Dr. Rachel Gerber discusses her path to becoming an OB/GYN and specializing in reproductive endocrinology and explains egg freezing. She and Dr. Fox review why patients choose to freeze eggs, the egg retrieval process, the difference between egg freezing and embryo freezing, and more.
“Egg Freezing: Further Proof That Men Are Useless” – with Dr. Rachel Gerber
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. In “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, I’m here with Dr. Rachel Gerber. How are you doing?
Dr. Gerber: I’m doing great, I’m happy to be here.
Dr. Fox: This is really exciting. Rachel is a reproductive endocrinologist aka a fertility specialist. And you’re at RMA of New York and you are one of the doctors in their Westchester office, correct?
Dr. Gerber: Yes, I see patients on the east side and Westchester.
Dr. Fox: Fantastic. And then we go way back obviously. I’ve known Rachel since she was a young medical child essentially, first year of medical school.
Dr. Gerber: Yes.
Dr. Fox: Unbelievable.
Dr. Gerber: I was so lucky I knew I wanted to do OB the moment I stepped into medical school. And so I shadowed on the labor floor. I met Dr. Barber [SP] your colleague. And he said, “Hey, you know, we’re doing a lot of research and why don’t you come by our office and learn about opportunities?” And that’s where it all began my first year of medical school.
Dr. Fox: Yeah, I remember he came back and he said, “Hey, I found this first-year med student I think I roped her in to do research with us.” And I was like…you know, which is great, you know, we try to recruit. And so Rachel comes and most of the people do research with us are, you know, third-year med students, or residents, or fellows, and Rachel is a first-year med student. Rachel is a force of nature when it comes to research, she just like, totally crushed it. You did a great job so it’s awesome.
Dr. Gerber: Thank you.
Dr. Fox: Yeah, and then we continued research. So tell our listeners where are you from? What’s your story? Give us your background. We’re gonna go into you personally first, and then we’re gonna talk a lot about egg freezing.
Dr. Gerber: Sure. So I come from Teaneck, New Jersey.
Dr. Fox: I’ve heard of it.
Dr. Gerber: Which is a suburb of New York, but a lot of people still say, “You’re not a New Yorker.”
Dr. Fox: You’re a New Yorker.
Dr. Gerber: But you know, it’s close enough. And I grew up modern orthodox went to Shiva, there through high school. I then was lucky enough to go to Columbia University in Manhattan.
Dr. Fox: You were an engineer, right?
Dr. Gerber: I was a chemical engineer, yes.
Dr. Fox: Wow, that’s hardcore.
Dr. Gerber: Yeah, it was nice because, you know, first of all, I was never a reading-writing type of person, but I always aced all my math and science tests. So it was great just to never…I had to take one single humanities course and then everything else was math and science and I was fine with that.
Dr. Fox: Right. So you know that I went to Columbia also, I was equally mediocre at all of the disciplines. But, you know, we had an interesting relationship with engineers because we took…the pre-meds, we took the same classes a lot we all took chemistry in this. But the engineers were so much smarter than us in all this. So they had to put them in a different class with a different curve and that’s why there’s like a separate engineering program. But yes, several of them could not read or write.
Dr. Gerber: Yes, that’d me. I still have my sister review, and you know, make sure my grammar is okay, my spelling is okay because she’s like the reader-writer in the family.
Dr. Fox: Okay. All right so you’re at Columbia School of Engineering, as a chemical engineer, when did you decide you can go to medical school?
Dr. Gerber: So about mid college I had first thought maybe I would do something in the environmental engineering realm. I always wanted to…
Dr. Fox: What does that even mean?
Dr. Gerber: Helping with carbon emissions, waste management, basically different ways to, let’s say, plastic recycling, things like that.
Dr. Fox: So Rachel from New Jersey in waste management, like Tony Soprano.
Dr. Gerber: Exactly. We get involved with the mafia.
Dr. Fox: A lot of mafia in Teaneck, it’s a rough part of town.
Dr. Gerber: At some point, I’d say about midway through I realized that engineering is essentially just computer modeling, and you’re alone in a room with your computer. I’m a very talkative friendly person I needed human interaction.
Dr. Fox: Indeed.
Dr. Gerber: I thrive off of, you know, chatting and building connections. And so I decided, you know what, I’ve taken all my pre-med courses because as you said you have to take chemistry, you have to take physics, you have to take orgo, and I just pivoted to medicine. I have two physician parents so it was something I knew about and so, you know, I made that pivot and I’m really happy.
Dr. Fox: That’s great. And so how did you decide to go to Mount Sinai because it can’t be the only school that wanted you?
Dr. Gerber: There was different decisions that went into it. Like for example, I got into some of the New Jersey State schools and they were cheaper, they were half the price. And it’s definitely luring because you come out of these programs with a lot of debt. But ultimately, Mount Sinai was just a warm welcoming place and it’s where my dad is actually a lifer there they call it. He did his training there he’s never left and he’s a big inspiration to me. So it was exciting I got to like, go to Honduras with him on a medical mission. I got to be on his team for the surgery rotation scrub in with him many times.
Dr. Fox: That’s awesome.
Dr. Gerber: That was a really cool experience. So I think I just always had a good feeling about Mount Sinai because of growing up with my dad there.
Dr. Fox: Right, were you born there?
Dr. Gerber: No, I was born in Beth Israel.
Dr. Fox: Ah, okay…
Dr. Gerber: Which is now Mount Sinai.
Dr. Fox: So because of you Mount Sinai had to buy Beth Israel.
Dr. Gerber: Yes, exactly. Well, my mom was a pathology resident at Beth Israel. So I guess she was like, you know, doing her pathology and then would just walk downstairs and have a baby.
Dr. Fox: You were her greatest specimen.
Dr. Gerber: There’s four of us but I’m the only one who went into medicine so there you go.
Dr. Fox: All right that’s interesting. All right, so you were at Mount Sinai and of course, that’s where our paths crossed for the first time.
Dr. Gerber: Exactly.
Dr. Fox: Okay, and from there, you decided OB-GYN you said right away.
Dr. Gerber: I knew right away. I just really…again, when I decided to do medicine, it was all about the human…like those connections you get with your patients. Getting personal with your patients, having conversations that other people might be uncomfortable with. I thrive off of really going there with patients about relationships, and their sex life, and you know, what they’re embarrassed about, and insecurities. Like I really…
Dr. Fox: That’s where you thrive.
Dr. Gerber: That’s where I thrive. Like, I feel like I am able, I hope, you know, to make patients feel comfortable. And that’s what gives me satisfaction is making patients feel comfortable. And going to these difficult embarrassing places with them and making them feel like they came out of it with a good experience and with some insight. So I just felt like nothing else gives you that other than OB-GYN.
Dr. Fox: Yeah, it’s pretty intimate in that sense.
Dr. Gerber: Yeah, also I hate men. No, I’m joking.
Dr. Fox: No, you’re not joking it’s…
Dr. Gerber: I’m a man-hater so it’s just is totally natural. No, but…
Dr. Fox: It’s a good thing you have sons.
