How to Improve Egg Quality – The Essential Egg Freezing Process Guide | Dr. Debbie Cassis

Dr. Cassis: [00:00:00] Whenever I see a patient, the first thing I do is I go over the menstrual cycle and this is what should happen normally, and this is what is not normal, and these are things that you should be looking out for in terms of your general health, your reproductive health, and your fertility. Patients should be having regular periods.

It is a vital sign for women, so that, that does 

Narrator: reflect it. Our health. Dr. Debbie Cassis is an OBGYN and reproductive endocrinologist who has studied at some of the most prestigious schools and clinics, including the world class IYRMA clinics. She is the founder of Hestia Fertility in Mexico City, where she supports patients looking to preserve their fertility and achieve their dream of becoming a mother.

Dr. Brighten: I want to talk about egg freezing and who should be considered as a candidate and maybe who's listening to this right now that might want to consider going the route of freezing their eggs. I think.

Welcome back to the Dr. Brighton show. I'm your host, Dr. Jolene Brighton. I'm [00:01:00] board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most up to date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or [00:02:00] share this with a friend because it helps this podcast get out to everyone who needs it. All right, let's dive in. Dr. Debbie Cassis, welcome to the podcast. Hi, Dr. Jolene. How are you? I am fantastic. I'm really excited for this conversation. I 

Dr. Cassis: know, me too. I think this has been a long time coming.

Dr. Brighten: Yeah, and we were just chatting. We haven't seen each other in a year, but so people know who you are to me. You were my fertility doctor. You are the person who retrieved all my eggs from my ovaries. This is the woman. Yes, I did. That I did. Yeah. And that's what we're going to talk about today. Perfect.

We're going to talk about egg retrieval. We're going to talk about fertility, egg quality, and get into what people should know about freezing their eggs. So I think very first thing we need to do is get everybody on the same page and go through some of the basics about ovulation and what people should know about fertility.

Dr. Cassis: Yeah, I think that's very important. Knowing your body I think is very essential. Most patients don't know. a basic [00:03:00] like menstrual cycle and that for me is just mind blowing that patients don't know like what they should expect from their bodies. So whenever I see a patient the first thing I do is I go over the menstrual cycle and this is what should happen normally and this is what is not normal and these are things that you should be looking out for in terms of your general health, your reproductive health, and your fertility.

So it all comes back to the basics. So knowing about your cycles, knowing. How long they should be when you're ovulating. if you have pain or not, if the bleeding is normal or not, all of those things are essential to get to know your body and then that makes it easier also for me so I can, you know, give you more information about what to expect when you're seeing specifically a fertility specialist, but knowing that is the first step.

So basically it's just Every month we should have regular cycles, right? Not everybody is right on the dot, but [00:04:00] having regular cycles Which means from 25 to 35 days from day one of your bleeding to the next day one of your bleeding That is what is considered normal. Anything less than that or more than that Then you should be seeing someone and having a talk with someone about why that is happening Right, and something that is also very important is that patients should know the, the phases of the cycle.

So you should know that the first phase, which is the follicular phase, is when the brain says, okay, ovaries, we need to start working. So they send a really strong signal. for the ovaries to start recruiting one of the eggs from our ovaries. And then that egg, the strongest one, is chosen. And you know, that's the chosen one for that cycle.

And that follicle grows and it gets the egg ready within the follicle. And normally in a patient who's 28 days, uh, their cycle's normally on day 14, they should be ovulating. So when the follicle is the brain says, okay, then we're ready to [00:05:00] ovulate. So it sends another like really strong signal for that follicle to break.

And then 14 days later, you either have your period if you're not pregnant, or if you're pregnant, then you don't get your period. So that first phase was follicular phase. And the second one after you ovulate, that's called the secretory phase. So it's very important for patients to know that the secretory phase, which is the second part, always lasts 14 days.

So if you are ovulating, it means that you are having regular periods. Someone who does not have regular periods is because they're not ovulating regularly. So just knowing that, just knowing that if you have regular periods, it means that you're ovulating, that's essential. You don't have to know all the phases, everything that I'm talking about.

You just have to know if you're a regular or not. Something else. is pain is not normal. We've normalized pain. You know, women, we're told that you have to, you know, fight through it. And you know, you can take some Tylenol, you can take something else, but pain is [00:06:00] not normal. And having pain during your periods and pain that is incapacitating, that is something that we, we should not, normalize.

So if you're having irregular periods, you're having pain during your period, even pain during intercourse, then all of that you should see a doctor and see what is happening and what you can do about that. 

Dr. Brighten: So I just want to go back to exactly what you said about what these normal parameters are and really underscore for anyone who thinks they may ever want to have a baby, If you are having cycles that are less than 25 days, they are more than 35 days, they are irregular, they're unpredictable, or incredibly painful, you want to address that now, sooner than later.

Because what can these be signs of? So these can be signs 

Dr. Cassis: of your ovarian reserve getting lower faster. Or not having quality eggs. So those are things that are essential for patients to know in order to look, [00:07:00] you know, for treatment. Especially if, not even if you want to be a mom, even if you just don't want that option taken away.

Yeah. Then you should go first, you know, your lifestyle shouldn't be, you know, you shouldn't be shackled to your menstrual periods, to your pain. You should. look into that. If you don't know if you want to be a mom, if you don't know what you want in life, it's still valid to want to have regular periods.

Patients should be having regular periods. That, you know, they call it the sixth vital sign for a reason. Fifth? Sixth? Fifth. Sorry about that. So the fifth vital sign. So it is a vital sign for women. So that, that does reflect our health. So you're talking about hormone health, you know, how the body is working, if you're under stress, if you're, you know, having a hard time with whatever, so that just, that reflects in our menstrual periods.

So if you're thinking about wanting, wanting to be a mom and you're having these irregular periods, these painful periods, then you should definitely see somebody about that. [00:08:00] Absolutely. And 

Dr. Brighten: you know, in the cases that we see irregular periods that could be polycystic ovarian syndrome. And while that is one of the top reasons that a woman may find herself being diagnosed as infertile.

Yeah. Absolutely. That condition can impact so much more of your life. And so I think it's really important, as you were saying, the period of being the fifth vital sign, your menstrual cycle being that valuable, for people to recognize that even we're going to talk about egg quality, we're going to talk about fertility, that these things There are a sign of your overall health and if you have these underlying conditions, you know, with endometriosis being a major cause of pain, that can put you at higher risk for ovarian cancer.

