391-405. 2. The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2012 Oct 12. 3. Parmegiani L, Garello C, Granella F, Guidetti D, Bernardi S, Cognigni GE et al. Long-term cryostorage does not adversely affect the outcome of oocyte thawing cycles. Reprod Biomed Online 2009;19:374-9. 4. Grifo JA, Noyes N. Delivery rate using cryopreserved oocytes is comparable to conventional in vitro fertilization using fresh oocytes: potential fertility preservation for female cancer patients. Fertil Steril 2010;93:391-6. 5. Hodes-Wertz B, Noyes N, Mullin C, McCaffrey C, Grifo JA. Retrospective analysis of outcomes following transfer of previously cryopreserved oocytes, pronuclear zygotes and supernumerary blastocysts. Reprod Biomed Online 2011;23:118-23. 6. Wennerholm UB, et al. Children born after cryopreservation of embryos or oocytes: a systematic review of outcome data. Hum Reprod. 2009 Sep;24(9):2158-72. Link: http://humrep.oxfordjournals.org/ content/24/9/2158.full.pdf+html 7. Tao T, Zhang W, Del Valle A. Human oocyte cryopreservation. Curr Opin Obstet Gynecol 2009 Jun;21(3):247-52. 8. Winslow KL, Yang D, Blohm PL, Brown SE. Oocyte cryopreservation/a three year follow-up of sixteen births. Fertil Steril 2001;76(Supplement 1):S120-S121. 9. Cobo A, Rubio C, Gerli S, Ruiz A, Pellicer A, Remohi J. Use of fluorescence in situ hybridization to assess the chromosomal status of embryos obtained from cryopreserved oocytes. Fertil Steril 2001;75:354-60.

Specialists in Reproductive Medicine & Surgery, P.A. www.dreamababy.com For more information, please visit www.dreamababy.com, email Fertility@DreamABaby.com or call 239-275-8118. Specialists in Reproductive Medicine & Surgery, P.A. 12611 World Plaza Lane, Building 53 Fort Myers, FL 33907 USA