Dr. Gerber: I have two sons, no daughters. But I actually…some people say, “Oh, you’re giving up the male patients.” Well, now I actually have a couple, but I never felt that was a loss when I was going into OB. I just felt a strong connect with the women patients and felt like that’s where I could shine with this kind of really, you know, intimate kind of relationship that I can make.
Dr. Fox: Okay, and so you did your residency at Cornell?
Dr. Gerber: Yes.
Dr. Fox: Right, and so at the time, you were co-residents with Carolyn Friedman…
Dr. Gerber: Yes.
Dr. Fox: Who I work with and is, you know, in this podcast regularly. You just saw her in the hallway, which was nice a little reunion.
Dr. Gerber: Yeah. It’s so nice seeing… Residency is really like a family, your…
Dr. Fox: A dysfunctional one but a family.
Dr. Gerber: Yeah, dysfunctional but yeah, and even sometimes you get mad, but you know, there’s always love there even if someone pisses you off, whatever it is. And it’s almost like a lifelong bond, it’s like a family member.
Dr. Fox: I’ve never been in the military but it’s like conceptually, it’s a group of people thrown together into these very trying and difficult circumstances. It’s physically taxing, it’s emotionally taxing. Obviously, it’s not the same as serving, you know, in the military, it’s not the same risk and, you know, sacrifice. But when you go through that and you come out of it, you just feel that bond like, we went through this together and you know, we’re forever connected.
Dr. Gerber: I agree.
Dr. Fox: All right, that’s cool.
Dr. Gerber: And my husband feels the same way about the other, like husbands and wives. They had their own club of like, we are the husband and wives of the…
Dr. Fox: We’re the neglected, the great neglected.
Dr. Gerber: …the OB residents and you know, while they’re at work, we can hang out and lament about how we never see our spouses.
Dr. Fox: Wow okay. And so you did your residency at Cornell, of course, we stayed in touch through all that time because, you know, you’re one of my faves. And then how did you decide to go into a career of fertility or Reproductive Endocrinology and Infertility, REI as it’s called? Because I wanted you to do MFM we were pushing hard, we were really throwing everything at you.
Dr. Gerber: I really didn’t go in knowing. I thought about a lot of different fields. But ultimately, I think what ended up doing it for me, is the satisfaction that I felt out of having such a discrete outcome of getting someone pregnant. And having it be, you know, attainable, and the steps being very laid out to get there. So, you know, just going through it when you see those positive pregnancy tests, it’s just so exciting, and so like, it just keeps you going and it just lightens up your day. I just really thrived off of that feeling of like, every day you get this positive reinforcement, and this like very goal-oriented care. And there’s many other things.
So, the other thing is, again, it’s a very intense process. The patients are under an immense amount of stress and anxiety, you have to manage that as well. So you have to not only provide good medical care but provide care that you know, makes them feel that they’re cared for emotionally. That, you know, they’re not just a number that you’re really thinking about them, and you’re in it with them, you’re empathizing with them. And have them come out of it, even if they’re not pregnant, feeling like whole from the process, that, you know, I feel like I was supported, and we gave it our best shot. And, you know, this is what we’re gonna change next time or whatever it is.
But I just knew that it was much more than the medicine, which is, again, always what I’ve really thrived off of. So just a combination of being so satisfied with kind of the actual medical work and getting that patient satisfaction of holding people’s hands through this really tough process, it just felt right for me.
Dr. Fox: When people end up, you know, in your office, like, you said, they’re already totally stressed out because that is…they don’t just show up, you know, the first time they’re trying to get pregnant, they already…
Dr. Gerber: Exactly.
Dr. Fox: …usually either they know there’s gonna be an issue because let’s say maybe they’re older or whatever, they have, you know, medical problems. Or they have nothing wrong, but it just hasn’t worked out yet. And that’s a very stressful situation for people. I guess it’s sort of similar to when people come to my office or Haris. Ours is a little maybe more fear than stress in that sense, they’re worried about what’s gonna happen and for you, it’s…but it is. There’s so much of the psychology aspect, and the social work aspect, and the counseling, there’s just so much that goes into that.
What’s interesting is, you know, New York City where you did your residency and at Cornell, there’s a world-class infertility center there. I mean, really one of the top you know, on Earth. But in Manhattan, there’s a bunch of them. We were talking about there’s a lot of places that are…
Dr. Gerber: There are
Dr. Fox: …just unbelievable, which is interesting, right? And so people come from all over to various places in Manhattan. But I think one of the advantages is when you’re doing a residency in New York, you get exposure to such good infertility care, and what it’s like. Because, in other programs where maybe it’s not as prevalent, or it’s not potentially as, you know, research-based world-class. In residency, you wouldn’t normally have a lot of that because you’re not doing fertility treatments as a resident. I mean, you’ll diagnose people who have fertility issues, but they’ll go somewhere else. And so a lot of residents don’t get exposure to that in order to decide they wanna go into it.
Dr. Gerber: Yeah, it’s a somewhat like niche field, it’s not your bread and butter OB-GYN. You know, you can’t avoid MFM, yeah, you cannot avoid MFM during your residency. But you really need to seek out getting good REI exposure. So at Cornell, you know, it’s really great for that and that’s why they match so many of the residents into it because we get such great exposure. Also, people who know they wanna go into it tend to go there as well, because it has such a great reputation and does such a good job at preparing us for fellowship.
Dr. Fox: Right. And so ultimately, you did your fellowship in Einstein?
Dr. Gerber: Yes.
Dr. Fox: And what was that like?
Dr. Gerber: It was awesome. I honestly would not have rather be anywhere else because Montefiore Einstein is a really special place because it’s just in the middle of a very underserved community that’s very densely populated. It’s very high volume, high acuity, patients who are just very in need of people who care for them, despite the fact that they, you know, don’t have insurance, they don’t have, you know, the money you find in New York. And because of that, you know, you feel almost like you have to hold their hand more, make sure that they get to their consulting appointments.
And make sure that you stay on top of the patient or they’ll get lost. Like okay, so go do your HSG, go get a semen analysis, go see, you know, hire risk pregnancy, go to GI get…you know. It’s like, for some patients in Manhattan, you know, organizing that they could do it. There it’s much more like the health literacy and just navigating the system is much harder for these patients. And so I felt a very strong ownership over that and making sure my patients got through their workup so we could actually move ahead with fertility treatments.
Dr. Fox: In one of our earlier podcasts we had on [inaudible 00:14:35] you know, who, you know, who I know. But she was describing the same thing because obviously, she’s at the same institution. And that idea of, you know, for a lot of what she has to do for patients is literally just, you know, rolling up your sleeves and doing it. And that’s how you show you care that you just get involved you know say, “Oh, do A, B, C, and D,” you really have to sometimes do that for them, or help people based on who they are and what their circumstances are. And there’s real value in learning and practicing and doing that because not everyone can do that for someone else.
Dr. Gerber: Yes. And then I remember saying once you go and you’re an attending with a lot of patients, you can’t do that anymore. Because I got really used to doing like making all the consults for my patients, calling up radiology, and making appointments for my patients. My attendings will be like, “You know, you’re not gonna be able to do this once you have…” But you know, it was something that I just felt like, I need my patient to do this. You know, I gotta make it happen, or I just felt this, like, you know, feeling like, if I didn’t do it, no one else was. And I got very close to my patients and attached to my patients like through this process.