Like these are things that we should not just dismiss whether, you know, we want to have a baby or not. 

Dr. Cassis: Yeah. And actually you got into a little bit of the ovarian cancer. Patients who do not ovulate, they have a higher risk of ovarian cancer. of endometrium cancer. So there's risks at, you know, at the, you know, middle end of your life that [00:09:00] you shouldn't be having.

You can lower those risks. So it's not about just wanting to be a mom, it's about your overall health. 

Dr. Brighten: Yeah. So speaking of risks, what are some of the things that contribute to poor egg quality? Because I think it's unfortunate that many of us end up in our 30s wanting to have a baby and not realizing that there are a lot of things that maybe in our 20s weren't the best choice.

Dr. Cassis: Yeah. So just, this is for general health, which obviously reflects on fertility, but just Good night's sleep. That's essential. Lower stress, which sucks because it's very difficult to manage stress, but just having spaces for you to manage stress and to identify how you can manage stress, I think that, that is essential.

And not drinking as much. No, uh, uh, smoking. Smoking really does, that does affect, uh, ovarian health. by a lot and just having a general like exercising just having a general good healthy lifestyle that does [00:10:00] help with fertility because you know I always tell my patients you know there's a Debbie that you know didn't go out didn't uh I've never smoked but uh didn't smoke didn't drink she went to bed by 9 p.

m and she exercised regularly and there's this alternate Debbie that went out, that had a lot of stress, that was maybe drinking too much, didn't have healthy eating habits. And it's the same Debbie, but that could go very different ways, right? So we have to take care of ourselves, not just because we want to be moms, because you do have to be very healthy to be a mom and have a lot of energy, but because it does help in the long run.

Someone who did take care of themselves versus someone who didn't. 

Dr. Brighten: Mm hmm. Yeah, and I feel like we do have to hold grace that like, you know, if we had known what we could have known earlier in life, we would have made different decisions. There's also career paths that some of us take. I think if you've got a big D, little R in front of your name, you didn't sleep well, you were very stressed, [00:11:00] like, and it's something that you're like, would have loved to not have those components and have my education and expertise.

Sure, but it just. wasn't in the cards. Yeah, no, I mean, 

Dr. Cassis: I wouldn't change what I studied for anything, but definitely there could be management of stress within what we do, you know, being medical doctors. So definitely that's a big one. But just general health, I think the saddest thing about what I do is I normally hear, well, if I had known.

Yeah. And it's like, we're here. No, let's, you know, go forward. But yeah, that's. Regret is a really something that you don't want to feel. So you have to make those choices early, which you know, those should be done during your 20s. But you know, you tend to want to enjoy life or whatever. But it's very important for us to take care of ourselves from the beginning.

Well, 

Dr. Brighten: And we're here now. Yeah. And so we're going to hope [00:12:00] a lot of people hopefully not have those regrets. Is there any way to know if you're, if you have poor egg quality, any kind of signs or anything that would drive someone to, you know, want to go to their doctor? So generally, age 

Dr. Cassis: is what dictates most of egg quality.

Unfortunately for women, we do have a biological clock. But Yeah. Yeah. Yeah. Lifestyle, lifestyle does impact, but signs that our body is giving us, like I said at the beginning, irregular cycles. very painful, um, bleeding. Very, like, bleeding between your periods. All of that are signs that something is not right and we should be making it better for us to make the, the environment where our eggs are better.

Dr. Brighten: Mm hmm. 

Dr. Cassis: Because, you know, we're, I don't, I don't, I didn't mention this when I started going on about the menstrual cycle, but we're born with the number of eggs that we're born and that just goes down. So that's what we have and we have to take care of it. 

Dr. Brighten: Yeah. Science hasn't gamified that yet, but I'm holding out.

I'm holding out. [00:13:00] I know we're, we are trying, but yeah, this is why we have to. So, you know, to that point, so we've got the age factor, that's definitely, I mean, that's not controllable. No. I mean, if you're getting older, congratulations, you're here, you're healthy, let's go. You're 

Dr. Cassis: living. 

Dr. Brighten: But outside of that, are there things that women can be doing that have an impact, can actually improve a quality?

Yes, so having a healthy diet 

Dr. Cassis: is essential. So a lot of processed foods have, you know, chemicals that can definitely lower our egg quality. Egg quality and quantity. Mm hmm. Smoking. Smoking definitely does bring down that egg quality and quantity. Mm hmm. Stress levels. So high cortisol, not having a good night's sleep, not having that that good night's sleep that makes us, you know, wake up and want to do more.

Yeah. So generally just having a healthier lifestyle that makes the environment where the follicles are, where the eggs are, it just makes it healthier. There are some supplements that I generally, [00:14:00] um, recommend, but if you're not, doing your part on lifestyle you know just the supplements are not going to make up for that.

Yeah so they go hand by hand but it's not one or the other. 

Dr. Brighten: Absolutely I always say you can't out supplement a poor diet and lifestyle but as you bring up supplements I absolutely know that everyone listening right now is like please Please tell me. Fertility expert! Tell 

Dr. Cassis: us! Okay so I basically the ones that I recommend that have a very good amount of of literature and science behind them.

So I'm going to say the five so you guys can write these down. So it's omega 3s, right, uh, coenzyme Q10, uh, vitamin D, which is One of the best folate or folic acid and which one, vitamin C, which is a good antioxidant. Those are the five that I recommend most or all of my patients are going through any infertility issues and some extras.

Talking about PCOS, I'm very on [00:15:00] board with my inositol, so just having someone who, to guide you to that, just guys don't go on Amazon and just buy whatever, just really have someone that can tell you this is the right dosage, this is what you should take, just having someone just tell you not Just dr.

Google behind it. Yeah, but having that and having someone tell you okay, this is normal. This is not normal This is what we can do. This is what something extra that you can take that just makes everything better and easier 

Dr. Brighten: Yeah, and I would echo not going to Amazon but you know to just buy whatever is there because I think you know, in all of the things you said, CoQ10 is the one to be most cautious about.

Whenever people are like, Oh, but I got it at Costco and it was really cheap. And I'm like, it's not what it says it is. Absolutely not. It's the, uh, you know, with the dosages that I was taking for, um, my, when I was preparing for my IVF with CoQ10, I remember the bottle being 120 for that supply and being like, This is [00:16:00] so expensive.

