I’ve struggled with fertility and I know many of you have, too. So we’ve invited experts from Spring Fertility to answer your questions 🥚Featured

cadran·Jun 13, 2022

Posted in:Advice Health & Wellness Spotlights

UPDATE: Check out this follow up post for answers to all the questions below

tl;dr: We are trying something new. The team at Spring Fertility is offering their time to answer your questions about fertility, and anything else egg freezing, IVF or family planning related that’s on your mind.

More details on the what and the why:

I wanted to host this conversation for Elpha members because fertility comes up A LOT on Elpha since family planning is a complicated topic for everyone, and especially for those of us who are also invested in work. But I also have a personal reason for hosting this conversation: I’ve had a painful and difficult struggle with pregnancy and fertility over the last few years.

I wrote a post on Elpha a few years ago wondering “should I have kids?”, but it turned out the question for me was really “can I have kids?” This was a hard truth that I discovered shortly after launching Elpha as a startup in 2019 (when I was 33). Over the last few years, I’ve learned that there are a lot of people like me that discover later in the game that everyone has different amounts of success with egg freezing and IVF, and that getting and staying pregnant aren’t easy for us all. When I was younger I thought I didn’t want to have kids and no one urged me to get educated about my fertility despite that, and so I waited. As I got older I changed my mind about wanting kids. I pretty quickly discovered that I didn’t understand my own body and health, and that I would have made different choices had I been educated about my personal fertility situation earlier. It was a truly painful experience for me that I hope fewer people go through.

These days, every time I’m chatting with someone who is thinking about their fertility, I find myself urging them to learn more about their unique situation and to take the first steps with a doctor to understand their fertility so they can make informed decisions and plan accordingly. I WISH someone had urged me to do that much earlier on. So since this is a space where we support each other and share our personal experiences and lessons-learned, I wanted to do that with this very sensitive topic.

I worked with Dr. Klatsky at Spring Fertility and had a very positive experience. I felt like he was extremely candid and direct with me during our work together. I value both of those qualities a lot (as you know from our culture on Elpha). He and the Spring Fertility team are also a world-class fertility center by the numbers, so I wanted you all to have access to their knowledge and expertise. So without further ado, I’d like to introduce the Spring team and share more context for how this conversation will work. Also: We’ve asked the Spring Fertility team to offer a special Elpha members-only discount in case you would like to explore your fertility with them. They’ve generously said yes, so please look out for that in a subsequent post.

How this will work:

Spring Fertility is a best-in-class fertility center that puts patient care first. They believe everyone deserves to have a family if they want one. They’re a team of scientists, but they’re also spouses and parents and have been patients, too.

We’ve invited Dr. Peter Klatsky, co-founder and CEO of Spring Fertility, Dr. Catha Fischer, Medical Director at Spring NYC, and Dr. Monica Pasternak, Medical Director at Spring San Francisco to answer all of your questions about fertility, fertility preservation and IVF!

Dr. Klatsky is dual board-certified, in both Reproductive Endocrinology & Infertility, as well as Obstetrics & Gynecology. Prior to starting Spring Fertility, Dr. Klatsky also designed and founded Mama Rescue, a mobile phone application providing emergency transport for mothers seeking emergency medical care in western and central Uganda. He’s received numerous awards for his dedication to patient care.

Dr. Fischer graduated with honors from Washington University in St. Louis before attending the Icahn School of Medicine at Mount Sinai. She completed her residency at Yale-New Haven Hospital and then went on to complete her fellowship in Reproductive Endocrinology and Infertility at Columbia University Medical Center-New York Presbyterian Hospital. Her personal ethos is that patients deserve exceptional clinical care and a compassionate patient experience.

Dr. Pasternak attended Columbia University where she majored in Middle East and South Asian Studies with a minor in Biology. Dr. Pasternak completed medical school at the University of Miami, where she also received her MBA, before going on to complete her Obstetrics & Gynecology Residency at Yale. Following residency, Dr. Pasternak completed her fellowship in Reproductive Endocrinology and Infertility at Cornell.

Whether you’re just starting to think about your fertility, or you’ve already decided that you want to freeze your eggs or do IVF, we want to make sure that all your fertility questions are answered. Post your questions below. No question is too small or silly – remember: everyone is at a different point in their journey.

