Everything You Need to Know About Putting Your Fertility on Ice with Dr. Julie Lamb

Today, I have one of my dearest friends and one of the most famous fertility doctors in the world here for an interview, Dr. Julie Lamb. She’s here to talk about her recent publication, The Fertility Experts’ Guide to Egg Freezing: Everything You Need to Know About Putting Your Fertility on Ice.

Dr. Lamb is a board certified reproductive endocrinology and infertility specialist at Pacific Northwest Fertility in Seattle. She graduated top of her medical school class at one of the finest universities, Northwestern Fienberg School of Medicine in Chicago. She was awarded a Fulbright Scholarship to study international women’s health in Zimbabwe. She then completed her OBGYN residency at University of Washington in Seattle and did her fellowship at UCSF. She is clinical faculty at University of Washington and directs the REI training program for OBGYN residents and is the director of The Center for Fertility Preservation at Pacific Northwest Fertility.

Dr. Aimee: Welcome, Julie. Every single person out there who is thinking about freezing their eggs needs to get this book from the very start.

Dr. Julie Lamb: Thank you so much for having me, Aimee. Yes. The information in this book is what I tell patients every day, so to have it at their fingertips is great. There’s so much information, it’s nice to be able to approach it at your own pace.

Dr. Aimee: Tell us why did you write this book?

Dr. Julie Lamb: I wrote this book because I feel like I have so many smart egg freezing patients and there is just so much information out there and it’s really hard to piece it together from Google, so to give them a resource that I know is evidence-based and exactly how I would answer their questions. It’s a resource I wanted for my own patients.

Dr. Aimee: What is egg freezing? Is it just something where you crack an egg outside when it’s really cold and then the egg is frozen? I know, I’m just being silly. But what is it?

Dr. Julie Lamb: I love it. Actually, when I Google egg freezing, sometimes it comes up with frozen chicken eggs, it’s hilarious.

Egg Freezing is a way to take charge of your fertility, and save your younger eggs in case you need help conceiving in the future. It’s certainly not for everybody. In the book, I give the 411 on what to consider when you’re thinking about preserving your fertility.

We spend our lives planning for our financial futures, but no one tells you to plan for your fertility future. I think it’s such an important conversation and I’m hoping to remove some stigma around the discussion so patients can be empowered to learn about their bodies.

Dr. Aimee: How can fertility preservation help people?

Dr. Julie Lamb: Even though we look young and feel young, the eggs are not as young as we feel and not as healthy as we are. Just because you look young and you’re super healthy, at 40 as many as 80% of the eggs are abnormal, and as many as half the patients, as you know, have difficulty conceiving by 40. Because of those challenges, you can preserve your fertility earlier for the chance that you might need it in the future.

Essentially, if I see somebody in their early to mid 40s that doesn’t have eggs left or isn’t being successful with their own eggs, we will consider the eggs from a younger person or donor. It’s often somebody that they’re not related to. Egg freezing allows you to essentially serve as your own donor in case your eggs aren’t working when you’re ready to use them, so they’re frozen in time. The ovaries age, but the uterus is just as young as you feel, so they’re waiting for you in case you need them in the future.

Dr. Aimee: I love how you phrase that. For those that don’t know, Pacific Northwest Fertility has one of the most successful egg banks in the country, if not the world. What that means is they kind of know how to freeze eggs really well.

For someone looking to freeze their eggs, how do you choose the right clinic? How do you know that your clinic is top notch when it comes to egg freezing?

Dr. Julie Lamb: That is such an important conversation and I think it’s something that often goes not discussed. I think there are a lot of places to freeze your eggs and a lot of people that are willing to do it for you, but you really have to educate yourself on what’s behind the scenes at the embryology lab where they’re keeping your eggs or freezing your eggs. Do they know how to unfreeze those eggs and make them into embryos? That’s where there’s a lot of diversity in the field and that’s what’s really hard to tell from a website or a podcast.

Learning about that and asking your doctor, not only do you feel comfortable with the doctor, because that is certainly number one, you want to have all of your questions answered, but number two is just asking them what their experiences are with using those eggs and what are the success rates at their clinic and their embryology lab in thawing and making them into embryos and causing pregnancies.

Dr. Aimee: So, I am now picking a clinic and I’m just so confused about what the process is. Can you just run me through the process from start to finish?

Dr. Julie Lamb: Sure. A lot of patients that I meet with come in at all different levels, and there are all sorts of conversations that you can have with patients empowering them to learn about their fertility. If you already know and educate yourself, you’re going to feel smarter when you’re meeting the physician and your team, and you’re going to know the questions to ask.

I think that’s really important, because people that are doing this are all smart, it’s just so outside of the way we think about things. Learning about fertility is tested, what these numbers mean, it’s really important to understand that it doesn’t mean you can get pregnant or not, it just tells you the efficiency of the IVF process and the egg freezing process. Learning a little bit about the process ahead of time helps you really inform yourself, one, to help you decide if it’s right for you, and two, to help you ask the right questions so you don’t feel as overwhelmed. It just makes the process so much easier.

