Inside Reproductive Health, Ep 21

Should All Women in their 20s Consider Egg Freezing and Is It Attainable? An Interview with Valerie Landis

Listen on Google Play / Apple Podcasts / Spotify

In this episode, host Griffin Jones talks to Valerie Landis, a proponent and advocate for egg freezing who has not only documented her own journey of freezing her eggs, but works actively to educate young women about the advantages of freezing their eggs in their 20s. Jones and Landis had a spirited discussion about the pros and cons of egg freezing.

Host Griffin Jones of Fertility Bridge -- Inside Reproductive Health Podcast -- Should All Women in their 20s Consider Egg Freezing and Is It Attainable? An Interview with Valerie Landis -- Episode 21

Links to platforms mentioned in the discussion:

https://www.fertilitybridge.com/inside-reproductive-health-episodes

https://eggsperience.com

https://eggologyclub.com

Griffin Jones: Today on Inside Reproductive Health I’m joined by Valerie Landis. Valerie has been working in women’s health for startups in the fertility field for the last decade. She travels across the country building partnerships with fertility clinics, she’s driving change for access to care, is a key voice in patient advocacy and education, especially for egg freezing. She documents her own journey about freezing her eggs. She has multiple social media channels, on Instagram, on Twitter, and she’s very active in the blogosphere. Valerie hopes that by starting the conversation about protecting women’s future selves with non-biased and fact-based information, women will feel inspired, brave, and act progressively. Valerie, thank you so much for coming on Inside Reproductive Health.

Valerie Landis: Hey, Griff, it’s great to be here!

GJ: there are other people I could ask if I wanted to talk to physicians or embryologists about more about the clinical side of egg freezing, and we probably will have them on, but you can still talk about that because I think you’ve done more research than any other non-medical professional in this respect. You’ve also done it, you’ve also talked to just about everybody in this field and so for those you haven’t met, can you give a little context for how this came to be?

VL: Yeah, it’s quite a history. It’s an evolution of some sorts, where essentially I didn’t realize I was going to be such an advocate for egg freezing until I embarked on it myself, and really saw the clinical benefits that it can give a woman in her reproductive years more time, and that’s exactly what I needed. So, in 2015, I froze my eggs for the first time, one of many freezes I will end up eventually doing, but you know, I started the process, and it felt kind of lonely. At the time, in 2015, the landscape was such that not a lot of people wanted to be very public about this, it was kind of a hush-hush thing.

GJ: That’s only four years ago, but in egg-freezing terminology, it seems like two decades ago.

VL: Oh, yeah. I mean, a lot has changed, even just since ASRM approved egg-freezing for commercial use,non-medical reasons. So, y’know, it was a little taboo back then, even within my clinics-- I’m in the industry, I’ve been working in women’s health, I feel very fortunate that my career has been in medical sales, because that has taught me about my reproductive system and my biological, like, how my body works, and when I can have kids. It taught me that throughout my entire career. I think if I wouldn’t have had that experience, selling birth control to hormone replacement to working in the lab with the clinicians and fertility clinics, I wouldn’t have necessarily jumped on freezing my eggs at 33 years old. But back in 2015, that was, I was like, really young for doing it. Everybody was like, oh, you have more time. The average egg freezer used to be around the age of 37, 38, 39… so that explains why a lot of people in the industry think it doesn’t work. Because there are lower results that… you have to freeze more eggs and do “egg math,” is what I call it, in order to make a live human out of those eggs that you freeze. If you freeze younger, you can freeze less time with better results. At the time, the landscape wasn’t such that they were encouraging that, right?

GJ: That makes me think— maybe I’m jumping ahead a little bit, but I went back to a piece that Broadly, being owned by Vice, they did a 45-minute expose about egg freezing, then I read another piece in the New York Times that came out last August that was sort of scathing about commercial interests in egg freezing, but I feel like the articles were a little bit poorly researched in some respects, or more misleading in some respects, because they sort of touched on what you were talking about, like, this used to be the service and because of commercial interest, now they’re targeting much younger women. To me, it seemed like, well, in the beginning, that didn’t seem like the highest yielding demographic to have, so talk a little bit about that.