But when you're doing four 800 milligrams of CoQ10, which in your 40s is more what you're gonna be looking at. Um, that doesn't mean that that's what every individual needs, but it gets really pricey. And that is one most supplements are you get what you pay for. And CoQ10 is definitely one of those. And I think Um, when women arrive to the place of wanting a baby, they wanted a baby yesterday, they want a baby in their arms now, and then we know, and I'm sure you're going to talk about this, but it takes a good 90 days for whatever you're doing to impact those eggs.

And so with that in mind, I really hate to see people spinning their wheels on something and they're like, well, I did this for three months. And you're like, um, we, 

Dr. Cassis: okay, good job for trying. I would love to work that way, but you know, it doesn't. It's a more long term thing. So if anybody in their 20s is listening, take care of yourselves, guys.

This, you know, we don't think about those kind of things when we're younger, but when you're here, you're like, [00:17:00] you can, I can, I can swear. Sorry. 

Dr. Brighten: You're an adult. 

Dr. Cassis: We're all 

Dr. Brighten: adults. It's okay. 

Dr. Cassis: You're like, nobody told me, I should've, like all of that. But what we can change, we just, we have to take responsibility for ourselves, you know, this is the one body we have, we have to take care of it.

And you're prepping, especially talking about infertility and talking about that you're gonna be creating life. You need to be healthy to create healthy life. So you need to be in the best place for yourself in order to become a mom, give life to that baby. So, you know, we should be doing that since we're 

Dr. Brighten: younger, right?

Yeah, and I love that because I think too often you will hear from people who only treat it like an egg. Like we've just got this egg and that's the most important thing, you know, never mind they forget that like there's sperm involved, but they forget that like there's also the uterine health. I always say like mom is the seed and the soil, like there's that extra layer of like you have to gestate and grow that human, then you nourish [00:18:00] that human, then you don't sleep for years for that human, like there's a lot going into this.

And it's, it's, you know, just for people to understand. I think one of the best things. That come out of, uh, people who do try to get pregnant is how healthy they get because of how much they invest in themselves. And so it's always something that I say, like, even if you never want a baby, don't, don't tell your body that.

Let's just act like we're going to do that so that you're 

Dr. Cassis: as healthy as possible. Yeah. I think that that is really important to do. You know, when you identify signs that you're not healthy, you should definitely have someone take a look at all of that and like guide you through that. So if you're having irregular periods, if you're having pain, I mean, I'm.

I think I'm getting very repetitive, but this is, this is something that everybody should, every woman should know, everybody who has, has a uterus, has ovaries, they should know, right? So, if that is happening to you, go see someone, and then from there, we can give you information that is going to help you.

In the long, [00:19:00] like at that moment and in the long run, especially talking about fertility. So if we go a little bit into that, so you're taking care of yourself, you're taking care of your eggs, which they are, you know, you have a finite number of them. And if you want to go a bit further than that, you want to do some fertility preservation, then there are options for that.

But if you are not healthy from the start, then all those options start getting less They're going to be less successful in the end. So that's, that's a, an important message for patients also. 

Dr. Brighten: Yeah. Well, I want to, I want to go into those treatments and I want to specifically start with AMH, anti malarian hormone, its utility, who should be measuring that?

Who is it less valuable for? What should women know? So 

Dr. Cassis: AMH is a very good marker for ovarian reserve, which is a number of eggs that we still have, An ultrasound gives us so much more, but I think like, if we're gonna do [00:20:00] either or, and it would be available to everyone, let's just do the AMH. Not everybody has access to a, someone who can do a proper ultrasound, right?

So, if you're gonna do something about your ovarian reserve, then go get an AMH. Don't ask Google to interpret that AMH. Have someone tell you, okay, this is what it means, right? So, it's not just a number and, oh, you're okay or you're not okay. There's a lot that goes into that. But if we're talking about, if we could do it to every woman, then I would ride again.

Like, I would go ahead and do it. The thing is, at least in Mexico, it's very expensive. Sometimes it's more expensive than going to a consult, to an appointment with a doctor. So, In my practice, what I do is I see patients, I, I do an ultrasound, a transvaginal ultrasound, I do the follicular, follicular count.

And if there's something that is out of what should be normal for that patient or for their age and, and all their, their medical history, then I add the AMH as an extra. 

Dr. Brighten: Mm hmm. Or [00:21:00] so let's do what are the normal parameters. And when you're saying follicle count, these are all the potential eggs in the cycle.

And this is typically happening in the first couple days of your period. Yeah. 

Dr. Cassis: So AMH can be done at any moment in your period. So that's, that's the, like the benefit of you doing AMH. You can just go and have it done. But the ultrasound, you have to do it between day two or three of your cycle. I can do it like, At any moment, but it'll be, it'll give you a better like picture of what, what we should expect at day two or day three.

Dr. Brighten: But the 

Dr. Cassis: AMH normal, let's just say if you're in your reproductive age, over one nanograms per milliliter. Okay. But if it's lower, then what happens is patients get like scared and stressed and then they are panicking. And if it's over, then they don't do anything. Yeah. So that's why you should see someone and have someone interpret it and say, okay.

Your AMH is fine, but what what else? 

Dr. Brighten: Mm hmm, 

Dr. Cassis: um, but [00:22:00] I would do it to everyone because what happens is by the time patients get get to me they're They're gynecologists and they didn't say anything. Yeah, they haven't done any testing. They haven't said anything. They haven't mentioned fertility they haven't mentioned ovarian reserve and you know when they get to Specialists then it's just having to do that work.

So this should be something that should be Part of the checkup that we do every year, your pap smear, you know, when you're over 40, your mammogram, like all of that, it should be part of a regular. Mm hmm. So I think we are lacking that. That's a big area of opportunity for, for gynecologists to do. 

Dr. Brighten: We should be doing that.

Yeah. And on the flip side of that, you know, new research is saying AMH should be accessible to women because it can be a great marker for PCOS. Absolutely. And looking at even adding that to the criteria or, you know, not necessarily being like you have to meet this criteria, but one parameter that could be suggestive of PCOS.

And I think when [00:23:00] sometimes women see a high AMH and they're like, you know, they're late thirties and their doctor's like, that looks great, but not realizing that that condition will look like you got a lot of eggs in the storage. They're not always quality. Yeah. So, you know, when you look at an AMH, that also helps in terms of predicting for, uh, How many eggs you can potentially retrieve?

