The Food Medic - S10 Ep 10 Everything you need to know about Egg freezing

Episode Date: December 4, 2023

In this episode Dr Hazel is joined by Dr John Kennedy, an O&G doctor who qualified from University College Dublin in 2000.  He has been working exclusively in fertility medicine since 2013 and is the clinical lead at Thérapie Fertility Clinic, with his expert team who have helped intended parents in Ireland to build their familiesThis episode covers: Reasons someone might freeze their eggs What is the best age to do it and is there an age cut off? Benefits of freezing embryos over eggs? Success rates with egg freezing Cost of egg freezing What practically happens (stimulation med’s and collection day) Should you check you AMH if you’re considering egg freezing? Interested in more content like this? Check out www.thefoodmedic.co.uk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello everyone and welcome back to the Food Medic podcast. I'm your host Dr Hazel. I'm a medical doctor, nutritionist, PT, author and founder of The Food Medic. It's our final episode of the season. I hope you've enjoyed it and if you have please do let us know by leaving a comment, rating and a review because it really does help. Today we are chatting about egg freezing with my very own fertility doctor. For those of you who don't know, earlier this year I froze my eggs and shared my journey on social media but naturally it opened up a bigger conversation and sparked more questions and I just thought let's just dedicate an episode to this and have a big conversation. If I'm honest I wasn't sure if I should share my experience but going through the process was so eye-opening, emotional, physically challenging in ways I didn't expect despite my

medical background and I wish I knew what to expect before I started this process. I also realise I'm extremely privileged to do this at a choice and that's not lost on me. I wish the access to fertility treatments was available to everyone. And I really have deep appreciation for people who are going through cycles of this because it's not easy. But I hope that sharing my experience has been helpful and makes you feel more informed about your own choices and what to expect if you go on this journey yourself. So today I'm joined by Dr John Kennedy, an Obzengani doctor who qualified from the University College Dublin in 2000. He's been working exclusively in fertility medicine since 2013 and is the clinical lead at Therapy Fertility Clinic

with his expert team who have helped intended parents in Ireland to build their families. I would like to disclose that I paid in full for my own treatment and was later interviewed by Therapy about my experience so you can find that on their podcast if you want to hear about my experience from the start to finish. Dr John, welcome to the Food Medic podcast. Thank you for having me. It's great to see you again. And for those who don't know you and your background, it would be great to just start there a little bit about you and your area of specialty. My name is Dr. John Kennedy. I'm the Medical Director of Therapy Fertility. We're an IVF clinic that's been open about two

years now. My background is in obstetrics and gynecology, so I qualified back in 2000, worked exclusively in Ops and Gyne by 2012-2013, and then transitioned into fertility treatments. Fertility Clinic, which I've been doing since 2013. Two years ago, we started a new IVF clinic, therapy fertility. We're based in Dublin. We've got satellite units in Limerick and Dundalk. And again, just being committed to transparent, affordable, evidence-based care. And it's been growing since then and it's going well. Thanks. Thanks for the good luck.

Amazing news. And we met because I was one of your patients earlier on this year. I went through my own egg freezing journey and that prompted so much discussion on social media and even amongst my friends and colleagues, which is why I wanted to have this conversation with you and just really share more information about it because I think it's not something that's really widely known, understood. There's lots of questions. So if we could just start from the beginning, what is egg freezing and who might decide to freeze their eggs? With respect to egg freezing, the idea is that as we get older, the quality and quantity of our eggs decline.

Averaging age, people run out of eggs at about 44 years old. By freezing eggs at a younger age, ideally under 34, but there's flexibility in that, you're preserving those eggs in time. And if you do run into problems later on, you have a plan B. People sometimes say insurance policy against future subfertility. I'm a little bit hesitant of that terminology. I think it has a tendency to over-promise and under-deliver. But certainly what you're trying to do is protect yourself against the possibility of future subfertility without alternatives. And who are the type of people who, or what are some of the common reasons why someone decides to freeze their eggs? It's very funny because I think this is something that's been growing a lot recently.