Dr. Fox: And so now you’re at RMA of New York, and you’re, you know, the big star there. And so tell me, how has that been? How’s it been transitioning from, you know, fellowship, where you’re, you know, doing all stuff to now, you know, you’re the big doctor?
Dr. Gerber: It’s really nice I have to say. RMA, you know, is a big practice with amazing people from the more senior people to the new people. Everyone’s been really welcoming, holding my hand through the process, making sure I’m comfortable with everything, I really don’t have a bad thing to say. And it’s really nice, you know, if you need something done, the nurses or your IVF coordinator, they collect the records, and they, you know, make sure…and you know, I’m just like, oh, wow, okay. So I guess.
Dr. Fox: You feel like I can just be a doctor.
Dr. Gerber: Yeah, it’s a whole new world and I appreciate those people so much. Because I’m not used to, but at this point, my time and efforts are best served just seeing patients and taking them through for their fertility treatments. So, it’s been a great experience.
Dr. Fox: And you’re currently both in, as you said in the Manhattan office on the East Side, as well as in Westchester. But also the plan is to expand in the Westchester area, correct?
Dr. Gerber: Yes. So in the months to come, I’m opening an office in northern Westchester and an embryology lab.
Dr. Fox: Right, that’s big for people who don’t realize…
Dr. Gerber: Huge.
Dr. Fox: The embryology lab is sort of like the center point of infertility treatments…
Dr. Gerber: Exactly.
Dr. Fox: …because you need…like, what do you do with these embryos? That’s where the science is how to protect them, and care for them, and watch for them, and test them, and do all these things.
Dr. Gerber: Exactly.
Dr. Fox: You need a world-class lab with air filtration, and you know, all these things and the right everything has to be…
Dr. Gerber: Yes, takes a lot of money to build a new lab.
Dr. Fox: Right, you can’t just do it in your basement.
Dr. Gerber: Yes. And they’re investing in this and we’re expecting that it’s gonna be a great venture. You know, there’s been somewhat of a boom in the housing market up in northern Westchester.
Dr. Fox: Yeah, Jersey, too, same.
Dr. Gerber: And New Jersey and so we’re thinking that this is definitely…you know, patients are gonna wanna stay there for their care. And if they can get you the same level of care they could get in Manhattan, you know, and they’re getting that same practice up in Westchester it’s a huge benefit for everybody.
Dr. Fox: That’s awesome. So let’s talk about egg freezing. So first of all, this is a topic you suggested to me when we were talking you were like, “Wow, you know, you should do a podcast on egg freezing.” And I totally agree so many people ask me about it. I assume it’s a major part of what you’re doing in consultations and discussing with patients. So why is it important? Like what about egg freezing makes it so topical?
Dr. Gerber: Well, really nice thing is that it’s being really popularized in the media and people are learning about it. And because of that, you know, we’re getting a lot more aware about really, what our biological clock means. So essentially, the whole concept of egg freezing is women are born with all the eggs that we will ever have. And even from birth, we’re on a slow slope down of losing eggs. And it’s not as bad as it sounds, we still have plenty of eggs to get us through our, you know, reproductive life. But unlike men who are, you know, producing millions and millions of sperm from puberty until they die…
Dr. Fox: Right, is that why you hate men?
Dr. Gerber: Yes, I’m jealous of their sperm production. There really is a biological clock where you know, egg counts are declining with time and with each…
Dr. Fox: And also the counts decline but also the eggs that remain, usually, the quality is lower as you get older.
Dr. Gerber: Exactly. So there’s two things that happen as women age. One is that the counts decline. And the other is that occurrence of genetic abnormalities called chromosomal abnormalities. Where there’s an extra chromosome or missing chromosome that also significantly increases with age. So not only are you working with fewer, but the ones you have are more likely to be genetically abnormal and not able to produce a healthy child.
Dr. Fox: Which is why as women get older, even if they don’t have, you know, “fertility issues” and they get pregnant, the rate of miscarriage goes up as you get older. And it’s really, for that reason, like you could have a totally working, you know, system, you know, the egg is firm, everything works fine. But if that egg by chance is abnormal, you’re gonna miscarry and those chances go up as you get older, unfortunately.
Dr. Gerber: Along with Down syndrome which is something that people classically know about. That the chances of Down syndrome go up, and it’s all part of the same concept. Now that we really have a good idea about this and women are kind of becoming more and more aware of the reality of this, you know, we’ve come up with this tool to kind of freeze somebody’s…
Dr. Fox: Literally.
Dr. Gerber: …literally, their fertility at a moment in time, and be able to kind of keep that age and egg quality frozen. And even as they age that will never change for those eggs.
Dr. Fox: Is this something that people come and ask you about, or is it something that you bring up with patients? Or how does it sort of work logistically with these types of conversations? Are people calling your office all the time to ask about it?
Dr. Gerber: Yes, people are typically calling for egg freezing consult. They typically might hear about it from friends, or we actually do and a lot of other, you know, big practices do egg freezing programming. Where we will set up question-answer nights now through Zoom, it used to be more maybe like a cocktail setting or something like that. Now we have these Zoom sessions called like egg freezing 101, and we advertise through, you know, social media and things like that. People sign up just to hear about what is it entail? Should I get this? You know, what are my chances of having a baby with this technology? When’s the right time to get it?
So we have, you know, our own avenues to talk to patients about that. But we get…probably about 50% of my consults are people that are coming to me who have already made the decision to freeze their eggs. And then by the time they get to me, often it’s a referral from their GYN or their OB-GYN that they say, “Hey, you know, I’m thinking of freezing my eggs.” And OB-GYN refers them to the fertility doctor to really delve into that.
Dr. Fox: So who should consider doing it, or who does consider doing it? And the first one that you said is just women who are…they’re getting older, let’s say, and they, you know, haven’t yet started to try to have kids right, either they are…for whatever reason, right. So is that the majority would you say?
Dr. Gerber: That is the majority. There’s a class of patients who really we recommend it even at younger ages, let’s say like in their 20s. That’s for patients, first of all, like cancer patients who are undergoing chemotherapy…
Dr. Fox: Because the chemotherapy could damage the ovaries and the eggs…
Dr. Gerber: Exactly.
Dr. Fox: …and cause infertility so you take the eggs out first?
Dr. Gerber: Exactly, yeah. And it can deplete their egg store more rapidly than your normal aging process does.
Dr. Fox: Even teenagers have had this. Sometimes you know even childhood cancers you know, you wanna make sure that they have fertility. Because, again, fortunately, if they’re gonna survive and do well, and then in their 20, 30, 40, you don’t want them to also be infertile now, it’d be great if you can have their eggs frozen.
Dr. Gerber: Exactly. So yeah, I’ve seen plenty in their teens even for that purpose. Another thing is, like, let’s say somebody has recurrent ovarian cysts or severe endometriosis and is getting ovarian tissue removed. Like getting surgeries where they’re removing parts of their ovaries, or they needed to have an ovary removed at some point. These are people who are at risk for premature depletion of their egg counts and they might consider doing it really even in their mid-20s.