I want to talk about egg freezing and who should be considered as a candidate? And maybe who's listening to this right now that might want to consider going the route of freezing their eggs? 

Dr. Cassis: I think if you want to be a mom, if you don't know if you want to be a mom, then you should consider egg freezing.

Especially if you're less than 35 and you're not sure what you want. I think those, that is a perfect candidate. So, I'm not saying that anybody, over 35 or anybody under whatever age, I just think that if it's something that you are thinking about, then you should at least look at the option. So any patient can do egg [00:24:00] freezing, but obviously your age Impacts on that result and your A MH and your follicular count impacts on the result of doing an egg freezing cycle.

But patients under 35 who are not sure if they wanna be moms, if they wanna be moms, but they don't, they haven't found, found, they haven't found the right partner yet. Or they have, but they're not sure and they're just looking into it. I think those are patients who would incredibly benefit from egg freezing.

And what 

Dr. Brighten: about patients that, you know, perhaps might have certain medical conditions that they should be definitely consideration. 

Dr. Cassis: So we also do, uh, oncofertility, which means patients who have breast cancer who have not yet become moms or want to have more children, that is also an option, like freezing, and especially patients with endometriosis.

So, endometriosis, normally what happens is, you take, doctors, we take a long time to diagnose. I don't understand why. Like, it goes Yeah, it's not on purpose, guys. I swear, like, sometimes I'm just like, [00:25:00] Well, you have had painful periods. That's not normal. Then we should start looking. We don't have to wait five years.

Some patients tell me, yeah, I've been going back and forth for like six years and they just told me I have endometriosis and I'm like, six years, why? Why did we lose that time? So we should be looking into it. We don't want to over diagnose it, but we should be looking into patients who are having regular periods, painful periods, because endometriosis does, like that's one of the medical conditions that affects.

ovarian reserve and ovarian quality. So even if you have a good amount of eggs, having endometriosis does affect the quality of eggs that you have. So patients who have endometriosis and they are, they have been diagnosed and they want to be moms or maybe they want to be moms and they're not sure. They would benefit from doing egg freezing, so they don't have infertility problems down the road.

Dr. Brighten: Yeah. And as someone with endometriosis, I would also say considering doing it before you have excision surgeries for lesions on [00:26:00] your ovaries, or if your doctor's wanting to put you on Lupron therapy for, you know, that therapy for a period of time, Lupron's a medication. It's basically chemical menopause.

I went through it. It was, it was rough. It puts you into menopause. Yeah. But I don't think Temporarily. Yeah, and it's temporary for people to understand, unless you're like 48, then it might be your gateway into that transition. But for people to also understand that those kinds of medications, it could be six months before you are recruiting enough eggs again to even be a candidate for that.

So that's something I also see missing from the endometriosis, endometriosis conversation is that. These different considerations for therapy is should we be considering freezing the eggs, depending, you know, if you have somebody who's 36 and their doctor's like, oh, we want to do, you know, you have lesions on your ovaries.

We want to go in. We want to excise that. I'd also say, make sure you meet with somebody who actually knows what they're doing with endo because if they don't, a lot of women lose too much of their ovaries. So I think that, [00:27:00] um, I think so often, At least in the United States, when we talk about egg freezing, people are like, these are just career women who want to delay things, and they don't realize that there are so many facets and so much nuance into this conversation of who might be a candidate, where it'sand as you were saying, the access to AMH, I also think we need to, um, kind of leapfrog over gynecologists sometimes and go right to reproductive endocrinologists.

to really get that individualized care that women so often need. Um, you know, as we're talking, I'm like, people probably don't. Are you familiar with egg freezing? So let's go over the process. Can you walk us through it? 

Dr. Cassis: Yeah, of 

Dr. Brighten: course. 

Dr. Cassis: So what we do with egg freezing is, I talked about this at the start of the, of the podcast.

So each month what we do is we ovulate one egg, right? So what we do with egg freezing is, is all of those eggs that were competing to be the one that gets ovulated, what we do is we do like a rescue mission of those follicles of those eggs in that [00:28:00] cycle to have more eggs in one go. So, we can take all of those eggs and freeze them.

So that's the, the, the gist of it. But what we actually do and what process that patients go through is, you start, you come into the clinic, right? So you're on your day two or day three of your cycle, and we start giving you medication, which is very similar to the hormones that the brain produces. But we give them at very, like, higher dosages to achieve what I was saying about recruiting all those.

follicles that are in our ovaries. So we make sure that all of the follicles that we're seeing for that cycle, that they grow, and that we can get a lot from that, uh, like cohort of eggs that we're seeing. So those injections, that's what they do. And the, the injections last typically from 10 to 12 days, or you're doing injections 10 to 12 days.

When I'm talking about injections, I don't want people to panic, but they are injections, but they're insulin. Super 

Dr. Brighten: tiny. Yeah, they're insulin needles. They're very 

Dr. Cassis: small. 

Dr. Brighten: But it's still, you're still, you're still. Injecting yourself. I will say though, I've seen, [00:29:00] um, on social media, women in the U. S. and they're doing injections and they've got these big old needles and I'm like, friend, no, no, no.

I know I think about the little pens that I use and I'm like, it's 

Dr. Cassis: so easy. 

Dr. Brighten: It's very, normally it's 

Dr. Cassis: very easy. It does tend to get a little uncomfortable as the cycle goes on because you're injecting in basically the same area with it, which is your stomach. So you do the injections 10 to 12 days. We are monitoring patients every other day, basically, so you do have to take time to do this process.

It's not like, oh, I'm, you know, going to get Botox. No, it's just like, this is a process that patients have to go through. So you do the injections. We monitor each day, each, uh, each other day, like every other day, sorry. And you come into the clinic, or you should be going into a clinic, and they should be doing all Uh, ultrasounds to checking how many are still growing, how fast they're growing, and that everything looks fine.

And then we do blood work to check how patients are, um, reacting to the medication. So estradiol [00:30:00] levels should start going up. And that helps us also make decisions about if we add medication, if we, lower the dosage, all of that. So once it gets to a certain point, which means that most of the follicles, so the follicles, I just want to, I always say this, so the follicles are like the houses of the eggs.

