Fertility, Egg Freezing, and You. If you have questions, we can help you get answers.

Fertility, Egg Freezing, and You If you have questions, we can help you get answers.

Let s talk about fertility If you re thinking about having a baby someday but aren t ready now, you should learn all you can about your fertility, the benefits and risks of delayed childbearing, and the facts about egg freezing for in vitro fertilization (IVF). This brochure is intended to help start you on that path. So first Your eggs and you These days it s popular to talk about 40 being the new 30. Unfortunately, this does not apply to the health of your eggs. A woman s fertility peaks in her 20s, then gradually declines in her 30s, particularly after age 35. 1 As a woman reaches her mid-to-late 30s, both the quantity and quality of her eggs decline. One important change is an increase in the number of eggs with genetic abnormalities. 1,2 Decline in ovarian follicles related to age 3 Did you know You are born with all of the follicles, or potential eggs, you will ever have (about a million) 1 At puberty, you have about 300,000 follicles, only 300 of which will ever be ovulated 1 Both the quantity and quality of your eggs decrease as you go from your 20s to your 30s, with a rapid decline after your mid-30s 1,2 Most women become infertile in their mid-40s, years before the average age of menopause (age 51) 1 Percent of ovarian follicles remaining 50% 40% 30% 20% 10% 0% 5 10 15 20 25 30 35 40 45 50 55 The number of eggs (ovarian reserve) you have at a given age may be related to the age at which your mother entered menopause. If she experienced early menopause, your supply of eggs will probably decline more rapidly than if she experienced normal or late menopause 4 You cannot judge your ability to have a baby later in life by your general health or fitness, or by stories you may hear from people you know or see in the media 5 Age (years) 2 3

Egg freezing: an introduction Breakthrough technologies in the field of infertility medicine have led to a recent increase in discussion about the biology of fertility, infertility treatment options, and delayed childbearing. With large companies now offering egg freezing (oocyte cryopreservation) as a health benefit to employees, 6 the procedure is occupying a lot of space in the media and has been the focus of conversations at the workplace, at social gatherings, and at home. Historically, egg freezing was an option for young women with medical problems. Now, women who do not have major health problems but are considering delaying having a family are wondering if egg preservation could be a potential option for them. The reasons these women may consider delaying having a family might include focus on career, lack of a partner, or simply wondering if having a family is right for them. 7 So, with all the buzz surrounding egg freezing, we d like to help you with some basic facts. What is egg freezing? The technical term for egg freezing is human oocyte cryopreservation. This is a novel technology in which a woman s eggs are extracted, frozen, and stored. Later, when she is ready to try and become pregnant, the eggs may be thawed, fertilized, and transferred to the uterus as embryos. Egg freezing for the purpose of delaying childbirth is fairly new. However, young women with health problems have been freezing their eggs for over 30 years for potential future use in IVF. Over the last 5 years, the technology for freezing eggs has improved dramatically. Today s methods include oocyte (egg) vitrification, a process that essentially flash freezes the egg, resulting in higher success rates than previous slow freeze methods. It s important to note that the American Society for Reproductive Medicine (ASRM) no longer considers egg freezing for IVF to be an experimental procedure. 8 This means that results from IVF using frozen eggs are similar to those using fresh eggs in young infertility patients and egg donors. However, these results may not be the same in different fertility clinics and in different patients and age groups. The ASRM does not currently recommend egg freezing for patients who wish to delay childbearing because there are insufficient data on the efficacy and safety of this procedure for these patients. The ASRM does not want to give women false hope by encouraging active promotion of egg freezing for the purpose of delaying childbearing. For more information from the ASRM, go to this link: www.asrm.org. Only you and your doctor can determine if egg freezing is right for you. So it s important to learn all you can about this process. 4 5