Your average person that we see are really people in their early 30s, to late 30s, who are single, they’re dating, they’re out there trying all the apps and the swipes, and in the grind. Or they’re really career-oriented, they’re on, you know, a great track to be, you know, a doctor, or lawyer, a business, whatever they’re gonna do. They just have not found the person that they wanna settle down with but they know that they want that in the future, or you know, that’s still an option they want to maintain.
And so they come to us and say, you know, “I’m interested in freezing my eggs, because, you know, I want to have a family one day.” Or, “I want the option of having a family one day, but right now, it’s not happening and I don’t see the time that it will.”
Dr. Fox: And I imagine this is also a stressful situation a different kind of stress. That’s really the stress of what if, I don’t know when that whole idea of what’s the future gonna bring. And I know listen, a lot of people it’s very stressful for them if, you know, they haven’t found the right person or as you said, they’re very busy they’re working hard to doing, you know, great things. And they’re like, “Listen, I don’t wanna get to age 40 and then at that point, start you know, potentially having problems or issues. Even though you don’t know what’s gonna happen, there’s a chance.
Dr. Gerber: Right. I completely agree. So another thing is, is that some companies, particularly Silicon Valley companies, the most common ones, Facebook and Google, actually offer egg freezing benefits for their patients. And I’ve seen a few patients that are coming from there and they’re coming at a younger age than your average patient…
Dr. Fox: To keep them off maternity leave.
Dr. Gerber: I guess.
Dr. Fox: Delay that by 10 years.
Dr. Gerber: They say it’s to retain the talent, it’s a benefit that they give to retain great female talent. It’s awesome. So they’ll often come and say, “Hey, I’m 30 but I have this benefit and I wanna use it because, you know…”
Dr. Fox: Who knows?
Dr. Gerber: “…who knows?” But if I’m gonna get this covered by, you know, my company, then I’m gonna use this amazing benefit and it’s gonna take stress off of me going forward.
Dr. Fox: Right. Have you had any patients yet who are doing this as a part of their transition process for transgender?
Dr. Gerber: Yes.
Dr. Fox: Right so…
Dr. Gerber: I have seen that. Prior to starting androgen therapy to retrieve eggs so that, you know, they could kind of move forward uninterrupted. So I have seen that and it can be complicated because for example, you know, we do transvaginal ultrasounds during this process. And that can be a very difficult thing for these patients. I know, for patients I’ve seen in the past, will do abdominal ultrasounds through the stimulation, which is not ideal, but it can be done.
Dr. Fox: Doable.
Dr. Gerber: And then just we tell them, when you have your retrieval, we have to do the transvaginal you know, but you’ll be asleep.
Dr. Fox: Right, they’ll have anesthesia.
Dr. Gerber: It’s a very rewarding thing to do but can be difficult for them to kind of process going through egg retrieval, while they’re also trying to figure out their gender identity, and you know, moving forward with that. And studies have really come out to look at, you know, whether you need to come off hormone therapies or not. And I think some data is coming out saying, potentially you don’t really need to. Used to be how long do you need to come off of it?
So they wanted to have people…let’s say, if you can catch them before it starts, which I’ve seen, you know, that’s great. But, you know, often it’s, you know after they’ve already gone through the transition so, you know, people say does it need to be one month, does it need to be two months? And now some data is coming out to say maybe they don’t have to go off it at all.
Dr. Fox: Wow, that’s so interesting. Just so everyone understands the biology of it. Egg freezing is different from embryo freezing. Meaning if you have a couple of, right, and they’re together, and for whatever reason, they’re not gonna have kids for a while, and they are gonna freeze embryo. So that’s different, right because that’s a fertilized egg plus sperm embryo, and that’s being frozen as opposed to just the egg.
Dr. Gerber: Yes. So it’s funny you say that because my mom always confuses the word egg and embryo, like when I’m talking to her and I’m always like, “No, embryo mum.”
Dr. Fox: The physician pathologist.
Dr. Gerber: Exactly. No embryo, you know, “No, it’s an egg.” Because, you know, it’s sometimes really hard to get straight to start egg and the embryo.
Dr. Fox: Yeah, right they both start with the letter E.
Dr. Gerber: Yes, exactly. But embryo freezing in some ways has benefits over egg freezing. So when you freeze an egg, you’re really far from a pregnancy, right? So when you freeze an egg, you know, you have to then fertilize that egg, you then have to grow it to be an embryo usually to day five through seven. Then you have to get an idea is that likely to be a genetically normal embryo or not, right? So you can either test it to find out or you know, just based on age, get an idea. And then once you have, let’s say, a genetically normal embryo, there’s still only a 60% chance that each embryo implants.
So when you have an egg, there’s still a lot of unknowns to get through and steps to get through before you get to hold that baby. When you freeze embryos, you’re kind of all the way down that line where you can say I have a genetically normal embryo, I know exactly what the fertility potential of this embryo is. It’s you know, gonna be 60% and then if I have two normal embryos, you know, it’s gonna go up to like an 80% chance of having a baby.
Embryo freezing really is scientifically a better process. They also thaw better than eggs, right when you defrost them they have a higher survival rate. I often sometimes say to patients, so, “You know, what is the benefit of eggs over embryos?” And they look at me, “Well, with an embryo you’re tied to that sperm, right.” Like you’re going all-in on that sperm once you make an embryo that’s the downside. So if you have a partner that you are sure that you want that partner to be the father of your baby. Or even if you’re like, “I wanna do this alone and be a single mom not deal with all the drama that men bring.” Then you get your donor sperm and make embryos and that really is a more ideal process. But most people are not there most patients want to still have the option open to use the sperm that they want when that sperm comes along.
Dr. Fox: Right, this is how Rachel sees men, just large creatures that walk about the earth containing sperm, right?
Dr. Gerber: Exactly.
Dr. Fox: We’re just vessels.
Dr. Gerber: That’s what I tell my husband. I say, “I have no need for you anymore.”
Dr. Fox: No, but that’s how you view them okay, that’s fine. So, I mean, again, it makes a lot of sense, you talk about it, because if someone…even if a couple comes and they’re gonna go through IVF, it starts with, you know, retrieving eggs from her. And let’s say you’ll get 10, 20, 30 eggs, whatever it is, but then when you fertilize them, suddenly, it’s not 30 embryos, now it’s 12 embryos. And then when you test them, you know, only six of them are normal.
Dr. Gerber: Exactly.
Dr. Fox: And so you’re sort of working your way down but again, it’s almost like a natural selection process. Those 6 embryos, each one of them is gonna have a better success than the original 30 eggs.
Dr. Gerber: Eggs, exactly.
Dr. Fox: And so when you’re freezing you just sort of halt the process, right there. Now, just because you mentioned it, the thawing, what is the likelihood if you freeze an egg, and it thaws and it’s gonna go through the process successfully. Like Harrison Ford did, for example, in “Return of the Jedi” when he was frosted, and he came out no problem. Han Solo made it through the process.