Submit your questions (can be posted anonymously, too) by June 18th. Drs. Pasternak, Fischer and Klatsky are then going to get together and write up thoughts and answers to your questions, which we will share with you in the coming weeks.

Lucile76·Jun 13, 2022

What’s the best age to do egg freezing for the majority of women?

lexiyan·Jun 13, 2022

What would you recommend for someone who knows they want to have kids and is in their late 20s, but doesn’t have plans to have kids in the immediate future? Is there anything they should be looking into or conversations they should be having with their doctor right now?

Rae79·Jun 13, 2022

I froze my eggs when I was 30, and 19 were retrieved across 2 cycles. Although I've heard tons of IVF success stories, I've never actually heard anecdotes about women who used their frozen eggs. How does it usually go?When I've looked into this in the past, I've been told that egg freezing only became popular within the past decade, so there isn't enough data yet to draw any conclusions about success rates when the eggs are used across different ages. I've heard it's good to use them within 10 years, but even that sounded like a guess.

iammyr·Jun 14, 2022

IVF doesn't exclude the use of frozen eggs. IVF simply means that the egg is fertilized in-vitro rather than within your body. Still one could choose to transfer back one of the fertilized eggs (called embryo) much later than the usual 7 days after extraction. In that case, it is called FET: frozen embryo transfer.So "IVF success" might include cases of IVF+FET as well as IVF+"fresh embryo transfer" (I just realized they have the same acronym :p) Incidentally, frozen embryos have more success than frozen eggs.

Rae79·Jun 14, 2022

I understand that, but I've still never met someone who has fertilized a frozen egg for IVF (and I know couples who originally froze embryos, and they also never ended up needing them because they got pregnant naturally).My endocrinologist told me that when I want to get pregnant, first I would try naturally. If that didn't work, she'd recommend we do a fresh round of IVF first before using my frozen eggs (which are supposed to be a last resort).Do you personally know anyone who used one of their frozen eggs or frozen embryos for IVF? I see you work at Google, so I'm guessing you have a lot more friends/coworkers who froze their eggs early on.(Also, your comment feels mean-spirited although I'm guessing you didn't intend it that way — if I had a long-term partner to freeze embryos with, we would have already have tried to get pregnant, we wouldn't be freezing. For me, I had to freeze eggs because I don't have a partner yet, so it feels cruel for you to tell me that I should have frozen embryos.)

ah2·Jun 14, 2022

there's a ton of stories about using frozen eggs from earlier on reddit in the r/ivf sub

iammyr·Jun 15, 2022

this is awesome thanks a lot! i didn't know

iammyr·Jun 15, 2022

oh I didn't mean it that way at all! sincere apologies Rae79, I'll be more careful in the future.I've learned a bit about this topic and my post was only meant to try to share and clarify eventual confusions (which I, for one, certainly had, in the past and still have, for sure)

CandiceB·Jun 14, 2022

You may find this article helpful https://www.sciencedaily.com/releases/2022/05/220526181147.htm

Rae79·Jun 15, 2022

Woah, hot off the presses! Looks like this just came out a few weeks ago. Exactly the type of data I was looking for :)

adriennesmith·Jun 13, 2022

I am a year postpartum and am thinking about the best way to regulate my body's cycle, hormone levels, and thus, fertility, again. I haven't gotten my period back yet other than the occasional spotting (I am still breastfeeding) and I am ready to reclaim my body's natural cycle!

January78·Jun 21, 2022

Hi! For help with hormone balancing, I'd definitely recommend working with a functional medicine doctor or naturopath.

Salina126·Jun 13, 2022

There are a lot of startups in the fertility space with things like take home hormone tests, egg retrieval services, etc. How should someone like me without any medical expertise assess which tech-enabled fertility services are backed by science?