Helping you make an informed decision Although egg freezing has been used in IVF for patients with medical conditions for some time, the option of egg freezing to delay childbirth is fairly new. Because of this, there are limited data available on the potential success of the procedure in all patients. To help you make an informed decision with your doctor, we ve gathered as much information as we could. Here s what we know now: Q: What is the best age to freeze your eggs? As you now know, the quantity and quality of your eggs decline after your mid-20s and the rate of decline increases even more after your mid-30s. So most experts, including the ASRM, recommend most women freezing eggs by age 38. However all individual circumstances may vary, and women should speak to their doctor about their fertility potential. It s important to note that, just as genetic abnormalities in a woman s eggs increase with age, there may be a similar increase in such abnormalities in eggs that are frozen after the mid-30s. 1,2 Q: How does a woman know if egg freezing could be appropriate for her? What we know is that a woman s eggs decline with age. So, the age of the woman at the time of egg freezing is an important factor. But it is not the only factor. The quality of a woman s eggs, which can only be determined when they are thawed, fertilized and developed is also important. A thorough assessment of a woman s reproductive health from a fertility specialist is essential before considering egg freezing. 6 Q: Is there an age after which I should not freeze my eggs? As previously noted, the ASRM has insufficient data on the safety and efficacy of egg freezing to delay childbirth. And every woman is different when it comes to the effects of age on fertility. Certainly, there is a higher risk for pregnancies at a later age, whether they result from natural conception, routine IVF with fresh eggs, or IVF using frozen eggs. A thorough assessment of a woman s reproductive health from a fertility specialist is essential before considering egg freezing. Q: How long can eggs be frozen? Simply because the techniques for egg freezing are so new, there has not been enough time to collect the data needed to determine the optimal time that eggs can be frozen before they are thawed and used for IVF. Q: Will all the eggs be viable when thawed? As it is not currently possible to determine the genetic quality of an egg at the time of freezing, some or all of the eggs may not be genetically viable. And some eggs may not make it through the thawing process. So you may need to go through more than one cycle to collect an appropriate number of eggs. Though there can be no guarantees, only your RE will be able to determine the number of eggs you will need to give you the best chance for a viable embryo in the future. Q: How successful will IVF be with thawed eggs? Success rates depend on many factors, such as the woman s age and fertility potential at the time of freezing, successful thawing, and a successful IVF procedure. Q: What are the risks? As with any advanced reproductive technology, there are potential health risks involved with the egg retrieval process and the ovarian stimulation that accompanies it. A woman considering egg freezing, or any infertility treatment, should talk to her RE about the risks involved. In addition, women should know that egg freezing in no way guarantees they will have genetically normal embryos that can be available for embryo transfer to have a healthy baby in the future. 7

Let s go through the process, step by step While individual patient experiences may vary, the process of freezing your eggs and potentially using them for IVF at a later time generally includes: Phase 1: Egg Freezing and Storage Consultation and workup Ovarian stimulation Egg retrieval Egg freezing and storage Phase 2: Egg Thawing and IVF In vitro fertilization Embryo transfer 8 9

Phase 1: Egg Freezing and Storage Consultation and workup Ovarian stimulation Your first step is to make an appointment with a Reproductive Endocrinologist (RE). An RE can help you understand your fertility potential, the possible risks of delayed childbearing, and the facts about egg freezing. Your appointment will likely involve several blood tests and an ultrasound screening. Then you will discuss your results with your RE. Treatment usually begins with medications that will help your body produce the multiple eggs required for your freezing procedure. 9 Each month new eggs form in your ovaries. Usually one egg matures and is ovulated. The other eggs stop developing. The medicines you receive help these other eggs to develop into mature eggs. 10 Therefore, freezing your eggs does not result in a net loss in your overall or future egg supply. Your doctor will also prescribe other medications to help your body prepare, depending on your specific needs. During this time you will visit the doctor s office regularly to monitor the growth of your eggs with blood work and ultrasound. 10 This phase of the process can take from 8 to 14 days. 11 The medications you receive during this process may cause some side effects, including but not limited to headache, bloating and other gastrointestinal effects. Some side effects can be serious and require medical attention. Of course, your doctor and nurse will closely monitor your treatment and should be immediately informed of any symptoms you experience. Egg retrieval At your doctor s office or clinic, you may receive light sedation or pain medication. An ultrasound probe is inserted into your vagina to find the follicles, and a thin needle is guided into the follicles to draw out the eggs. 11 The retrieval process usually takes fewer than 20 minutes. 11 You may experience some pain during the procedure and mild cramping afterwards, and you may experience a sense of fullness or pressure over the next 2 weeks. 11 Your doctor can help manage any post-procedure symptoms. You should plan to take the whole day off from work and have someone drive you home from the appointment. Depending on the number of eggs your RE suggests you freeze, you may need to undergo more than one egg freezing cycle. Egg freezing and storage Finally, your eggs are frozen for future use. Frozen eggs are stored in tubes in a liquid nitrogen storage tank. Individual clinics vary as to the length of time they will store your eggs. At your initial meeting with the RE s nurse, you may discuss storage and plans for your eggs should you elect not to use them. The entire process from screening to freezing and storage takes approximately 2 months. However, for most of this period you will be able to continue your normal activities. 10 11

Phase 2: Egg Thawing and IVF In vitro fertilization When you decide the time is right to try and have a baby, your RE will advise you to try getting pregnant on your own for 6 months or more. 1 If this doesn t work, you will visit your doctor and make sure you are healthy and ready to carry a pregnancy to term. Fertility tests will be done on you and on your male partner or, if needed, your sperm donor. If you decide to use your frozen eggs, the process of IVF will begin. First, you will begin a cycle of medication to prepare your uterus for pregnancy. This cycle usually lasts no more than 10 days. Next, your eggs are thawed and fertilized in a lab using sperm from your partner or donor. You and your RE will discuss the results and determine next steps, including how many fertilized eggs are genetically normal and available for transfer. Embryo transfer Generally, within a few days of thawing, one or more fertilized eggs (embryos) are implanted directly into the uterus. This procedure is usually brief and may cause some discomfort that is often compared with discomfort experienced during a routine pap smear and pelvic exam. Sedation is usually not required but a mild sedative may be given. 11 You will continue to take hormones to support the early stages of your pregnancy. About 10 to 12 days after the embryo transfer, your doctor will know if you are pregnant. The Process Phase 1: Egg freezing and storage Phase 2: Egg thawing and IVF Consultation and workup Ovarian stimulation Egg retrieval for freezing Egg freezing and storage In vitro fertilization Embryo transfer 12 13