So we don't see the eggs in the ultrasound, we see the follicles. So once they get to a certain, um, size, which is about, 18 to 20 millimeters, and your estradiol levels get also to a certain, um, threshold, then we do injections to help mature the eggs that are inside the focals. Now I will say those ones are awful.

Yeah. Yeah. Those are the big needle. Yeah, those are called trigger shots, which sounds very scary and sounds horrible. Like who is going to, like, what are they going to do to me? But it's just the same injections. But these are essential because what they do is mature the eggs. So eggs that are not mature are eggs that cannot be fertilized.

So the objective of doing egg freezing is having A lot of mature eggs that we could [00:31:00] eventually use and fertilize, right? So once we do the trigger, after the trigger shot, it's 36 hours, and then you go into an OR. Normally you should be sedated, so it's not uncomfortable. You better be! Well, a lot of patients tell me, like, I did this and I don't know where, and sedation, it's just so they gave me something orally, and I'm like The U.

S. is problematic in that way. Endometrial 

Dr. Brighten: biopsy, no pain management whatsoever. IUDs, no pain management. I know, in Mexico, they're like That's barbaric. Do you know? No, that's crazy. I 

Dr. Cassis: wouldn't like what we do is we put a needle inside your ovaries. So wait, but how does that needle get there? It's through the ultrasound, but from the vagina to the ovaries.

So through your vagina to your ovaries, that's, I'm very graphic, but it does. There's a needle in your abdomen, right? We're doing an ultrasound. We're seeing everything we're seeing what we're doing. So that makes it safe. That's still a needle [00:32:00] that goes inside your abdomen. And into your ovary. And I wouldn't have someone awake.

You're, you're, you know, the position is not comfortable. I was out. 

Dr. Brighten: I mean, I 

Dr. Cassis: know where you 

Dr. Brighten: put my legs, but I was out. 

Dr. Cassis: So ideally, if you're doing this, they, Should you be using anesthesia? Not anesthesia where you have to use a tube to breathe. You're breathing on your own. 

Dr. Brighten: At 

Dr. Cassis: least here what we do is we have an anesthesiologist just checking your vital signs, checking that everything is fine, that you're doing fine.

And we do the procedure which typically lasts from 15 to 20 minutes. So what we do is the follicles are full of fluid. We aspirate that follicle. We give those test tubes to the lab, which should be right next door to where we're doing the procedure. Yeah, so it's like a little straw that just goes 

Dr. Brighten: into a tube.

This is where the 

Dr. Cassis: term test tube comes from. So these test tubes, they're given to the embryologist and they look through the microscope and they look for the eggs. And so they are shouting 1, 2, 3 and they're telling us the [00:33:00] number that we're getting. And then once that is done, you go into recovery for half an hour to an hour.

Make sure you don't have any cramping, that you don't have any pain, any nausea, anything like that. And then you can go home. So from like the first day you came to when you leave the clinic after your retrieval, it's approximately 14 15 

Dr. Brighten: days. 

Dr. Cassis: So that's how long the whole process lasts actively. And that same day normally we know how many eggs we got and we know how many are mature.

So we're only freezing mature eggs because those are the ones that eventually you're going to want to use and can use. 

Dr. Brighten: And so a myth I want to bust. People often will say IVF because you're taking your eggs, you are using up all your eggs, you are losing your eggs, it can cause menopause sooner. Talk about why that's not true.

Dr. Cassis: No. So. Okay. Why I said rescue mission is because every month, doesn't [00:34:00] matter what we're doing, doesn't matter if we're taking care of ourselves. If we're not, if we're pregnant, if we're taking oral medication, if we're taking contraceptive, whatever we're doing, we lose eggs every month. So that number is around 1500.

A month. Some patients lose that lose eggs faster, some lose it less, like less fast, but we lose eggs every month. So what we're doing is we're trying to save those eggs. So it is a rescue mission. That doesn't mean we're gonna take away from what you have. So we're not pushing you into menopause. We're just rescuing those that were gonna be lost anyways.

So that's what we're doing. We're not making patients have menopause before, that's not true, and we're just helping you have more options for your future and for patients who have medical conditions, who have endometriosis, who have other things, they couldn't become moms if there wasn't these kinds of procedures.

Dr. Brighten: I have heard more than once from [00:35:00] celebrities who've gone through IVF who have said, IVF is why I have breast cancer. IVF is why I have ovarian cancer. Let's talk about what this research says. So there's a lot of research. There'swe've 

Dr. Cassis: been doing thiswell, not me, I'm, I'm You're like, I'm not old. Don't call me old.

No, no, no, no. I mean, I'm over the 35 threshold, but I'mwe're still young. But, um, IVF has been around for like 40 years, a little bit more. So there's a lot of evidence that that small amount of time that the estrogen levels are higher does not put patients at risk versus someone who didn't do it. 

Dr. Brighten: Of 

Dr. Cassis: course, there are patients who have history of breast cancer or ovarian cancer who have a little bit more risk, but in the general population, it does not push you into having breast cancer, ovarian cancer, any type of gynecological cancer, or even I've heard patients tell me stomach cancer or any type of cancer, but the, but it's such a small [00:36:00] amount of time that you're exposed to high levels of estrogen that it does not affect in the long run.

Mm 

Dr. Brighten: hmm. 

Dr. Cassis: So even patients who have undergone some patients need more than one cycle, even patients who have done three, four, five cycles, they do not have a higher risk of having breast cancer or ovarian cancer. So that's not, that's not true. Taking care of ourselves, that is something that could potentially make patients either have breast cancer or ovarian cancer.

What we do is we always ask patients if they have mom, sister, aunt, grandma, if they have a risk of. Like, um, genetic cancer, then we take measures into not having those estrogen levels so high. That is why we always ask medical, um, your medical history. But yeah, it doesn't. 

Dr. Brighten: How many cycles? How many eggs should people be saving?

How many cycles should they be anticipating? And I'm sure this varies by age. It varies by age. 

Dr. Cassis: [00:37:00] But if, if you were to say like for every woman, what is the. The number, I would say 15 mature eggs. If you can go over that, that's great. If you can't, then your possibility of success using those eggs is less.

So when I'm talking about success, I'm talking about using those eggs and taking a baby home. It's not about. getting embryos, it's not about getting pregnant, it's about taking a baby home. So the more eggs you, essentially the more eggs you have, the more chances you have of that happening. So if we were to say like a number, 15 is normally what is best at any age.