VL: No, you bring up a really great point, and I’m blushing a little bit, because I saw that Vice/Broadly, and I was thinking, like, gosh, we have so much work to do. This is a complex topic. Fertility touches the core nerve of everyone’s values and family. And so, that is a deep root. And you can’t just blanket statement, Oh, these clinics or these standalone clinics or these egg-freezing-only focused places are targeting young people. It’s where the best bang for your buck is, so why wouldn’t they target… I mean, medically, that makes sense. I would encourage, full-heartedly with no reservations, that somebody that’s straight out of college would do this. It’s no different than the milestone of completing college or buying a house. It’s right up there with you for what you should do as a female in today’s society, we have this amazing science, this amazing technology that took years to develop or perfect. Currently, it’s the best thing that we have for prolonging our fertility futures and at least being reproductively, biologically still right up there with men.

GJ: That’s really bullish on egg freezing, in terms of who should do it, in terms of its overall utility. I don’t know if I would echo that same message as strongly, I guess I just don’t have a reason to, but it’s…

VL: Think about...okay… I just challenge you on this aspect. Think about, like, how busy our lives get. And you don’t know… I’ve seen 25 year olds get cancer. So when’s a great time to freeze-- when you’re faced with your life or death situation, or when something happens in your life, or maybe you’re not financially ready, but I think that it’s at the quality level, just like getting a college degree, egg freezing prolongs your family future, no matter what happens in your life. You don’t know where the cards are gonna fall. And the reason I’m very bold about that is because look at when we collect egg donors for third-party reproduction, for example, they’re not the thirty-year-olds that we’re asking to donate… we’re asking the twenty-year-olds, because that’s the most viable egg. If you want egg freezing to work, you’re never able to get a better egg than when you’re in your early 20s. So that’s what I’m saying. You just finished this huge milestone of your career, and now you’re with your education and your career, so now you’re going to go be able to be in the workforce or date the right people or have fun, and what a great opportunity to put in front of yourself. That’s why I suggest or say that if you really want this to work, your early 20s is biologically your best time.

GJ: Do you feel that it’s so much better than 28 or 29—

VL: Yes!

GJ: — because to me 28 or 29 seems to be so much better than 38 or 39, which was previously the norm and to me, it also seems that at 28 or 29 you have a little bit better of an idea of where your life is just as an adult. Why is 22 so much better than 29?

VL: Well, we could debate the age factors, but really I would challenge or say, if you think about all the things that get thrown on your plate by the time you’re thirty, yes you may know more where you’re at, or if you’re going to have a kid naturally, or if you even found the right parenting partner, but I just challenge you...how much of a weight you will take off your shoulders if you did it just like you got your college degree? Or if you went to grad school? How many years is that gonna put you out before you’re ready to have kids? The trend right now is that everyone’s getting married later in life. If kids come after marriage, then we’re delaying things on purpose. I think that you could do it just once, in your early 20s, vs. a couple of times in your later thirties. What I’m seeing now, Griff, is technically a lot of women because they’re not getting these normal AMAH tests with their OB-GYN appointments yearly or when they have their scheduled paps, is that there’s early ovarian reserve loss, and that’s a real thing. You might be 30, but your eggs might be at a reproductive age of 40. Now you’re panicking to get egg freezing done at 32, because you didn’t know, and you just learned about it at 30 and it took you a couple of years to ask your OB-GYN or see a fertility doctor or find one.

GJ: Do you believe in this because of its potential, because it’s revolutionary. How do you then balance that with making sure that people don’t receive this as a silver bullet message? Because I think some people are… if they’re not relaying it as a silver bullet message, they’re allowing it to be perceived as one, I think… where… I think there’s a lot of cocktail parties, for example, the entire slogan of “stop the biological clock,” it’s a lot more complicated than that. Somebody might have male partner issues. They might have [unintelligible] using their own eggs in the future may not help them or they might not need it, and then if they do, IVF is an entire other aspects of education. How do you balance this is something that is so powerful, so revolutionary, with it’s not a silver bullet and there are these other things to consider.

