Tips for Talking to Patients About Fertility

Jennifer L.W. Fink, BSN

Disclosures

September 12, 2016

Educate About Egg Freezing

It's important to share realistic information about the effects of age on fertility as well as fertility treatment and preservation.

"Honest conversations about the limitations of science are important," says Dr Rackow.

Female fertility decreases gradually beginning around age 32 and declines more rapidly around age 37; by the mid-40s, most women are unable to sustain a successful pregnancy. Women over 35, as well as women with known risk factors for infertility, who are trying to conceive need to know that it's best to seek help sooner rather than later For these patients, both ACOG and ASRM recommend an "expedited evaluation... [and] treatment" by a fertility specialist if 6 months have gone by without conception.[3]

Egg freezing is perhaps the most discussed option for protecting and preserving female fertility. Once a technique strictly used to protect the fertility of young patients undergoing fertility-destroying treatments, egg freezing is now a way for women to save young, healthy eggs for use in later life.[4] But fertility experts say it's important for providers to be up-front with women about the promise and pitfalls of egg freezing.

"Egg freezing does not guarantee conception in the future," Dr Rackow says.

A 2015 study in JAMA found that live birth rates per embryo transferred were 56.1% for embryos from fresh eggs and 47.1% for those from frozen eggs.[5] Scientists are still teasing out the reasons for the discrepancy, but the bottom line is that women can't assume that freezing eggs will guarantee eventual parenthood.

Furthermore, egg freezing is expensive—about $10,000-$12,000 plus yearly storage fees, says Dr Molinaro (though some companies now cover egg freezing as an employee benefit). Still, it's the only method available to women to extend their fertility. That's why it's so important for healthcare providers to discuss reproductive planning with their patients on a regular basis.

"If the discussion is not started," Dr Werner says, "the patient may miss her window of opportunity."

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