But of course if you're under 35 and you have 10, you still have a good chance. If you're over 39, then the 15 should go a little bit towards more because your chances of having a baby out of those 15 is a little bit less versus someone who is 30, 35. 

Dr. Brighten: Mm hmm. I want to talk about the drop off, though, because [00:38:00] you talked about how you collect these eggs and you're looking for only mature.

Mature is what gets frozen. So there's going to be a drop off, I suppose age related as well. Yeah. Mm hmm. So, basically, this is a marathon, right? So, when you're doing egg freezing, I just want to say, that is exactly what everyone should say to anyone considering reproductive technologies. This is a marathon.

Because as someone who's in it, I still want to keep sprinting and I'm like, it ain't like that. 

Dr. Cassis: No, 

Dr. Brighten: I 

Dr. Cassis: wish it were faster. I wish it were easier. Even when you, when you're trying to get pregnant, just, even if you, if you do that naturally, it's still a whole process. And then adding to that, all this waiting, all this expectation, all this, everything that you have to do, then it really is a marathon.

So it takes a long time. So, normally it really depends on the patient and each patient is obviously different, but most patients don't get pregnant in their first cycle, [00:39:00] but normally when I see a patient I tell them, okay, so maybe one cycle, probably two or three. It depends on what they're looking at, if they want to have one baby, two babies, if You know, if you're doing egg freezing, how old you are, how you visualize your family, all of that comes into 

Dr. Brighten: play.

Is there a point in which you need to use those eggs? So presumably you can't freeze eggs at 32 and then venture into 55 trying to have A baby. What, what, what should women be considering for a realistic timeline? So 

Dr. Cassis: normally if we're talking about doing IVF and then doing a transfer, the like global age at which we do the cutoff is 50.

So after 50, we don't recommend just because there's higher risk of preeclampsia, diabetes, and you know, you want to still be able to see your kid get to at least 18, 20. I mean, our lifespan has gotten. Uh, a lot, uh, [00:40:00] longer, but still, you wanna be active enough to be present in your kid's life, right? Mm-hmm

So that's why the cutoff right now is 50, but 

Dr. Brighten: preeclampsia though, for people who don't know what that is. Mm-hmm . You said preeclampsia. You pre preeclampsia. Yeah. So, sorry, I got 

Dr. Cassis: very technical. So preeclampsia is high blood pressure during pregnancy. 

Dr. Brighten: Mm-hmm . 

Dr. Cassis: So if there's a higher risk of, of having high blood pressure during your pregnancy, which is.

Not the best for the mom, not the best for the baby. There's a lot of complications going into that. But it does put patients at risk the older we are. But, um, we were talking, I want to go a little bit back, uh, to the marathon. Yeah, yeah. the marathon. I know, because I interrupted you because I was like, that is such a 

Dr. Brighten: brilliant analogy.

And 

Dr. Cassis: then, and then I just get into the science of it and I just lose, lose my footing. So you, you start with a certain amount of eggs, but. Those eggs, some patients tell me, I don't want to have that many eggs frozen because, you know, they're kids and that's a whole other political thing, but [00:41:00] this is a marathon and this is a funnel.

So you start, you know, with a large amount of eggs and not all those are eggs. You, you have, I'm going to go into numbers right now. So let's say you have, you know, 10 follicles, out of those 10, not all of them are going to have eggs retrieved, then not all of them are going to be mature. If we go into fertilizing, not all of them are going to fertilize, and not all of them are going to be embryos.

So, humans, we basically suck at being, at reproducing, even though there's a lot of us in the world, but we really do suck. And you see it in the lab and you see it once you do this. So you start with a large number and then it goes down to maybe two to three embryos and then not all of those embryos are healthy.

What I mean by healthy is they don't have the number amount of chromosomes, which should be either 46XX for women or 46XY for men. And anything over or under is healthy. generally not compatible with life. [00:42:00] So you're going from a big number of follicles to a smaller amount of eggs, to a smaller amount of fertilized eggs, to a smaller amount of embryos, to a smaller amount of getting pregnant, and then taking that baby home.

Dr. Brighten: Mm hmm. 

Dr. Cassis: So for me it's very important that patients understand That, that, that is why we want to have that bigger number at the start. Because even though, if you have the, I'm talking about the 15, right? Even if you have that 15, it's not, it's not, um, a guarantee that you're gonna have a baby from that.

Dr. Brighten: And 

Dr. Cassis: sometimes, what they say is that, why, why, we started with 20, why don't, why haven't I gotten pregnant? So there's a whole other thing behind this and not just doing oh, I did egg freezing and then great. I'm done It's like no you have to understand the limitations of what we do And that I would I wish every patient would get pregnant But it doesn't work like like that and managing those expectations for me is so important 

Dr. Brighten: Yeah, and that's the drop off that I was alluding to before we took a little detour, uh, is that you [00:43:00] have the large number of eggs and then it dwindles down to what's mature, to what fertilizes, to what actually grows.

So just because it fertilized doesn't mean it's going to make it past three to five days. And then even after that, even if they are PGTA normal, which is the genetic testing, you were talking about the leuploid embryo where you've got the right amount of chromosomes, it's Even those may not implant. And I think a big myth that really shows, at least in the United States, absolutely how horrifically poor our biology, our sex education, all health information is, is the myth that people think every embryo becomes a baby.

Yeah, that's simply not 

Dr. Cassis: true. I mean, it would make our job easier, but that's not true. It would make my life easier. It would be 

Dr. Brighten: a lot Yeah, that would have been so much easier. I mean 

Dr. Cassis: That is certainly true, and not wanting to get political, but not every embryo is going to be a baby, right, it's not going to give you a baby.

So, embryos [00:44:00] represent an opportunity for patients to get pregnant and to take that pregnancy to term and take that baby home. So, when I tell patients, you know, specifically talking about fertility, how many babies do you want? Right? No, I want two. Okay, so for every baby that you want, we should have two euploid embryos.

Dr. Brighten: Mm hmm. 

Dr. Cassis: So that's the reason why is because not all embryos implant, not all, even euploid embryos, not all of them implant. No one is, if someone is giving you a hundred percent success rate, they're lying. Yeah. So just, If it's too good to be true, it is. It's very important for me to, for patients to understand that.

And it really goes back to what we were saying at the beginning. If we don't know how we function, our menstrual cycle, our biology, everything, then going through all of this is very difficult because. You question everything, but not in a good way because it doesn't come from knowing yourself and knowing your health.