And your own journey, I think, would reflect this. The people who are most likely to freeze eggs are people who've heard that other people have frozen eggs. That's what tends to drive it through. true. But the cohort you're trying to appeal to are people in their very late 20s or early 30s who know for a fact that they don't want to have children for the next few years. They might not be certain they ever want to have children, but they are very much aware that who they will be in seven years' time might be very different to who they were seven years ago, and they want to kind of preserve their options. that's the cohort that i would ideally appeal to i think look i've been beating this drum for years i think fertility testing not necessarily

doing anything about it not necessarily freezing eggs is really critical and should be undertaken by everybody in their 20s i think everybody should have have an AMH. And if it's normal, off you go. You don't need to do anything else. If it's low, or if there's other issues with it, then it should spark a conversation about how important is this to you? What do you want to do to protect your options? So I think that knowledge is empowering. I think it gives women options. It gives them an agency and control over their reproductive potential. But it has to start early. And I think even if it comes to things like egg freezing and certainly when it comes to things like fertility treatment, the one common thread that tends to go through from people is that I wish I'd done this a bit earlier. Now, there is too young.

Don't get me wrong. If somebody comes along and they're 25 years old and everything's perfect,'m saying i want to freeze my eggs now and that's never a reason to i'm probably going to tell them to hold off and maybe check the amh they don't need to you know because there's no i'm not going to be any substantial drop in the quality of their eggs but if they're in their 30s different story yeah let's just quickly circle back to AMH for those listening who may not have heard of this test. And also I think sometimes it can be interpreted as egg quality, which isn't necessarily true. So let's kind of just describe what this test is and what it tells us. So it's a blood test. AMH stands for anti-malarian hormone. This is a protein produced by the ovaries.

And the idea is it tells us about the ovarian reserve. It gives you an idea of how many apples are left in the barrel. You're absolutely correct. It doesn't tell you about the quality of those eggs. There are other factors that give you information on that, but that's a very difficult thing to know. You're also correct in that AMH gets massively misrepresented. When you see it in media, you see it in TV shows, you see your character from some soap opera having a blood test and being told, oh, they're infertile,

that they're generally referring to an AMH and they're doing it all wrong, such is often the case. The AMH will not tell you how likely you are to conceive spontaneously, nor will it tell you if your eggs are any good. It will tell you two things. It will tell you how proactive you need to be about your fertility options, to an extent, it's one of the markers. And the other thing is it tells somebody like me how you might respond in terms of dosages and medications. If you were to do something like egg freezing or you were to do something like IVF, how many eggs could we reasonably expect? And it's a crude marker, even for that, we don't always get it right. It gives you a framework, a jumping off point.

The other thing it generally twins with is a scan of the ovaries. So you do an AMH and then you also do an antral follicle count, which is an internal scan, ultrasound scan, looking at the ovaries. So you do an AMH and then you also do an antral follicle count, which is an internal scan, ultrasound scan, looking at the ovaries and looking at the number of small little follicles that are dotted around the ovaries. And that figure marries with the AMH, again, to give us a more complete picture of what that individual ovarian reserve is. What's interesting about ovarian reserve is it's just a single snapshot in time. So if your ovarian reserve is normal or low or high, and there's various reasons that might be the case, we don't know where that will be in a year. We don't know just because you've done it and it's normal, doesn't mean it's not falling quickly. If it is low, it doesn't mean it'll be catastrophically

low in a year. It might just be trundling along in a relatively straight line. So how AMH behaves over a woman's lifetime is not completely understood. And this is an area of medicine that we're exploring at the moment, I think. What should an AMH of an 18-year-old be? What should it be in a 25-year-old, in a 30, in a 35, in a 40-year-old? And when you look at some of the results that are published by the labs, the ranges are crazy. They're like 34 and normal amh is anywhere between 5 and 80 like that it makes no sense to me at all that's that's

