Dr. Philip Chenette, Pacific Fertility San Francisco, is a past recipient of the American Fertility Association’s (AFA) Family Building Award. He is an Assistant Clinical Professor with the Volunteer Clinical Faculty (VCF) in Obstetrics, Gynecology, and Reproductive Sciences at the University of California San Francisco (UCSF).
Dr. Chenette has spent the last twenty years specializing in the treatment of patients with complex infertility diagnoses and women over 40. In clinical care he emphasizes Comprehensive Chromosome Screening (CCS) to minimize the risk of chromosomal disorders like Downs’ Syndrome and to maximize success rates while minimizing risk.
Eggsurance Interviews: Dr. Philip Chenette
Q. How long has Pacific Fertility Center been offering egg freezing?
A. More than ten years now. Pacific Fertility Center started egg freezing in 2007. We participated in some of the early technology development with Irvine Scientific. As there is a fairly steep learning curve for an embryology lab, we took our time establishing the safety and effectiveness of the procedure.
In the last few years, egg freezing has expanded and changed much of what we do. We are helping women manage their reproductive lives today. Not just curing infertility, but helping women balance the challenges they face in education, career, and family.
Q. What is the optimal age for egg freezing?
A. The earlier the better for egg freezing. We would welcome women age 25 – at completion of education and professional training. Our research on the genetics of eggs and embryos shows that women, on average, will yield about 7 healthy embryos at age 25 per freezing cycle. That number drops down to 3 healthy embryos at age 35. So, there is a significant drop in the quality of eggs over that 10 year period.
At PFC, we don’t have an age limit on egg freezing as we individualize our treatment. For example, a 40 year old with a high antral follicle count and healthy ovaries might find it reasonable to give egg freezing a try. There is no question though in younger woman outcomes will be better.
Women have choices to make. Talking with an expert, and developing a fertility-life plan, are important steps. The earlier you think this through and decide how you want to manage your fertility the better.
Q. Do you think it is better to freeze eggs or embryos?
A. I go back to the Italian data that shows that there is no difference between freezing eggs and embryos.
For most women there is not really a choice. It comes down to the presence of a male sperm source. If you have a sperm source that is going to be the father of your children then embryo freezing is a proven option. We have lots of data on the outcomes of embryo freezing. Prior to embryo freezing we recommend Comprehensive Chromosome Screening (CCS) to make sure that the embryos stored are healthy. CCS screened embryos yield very high pregnancy rates.
The more common situation is that there is no sperm source, no partner, or a recent break-up, in which case egg freezing is the best route. You can go into egg freezing with confidence because the best data show egg freezing works just as well as embryo freezing.
Egg freezing retains that flexibility to make a decision on the sperm source sometime in the future.
Q. The ASRM removed egg freezing’s “experimental” label in 2012, how do you think this will affect the future of egg freezing?
A. We welcomed the removal of the experimental label. The data is pretty clear that egg freezing is effective and safe; ASRM has moved to align its statements with that.
Professional guidelines are important, but they are just that, guidelines. Doctors always need to think in the best interest of their patients – we need to make the choices that are right for them in their lives. Fertility preservation is a great way to reduce the risk of age related fertility problems. It’s the right thing to do.
A professional society is always going to be cautious and look for long-term study. While professional guidelines are important ultimately you need to make decisions with your own doctor. With egg freezing the research and technology moved so fast that it took awhile for the ASRM to catch up.
Q. PFC has the first frozen egg bank in Northern California, how do you think egg banking will impact the future of assisted reproductive medicine?
A.Egg banking has opened up options and improved flexibility. With egg banking we can be much more efficient in our use of eggs. For example, a woman who decides to use donor eggs to conceive can use frozen eggs, rather than having an individual donor. She can choose just what she needs.
With frozen eggs, the cost of oocyte donation is going to come down. Right now egg banking is limited by donor selection, but I think that is going to change soon with a much broader selection of donors. Only good things will happen. Clearly egg banking is the wave of the future in the egg donation world.
Q. What is the one thing you would like to tell women about egg freezing?
A. Fertility treatments today are about helping women manage their reproductive lives.
What I mean by that is that there are all kinds of pressures to delay reproduction – pressures of work, school, raising a family, establishing a career… and pursuing those is completely contrary to the dictates of biology. Biology is really saying that we should have our kids when we are young. Social progress has pushed us into a very uncomfortable position with regards to our reproductive lives. This conflict between biology and society creates pressures that must be resolved.
So how to you achieve your goals? How do you complete your education, establish a career, and have a family?
There are a number of options today including fertility preservation, egg freezing, fertility therapy including CCS. Women have choices to make. Talking with an expert, and developing a fertility-life plan, are important steps. The earlier you think this through and decide how you want to manage your fertility the better.