It comes from just [00:45:00] wanting to be pregnant yesterday and wanting a baby, and then you're not understanding the full scope of what 

Dr. Brighten: we're trying to achieve. Absolutely. And I think, you know, you said like, I don't want to get political. I think it's even ridiculous we have to make that statement because all we're talking about is science and basic biology and the only reason Any of this is considered political is because people have decided to legislate women's bodies and I respect whatever anyone's belief is around, you know, around, you know, when life begins.

And I think that we should, we should just respect whatever anyone's belief is in general about these things. Uh, but the thing is that has really gotten me is that I've just seen where, and this happens in the United States because we all know who we are. We all know what we're talking about when we say this.

Dr. Cassis: I'm trying to be politically correct, but we know what we're talking about. 

Dr. Brighten: Yeah, and it's these politicians acting like we're just throwing away embryos. That like, oh, these women, they just get all of these embryos and then they just throw them away. And I'm like, if you knew how hard we work for these [00:46:00] embryos, how many Two weeks of injections.

People might be like, oh, that's nothing. Uh, it seems like nothing on the timeline, but, uh, you know, a good friend of mine who went through IVF as well, she has never told more than five people she went through IVF because she was like, I just feel like there's so much stigma around it. But that's the way that she was able to get her two babies.

But she talked about how. Just how exhausting, how time consuming. She was like, it is more than a full time job to be going through all of this. And so I just say this because I, you know, it's like, I know what I read, but until I was the person going through it, I never really understood it. And I also think that no matter what your beliefs are, understand that the emotion, the heartache, the pain, the journey of all of this is so exhausting that whatever your beliefs are, you can.

still hold space to be kind to somebody who is on this journey. Definitely. I think 

Dr. Cassis: just not having that empathy, it just. I think that's where we as doctors fail, not [00:47:00] understanding what patients are going through and what it does imply. Just going like, Oh, do another cycle. No, I mean, far from the cost, just the physical, the emotional pain that you have to go through.

We have to understand that and validate that because it is, it is very difficult. Even patients. Who, you know, egg freezing, right now it's a little bit more, what I was talking about, about if you don't want to be a mom and having options and if you want to be a career woman and all of that. Even if you, like, go through egg freezing, it's, you're still having to do injections.

It doesn't matter the reason why you're doing it. And I always tell patients, okay, you're going to be bloated, you're, you're going to be Your clothes are not gonna fit. 

Dr. Brighten: Mm hmm. 

Dr. Cassis: You're gonna feel very tired you're gonna feel kind of miserable and then you're gonna hate on everybody you're gonna start crying for no reason and That's part of the process and you need to understand that you're gonna go through this 

Dr. Brighten: Mm hmm 

Dr. Cassis: and if you don't tell patients if you don't acknowledge that they're gonna go through that then it's just it's just like a Like hitting them in the face when it happens.

Dr. Brighten: Yeah. Well, and I [00:48:00] also appreciate that you discussed the limitations, you know, that, uh, everything can be perfect. Everything from the science parameters is exactly as it should be and it doesn't work out and we don't have an answer. We just haven't arrived at that place. You were talking though about how uncomfortable it can be and, and do you have any tips of like, you know, ways to minimize discomfort going through the egg freezing process or how to recover after an egg retrieval.

So first of all, I know this is, I don't want to say obvious, but just stay hydrated. It feels obvious, but hydration is the complication of, uh, you know, ovarian hyperstimulation syndrome. This is one of the ways to, to 

Dr. Cassis: minimize that. Yeah. So, uh, ovarian hyperstimulation syndrome, basically what we're doing is ovarian hyperstimulation syndrome, but when you go a little bit over that, then that can lead to complications with your health.

Right? You should be, if you go in healthy to a clinic, you should [00:49:00] be going out healthy. Right? So, there are complications to doing these, um, these kind of procedures, doing egg freezing or doing IVF. We're very careful about that. And we're very That's why there's all the ultrasounds and blood tests. That's why we do all of that.

But, there are things that you can do to minimize those. Every time, at least, uh, when I, when I see my patients, I always ask, how do you feel? I feel like this, I feel bloated, I feel like, I need you to drink electrolytes, not just filtered water, not just regular water, electrolytes. I need you to stay hydrated, I need you to give in, not give in, I don't know if it's the right word, but really do give in to the process and live the process at that moment because sometimes we're just thinking ahead of, live it, I mean, enjoy it is difficult but.

You just, you will have 

Dr. Brighten: good skin 

Dr. Cassis: and hair. 

Dr. Brighten: Yeah. With all that estrogen. Yeah. But 

Dr. Cassis: then after the levels go down, they say, Oh, my hair fell out. And I'm like, 

Dr. Brighten: I'm sorry. Yeah. It's [00:50:00] part of the, yeah. So everybody knows IVF doesn't cause hair loss. IVF, when your estrogen levels go up, it changes the hair cycle.

The hair basically stays in a resting phase. Then the estrogen drops. Then the cycle starts again and you shed hair. Same thing happens postpartum, but IVF is not as extreme as postpartum. Yeah, no, no, 

Dr. Cassis: it's, it's a little bit different. But the, the basics are based, are the same. Um, so staying hydrated is very important.

Having a support system. Some patients, especially patients who do egg freezing or, or patients who want to be single moms, sometimes they go through it alone. Yeah. And it's so tough to do that alone and not having someone just, just say, Hey, how are you? I think that's. Having someone there to help you through it, or even someone who's been through it, it also is very helpful.

Um, not exercising. This is the only time a doctor will tell you not to exercise. That and after the transfer, 

Dr. Brighten: it's like the, the, I think that was one of the worst parts because exercise is like one of the ways I manage my mental health and [00:51:00] my stress. And then, and then you have to like, I mean, you could still walk gently, but to get that sweater, lift weights, and that stuff.

the part where I was like, and now I feel the mental health component of this. So yeah, not exercising. And why? Why 

Dr. Cassis: is it that you got to 

Dr. Brighten: stop? 

Dr. Cassis: So the ovaries are normally the size of walnuts and they're suspended by a ligament that is attached to the uterus. And there's another ligament that has all the blood flow to the ovaries.