bananas so we're kind of trying to tighten all that up what should it be relative to where you are as an individual yeah what's so important from what you've just said is how it's one test not taken in isolation but in the context of all of these other tests because that was the first investigation that I did as part of my workup with therapy fertility and my levels were very low which was something that did shock me and also make me go into a slight panic but after speaking to you and we did all of the rest of the investigations and pooled it all together and looked at it and you explained to me these are all the factors that we need to consider I was a lot more reassured and also didn't feel like this this particular blood test meant I was going to be destined for infertility. But because what I've

seen, though, is that you can get these AMH testing done in kind of postal labs, you don't speak to a doctor, and you just get a letter through the post. And that's what I got, which said low ovarian reserve. And then, you know, I'm a a doctor myself so i can reach out to colleagues and ask their opinion but if you're someone who doesn't have that support it can be quite shocking so i think yeah a really really important message for any women going through this is do not panic based on your amh level and and consult with a health professional and it doesn't mean that you're destined for you know infertility far from it i think the critical distinction is that amh the blood test is not a diagnostic test it's a screening tool it really is just a first jumping off point into the conversation about

an individual's fertility potential and there's so many more factors which are probably more relevant there are people getting pregnant all the time with critically low ovarian reserves they're just firing at an egg every month and and giving themselves a pregnancy shot so it you you're completely correct and especially with the rise of microcapillary testing and home kits and things like this you can be left bereft i think there needs to be a general education piece around this that I see kind of living in the same space almost as cervical screening. I think women are now very educated as to the benefits, the reasons for doing cervical screening and things like that. I'd love to see the same kind of thing happen to the same extent with AMH, where there isn't the

level of panic. I had a smear test and it's a little bit abnormal. That doesn't mean you've got cancer. That doesn't mean you're going to get cancer. In fact, it means you're not. Great news, you know? So I'd love to see that same kind of dialogue happening around fertility screening. Yeah, absolutely. I think the age kind of conversation is so interesting, because for myself, just kind of reflecting on my own experience it wasn't until the last few years that I started thinking about egg freezing and it wasn't until the last few years that I could afford egg freezing and I think there's a bit of a juxtaposition there because you know a lot of women aren't really thinking about it until late into their 30s when potentially they should have done it a little bit earlier.

So what is really the age range that you would like accept up to what point? I mean, that's a really tough question because everybody, you're really talking about individualized care. So I'm not going to turn people away, but certainly if you're the other side of 40, the chances of success with the frozen eggs are greatly reduced and you have to have that conversation. So irrespective of a woman's age, results, and history, when it comes to something like egg freezing, there are two and really only two critical questions that you need to ask and answer to the best of your knowledge before you undertake it. The first is, how many eggs do you think we're going to get? And we base that answer on things like the AMH and the

antral follicle count, the scan and the blood test. The second question is, are these eggs any good? That's a much harder question to answer because the way you determine if an egg is good is you try to turn it to an embryo in a person. And you're not doing that. You're holding those eggs in time. So there's a couple of things that somebody might have in their medical history, like endometriosis or something like that, which could have an impact on the number. But broadly speaking, we base the likelihood of a live birth from an egg on the woman's age when that egg was frozen. And that's where age comes into it. These are crude numbers I'm going to give you now. They're very crude numbers, but

they're not entirely without value. If you're under the age of 34, we think that each egg you freeze has about a 3.5% chance of turning into a baby. It's a number that always rocks people back on their heels. It's a shockingly low number, but it's reflective of the fact that we as human beings aren't particularly fertile creatures. We're not fecund. We don't have litters multiple times every year. So that's always a lower number than people think.