OK, what will this cost? A baseline screening can be conducted during an initial consultation to give you a better understanding of your fertility potential. The initial consultation fee varies from center to center but is nominal ($99-$299) considering the overall cost of treatment. Treatment costs vary from region to region and among individual fertility clinics. To give you a general idea, the average price for an egg freezing cycle can range from $6,500 to $18,000. 12 14 The annual egg-storage fee is about $500 a year. 12,13 When you are ready to try and get pregnant, your eggs are thawed and fertilized via IVF, and the embryo is transferred to your womb. The average cost of a typical IVF cycle is $12,400, according to the American Society for Reproductive Medicine. 15 However, your cost for IVF would probably be less, since your eggs have already been retrieved and frozen. Of course, the costs listed here are national averages; your costs could be lower or higher depending on where you live and the cost of medication. Some fertility clinics may offer discounts or financing options, so check around! Women have also visited www.eggbanxx.com for help with egg freezing costs. Depending on your insurance plan, some of the costs of the procedure and medications may be covered. Verifying your health insurance benefits for freezing your eggs is easy. Simply call Fertility Lifelines toll-free at 1-866-538-7879. Additionally, some major companies have recently announced that they will cover the costs of egg freezing for their employees. 6 Check with the Human Resource representative at your company. 14 Talk to a Reproductive Endocrinologist! If you would like to learn more about egg freezing and delayed childbearing, or if you would simply like to know more about your own fertility and options, your best course of action is to talk to a Reproductive Endocrinologist. An RE can best explain the procedures, benefits, and risks, and assess your reproductive health and chance for success. The resources below can help you find an RE near you, prepare for your visit, and explore ways to save on medication. www.myeggfreezing.com To speak with a patient advocate call this toll-free number: 1-866-538-7879 www.asrm.org References: 1. American Society for Reproductive Medicine. Age and Fertility: A Guide for Patients. 2012. 2. Franasiak J, Forman E, Hong K, Werner M, et al. The nature of aneuploidy with increasing age of female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2013;101:656-663. 3. Wallace WHB, Kelsey TW. Human ovarian reserve from conception to the menopause. PLoS ONE. 2010;5:1-9. 4. Bentzen JG, Forman JL, Larsen EC, Pinborg A, et al. Maternal Menopause as a predictor of anti- Mullerian hormone level and antral follicle count in daughters during reproductive age. Hum Reprod. 2013;28:247-255. 5. Mac Dougall K, Beyene Y, Nachtigall RD. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod. 2013;28:350-356. 6. http://www.nbcnews.com/ news/us-news/perk-facebook-apple-now-pay-women-freeze-eggs-n225011. 7. American Society for Reproductive Medicine. Fact Sheet. Can I freeze my eggs to use later if I m not sick? 2014. 8. The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Mature Oocyte Cryopreservation: A Guideline. Fertil Steril. 2013;99:37-43. 9. Gonal-f RFF Pen (follitropin alfa injection) full Prescribing Information. EMD Serono, Inc. 2011. 10. American Society for Reproductive Medicine. Medications for Inducing Ovulation: A Guide for Patients. 2012. 11. American Society for Reproductive Medicine. Assisted Reproductive Technologies: A Guide for Patients. 2011. 12. New England Fertility. Egg freezing. http://www.nefertility. com/treatments/egg-freezing. 13. USC Fertility. http://uscfertility.org/fertility-preservation/egg-freezing-faqs/. 14. The Fertility Center at NYU Langone. Egg freezing costs. https://www.eggfreezingcosts.com/egg-freezing-costs. 15. American Society for Reproductive Medicine. Q006: Is in vitro fertilization expensive? http://www.asrm.org/detail. aspx?id=3023. 15

Fertility, Egg Freezing, and You No one can predict the future. But consulting a Reproductive Endocrinologist about your reproductive health and the facts about egg freezing, IVF, and delayed childbearing is a good first step to understanding your fertility potential. Some things to remember: A woman s fertility generally peaks in her mid-20s; the quantity and quality of her eggs declines more rapidly after her mid-30s Egg freezing technology has improved The American Association for Reproductive Medicine has determined that the process is no longer experimental, but has not endorsed it for delayed childbearing due to insufficient data There are benefits and risks for both egg freezing and IVF, and these procedures are not for everyone Even with egg freezing, some women who delay childbearing may not be able to become pregnant later on, when they want to be. It is important to consult with your OB/GYN and a Reproductive Endocrinologist (fertility specialist) to determine your chances for success Only you and your Reproductive Endocrinologist can determine if this is a good option for you Brought to you by EMD Serono, Inc. is a subsidiary of Merck KGaA, Darmstadt, Germany. 2015 EMD Serono, Inc. All rights reserved. US-FOL-1114-0001