So the ovaries during IVF, they get to like orange sized or grapefruit sized. And that is, that is why. The bloating, the uncomfortable, and it feels weird, your, your, uh, clothes don't fit. It's because your ovaries are basically inflamed, right? So they're hanging from this ligament that has all the blood supply, and if you do exercise, if you do even light yoga, sometimes they're like doing these poses and twists, nothing like that.

So the ovary twists onto itself because it's so heavy. And then the blood supply is [00:52:00] cut off the ovary and that hurts and that is a surgical emergency. So we have to go into the OR and detortion that ovary, which is why don't exercise when you're doing any type of IVF egg freezing cycle. It's not because we don't want you to be exercising, it's just, I always tell my patients why because essential for, for, Patients to understand why I'm making decisions and why I'm telling them what I'm telling them, but don't exercise and Try to try to focus on one why you're doing the process is also very important in order to to go through it So at least for me I think having that support, even if it's not a friend, even like professional support, some, your therapist, anybody, that is, that is also important for patients to have during that, 

Dr. Brighten: that process.

Absolutely. And higher protein can also help with preventing OHSS. I realize we like kind of talked about that. What are the signs and symptoms of OHSS? [00:53:00] Why do, why should people, and that's ovarian hyperstimulation syndrome, why is it that people want to be aware of this and, and not take it lightly? So 

Dr. Cassis: first of all, the signs, I'm going to go through that because I was like thinking ahead and I was like, no, no, let's go back.

So signs. bloating, which is normal to a certain point, right? If we're seeing that estrogen levels are going really, really high, then you're going to feel very, very tired. You're going to feel a lot of bloating, a lot of cramping, and then you might start, um, not peeing. That's one, also one of the signs. 

Dr. Brighten: Uh, you 

Dr. Cassis: can get shortness of breath, nausea, uh, vomiting.

All of that are signs of OHSS going from mild. to severe, right? So we don't want patients. It's been a really, really long time since I've seen a severe case because we know how to handle that. But if you're very uncomfortable, if you're very bloated, if something doesn't feel right, you have to speak up. I always ask my patients, but sometimes some patients, [00:54:00] they're more quiet.

But if you're feeling anything out of the ordinary, You should tell your doctor this, like, why am I feeling this, is this normal or it's not normal? 

Dr. Brighten: Mm hmm. 

Dr. Cassis: Because it can go from, you know, some bloating to having a clot because, you know, um, estrogen helps produce VEGF, which is one of the vascular endo, oh my god, VEGF, endothelial, basically what it, what it does, it makes.

More, more fluid come into your abdomen. And that could potentially make your blood, uh, clot and then have any complications from blood clotting. So that's also important. That's why we tell, we ask patients how they're feeling because complications can really be severe. Patients can end up in the ICU.

I've never heard of a patient having, you know, to stay more than a certain amount of days in the ICU or any deaths from that. [00:55:00] You know, we have to look out for, for all of 

Dr. Brighten: that. Absolutely. Now, post egg retrieval, you just had, you just had a needle in your ovaries, so don't take that lightly. What should people be doing to successfully recover from that?

So the day of the 

Dr. Cassis: retrieval, just stay at home, you don't have to go anywhere, you don't have to work, just take the day off, take it slowly, go home, you don't have to stay in bed, you still do have to move around, and you can, you know, stay laying down, watch a movie, watch a series, read, whatever, and you stand up, you go to the bathroom, you eat, So, just having rest is, is perfect that, that day, and then after that, you have to eat healthy.

Right? So, most patients, they have a little bit of, of nausea, and they, they tend to not eat healthy, or they tend to go the processed route, and they're like, I can do anything, I wanna, you know, um, I've been so good for like three bites, now I'm 

Dr. Brighten: just gonna binge. Yeah. 

Dr. Cassis: So, don't binge. Like, uh, Dr. Jolene said, higher protein.

Try [00:56:00] to make your meals. very balanced and hydrate. Again, hydration is going to be essential for this, for your recovery. And then be like, talk to the doctor who did the procedure, right? So if you're not, if there's something that is not right, again, tell your doctor, ask them if this is normal or not. Take time for yourself.

Make sure you understand They give you feedback on the cycle, which is very important. Sometimes, we tend to say, we got this amount of eggs, we'll see you later, and then no one does that feedback. No one tells you this is what is going to happen, this is, so that is also important to have. And just generally taking care of yourself.

From the day of the retrieval. So your next period is about 10 to 12 days. It depends on the patient. So you're going to have your period eventually, and that period tends to be painful and tends to be more, a lot more heavy than your regular periods. So also expect that, and that is to a certain degree normal, [00:57:00] but you just try to do whatever you normally helps you that it's not exercise.

Please don't exercise either after the retrieval. 

Dr. Brighten: Yeah, so you're going to be looking at like a good three weeks minimum of not exercising and uh, we were talking about the OHSS. It's really like if you do develop that, um, I just see all the time I hear from people that are like it's a countdown to the period because once your period comes, so many of those symptoms go away.

And the reason why the period's heavy, all that estrogen building up the endometrial lining. So, um, But as you were saying before, if it's incredibly painful, if it's very, very heavy, lots of clots, check in with your provider again. Yeah, definitely. How can people work with you? I bet there's going to be people right now who are like, how do I get in with this doctor?

Okay, so I 

Dr. Cassis: have my own clinic. It's called Hesta Fertility, and I I do everything there. We have all the services that you would need in order to check your ovarian reserve. If you suspect that you have endometriosis after hearing us talk, if there's, [00:58:00] if there's any doubt that you want to be a mom or you don't or whatever issues you have with all of this, then I can definitely help.

So I can leave all my socials on We'll put, we'll link them 

Dr. Brighten: all for sure. So 

Dr. Cassis: Hestia Fertility, what we want is Patient centered, and not just saying patient centered, like actually achieving patient centered, so we have everything that you would need in order to make this whole journey and this whole process as tolerable and even, I'm gonna say it, enjoyable as you can, because that's, I mean, we go through a lot.

Um, as women, like this is like another layer of what we go through, so that journey for me is very important. I love that. 

Dr. Brighten: Well, thank you so much for coming on the show, it was so great to chat with you and see you again. Same. I could stay here for like three hours still talking. We could talk about so much.

You're such a wealth of knowledge, but I think 

Dr. Cassis: all of this information is going to help a lot of women. Thank you for having me. If you guys have any more questions, you can reach out to both of us, we'll leave our socials. Thank you so [00:59:00] much, really, for having 

 

me.