Now, you've got to look at that not just in isolation. 3.5%, that's per egg. If you have 10 eggs frozen, that's always a lower number than people think. Now, you've got to look at that not just in isolation. 3.5%, that's per egg. If you have 10 eggs frozen, that's 35%. If you have 20 eggs frozen, that's 70%. Those numbers start to look a little bit better. But as you get older, that 3.5% drops. And at 40 years old, we think roughly, in the absence of other information, that number probably sitting at around 1%.

And that doesn't seem to some people like a big drop, but it is. 10 eggs at 3.5% is 35%. 10 eggs at 1% is 10%. So that's a big gap there. So when you're talking to somebody about the relative merits of egg freezing, they're the two questions you have to try to answer for them. And if you've got a 42-year-old woman who's got an AMH of three, you're going to tell her, we're going to get maybe two eggs from you per cycle. And we think the value of each egg is about 0.3 to 0.4%. So each time you do a round of egg freezing, you're going to have a less than 1% chance of having a baby from that cycle. That's a hill to climb. Are you sure this is something you want to do? And I think it's one of the traps in egg freezing is that people believe, well, I'm better off having one egg frozen than no egg frozen. While that might be technically or mathematically correct,

if it's probably not correct enough to justify the financial, physical, and emotional implications of going through all of this. So again, it's not our job to tell people what to want or what to do, but we need to make sure they have a very, very clear understanding of their challenges. Do we think we're going to be able to get across the line and get an over 50% chance of the baby in one cycle, two cycles, three cycles. And I would have had plenty of younger patients who had low ovarian reserves who would do multiple cycles, but they knew at the front end that that's what it was going to take. So it's all great. It's when people get talking, I'll just do it once and see how I get on. That's

fine. But if we know with a high degree of certainty that you're going to get very low numbers, then you do it once and you only have two eggs frozen, and then you don't do it again, is that really hope? And it's something I struggle with a little bit because you want to try to help people, of course, but you sometimes have to kind of check their expectations a little bit and especially when people get older. So if somebody somebody's older they're looking at egg freezing you need to

have a kind of a more of a frank conversation about it look why are you freezing your eggs how important is having a family to you and the thought exercise which i hate saying i almost shouldn't say today is if you were told and this isn't the case but if you were told um you only had a year to have a baby what would you do you know and i'm not saying that that's all that's ever the case for people but it's a really good thought exercise to kind of focus focus the mind for people who can freeze out but maybe are not optimal candidates i think i was one of those people who was shocked by that stat the 3.5 percent And I remember sitting in your office when

you were kind of explaining to me and how at each stage of the process, it also changes kind of the probability because, you know, you want to stimulate X amount of follicles and then you collect of those follicles only X amount of eggs and then of those eggs only x amount of are mature and then you end up with this really small pool of eggs that are going to be frozen in the end and then of those eggs which which ones will actually be used as embryos and so at each stage of the process i was like oh my gosh like i think it's so important to to kind of really remind people that it's not a guaranteed pregnancy at the end and it increases your probability by having that there but I do agree that you can't say it's an absolute insurance policy I know and that you really hit on something there and how much work and time and effort you're going to have to put into it and what you're going to get out of

it these are really really important conversations to have and that's what we're trying to do we're trying to demystify i think we've done a really good job uh in the last few years there's been a lot of dialogue on fertility testing on egg freezing awareness i think that's better than it's ever been before where i think we've done a really terrible job is on the challenges associated with egg freezing so i would have had people even like a couple of months back somebody came in they had a consult we gave them loads of information and then they were booked in to see me just for a medical review before we go ahead and they reached out and asked oh when I see Dr. Kennedy is that the day they take the eggs like oh we've got some work to do here you know there's a huge disconnect between this

is not getting a pedicure this is this proper this is meds you know we're stimulating ovaries we're giving injections this is not easy i think it's worthwhile i think it's certainly good to look at but it's not easy no i agree with you and i think you know going through the process when you get all of your stimulation medication arriving on that first day which is going to do you for the next couple of weeks it can be quite overwhelming especially if you're not like okay with needles and and kind of dealing with medications I mean it does absolutely get easier and you kind of fall into a routine. But I think I was a bit taken aback on that first day when I received all that medication. So I'm really glad that you brought that up.