Dr. Gerber: So you know, generally the thaw rates for eggs are between 80% and 90%. And they’ve really gotten better it used to be lower.
Dr. Fox: Used to be like 20% to 30%.
Dr. Gerber: Yes, our technologies, we have something called vitrification, it’s a new technology, flash freezing in liquid nitrogen. And that whole process has really furthered the field of fertility, preservation, and egg and embryo freezing. And I think that’s part of what has now made it go from a designation of an experimental treatment to an FDA-approved treatment fertility preservation.
Dr. Fox: That’s a huge difference because again, you’re talking just 5 to 10 years ago, the success of thawing an egg was 20% to 25%. So people…it may not be worth it also, because the likelihood is, you know if only 20% to 25% of the eggs are gonna, you know, make it through the process, and you’re spending all this money and time and effort wherever. But if it’s 80% to 90%, that’s really good.
Dr. Gerber: Yes, so it’s a little different. So it’s a little higher, the younger you are like a lot of this process, the younger you are the better they thaw. But in general, yeah, about 80%, 90% thaw. For embryos, it’s closer to 98% to 99% so it’s a really rare occurrence that an embryo doesn’t thaw.
And then once you go to your next step of fertilization, you know, typically we have about 70% fertilization rate, let’s say. Of course, again, it has to do with, you know, what the sperm is like, again, what is the age of the patient at the time of freezing. And then after that, you have about a 50% to 60% chance of going to blast. Which the blast is our term for embryo that we can now put back.
Dr. Fox: Right, it’s not an explosion but it’s short for…for those who don’t, it’s short for blastocyst, which is a medical term exam.
Dr. Gerber: Exactly.
Dr. Fox: It does sound like use a firearm and shoot it into her, you know.
Dr. Gerber: One interesting thing is like, you know, I never really realized this until I became an REI, but humans have like a shell, just like an egg has a shell. And we actually hatch out of our shell. And that happens at the blastocyst stage. So it’s kind of cool because you actually watch it kind of like really just shoot out of its shell. And just like a chicken, we’re really not that different than…
Dr. Fox: We’re not…
Dr. Gerber: …reptiles.
Dr. Fox: We’re really not. So take me through the process. So let’s say someone comes to you, and she is pretty certain she wants to do this. And she meets with you and obviously, you make sure that there’s no reason she shouldn’t do it. Or, you know, you talked about, you know, all this, you know, the decision. But she decides, and you decide, we’re gonna do it. So step by step what would happen? How does that work in terms of how long does it take? What procedures does she need, what medications you know, all of those?
Dr. Gerber: The process start to finish is typically two weeks. And that’s after, let’s say, maybe from initial consultation, it could be anywhere up to a month before we can get you into a cycle. And that often actually depends where in your cycle you are, because we typically start with your period, right? So if you happen to come when your period is next week, we could really potentially start at the next week. But if you’re three weeks from your period, you know, then we have to wait a little longer.
Dr. Fox: And they could wait months if they want to.
Dr. Gerber: They could wait months that’s up to you. So some patients are like, I wanna go ASAP. Some patients just wanna hear about it, mull over it. You know, think about the finances, get the finances together, and get emotionally prepared for it and say, give me a couple of months. So you get the whole, like, you know, slew of different people who have different timelines.
But once you actually start, what it is, is really injections. So two to three injections a day. Those are injections that go really into your lower abdominal fat. So they are small needles, we call them subcutaneous, it just goes right under the skin. And people definitely, I think, have more of an emotional fear about it of the concept of injecting themselves, and going through this very kind of emotionally taxing process of freezing your eggs and understanding what that means. But the injection itself, most of what I hear is that the build-up is worse than the injection.
Dr. Fox: And what are they injecting themselves with?
Dr. Gerber: So they’re injecting themselves with hormones that basically grow the eggs that they have in their ovary. So let me take one step back. So every month at the start of the month, a certain number of eggs get brought up from the ranks in the ovaries from the microscopic eggs. They get brought up to battle it out to ovulate that month, right. Those are called antral follicles. In a normal natural cycle, one of those follicles grows and takes off and basically kills all the rest. It’s like a little battle or war going on and then you get the winner the…
Dr. Fox: Like a little “Hunger Games” in the ovary.
Dr. Gerber: Exactly, it’s an ovary “Hunger Games” where the one builds up, you know, the most strength and the most hormone receptors and soaks up all the egg food and the rest get left behind. And they just…we call it atresia. So they kind of just…they die. So what we do is we tell the body, you know, don’t just pick one, you know, if you have 10 to start, we’re gonna pick you all, you all are winners.
Dr. Fox: Everyone is a winner.
Dr. Gerber: And we flood the system with hormones so that, you know, not just the strongest one with the most hormone receptors can respond, but we can actually get all of those eggs to respond. And so initially, the two different injections you take are really…as one of my attendings used to call it they’re egg food, they’re just hormones that grow these eggs. And while this process is going on, you actually come into the office every two to three days to start to get bloodwork and ultrasound so we can make sure that your hormone levels are going up appropriately.
We’re not hyper-stimulating you and making you, you know, become an egg farm bloated, you know, egg farm. You know, also to know do we need to increase the medication or decrease the medications. And we physically watch the eggs, they’re called follicles when we look at them. We physically watch the follicles grow. And we measure them.
Dr. Fox: Right, because the egg is microscopic.
Dr. Gerber: The egg is microscopic.
Dr. Fox: But the fluid they’re in, you see in ultrasound.
Dr. Gerber: Exactly. So you know, they almost look like a cyst would, which is just a fluid-filled circle but we know that there’s eggs there. And when we watch your hormone rise we know there’s healthy eggs there. So you know that is going on for about a week. And then once your eggs get big enough, we add in a third shot to prevent you from ovulating. Because your body at some point is like okay, I got all this going on I got all these large follicles it’s time to release them. But we don’t want you to release them into your, you know, pelvis we want you…
Dr. Fox: We wanna get them.
Dr. Gerber: We wanna get them you know ourselves. So…
Dr. Fox: Just to interrupt you for one second there, this process that you’ve been discussing, number one, during this time, people can still go to work, they’re not like ill right I mean…?
Dr. Gerber: Of course, yes. A lot of our patients they like to come you know some…not everyone but you know, they wanna get in at 6:45 for their ultrasound. Pre-COVID this was more of a thing. Now work from home makes it a little easier. And then they’re out and going to work. This is not something that really is gonna change like how you live your day-to-day life. The one thing is, you know, as the ovaries get big, the most common complaint is that they feel bloated, because they are literally full of…
Dr. Fox: They’re bloated.
Dr. Gerber: …ovary, and they’re bloated. And so once your ovaries get large, we do say, you know, take it easy with the exercise, because we don’t want them bouncing up and down and potentially twisting. And also at that point, we say, you know, also hold off from having sex.
Dr. Fox: Because in case you ovulate, you’ll be Octomom.
Dr. Gerber: Yeah, well, that’s true. So really, let’s say for the first couple days until your ovaries get big, you know, you can still exercise, have sex, there’s no restrictions. Once they get big, you can still go to work, go out to dinner with your friends, you can even have you know, a glass of wine here and there. But just, you know, lay off of the intense exercise and things, where your ovaries are gonna, be moving a lot. So yes, it’s not something where you’re like locked up for two weeks. Women are going to work and living their lives and kind of just, you know, having a friendly visit with us every other morning.