Rae79·Jun 13, 2022

Totally agree with this. So much stuff in the space seems predatory, like the pink tax times 1,000.When I was 30, my endocrinologist told me I’d better hurry up and freeze my eggs because over 30 the procedure would be less effective. Now I know people being told it’s still a good idea to freeze eggs at age 37.I guess science may have advanced, but cynically I see this and assume clinics figured out that women 35+ can better afford the hefty price tag of the procedure.

ah2·Jun 15, 2022

it is def much easier, much shorter and much cheaper to freeze eggs in your 30s then at 37. Another useful article is this: https://www.fertilityiq.com/ivf-in-vitro-fertilization/the-ivf-process you need a TON of eggs to get to a live birth. And at 37, the percentage of how many are likely chromosomally abnormal bumps up to 64% vs. ~50% in your 30s.when you're younger you typically need lower doses, and less rounds to get the same number of eggs as being 37, plus they're likely to be better quality.

Rae79·Jun 15, 2022

Totally get that (and I had to do multiple cycles to get 19 eggs, even at age 30). The cost was $30k, of which my insurance/employer covered $20k.I'm saying that my doctor told me to do the egg freezing procedure ASAP because my fertility would decline rapidly after 30. And then a few years later, the same clinic I used told my 35-year-old friend that it was a good idea for her to do the procedure too (and I think they even told her there was no rush). Based on what they told me (that it was a HUGE rush), it seems like they should have told my friend in full disclosure that the procedure had really low odds of being successful.But no, they were like, "We'll happily take your money." And then yes, she did get a poor outcome, and likely would need to do multiple additional cycles for there to have been any point in her freezing at all.My point is that I think it was misleading and potentially unethical how this was presented to my friend, and even discriminatory because they presented it very differently to me.p.s. The article you linked to is behind a paywall that ranges from $195-750 depending on how many of their articles I want to read (at least those are the rates it's showing me).This is exactly the kind of shit I'm talking about. This industry actually charges women money to learn basic information. I much prefer the scientific research such as the one @CandiceB linked to above.

Iynna·Jun 14, 2022

Thank you so much for doing this OH with us! @cadran once again thank you for creating this space for us! I have SO many questions so if it gets too long and you have some *reliable* resources I should look into, I'd happily review these too. I'm soon to be 30 (OMG haha), and very far from thinking about children (still not a firm yes I want children and also not a definitely not but of course want to give myself options). I hear and I see that egg freezing is crazy expensive, but I actually don't fully understand how women are being charged and how much on average would the treatment cost (let's assume all out of pocket)?Are you familiar with other countries that have more favorable terms for women (e.g countries where healthcare is not as expensive as the US)? Along the same wavelength, any countries that are known to provide quality care? How long is the process of freezing eggs? I have heard the process is difficult on the women's body, is this true? What could the cons of doing it (from a health perspective)?Can women have irreversible side effects? It's a known that black women are most prone to death during childbirth, any similar studies with regard to egg freezing (trying to stay alive for as long as possible :)) THANK YOU!

iammyr·Jun 14, 2022

[disclaimer: not posting anon "if I can avoid it, meaning the info is not too personal "and" no major danger/risk is threatening me sharing this info" to encourage others not too feel like fertility topics/issues were something to hide]the Preimplantation genetic testing for aneuploidy (PGT‐A) is another technique around which there isn't much studies/data. It is difficult to decide whether to go for it and risking to damage an embryo due to the biopsy, or to skip it and risking a spontaneous abortion or health issues in the child.would you recommend doing it?

iammyr·Jun 14, 2022

iammyr·Jun 23, 2022

[asked my own doctor] AMH and menopause are not completely unrelated but a high AMH is no indication about late menopause. It exclusively indicate the current (it can also vary) ovarian reserve.

Mistie8·Jun 14, 2022

would you recommend the supplementation of DHEA even in cases where the ovarian response to IVF is not too bad (10 eggs retrieved, 6 blastocysts, of which (after PGT-A) two normal, two mixed and two abnormal - age 38)? Considering that currently both DHEA and total testosterone (according to blood tests) are both on the lower end of the recommended range (2.53 mcmol/l and 0.8 nmol/l respectively)?Is there any further warning/recommendation that you would like to give in relation to DHEA supplements?