One of the questions that some people have asked me, and I think i did ask you in the beginning was what would be the value in freezing embryos over freezing eggs at this stage yes yeah so this is on the kind of go all day on this so when you freeze eggs the first hit you're going to take is at the far end is at the tall survival rate we think 80 to 90 percent of the eggs will survive the fall well our numbers in fact are a little bit higher than that. But you always try to under-promise and over-deliver. So we say 80 to 90% of the eggs will survive the thawing process. With embryos, which are frozen after five days, that number is over 99%.

So straightaway, freezing embryos, embryos are more robust than eggs. They're less delicate. So they can cope with the freezing and thawing process more easily. So that's straight away a success rate differential. The other thing, of course, is that if I have 10 eggs, and I've quoted a 35% chance of having a baby with those 10 eggs, that's a very crude and unprocessed number. If I can turn those 10 eggs into three embryos, that 35% suddenly turns into 60%. But if those 10 eggs turn into zero embryos, it's zero. So by taking the eggs, fertilizing them with sperm and growing them out and then freezing them five or six days later, you've proven, you've made those embryos

and embryos undergo a test, a qualitative test, a quality test. So you get a much better idea. Still no certainty, but you get a much better idea of the value of what you have frozen. That's the upside. The downside, of course, is twofold. One, it's much more expensive because, and it's much more expensive because you're doing way more work. Now, those costs even out. You can either freeze eggs and then turn them into embryos later on that'll all come out or you freeze embryos and then use them later on and that will all more or less even out of the wash but the other problem of course is what are you preserving you preserve are you preserving your fertility as an individual are you preserving

your opportunity to be in a relationship down the line with somebody? And if you're a heterosexual female, the idea of freezing eggs is that you are going to hopefully embark on a relationship. And if you have embryos frozen, then that guy might be entitled to feel a certain way about it. Well, I'm not involved in those embryos, so I don't want to use them. Equally, and this was something that I had a little come to clarity moment, even if you're gay or you're a lesbian and you know you're going to be, you might say, oh, I'll just freeze embryos. But then your prospective partner isn't involved in the selection of the donor sperm.

And that's not a small thing either. That's a real thing that you should be doing as a couple. So it depends what you want to preserve do you know for a fact that you want to have children down the line and you don't care at all about the social logistics of that or are you hoping to preserve your fertility so that you can embark on a meaningful relationship down the line and have a child with that partner. And these are things to think about. So many factors to consider. Before we move forward, I think it would be really helpful to just talk logistically and practically about the actual process, because there are lots of different stages to your initial consultation, the workup, the treatment

process, egg collection, recovery. If we could just do like a little timeline and what to expect. Yeah, yeah. Oh yeah, just knock that out. It's two minutes. So you have your nurse consultation, you do your testing, and then you have your medical review. You get your information on how many eggs we think we're going to get, and you decide I want to embark on this. The next thing generally you'll have to do is you'll have to do HIV hepatitis B and hepatitis C screening. It's a legal requirement. It has to be done here. It has to be done within 90 days of the egg retrieval. This is to protect everybody else from you, and we do it on everybody else to protect you from them. That way we know the eggs and embryos that we're storing in the laboratory don't have any risk of

infectious diseases. After that, then you need to get your schedule together. And generally speaking, there's loads of different ways of managing cycles, but generally speaking, you will start tablets a week before the bleed that you want to start your stimulation cycle on. Okay, so about a week before that, you start on estrogen tablets. The way we work here is very kind of structured and process driven. You then get a bleed. You will then start on injections, your stimulation injections. One injection a day going to two injections a day.