Once you read the book and educate yourself, then you go and meet with the physician or the fertility doctor and you talk about your history. It’s actually really detailed, they want to know all sorts of things about you and your health, prior surgeries, your menstrual cycles, your family history, when your mom had her last baby, all the things that impact your fertility.

Then we talk to you about the testing. That’s when people tend to glaze over, it’s just so much information, it’s hard to interpret and it’s hard to figure out how it applies to you when you’re not even trying to get pregnant.

We talk about the testing. We often do an ultrasound and look at the ovaries, because that’s one of the ways we can tell what’s going on. That’s a transvaginal ultrasound, which can kind of be a little bit scary when you’ve never had that done before, so knowing that that’s coming helps you feel prepared and in control.

Then you learn about the process. I usually meet with the patient and do the history, and then we do the testing. If they haven’t read the book, I send them a copy of the book. We just talk about all the ins and outs and answer their questions. Some people know for sure they want to do it and some people I’ll meet quite a few times with. There’s no right or wrong answer. It’s just figuring out if it’s right for you and not waiting until the success rates decrease. Just informing and empowering yourself so you can figure out the right plan for you.

When you actually start the egg freezing process, which is what you were asking me about, it’s a lot. It’s not fun, it’s not the way you’re hoping to spend your weekends. It’s a series of vaginal ultrasounds and it’s a series of injections that help those ovaries grow, and to optimize the process we follow it with bloodwork and with ultrasounds.

Dr. Julie Lamb at PNWF

Once they’re about the right size, we actually go in. Since you can’t ejaculate your eggs, you have to go in and get them. It’s another big gender inequity, in my opinion. We have to go in and aspirate each little follicle, and with the follicular fluid comes a little egg. That part is uncomfortable, none of us like a needle in our vagina, so you go to sleep for about 10 minutes.

During that process, we get the follicular fluid and the embryologist looks under the microscope and pulls out the eggs. The recovery is super variable. There’s a lot of biological diversity. Some people feel great and go right back to work. Other people feel bloated and uncomfortable for a few days up to even a week.

Then you sit down with your doctor again. With COVID, now we Zoom, which is a lot easier to fit into your busy day at work. We talk about what went well and what we were surprised by, and how did you feel, what did we expect. We just have a conversation about what are your family building goals, how long are you going to wait. We figure out is once enough or do we need to do this again, and how we can optimize the process for that individual. It’s very individualized, and that’s really important.

Dr. Aimee: I’m still stuck on you can’t ejaculate your eggs. I feel that needs to be a t-shirt, a bumper sticker, a baseball cap. It’s so true.

How can you best prepare for egg freezing? You can Google it and there’s so much stuff out there about how to best prepare. How would you tell your patients to best prepare?

Dr. Julie Lamb: I tell patients to learn about their bodies, learn about their fertility, understand it, and make sure they have all their questions answered before they go through the process. I really think that you have to feel like you’re doing everything possible to give you a successful cycle. That helps make the process easier. When you’re less stressed out, it’s not as painful, it’s not as hard. Knowledge is power.

Other things, improving your nutrition, improving your wellbeing. The book talks a little bit about what you can do to clean up your eating and what supplements and vitamins to take, and eliminating alcohol, and just moderating things. A lot of the things we do in our life are probably fine, but you just want to feel like you paid attention. It’s a complicated and expensive process, when it’s out of pocket, and you want to feel like you did everything possible to make it as successful and as easy for you as possible.

Dr. Aimee: Yes. You mentioned one of the important things to do when you’re looking for a clinic is making sure that you feel confident that they can actually thaw your eggs. When you’re ready to conceive, what actually happens then when you’re ready to use your eggs?

Dr. Julie Lamb: I have patients come back and see me when they’re ready to talk about using their eggs. We have that preconceptual consultation and we talk about the age that they froze their eggs, the age that they are now, what their family building goal is, we look at the sperm of their partner, or oftentimes women are doing this on their own with donor sperm or with a female partner. All of those things play into the decision about when to use the eggs and when to optimize natural fertility.

If I have a patient that froze her eggs at 33 and now she’s 35, she might have a very good chance of conceiving on her own and be able to save those eggs for a second or third child. So, it’s always a super individualized conversation. If they froze them at 38 and now they’re 43, then it just doesn’t make sense, they’re so much more successful to use the eggs at a younger age. We make them into embryos and plan the next steps together.

Dr. Aimee: Perfect. Do you have any special tips for women so they can get ahead of infertility or stay ahead of it?

Dr. Julie Lamb: I think the number one tip I have is just learning about it, learning what an AMH is, learning about the fertility window. I see so many people that feel young and are healthy and it just isn’t successful for them in their early to mid 40s. Planning for it and learning about it before you need it, I think, is key. Even if you’re not ready to freeze your eggs, if you’re 35 and not ready to have a family, learning about how your fertility changes with age so you can plan your future family around that is my biggest tip.

It’s just very empowering and helpful for the future. There’s no right answer. Certainly, not everyone should freeze their eggs, but it’s nice to have that option. I even have patients that will go out and get a job and do it a year later so that it’s covered by insurance. Just having that information — who covers this, would I want to do this, I don’t want them to try for five more years and say “I didn’t realize that it’s hard to get pregnant at 40’ — having that information so that you can make more informed decisions for yourself is important.