Mistie8·Jun 23, 2022

I asked my doctor and DHEA is a steroid and esp. in case of high AMH it is not recommended to take it. In general he said that data are not clearly in its favour.

iammyr·Jun 14, 2022

[disclaimer: not posting anon "if I can avoid it, meaning the info is not too personal "and" no major danger/risk is threatening me sharing this info" to encourage others not too feel like fertility topics/issues were something to hide]is there specific steps/analyses/monitoring that you recommend one should ensure our doctors do perform, before and after frozen embryo transfer, in order to raise the chances of success as much as possible?

Mistie8·Jun 14, 2022

if one wanted more than one child from frozen embryo transfer, how much time should one consider in between one eventual pregnancy+delivery and the next?

Mistie8·Jun 23, 2022

I asked my own doctor and he said that it depends on how the delivery goes. Also different doctors have different opinions about this. In general, his belief is that 6 months are enough. But it can vary from 6 to 12 if you had a C-section or other complications, etc.

Kamala177·Jun 14, 2022

Best treatment to follow when you have endometriosis and want to have babies by a donor

KCuesta·Jun 14, 2022

What age would you recommend to start with this kind of treatment if you suffer of endometriosis ?

Ingeborg96·Jun 14, 2022

Thanks for doing this! I've heard about higher risks for certain medical diagnoses like autism etc. if you give birth after the age of 36. I'm curious about the reality of these risks versus how much is here-say. I'm also curious whether freezing eggs at 36 would do anything then to support lower risks around these, or whether if you're freezing eggs past 36 it comes with the same risks.

AudreyRochas·Jun 14, 2022

What is your recommendation for someone who is 45, doesn't respond to stimulation, has adenomyosis and has tried IVF with an egg-donor thrice with no result? Is there anything that should be investigated?

innachilik·Jun 14, 2022

I am 37 and have been told that I have decreased ovarian reserve (low egg count). Does it make sense to still go for freezing eggs process? And what would that mean for me (aside of increased costs and need of several cycles of egg extraction)?Secondly, according to my doctor the chances are higher to impregnate the egg after the hormone treatment rather than freezing them first and creating an embryo 1-2 years later (and also cheaper apparently). Since I am not ready to become a mother just yet, would my chances significantly decrease if I chose to pause the process and do egg extraction (and potentially IVF) next year when I am 38?!

tarasuperkin·Jun 14, 2022

Just here to say how amazing this is. Thank you for creating the space for such an important and, at times, overwhelming topic! So much has changed (even in the last 7 years since having my first) and it's truly incredible to see such an open conversation from experts.

Margurite151·Jun 14, 2022

Can you talk about the differences between egg count, egg quality and the results of what they mean? What's the time window for having children if our AMH (ovarian reserve) results are above 51 percentile for our age group (are over 35), should we be worried about our ability to bear children in early 40s, or would it be impossible to get pregnant at 40 and after (meaning, do I need to rush to have kids within 3 years otherwise I'll never bear children)? I often have family members freaking out I haven't frozen my eggs because they did at my age and had issues having children due to incapability their stuff with their partner's sperm.

allisonthompson·Jun 14, 2022

I just wanted to say thanks for doing this! I never knew anything about freezing my eggs. We started trying for a baby when I was 31 and I'm happy to report that I'm now 33 and pregnant with our first. It's super exciting, but it was very stressful for the 2 years of trying and I was often frustrated at myself for not doing research earlier. I knew I wanted kids, but knew that they would happen slightly later in life, and desperately wished I had known about even checking in on fertility health earlier in my life. Thanks for getting this message out there and I hope more women are able to be educated on this topic!

Chelsey103·Jun 14, 2022

My spouse and I started trying when I was 36. You always hear concerns about being able to get pregnant and lower egg counts as you get older, however, I actually did get pregnant fairly easily twice. Unfortunately both resulted in miscarriages. Are there any tests to understand if this would be an issue that would come up? This was not something I would've anticipated when everything else has seemed fine. I've also heard other women like me who have struggled with miscarriage. I wish this was something I would've known more about sooner. Thanks for providing this space to ask!

iammyr·Jun 15, 2022

Most women are recommended to "first try naturally". Here where I live, they recommend trying for 1 year or 7 months if you're over 35.However, I've talked to a gynaecologist who admitted that this is done only because the health insurance (where I live) covers the cost of the fertility test and therefore pressures doctors not to prescribe any test for as long as possible, so that they can save money.Would you recommend instead, doing fertility tests immediately, rather than waiting for a while to try naturally? Which tests would you recommend?