They will start on a Friday. Your first scan is seven days later, the following Friday. You keep going, we analyze that, then we bring you back for another scan three days later on the Monday. So at that point, you've had 10 days of stimulation injections. On that scan, we might also check some hormone bloods and we'll see how many follicles, the size and number of follicles that you have. And then we will make a determination as to whether or not you are ready for egg collection on the Wednesday or Thursday of that week, or if we need to re-scan you with a view to egg collection Thursday or Friday, if the follicles need an extra day or two of growth you take a trigger injection a critical injection that is to be timed very very exactly we perform

the egg collection 36 and a half hours after the trigger so we're really really precise about these things and you'll remember this from coming in if you're coming in a very specific time and oftentimes I'll be a bit ahead of myself I'd love to bring somebody in earlier but it's not the right time to do it you've got to wait the five minutes or the ten minutes everything is very regimented the egg collection itself is done under conscious sedation and this is something else that there's a lot of misinformation around this is not a general anesthetic there's no machine breathing for you there's no tube in your throat or anything like that. You're given a combination of midazolam and morphine. And

what that does is make you drowsy. It stops you laying down memory. And most people doze through the egg collection and don't remember anything afterwards. Some people can find it a little bit uncomfortable. We try to be as transparent as possible about how egg collections can be a little bit uncomfortable um but it takes everybody differently how did you find your egg collection i just remember he gave me the midazolam and then i was out i was just i was just asleep uh dozing away and then they said hazel the procedure's over now and you can wake up and they were wheeling me back out and i was very tearful afterwards which i'm told is quite common kind of just when you're you know they reverse the anesthesia or not the anesthesia but the sedation

and i was just a little bit tearful but the actual procedure brought me no pain whatsoever the days afterwards i had some tenderness but um it was a lot less painful than i expected and that's fantastic and i think we always want that to be the case but it's not always the case and i think it's it's another perfect example of making sure that you're very clear with the person this isn't uh a general anaesthetic and i think response to sedation is hugely a function of what that person brings into the room with them. And the more you can find your happy place, you know, and be relaxed. I've seen people fight through sedation over the years. And you can see them.

They're ramping up their cortisol, ramping up their adrenaline. And you get through the procedure as best you can. And then as soon as it's finished, bang, they're out. And they're gone for the next 12 hours you know so if you can and it's a very unfair thing to ask somebody to be relaxed at a very very stressful time but there's there's things you can do like it's crazy i've got a spotify playlist you know um there's things you can do to try to make it a more relaxed environment you can be kind you can treat people like they're human beings. And I think that vocal local, as we call it, sometimes in medicine,

that conversation just to kind of de-stress people who are very high frequency when they come into a procedure room to have something like this done, you can take a lot of that anxiety out of it with a kind word. Yeah. And the staff were amazing, the nurses especially. I think it's just an Irish thing maybe, but they were just cracking the jokes and making me laugh afterwards and making sure I had a cup of tea and a biscuit, which I was loving after having to fast for the procedure. the egg collection later that day i think it was that day i got an email then to from the lab to say how many were mature and able to freeze which i was so surprised with the quick turnaround but then kind of what should people expect in the recovery period how long do you need off work

exercise so generally speaking with the type of triggers and medications we use your response and reaction to the medication won't be as bad as you think it will be that's by far and away the most common piece of feedback we get you will feel bloated and swollen for the two days before the egg retrieval and you feel will feel bloated and swollen for the two days after the egg retrieval they're the four baddish days, you know, where you're bloated and swollen and uncomfortable. What we generally find, especially if we're using the type of triggers which switch everything off pretty quickly, is that if you have your egg