VL: Yeah, I mean, it is a tough debate. Every person is different. And there’s a lot of people out there, my own sister, for example, that wouldn’t even consider egg freezing-- and she has me as a sister! I’m in her ear, saying, hey, I think you should do this. She had a broken engagement, luckily she’s dating someone now who could be a parenting partner for he, he has that potential, they haven’t decided to go down that path, but I mean you could look at every individual scenario and come up with a reason why or why not. I think education is power, and that’s why all of my platforms, whether it’s the Eggsperience website or the Eggology Club podcast, or even the video doc that I'm currently producing, This is Egg Freezing, it’s going to show you and showcase exactly all of the pieces of the puzzle. Because you have to take all of that information, because when we know better we do better, you have to take that information and figure out what works for me, what are my goals, and what are my values. Like I said, fertility goes straight down to the core of your values. If your values are that you really know that you want to have a kid, I just warn women because I’ve seen it. I’ve got a lot of older friends, and I’ve been in… these topics, I’ve been in common debate amongst ourselves, and because I have older friends, I’m hearing their perspective later in life, and what.. Maybe…. Y’know… maybe it takes the right person. Meeting the right person, to all of the sudden have this epiphany that you want to have children. I just say that it protects your future, and why not give it the best chance of survival. The best chance of survival is a 20-year-old egg, that’s where we use egg donors from, I think the cutoff for egg donors is like 27 or 28, for some of the egg banks. Why would it be any different for an individual?

GJ: What are the biggest misconceptions that you see that the public has or that prospective candidates have about egg freezing?

VL: Well, there’s a lot, and it keeps changing. As the news develops their story angle to try to get eyeballs because it’s very calculated. Y’know, like, I just read an article recently, “I didn’t know I couldn’t get pregnant.” That’s a very bold statement tagline of an article to get someone to click on it. But it’s true. I do think that women don’t know they can’t get pregnant because they see celebrities… but what have we taught them? We teach them that Janet Jackson can get pregnant at 50. We tell them about how many other celebrities who have used different types of IVF for fertility and oh! They got pregnant with no problem at 40. I think what we’re doing is we’re giving them the false hope in those aspects, and we’re not teaching them about their reproductive clock and about how their body works. Most women, in general, that I talk to on a regular basis, don’t even understand their menstrual cycle and when they can get pregnant in their monthly cycle. I think that we’ve pushed birth control -- if you look at the evolution of birth control, we’ve pushed birth control down women's’ throats for the last 30+ years, that every doctor visit on average, we see our OB-GYN less than 12 minutes one time a year, that’s not enough time to have a conversation about egg freezing, or the benefits that it could do. And the conversation is, well, ok, great, I got your pap, now what birth control do you want for this year. We don’t even talk about whether you could have other birth control methods, or how you can protect yourself from STDs and STIs, and that could potentially be a deterrent for pregnancy down the line. We’re not talking about all the key factors and there’s a lot of factors, so that’s a conversation. I understand why that twelve-minute doctor visit, it’s just not possible. So women are going to have to seek information from other places, and that’s what I hope to provide.

GJ: Information… should they need to know, for example, your education, you take women through the process. What are the things that every woman should consider or needs to know when she’s deciding on this process?

VL: I think you need to find a clinic that you jive with, and a doctor that you’re comfortable with, and you can ask any questions and you’re not a burden. I think that’s super important. That’s why a lot of these freeze-only clinics, standalone clinics, are popping up, is because these women want the individuality. And I don’t know if clinics were doing that really well before, because they were so busy worrying about getting people pregnant, they were worried about their statistic rates, they were worried about getting their numbers increased so they can continue to do business, this is an expensive procedure, and not everybody has $10K to embark on this process. But, what I say, is that where there’s a will there’s a way. I have plenty of resources to help you source your hormones for less, how to apply for discount programs, how to negotiate multiple cycles with a clinic and to debate all those things. So I can provide all of those source resources where, if you really want to do this, you can do this. But I think you need to have a realistic strategy and a game plan based on your age, based on how much money you have, and your social demographics, how much you want to invest in your family future, and what comfort level you are at the percentage of whether or not it’s going to work. There’s a couple of egg calculators out there, and I can provide a couple of links for your show, and you can literally put in your age, how many eggs you physically got frozen, and it will spit out a percentage of how many… what percentage to a live birth you can get. You need to start with how many children you want. If, for example, I want three kids, if I don’t get late too started in life, and I’m the partner, then ok. If I want three kids, I need at least 30 eggs. No lower than 30 eggs for a percentage…

GJ: How do you calculate that, and how do you respond to someone who says, we just don’t know how many eggs we should be freezing now?