Dr. Aimee: I think a lot of times people are just scared about what’s going to happen them, if it’s going to cause cancer, it’s going to make them feel super bloated. What can people expect during an egg retrieval and what can they do during the treatment itself to have the best experience?

Dr. Julie Lamb: That’s a great question. We talk a lot about that in the book. What can you do to stay hydrated and stay on top of your symptoms? Certainly, everyone is so different. Understanding that you don’t know how you’re going to feel and giving yourself some grace and some leeway.

Before the pandemic, I used to tell people to quiet their social schedules, not travel as much, and make just more self-care time. Now we all have that, so it’s actually a great time to do this, because no one is traveling on the weekends and no one is traveling for work, and it’s a little bit easier to fit this into your life. Making space for it in your life and not having such a busy work and social schedule I have found very helpful for patients.

I usually tell people that it tends to be less physically demanding and more emotionally demanding than they anticipate. We can help you with the physical part, but doing things to support your emotional wellbeing, whether it’s a therapist, yoga, acupuncture, exercise, really dialing into what supports you the best, all the things that help you tolerate stress. We often tell people to quiet down the exercise, so if you’re a big runner then you need to transition, pivot, and find some other stress reduction mechanism that can help you tolerate the process.

Dr. Aimee: I think having a doctor that you feel a really good connection with, like yourself, is really important. Another thing you mentioned, and I know there is a beautiful chart in the book as well, and you talked about doing a post-egg-freezing consult. How can you tell what the fertility potential of the eggs really is and know if you’ve frozen enough? How do you guide your patients around that question?

Dr. Julie Lamb: That is probably the hardest part in all of this, knowing what the reproductive potential is of the eggs. It’s much easier to predict, it’s much better studied, much more evidence-based to look at the potential of embryos. But when you’re not partnered and you’re not ready to parent, it’s certainly the right thing to do to freeze eggs.

We tend to freeze more than you think you’re going to need. I guess that’s probably the key. There are some tools out there. The Brigham and Women’s Harvard Egg Calculator is based on the current data. I actually extrapolated some of the current papers and put it in a chart in the book just to give people a ballpark, but it’s more important to really make it clear the inefficiencies of the process.

Human biology is more inefficient than most women can ever imagine. It takes more eggs to make a baby. If you freeze 10 eggs, it just doesn’t guarantee a baby. No matter how many eggs you freeze, you’re never going to be 100%. Understanding that it depends on the fertility potential of those eggs that we don’t have a test for, the future sperm that you don’t know yet, and how all of those pieces come together is very different for different patients, so erring on the side of caution.

There are so many things that weigh into how many eggs you want to freeze. Things like how long you’re going to delay. If you’re going to wait until your 45 to conceive, then you need to save a lot more eggs than somebody is going to procreate at 38, and it’s still a renewable resource where we can go and get more eggs if we needed to.

How many kids you want to have, how open you are to other options for family building, there are a lot of beautiful ways to build a family and looking at those, too. If you’re open to if your eggs don’t work using a donated egg or a younger sister’s egg, then you don’t need to save as many as someone who says biological children are so important to them.

All of those things weigh into it. I actually have patients play around with the little egg calculators online just to better understand how age affects it and the number affects the success rate. I think most people are surprised by how low it is. I think the data is building and we’re going to have more information soon.

The clinics and embryology are getting more leveled out in their success rates, we don’t see as big and huge of differences between different clinics that we used to, so I think in general egg freezing is becoming not only more popular but much more successful across the board. Choosing a clinic that’s been doing it for a long time and that uses a great embryology lab that has good success rates is really important in kind of optimizing your success rates.

Dr. Aimee: If you guys know someone who is thinking about freezing their eggs, if you’re thinking about freezing your eggs, you guys have to share this episode with them. And make sure that you guys get this book. It’s a great read. I read it and learned from it, and I tell all of my patients about it.

I love that you’ve created this as a resource for women. Thank you so much for all you’re doing, Julie. Is there anything else that you want to add?

Dr. Julie Lamb: Don’t hesitate to find a doctor you like. I love that you are raising awareness and starting the conversation. There’s not just a magic one person. You have to feel valued and respected and that your questions were answered. The more you know about the process, the more in tune with your body, and you’ll just have a gut feeling if it’s right for you. It’s not that you need to do this, it’s just that you need to learn more about it to figure out if it’s right for you.

Dr. Julie Lamb

Dr. Aimee: Love it. It’s always nice to have eggs on ice.

Dr. Julie Lamb: Yes. Everything you need to know about putting your fertility on ice.

Dr. Aimee: There you go. It’s always nice to have eggs on ice and everything you need to know about putting fertility on ice.

Dr. Julie Lamb: Thank you so much for your help with this book. You’re such an inspiration in everything that I do.

Dr. Aimee: Thank you for tuning in today. I’m going to bring Dr. Lamb on to join us for one of my next egg freezing classes, too. Go to EggWhispererSchool.com to sign up.

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Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com