retrieval on Wednesday, Wednesday you'll be uncomfortable, Thursday you'll be uncomfortable, Friday you'll start to feel a bit better, and Saturday you'll feel so much better. But three days after the egg retrieval, you're almost back to yourself. That's what people tend to report. And your bleed, your period can often come on a little bit faster than you would maybe within seven to 10 days of the procedure itself. So you'll definitely need one or two days off work, one for the egg retrieval itself. I generally recommend taking at least one day off afterwards. After that, I think it's a bit individualized again. I think it depends what you do for a living. Are you working on the wards? Are you working in a hospital? That's good. Are you doing some kind of hybrid thing where you can work from home and get online for a few hours and cover eight days work? Because again, you have to

understand that for the vast majority of people I'm looking after in this space, these are professional women looking to hold down jobs. They don't want to take a whole bunch of time off work to do this. And if they don't have to, and there's several ways of doing that, then you can get away with it. Return to exercise, return to things like that. Generally, four, five, six days after the egg retrieval, you should start feeling very much more like yourself and you can start to get back into it. I think like I would definitely agree with that timeline it was maybe three days of tenderness and bloating I don't know what I was thinking trying to fit into my normal jeans but that was just out the window definitely just wear sweatpants for a few days but one thing I found and I don't know if this was just maybe me like an emotional release after the procedure or what it does is, it's called

Bucerulin or Superfect. It uses the tank of FSH and LH that's in your head and it empties that egg. So that FSH on that LH is what matures the eggs and just before they release them, we capture them. What that also does is just for about a week, it runs that tank empty. So it drops your estrogen, drops your progesterone. Now, that's great because it allows the ovaries to recover that much faster and that bloating goes down much, much faster. The downside is that it leaves you in what's called a hypo or low estrogenic state. It's a very temporary and very artificial and very temporary and very temporary menopause. And that's why people become tearful and that's why it can be i mean there's other reasons you've just gone through

a lot you know yeah for a lot of people that there's other factors but the pure hormonal physiology of it that's why that explains a lot um and also validates why i was feeling that way one of the kind of the other conversations which we briefly touched on is the cost of egg freezing. And when I was doing my research, it just seems to be across the world, there's such extremes of costs. Like in America, it's obscene, the costs that people have to pay. And I just really, my heart goes out to people who have no choice but to pay that um what is the average cost that people maybe would expect in the UK and Ireland it's tough for me to speak to averages I can certainly tell you what we're doing I know

America is 10 to 20 grand for a cycle of equities you know uh which strikes me as being bananas I don't know how they're coming I genuinely don't know how they're coming up with that number. Whenever I've asked anybody in the field, they're like, oh, you know, cost of living and salaries. Come on, man, that doesn't make any sense. Generally speaking, egg freezing is somewhere between 3,000 and 4,000 euro per cycle, I think. But again, that's all there.

Then there's us. And what we wanted to do is we wanted to make this accessible we wanted to make this available we want to make this affordable so our out freezing i think is two three two thousand three hundred for the cycle if you then do have to do a subsequent cycle it's cheaper the second cycle is just under two thousand euro that's the first because a lot of people will need more than one cycle. So how much money do you have to put aside to do this realistically is a conversation you need to have before

you even get into it. And that comes with the consultation and the results. After that, then you have to start thinking about the storage fees. And again, a lot of clinics are operating on a yearly every year you're getting this invoice. It's a bit of a pain in the ass, to be quite honest.

We're trying to model it much more on a kind of a subscription kind of thing. So we charge 18 euro per month to store these eggs. And as you add more eggs to the pool, we don't charge more. It stays at 18 euro per month. Now, I reserve the right to change my mind about that in the future, because we are getting hosed with some people who've got loads of eggs frozen and that's great it's great for them you know but you have to look at these models but you're but it means that the month you stop storing those eggs that's the month you stop paying for them you're not going to pay an extra year just because you happen to be on the wrong side of it you with me so yeah