VL: Well, I think that if you freeze in today’s landscape of vitrification and you don’t have a slow-frozen eggs, which was the technology that was used before 2012, then you can safely say that the 2-12% chance that any eggs that you produce, each egg will have a live birth. So, that’s a low percentage per egg, but if you think about it, it’s just like a dozen. I always say it’s nicer to have a baker’s dozen, 13, and every 12-13 eggs is roughly one baby. Now, that’s given that you’re not freezing over 37, 38, 39-- then you need a couple more in that baker’s dozen.

GJ: Ok.

VL: That’s a good gauge for the number of eggs. Now, keep in mind, let’s say, I hear this two. A lot of women have frozen, and they only got four or five that cycle. What that means isn’t that you only have four or five eggs. What that means is you only have four or five eggs grow at the right rate that were mature enough to freeze. So, I really think the antral follicle count, which is the ultrasound that is done beyond the AMH test is a good predictor of how many eggs you can produce depending on how you stim. We have to be able to take the hormones and your body respond to them. If you have a poor response, then it’s gonna affect your cycle, too. Don’t get discouraged just because you only have four or five eggs that were frozen. I always talk about plan on, if you’re in your thirties, which most women are right now, there are very few 25-year-olds or 20-year-olds are really doing this, there’s a select few, but I think that it’s more commonplace, right now, the demographic has shifted from the 37-38 age frame to more 33, 32, 30-year-olds, which is great that that trend is coming down in age quality, ‘cause that helps a ton in the reproductive years, but you’ve got to think like, ok, how many eggs are right for you? And have that discussion with your doctor. That’s why I say go back in the beginning portions and find the right doctor for you. Find the right clinic that you feel comfortable with.

GJ: You and I have spent a lot of time talking about how people find these clinics, how clinics should court prospective patients, and about the go to market across North America and just what’s happening in different markets with this. Are you… what I’m seeing right now is a race by some people that are really ahead and then 80-90% of other people which are just like, yes, we would like that too but haven’t really put forth an initiative in terms of really marketing their program as something apart. Do you see it that way?

VL: I think among the physicians, you and I both call upon them on a regular basis nationwide, and I think a lot of them, there’s quite a few doctors that are hesitant because of, look at some of this news and media and press that’s been out, it’s rather negative to the clinic. Because, oh, they’re doing fun things on Instagram, then quality must be low. Or because they offer discount programs for egg freezing, well, then, that must mean that they are not a legit clinic, y’know. That’s just not the case. If an average IVF cycle is $12,500 from start to finish, from egg collection to retrieval to making an embryo to implanting an embryo and having a transfer, then why is egg freezing $10,000? I think it should be $6,000 at max. Because I work with all the clinics nationwide, I have a very good perspective of what each area of the country is being competitive with. And I think, too, partly these clinics are a little competitive and y’know they’re worried about what their next door neighbor is doing, rightfully so, because there’s only so many patients out there, but what I think they fail to realize is that this demographic of egg freezing if it’s done well and right and they hold true to some very transparent, transparency and not hold their cards so close to their chest, then it will come back and benefit them.

GJ: Would you agree that egg freezing is moving beyond what we might call the first-tier, coastal, affluent cities? I think we’d probably agree that it’s here in the Bay and New York and Los Angeles, and now I think we’re starting to see it in Charlotte and y’know Orlando or other cities that are still pretty well off economically and pretty well distributed in terms of age and professionalism, that we’re beyond the coasts now and we’re starting to see Dallas, Houston, cities like those are starting to see a lot more egg freezing.

VL: Yeah, I think before we used to just talk about how, oh, it takes so much professionalism to understand how to freeze an egg. And it does. The embryologists do have to do this with a lot of skilled training and a lot of practice. I think we’re now coming to this flux where just about everybody that’s an embryologist has some experience with vitrification. They do it for embryos, that we have more skilled professionals. That is why it’s able to go to the smaller-knit communities, like, North Carolina or y’know the suburbs of Texas and maybe up north in like Wyoming and Utah. These are not necessarily areas that advertise about egg freezing before. But the emphasis on how this is the growing marketplace for their practice to find the spaces where they can make revenues meet a higher demand.