Dr. Fox: And also this process that you’re describing is also the exact same process that a woman who’s about to undergo IVF would do, or someone who is herself an egg donor it’s…
Dr. Gerber: Exactly.
Dr. Fox: …the same process…
Dr. Gerber: Exactly.
Dr. Fox: And we’ll sort of say where that point differentiates. But it’s the same thing that anyone undergoing…
Dr. Gerber: Exactly.
Dr. Fox: …IVF would do. Okay, so now she got the shot to not ovulate and so?
Dr. Gerber: And so now, once enough of the eggs are large enough that you know, we think the eggs are fully cooked and ready to come out, we give you a shot to actually trigger ovulation because we’ve been stopping it all that time. Now we want you to ovulate and 36 hours later, we put you to sleep, and we actually suction the eggs out through a vaginal procedure.
Dr. Fox: And so just so people understand, this is done not in the hospital, but in your office.
Dr. Gerber: Exactly.
Dr. Fox: So there’s as an anesthesiologist there gives you an IV, you go to sleep, so you’re comfortable. The procedure itself is done with a needle through…there’s an ultrasound in the vagina and…
Dr. Gerber: Exactly.
Dr. Fox: …the needle that goes through there to the ovaries as well. Meaning it is a needle, it’s puncturing your body going into the ovary, but it’s not through your belly and you’re asleep so it’s not painful. And when you wake up, there’s no like, stitches or anything.
Dr. Gerber: Exactly.
Dr. Fox: No, it’s…
Dr. Gerber: There’s no incision, you know, it’s really just like a…it’s a puncture, it’s like a needle puncture. And let’s say those punches are in a hidden spot no one will see them.
Dr. Fox: Right. And you’re in how long does that procedure actually take? Once she goes to sleep from when you start to when you finish?
Dr. Gerber: Ten, 15 minutes at most.
Dr. Fox: And then she wakes up and when she’s not groggy she goes home?
Dr. Gerber: Exactly. And I usually tell them that day, you know, maybe don’t go to work. Like some patients, you know, they’re like, “Can I go to work in the afternoon?” I say, you know, “You’re gonna be groggy because, right, you get prop before you get, you know, real deal anesthesia and I don’t know that you’d be on your A-game.” Now, with your work from home, though…
Dr. Fox: Maybe.
Dr. Gerber: …maybe you could sign on and you know, sit on your computer. But if it meant going to the office and being on your A-game, I would say, for that day, at least hold-off. And by the next day, they’re back to work.
Dr. Fox: It’s the same anesthesia people get for anoscopy for example.
Dr. Gerber: Exactly.
Dr. Fox: It’s, you know, maybe their wisdom teeth out similar type of…
Dr. Gerber: Exactly.
Dr. Fox: …anesthesia. And so, at this point, so they’ve had the procedure, you’ve harvested or retrieved a certain number of eggs, hopefully, a lot. And then this is where it differs. So like, if they’re gonna freeze their eggs, then where do they go? They go to the lab that does the freezing?
Dr. Gerber: So our lab is one lab so you know…
Dr. Fox: Right, meaning the next room.
Dr. Gerber: The next room so the lab is attached to, you know, the procedure room. So as you’re, you know, doing the procedure, you’re getting a real-time count, which is very satisfying. You know, like, 1, 2, 3 go yeah, I got that, you know, we’re getting eggs. And so by the end of the procedure, you know how many you got, in so when the patient wakes up, they know. If they’re doing egg freezing that same day, they get frozen in the liquid nitrogen, like I said, flash-frozen, and then they’re in storage.
Dr. Fox: And now since it’s an egg, and it’s only one cell, you can’t test the egg for genetic abnormalities.
Dr. Gerber: Exactly.
Dr. Fox: Right, because you would destroy the egg. You could do it but you destroy the egg. So when people get their eggs frozen, let’s say there’s…What’s the typical number for someone who say a 35-year-old woman how many are you gonna get, on average, ballpark?
Dr. Gerber: On average let’s say 10 to 15 eggs.
Dr. Fox: If 10 to 15 eggs, you don’t know which ones are genetically normal or abnormal?
Dr. Gerber: Exactly.
Dr. Fox: Since you’re younger, presumably, there’s a higher chance that they’re normal. So they all get frozen. And then she’s done, correct?
Dr. Gerber: Right. So then you really have a consult where you say, you know, are we happy with this outcome? So there’s tools that we can use to try and give someone an idea based on you know, the usual statistics of how eggs do. You might say, okay, you have 10 eggs you’re 35 what are your chances of having a live birth from this, you know, from this amount of eggs? And let’s say it could be, you know, 70% chance of having a live birth. Okay, well, what if we got 10 more eggs, now you’re up to, you know, a 90% chance.
Dr. Fox: Right. I mean, she could do it again let’s say?
Dr. Gerber: So yes, you can do it again. And often it’s very much a financial decision. But really, sometimes, you know, patients come and say, you know, “I’m doing this once, what I get is what I get, that’s all I can afford.” Other patients say you know, “I wanna get to that 99% chance that I’m gonna have a live birth from this.”
Dr. Fox: So do several times.
Dr. Gerber: And they’ll do it several times. And a lot of that has to do with what your baseline egg counts are. So you know, one of the main things that tells us you know, how well you’re gonna do is a test called the AMH, the anti- Müllerian hormone. Based on that we kind of can get an idea of what to expect from a cycle. Again, once you have your outcome, you make a decision, you know, are we happy, are we not, you know that kind of thing.
Dr. Fox: Just so everyone understands that she weren’t doing egg freezing, and she were doing IVF instead of freezing the eggs that day, you would fertilize the eggs that day?
Dr. Gerber: Yes.
Dr. Fox: He would give you know, a sperm sample, a semen sample, and then…
Dr. Gerber: Exactly.
Dr. Fox: …you would do it there. And then you would be looking in the lab, how many become embryos, and then you go from there.
Dr. Gerber: Exactly.
Dr. Fox: So again, the process is the exact same thing as IVF but you just sort of stop after the…
Dr. Gerber: Exactly.
Dr. Fox: …after the retrieval.
Dr. Gerber: Exactly you stop that day.
Dr. Fox: And what is the…for her what is the recovery time from after she has the procedure till her ovaries sort of come back to normal? She’s not bloated, and she sort of feels let’s say…
Dr. Gerber: So within a week…
Dr. Fox: …typical.
Dr. Gerber: …you know, I think the bloating will come down significantly. And really by two weeks, the ovaries will have shrunken down to their normal size.
Dr. Fox: So the whole thing is then basically four weeks start to finish…
Dr. Gerber: Yes.
Dr. Fox: …from when she starts to when she is sort of back to normal which is…
Dr. Gerber: Exactly.
Dr. Fox: …one cycle. And what is the cost of this, typically if someone’s they don’t have any coverage for it? What is the typical cost?