we're trying to be really transparent about what these costs are up front, what you might be able to expect from the whole process. In Ireland, for people in the Republic, we have the advantage of what's called the DPS card, the Drugs Payment System card, and that covers most of the cost, most, about 90% of the cost of the medications. And that's great. And in Ireland, we also have a reimbursement system that if you pay for private medical expenses you can claim that back i think at 20 tax rate so you get 20 of everything you spend back so if you spent 5 000 euro for pick a nice random number uh on medical care you get a thousand that back at the end of the year so it's it's not like we have just

introduced public funding for fertility but it's not like we have just introduced public funding for fertility but it's not gonna go anywhere near egg freezing not for a long time yet i think and i mean i imagine it's the same in ireland as it is with the nhs where if you have a specific medical reason i.e you're undergoing um oncology treatment for example, you can have free egg freezing and egg fertility or egg preserving treatment. There is, but there's only one centre in the country doing that and they're a little bit overloaded. I would love to see a much more nationalised structure on that too.

But yes, it does exist. Dr John, before we finish, what's something that you wish you could tell everyone who are considering freezing their eggs? Get your AMH checked. Get your AMH checked. Get your AMH checked. Get your AMH checked. Take the result, just as we said, with a pinch of salt. It's not the be-all, end-all, but it's a really, really good starting point to tell you if you need to get more information. And that's what I've been advocating

for for years, and that's what I want to see happen. I do want to see more people to be considerate of egg freezing. I do want to see that in the context of more people being considerate just about their fertility in general. As I said, nobody ever goes through fertility without saying, I wish I'd started. It's just the common thread. And I'm biased. All I see day in, day out is couples and women struggling to conceive. So my brain's fried for that. I know, I don't see the world through the same lens as everybody else at this point. But really just fertility awareness, get the information. I think there's a fear when it comes to egg freezing that we're looking to exploit fear or exploit vulnerability or get people to do something they don't need to do. That's not it at all. Genuinely come in, get the information, get the real, transparent, honest information and then make an informed decision.

At that point, whatever these people decide to do is the right thing to do. Of course it is, you know, but it is about ownership, agency and awareness. That's all I care about, really. Absolutely. Finally, I've got three questions for you that we ask all our guests. It's just a bit of fun. The the first is if you had an extra hour in the day what would you do the safe answer is i'd like to spend it with my wife and family but in which i love very much honestly i know already what the answer is i'd work um work i know i'm very fortunate i i struggle to find anybody i've met who enjoys their job more than I do. I love my job and I throw myself

into it. And if you give me extra hours, I'd probably just kind of see some patients, do some work. It's kind of sad. I get that. I get that it's sad, but you know, whatever. Least himself away. A little promo for fertility medicine for any medics thinking about. Oh, well, I mean, you know, yeah, absolutely. 100 100 if you're going to a desert island what are three things you're taking with you design three things um kindle oh no electricity okay books uh a book a library some some manner of large book don't think i'd be able to get by without reading that's an absolute de-stressor for me. I'm a fidget. I'm a little ADD kid, I think, you know, at heart.

So something probably to fidget with. I'm not going to try to game the system and try to find something that gets me off the island. Don't mind my own company so much over shorter periods of time. Yeah, yeah, I think just literature, reading, something to do with that place, I think I'd be quite happy. Good. And finally, what's one thing that you're grateful for today? Today? Today was a good day. I got a lovely piece of feedback from somebody who went through egg freezing who is trans. So they're freezing eggs and then transitioning from female to male.

And they gave just a lovely piece of feedback through the portal. And I found it personally very, very effective because it's a topic that's very close to my heart. And to know that you're delivering kind care to scared people who are able to go through it because you're being kind not just me but the whole team I'm profoundly grateful to have that opportunity that's a lovely a lovely note to finish on well thank you Dr John for your time today this has been such a great conversation and i'm excited to hear everyone's thoughts on it and if they want to find more about you therapy clinic is on online and also instagram as well yeah thank you amazing thank you that's all from me but before

you go i've got a little favor to ask you and that is to please leave us a review and rating and to share this episode with someone you know will love it too. See you next time.