GJ: Suburban Houston is one thing. Wyoming or Buffalo, New York, where I’m from, or Grand Rapids, Michigan, that’s another thing. Do you think that egg freezing is going to catch on in these areas? Because at the end of the day, where I’m from, where some of the people are listening from, this isn’t an affluent area, relative to the Bay…

VL: Yeah, you’re more countryside…

GJ: It’s smaller and just this is a place where people are more focused on how much they’re paying at the pump, that’s not to say there’s no affluent people, there’s no professionals, because of course, that segment exists everywhere, but when we’re talking about $5000 for an egg freezing cycle, which it often is, and we’re breaking that over the course of however many years, plus storage, we’re talking about a car payment for a lot of people. Do you see egg freezing moving to these places that are not the first tier cities, or even like the other areas?

VL: Larger populations. Y’know, I think it depends on how good the clinic is to recruit the talent of embryologists that can do this well. I think that if they recruit the talent, there’s gonna be…listen, the urban cities, the New York, the San Francisco, the LA's, the Chicago, Dallas, or Houston, those are very first-tier cities where there’s lots of competition. But not everybody is going to want to live in the city forever. I’m originally from about an hour west of Philadelphia, Pennsylvania. And maybe someday I would want to raise a family there, y’know? And so they need IVF, too. And I think that y’know, if the trend is growing, the clinics are going to meet the demand. It’s just gonna take a little longer for progress to get there. But I know, okay, so if we’re looking at like that demographic person that currently lives in these areas that are maybe even a little bit more remote, they look at these prices…

GJ: It’s not even a question of remote so much as it is affordability and just the zeitgeist. The woman working at Bain & McKenzie or at Apple or at Facebook is hearing this all of the time, because it’s what her coworkers are saying, or the groups she’s going to are talking about, it’s what she reads, whereas someone might work for a regional bank or a car dealership in a place where $50,000 is a pretty decent income, that affordability and just priority in terms of what the rest of their peers are doing, I don’t know how that translates.

VL: I think we have a lot of work, yeah, I think we have a lot of work to do in access to care. And that’s one of my biggest passions is access to care. There’s a number of startup companies at the moment that are currently working on employer plans that can be supplemental insurance to help cover, or with RESOLVE, for example, we’re trying to help access to care in certain states that are medical … that have current friendly medical friendly fertility benefits. So there’s a lot of work to be done in that entire area. I think that’s a continuous thing, it just doesn’t stop and start. And until we address that infertility is a disability, then we have a problem with our whole ecosystem with healthcare.

GJ: Because that affordability issue really is a determining factor of the age, as well, right? That’s the reason why 39-year-olds are freezing their eggs. ‘Cause they’re the ones who can frickin’ afford to do it. Whereas…

VL: Right. They’ve had so much earning potential already, that their earning potential matches their time. Unfortunately, their biological clock doesn’t equal that. So, if you did the statistical figures or, I’m not a math person, but I know some friends that are, and they have done this, they said, “If I would have frozen at 37, 38, 39, how many freezes would I need to equal the same reproductive benefits as if I would have frozen when I was in my early twenties?” And actually, turns out you can do less freezes in your twenties, for eventually you can afford it, but at 20 you can’t, and it would be more valuable to take up a loan in your 20s and buy freezing than it would to wait until your later 30s and freeze just, because you have the economical power to do so.

GJ: That loan you take out is really difficult to stomach and maybe even not possible to take out when someone’s graduating from DePaul with $60,000 for frickin’ bachelor’s degree in a social sciences discipline.

VL: Sure, I get it. I get it. And the jobs out of college aren’t those $100,000 jobs that they think they deserve or want or that they were promised. What I’m seeing is a lot of parents are stepping up as a graduation present and giving their child egg freezing to ensure that they have grandchildren someday. It’s not a bad gamble. What I think though is affordability and loans are more prevalent than you think. There’s a lot of startup companies and fertility focus loans, there’s future family, there’s Egg Fund, there are resources out there, it’s no different than going and buying a car, you said that earlier. I think it’s a priority shift. Are we going to prioritize vacations and your latte at Starbucks, or are you going to put your family’s future in balance and say nope, I’m going to go on a savings diet for the next year to freeze my eggs. It’s a priority mindset factor.