Dr. Gerber: It’s a tough question to answer. There’s different programs and people have different costs. I’d say, you know, on average, maybe the egg freezing itself can be the range $4,000 to $6,000. But then when you add medication costs…
Dr. Fox: Right, a lot of is the hormones that you inject are expensive.
Dr. Gerber: …believe it or not that almost doubles the cost. So that you end up closer to $8,000 to $10,000. And there are some places that are cheaper than others, patients will often do price comparisons, and see these different programs. And you know, a lot goes into making the decision of where you are gonna freeze your eggs. So some people might say it’s purely gonna be financial, right, cheapest place, I’m gonna go there.
And a lot of people say, you know, “I want a place that’s been doing this for a long time, has babies from this for a long time, has an IVF lab that actually fertilizes and grows these doesn’t just stop at the eggs. So you know what their actual outcomes are for live births. Often those bigger programs that have those outcomes and have the data and the long-term outcomes that have been doing it for 10, 15 years might be a little more expensive, to be honest.
Dr. Fox: Yeah. And also the times when insurance might cover it, I suppose. Again, if your company has benefits, it’s not the insurance that’s your benefit. But I guess if there’s like a medical indication that someone’s covered before, like you said, for chemotherapy.
Dr. Gerber: And they will.
Dr. Fox: But for this sort of more common situation…
Dr. Gerber: Because social egg freezing is kind of the…
Dr. Fox: And it’s typically not covered, I would imagine.
Dr. Gerber: It’s typically not yes.
Dr. Fox: Got it.
Dr. Gerber: The thing is, you know, us as fertility doctors, we don’t like the term social egg freezing, it’s basically preventative medicine, right, you’re preventing infertility in the future. And, you know, we see it as preventative care, like anything else you do to kind of hold off having you know, some sort of medical or health issue in the future. Of course, we think that it should be covered by insurance. And, you know, now with this amazing New York state mandate that came through for large companies have to cover IVF. And they have to cover egg freezing for cancer patients and patients who are at risk of early egg depletion. And hopefully one day, they could see that if you’re covering infertility, then this is basically a preventative measure for infertility.
Dr. Fox: Well, it’s also…I mean, if you’re an insurance company, or take insurance out of the equation, you’re just a couple and you have your own finances. If you’re gonna have to pay for your IVF this may be more cost-effective, potentially…
Dr. Gerber: Definitely.
Dr. Fox: …because you’re doing…it costs, but you’re doing it on the front end to prevent potentially issues on the back end. And so yeah, there’s a way probably to have an actuary figured out exactly what the math is. But there is math there, like there is a benefit, potentially. And so if an insurance company is saying, “Listen, we’re gonna have to cover IVF, maybe we’re better off having our subscribers do…” you know, if they want to obviously.
Dr. Gerber: Right, because…
Dr. Fox: “Do this in their 30s and maybe have a better success rate, fewer IVF cycles, fewer complications, also, the pregnancies might be lower risk, you know, ultimately if the eggs are younger.” It’s hard to know this because the data isn’t perfect, but conceptually, it makes sense that if the whole process is gonna have to be covered by somebody that may be better off to just start early.
Dr. Gerber: Yeah. And another benefit, you know, it’s really kind of weighing the pluses and minuses when you think about what age should somebody do it right? So if you do it, let’s say in your early 30s, you’re more likely to need fewer cycles, right because your eggs have less genetic abnormalities and you’re likely to get more eggs in time. But you’re also less likely to use them because you have more…
Dr. Fox: You may find someone in a year.
Dr. Gerber: …of a chance to find someone and have, you know, a baby, you know, exactly in the next couple years when you’re still…
Dr. Fox: And the technology might have improved in two or three years, and then you feel like, “You know, I did it…you know, I got the 2020 model…”
Dr. Gerber: The old…
Dr. Fox: “…and I want the 2023 model.”
Dr. Gerber: The iPhone you know.
Dr. Fox: “I have the iPhone 9 and, you know, it doesn’t, whatever, doesn’t cook breakfast for me like the new iPhone does.”
Dr. Gerber: But once you get to your late 30s, you know, you usually need more than one cycle to reach that 80 plus percent chance of having a live birth from that you know, cycle. And another thing to keep in mind is a lot of people want more than one baby. So often it’ll be like, “Okay, well at, you know, 30 if I have 10 eggs I have a really good shot of having one baby. Well, actually, I want three babies. Okay, then maybe we need to do another cycle.” So you kind of have to plan with that as well. I think some studies have done a cost-benefit analysis have really shown that mid-30s is a sweet spot in terms of where actually you still have a nice in term of getting…
Dr. Fox: Not too late not too early.
Dr. Gerber: …a baby from it. But you have actually a higher chance of actually using them.
Dr. Fox: No that makes a lot of sense. I imagine you must have people also who do egg freezing and then let’s say a year or two later find someone and they’re not gonna use the eggs. They’re gonna try their own…
Dr. Gerber: Exactly.
Dr. Fox: …and it’s like their insurance policy, A, if it doesn’t work, or B, let’s say they wanna have four kids. And so at their fourth kid, she’s gonna be you know, in her 40s and maybe that time.
Dr. Gerber: We see that all the time. That they come in after having a baby or two on their own and then they come in their 40s for the second or third kid and now they have these eggs frozen. So yeah, you know, it’s not all about that first baby things happen. Maybe sometimes people get divorced, and they want to have…you know, meet someone new and wanna have a family at a later age and they can go back to those eggs. I’ve seen some patients interestingly, you know, they have a boyfriend, let’s say they’re not 100% sure on, and will discuss freezing half eggs, half embryos, so kind of hedging.
Dr. Fox: Wow, I like that.
Dr. Gerber: And I’ve seen that more so, unfortunately, in cancer patients.
Dr. Fox: What happens at conversations where, “Honey, let’s freeze the embryos but I’m gonna hang on a couple of eggs, just in case I find someone better. Let’s not…”
Dr. Gerber: Well, you know…
Dr. Fox: “…fertilize all of them,” you know.
Dr. Gerber: If it’s a husband, this doesn’t happen, typically. But typically, they’re not in the room for that consultation.
Dr. Fox: “Wait, honey, why are we only fertilizing half those eggs? What did you do with the other half?” “Just in case. You know, you’re okay.”
Dr. Gerber: Sometimes the guy…believe or not I’ve seen cases where the guy is on board. Like the guy is also like, “You know, I think this is going well but I see your point, you know.” Or another case where it has seemed more, you know, like an easier conversation is if you’re doing egg freezing for cancer. Where someone finds out they have a cancer diagnosis, they now have a week right to decide freeze embryos or freeze eggs and they’re in a relationship. And now it’s like bam, are you gonna get married to this guy? Do you wanna be tied to the sperm forever? And then it’s like an easier decision to say let’s hedge and let’s do eggs and embryos.
Dr. Fox: Plus, you know, she’s about to get treatment for cancer so he can’t talk back.
Dr. Gerber: Oh, yeah exactly.
Dr. Fox: He says, “Whatever you say it’s all good.”
Dr. Gerber: Exactly.
Dr. Fox: “I’ll do anything, it’s okay.”