iammyr·Jun 15, 2022

do multiple cycles of IVF/ICSI carry any health risk or decrease of fertility level? does the time distance between one and the other affect this risk, at all?

iammyr·Jun 15, 2022

which explanation do you think there could be to the fact that there is so little research and stats that are reliable and comprehensive, performed around IVF, fertility and related techniques?Do you think this situation is improving? If not, why?

iammyr·Jun 15, 2022

if one was to travel to a different country for the FET, how much time would they need to spend in this other country before all checks and procedures were completed?

iammyr·Jun 23, 2022

[asked my own doctor] during FET one can take medications and do lab tests from wherever they live in the world. Then one needs to book at least 2 nights for traveling to do FET: arrive the day before, leave the day after.Your local lab will then need to do the pregnancy test after 10 days. etc.

Bella·Jun 15, 2022

Thank you for opening up an amazing topic and discussion!!I've come across a lot of contradictory information regarding conception and pregnancy with bicornuate uterus. My doctor didn't give me much information about this when they diagnosed me with it, but I know of women who've had to go through IVF to conceive with a bicornuate uterus.I'm 29 and hadn't planned on having kids just yet, but now I'm concerned it's going to be more difficult to conceive.I'm not sure if this is in the same area as fertility issues, but thought I'd ask!

Monet87·Jun 15, 2022

I am 30 and married, but ideally, we don't want to have kids right now. We want to figure out our careers, travel, and buy a house which will all take a few years. What should I be doing now to prepare us for fertility? What data should I be gathering to make informed decisions? I am scared we will wait until it's too late and then have regret.

codev91·Jun 15, 2022

Thank you so much @cadran and everyone at Spring Fertility for making this possible! I have been thinking about this a ton lately and it's so nice to be able to ask experts in the field. I am 31 years old and would like to have a family someday, however, my partner is three years younger and not sure he is ready to start a family yet (he said he would prefer to start trying to conceive in 2-3 years, but would consider one year from now). Infertility runs in my family (my mom, grandmother and great-grandmother all had issues trying to conceive, and my mom used IVF for both my sister and I, despite starting to try to have kids in her late 20's). I spoke with my doctor about this and he said if I am planning to start trying to conceive in the next 12 - 18 months I probably don't need to worry about freezing my eggs, but if I wanted to wait longer he would suggest considering it more seriously. I have a few questions about this: 1) It is recommended to do any testing, prior to trying to get pregnant, to assess whether I may have any fertility issues? The reason for this question is that if it turned up that I may have trouble, I would want to start trying sooner rather than later, but if everything looks good then I may be ok to wait a couple of years. 2) Even if I wanted to start trying to conceive in the next 12-18 months, should I freeze my eggs in case I wanted a second child? Even if I started trying to have kids one year from now an everything went smoothly, I would likely not start trying for a second until at least 34-353) I think this may have been asked elsewhere so feel free to ignore if you have already answered, but what is the typical cost of freezing eggs for someone in their early thirties? My doctor said the "ballpark" cost is $3k-5k / round (I live in Boulder, CO) + ~$200 / year for storage, but I have heard a lot higher numbers from friends who have had it done (though they also live in other cities). I'm also not sure what the typical number of rounds is for someone in their early thirties. 4) How hard is this process on your body? Would it be difficult to work while undergoing egg freezing?

tracy·Jun 16, 2022

How do you evaluate the quality of an egg freezing clinic?In disclosure, I went to Spring Fertility for consultation and had quite a bad experience. Dr. Klatsky had trouble finding my ovaries during an ultrasound (I didn't realize they were hard to find; at least no other doctors or nurses ever had trouble) and had to call in someone else for help after 15 minutes of poking the wand around. I was told I had only 7 follicles, then only 2, then 9, on subsequent visits to Spring Fertility. (I later went to another clinic and in one cycle was able to get 30 eggs extracted, so I at least have 30 follicles!) Dr. Klatsky also recommended that I do a procedure to remove a cyst that he had found, only to realize when I actually went in for the procedure that there was no cyst. I still had to pay $1k out of pocket for an entirely unnecessary procedure. Given my experience at Spring Fertility, it makes me a little nervous to see them doing this AMA and advising people on something so important.

cadran·Jun 23, 2022

Thanks for sharing your experience, Tracy. And I'm sorry to hear it wasn't a good one. Fertility is stressful and everything about it feels so ambiguous (and also expensive!) It wont surprise you to hear that I can't speak to your personal health or the experience you had, so I defer to their team on that.In terms of choosing Spring, here was my process:1. I talked to friends in the bay area about where they went and which clinics they hard good experiences with or heard were good.2. I looked on Yelp and at some of the fertility ratings websites. 3. I reviewed clinic success rates using sart (https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=2000045) and comparing Spring to other clinics.

SenZhan·Jun 17, 2022

I just turned 38, and for most of my life I was on the side of not having children, so I didn’t explore egg freezing options earlier. Now I’m with a wonderful partner, and if I were ever to have children, it would be with him. But as much as I would love for him to have kids, I’m still not ready or sure about my own desire or capacity to be a mother. I know people say that you’re never quite ready, or that you become ready by going through it, but this is not reassuring. This is such a transformative life decision to make on the wager that things will change once you do it, and you can’t change your mind anymore. When I think about trying to have kids now, I notice myself shutting down, refusing the possibility, and escaping in my mind to all the other things I’d prefer to be doing now. I think I anticipate motherhood with fear because I associate it with the loss of my freedom and agency to live my own life. In an ideal situation, I would keep living my child-free life to the fullest for another 5-7 years, and perhaps be actually ready to settle down at 45 and do the kid thing then. But I need to contend with the reality that my physiology would make it difficult to have a safe pregnancy, and a healthy child. My partner would prefer to have his own biological child, rather than adopting. I would also prefer that. I was told by my gynaecologist that egg freezing at my age would not necessarily improve my chances of a successful pregnancy down the line once I’m ready, compared to if I just went for trying to get pregnant now. But buying myself time would be worth it for me, even if the chances of success with egg freezing don’t improve, but match the probability of success as trying to have a child now. What would you suggest for me? Does egg freezing make any kind of sense? Is there a different frame of mind I could try on that would help me to think about things differently? Thank you so much for your time.

Una74·Jun 18, 2022

It's incredible that Elpha is offering this forum - I'm so excited to see this!I've been on an anti - inflammatory diet and hormone balancing path for several months. I haven't started TTC yet but I know being 38 almost 39, age is definitely a consideration. Whenever I think of ART/IVF, I envision so many needles because of the hormone shots! After coming off contraception and working very intentionally to balance hormones, I'm not so thrilled about then taking hormone shots to potentially throw off the balance of my hormones. Are there any "gentle" ART options available? Will ART always require taking hormones in some way?

iammyr·Jun 21, 2022

I had the same thoughts as yourself and I have your same age (and about starting my second IVF cycle). feel free to reach out ;)

Karen2·Jun 19, 2022

What do we know about the effects of a COVID infection on egg and sperm quality during the preconception phase? Is there a way to test for this? I’m just recovering from a mild case of COVID but my husband had a rough time with it last summer - sick for nearly a month. I’m nervous now about trying for a baby soon.

Lore152·Jun 20, 2022

Can you send answers to these amazing questions via Elpha newsletter or podcast or something please? I don't want to miss this!

cadran·Jun 24, 2022

Hi! We are going to send out an email :)

teresaman·Jun 20, 2022

I've briefly looked into Spring Fertility before and signed up for a session where you could get your AMH count evaluated. Though upon my own research, it seems that those who are on birth control (which I am on currently - the pill) are not advised to get their AMH count as the results would always be lower than if they were not on birth control.Is that correct? What are some of the preconditions that should be true prior to getting AMH count tested?

Rae79·Jun 25, 2022

I know we are past the deadline for this. But on the topic of Roe v. Wade: I've already frozen my eggs. Given the new dangers of being pregnant in the US, could I take steps such as having my tubes tied or having a hysterectomy, and then use surrogates to carry any children I would want to have?

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