Dr. Gerber: And another option that I always discuss with my patients is sometimes I say to them, “Is it important for you to have a baby whether or not you end up with a partner?” If you hit a point where you think…you know, is there a point you might hit where you say, “You know what, I’m doing this on my own?” In that case, you can freeze some embryos with donor sperm and some eggs, and that way, you know, you have your embryos that you can test or that you have a much higher implantation rate, and save those and still try and meet, you know, Mr. Right, you know, on the way.
Dr. Fox: That’s amazing. In terms of long-term, do we know how long they can be stored, and still survive, like does time matter?
Dr. Gerber: Indefinitely is what we would say right now.
Dr. Fox: That’s what we know with embryos, right?
Dr. Gerber: Yeah, we have 20, 30-year-old embryos at this point.
Dr. Fox: What happens to unused eggs? Someone said, you know, “I’m hanging it up, I’m done, I never needed them, or whatever, I needed, some of them.” What happens to them ultimately?
Dr. Gerber: You know, when you start, you do sign a lot of paperwork that talks about different disposition for the eggs. Ultimately, you know, once in every case, there’s a storage fee, right, to maintain these…
Dr. Fox: Like an annual…
Dr. Gerber: An annual fee. Often, like when you initially do it, you get one or two years to start, and then you have an annual fee. Really, at that point, they’d say, “Okay, what do you wanna do with them?” Okay, so a lot of people might just say, you know, destroy them. Others might say, you know, donate them to science, which is a very common thing we see with discarded embryos as well. And we actually have a whole network of research that we do with patient’s embryos, that is really important and amazing research coming out of that. Or some people might choose to donate them to other people.
Dr. Fox: I would imagine that would be a real productive way for people who need egg donors because that’s a very expensive process and complicated process. But there must be so many people who have eggs that they’re willing to donate, or do they sort of feel squeamish about it because it’s their genetic material being passed on?
Dr. Gerber: It’s something that’s very personal for people. I feel like people might have a harder time letting go of embryos and eggs. But, you know, I had a patient who was so lovely, and she made embryos with her husband, but she had a same-sex male couple friend, who she was very close with, who she actually gave half of her eggs to. So she did a stimulation cycle and…
Dr. Fox: And so they could use one…
Dr. Gerber: …gave half…
Dr. Fox: …to their sperm.
Dr. Gerber: To their sperm and said “These are for you.” And of course, all the legal paperwork, and everything is signed off on. And then she had embryo she had babies, we saw those babies being born. So people get creative with these things. You know, if she’s like, “I’m doing this stimulation,” she had good ovarian reserve, she was young. She said, “Let’s give some to my friends who need them.” So, you know, it’s a very personal decision, there’s options.
Dr. Gerber: Right. And these are things you obviously bring up at the beginning of the process, but…
Dr. Gerber: Exactly.
Dr. Fox: …they can evolve over time.
Dr. Gerber: Exactly.
Dr. Fox: In terms of…I’m just curious for the people who are troubled by like, embryonic research, do they have the same troubles with research on eggs alone? Have you seen that?
Dr. Gerber: I would say no.
Dr. Fox: Right, it’s different.
Dr. Gerber: No, I think that for everyone who believes that life begins at fertilization, which is a very dangerous stance and rising in the fertility field that would really move us back decades and be really horrible for families who are using infertility treatments. I…
Dr. Fox: But this is before that point.
Dr. Gerber: …don’t think anybody, you know, could argue that life begins with an egg, you know, you need a sperm. The sperm is good for…
Dr. Fox: For something
Dr. Gerber: …some little piece of the puzzle there. So yeah, I don’t think that that would be the case.
Dr. Fox: Okay, one last thing totally unrelated. Even though the podcast won’t be dropped today, I understand you wanna wish someone a happy birthday today?
Dr. Gerber: Oh, yeah, so it’s my son’s two-year-old birthday. He’s a very, very happy kid, his name is Sammy. He’s really sweet and cuddly. He is getting to his terrible twos and he throws his food on the floor a lot, and you know, things like that. But he’s cute enough that I forgive him.
Dr. Fox: [inaudible 00:57:37]. For a man-hater, you’re surrounded by men. You have a five…
Dr. Gerber: I know.
Dr. Fox: …year old who just had a big ice cream and piñata party.
Dr. Gerber: Yes. So both my boys, I have two sons, are fall babies. So October and November about a month apart so it’s been a fun month of birthdays. And we’ve been getting creative with coronavirus, doing our outdoor parties and my son in a pod with his class. And so we have…
Dr. Fox: He’s a five-year-old, I assume.
Dr. Gerber: Five-year-old yeah. We had them all over for the piñatas and ice cream. And we bought…last minute I just did the piñatas and ice cream the day before my husband tells me “Oh, by the way, I bought a bouncy house too…”
Dr. Fox: Oh, nice.
Dr. Gerber: “…I thought maybe there wouldn’t be enough entertainment.” So now we own a bouncy house.
Dr. Fox: Oh, you didn’t rent it you bought it?
Dr. Gerber: We did not rent it because my husband crunched the numbers and it was like you know, less than $100 extra to just buy it. And he got an end of the season sale…
Dr. Fox: It’s like “Supersize me.”
Dr. Gerber: Exactly. So we’ve got this huge bag in our garage that’s this massive bouncy house. But you know, it’s really popular with the kids so my son…
Dr. Fox: Yeah, and the emergency room physician. The only thing they like better is the trampoline.
Dr. Gerber: Yeah, you know, I think I’m gonna hold off on the trampoline. I’ve seen some things in medical school that have scarred me for life from the trampoline.
Dr. Fox: That’s the one thing that…we caved on everything with our kids because we’re such pushovers we even got dogs right, ultimately. But I put my foot I said, “We’re not getting a trampoline I just can’t be in charge of that. I’ve seen too much I don’t wanna any part of that so no trampoline.” Wow, excellent. Rachel, thank you so much for coming on this is great. First of all, it’s great to catch up I love seeing you. It’s just so nice to see how you’ve grown from your young…
Dr. Gerber: I know.
Dr. Fox: …tadpole stage as a first-year medical student where you, you know, knew nothing you couldn’t read or write, as you said. And now you know, you’re a researcher, you’re a doctor, you’re an OB-GYN, you’re an infertility, doctor. You’re living out in Chappaqua with the Clintons, you know, you got a bouncy house, you got kids. It’s all going for you, you’re doing awesome.
Dr. Gerber: Thank you.
Dr. Fox: And you’re great on the podcast because you know, as you know you’re funny so it’s good.
Dr. Gerber: Thank you, I try.
Dr. Fox: It helps. Do you do that with patients, you keep your personality, do you get all like [inaudible 00:59:57] serious on them?
Dr. Gerber: No, I try and crack a couple of jokes in there, yeah, whenever I can throw at least one or two in.
Dr. Fox: A zinger?
Dr. Gerber: Yes, and try and get a smile is really…it makes me happy to get a smile from patients.
Dr. Fox: It’s all about. All right well, thank you so much.
Dr. Gerber: Thanks for having me.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at email@example.com. Have a great day.
The information discussed in “Healthful Woman” is intended for educational uses only, it does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.