GJ: Marketing wise, that parents paying for their kids graduation present, that might be the play, especially in certain markets, because it comes to this is how forward-thinking we are, we got Rachel this when she graduated from Vassar and so…

VL: Well, I wish my parents had done it, but I don’t know about you, Griff, but I grew up in a generation where my parents didn’t pay for my college, I paid for my college and own my home, I paid for my first car, and I also paid for egg freezing, so I think it can be done. Once again, I go back to the whole mentality where if you want something really really bad, you can figure out a way to get it.

GJ: I want to conclude with this because it’s something that you had talked a little bit about earlier or at least made me think of, and I don’t feel that it has to be exclusive with or without the egg freezing conversation, I just happen to think that they go together, and so people might think, oh, this is a way of either pushing or pushing against egg freezing, really I think it’s a more esoteric conversation that we want to have as a generation, which is just as a generation did we wait too late? Are we waiting too late? I talk about this with people in the field sometimes, and it’s just like, this is just me speaking anecdotally as a single 33-year-old. I feel that so many of us just didn’t think about this in our early 20s, whereas in previous generations, throughout all of human history, you were thinking about fertility pretty darn young because that was your role of all of human life, was to reproduce and then die. And now, we’re at a point where we’re not thinking about it in our early teens, because we’re so educated to not get pregnant by any means necessary, at least anyone in the middle class is taught that rigorously, and really not thinking about it in your 20s, because I just got done with college, which was probably not where I wanted to be or not worth my investment and now I finally got some liberty and figured things out and I want to enjoy this, but I’m in my mid-20s in a time where that would have really been a mature time to find a partner and start building one’s family, it’s just not something that we’re really thinking about and then all of the sudden, you’re like, oh, we’re in our mid-30s now, so is this a conversation we need to have, or do you think about it sometimes, and I don’t think it means we should or shouldn’t do egg freezing, but are we waiting too late.

VL: I think if you look at the paradigm shift for how marriage and family is shifting right now, you have to go back to how did that start, where did that trend, where did that come from, and freezing really is the most advanced technology since the birth control pill. The birth control pill, when that came out in the early 50s and 60s, it was a revolution for women to have the freedom of worrying about having so many children that they didn’t know what to do with, and they had to be careful when they had sex. I think that then we pushed it down women’s throats for the last 30 years or 20 years, so now we delayed it automatically because we are able to enjoy the act of sex… it has other meanings. It’s not purely for the act of reproducing. That brought on the sexual revolution. Then the sexual revolution brought on commitment issues. And now we have swipe dating and look how fast and how easy we can go to the next… find someone new if all of a sudden our luster doesn’t match. And so I think what we’re doing and social media, you can blame social media on this a little bit, too. We don’t know how to talk to each other. We don’t know to what the other sex is thinking and we are having different value systems where like we’ve given men the opportunity to be endless bachelors or to be Peter Pans and so I think we’re a byproduct, our generation, early 80s babies, we’re a byproduct of the evolution that is just happened now. So are we leaving it too late? Yeah, we are, but luckily, because of egg freezing and because of IVF technologies, and how this has shaped baby making, it’s not as big of a deal as it was when it wasn’t around. So I think that because we’ve developed the technology until we’re able to figure out a way to fix the mitochondria in an egg, egg freezing’s all we’ve got. So until we can grow egg cells from immature PC cells and go through that whole scientific process, egg freezing is all we have. And what we know is if you freeze younger, you can be your own egg donor.

GJ: So these massive cultural implications caused directly or indirectly by the technological revolution of the birth control pill, and by the way, I put birth control on the level of significance of steel and electricity. It is that massive.

VL: It is so important.

GJ: The solution to those cultural implications could be just… led by egg freezing?

VL: I think it could be. I’m not a predictor of the future, but it appears that it’s on that path, yeah. It’s been an interesting discussion with you, Griff, I really appreciate your views, as not only a man but as someone in the industry.

GJ: I try to think about it because I always think about and… this is why I put our philosophy in marketing really front and center on social media, I invite the public and prospective and current and future patients to look at it, because I just always feel like Vox is out to get me, well, not to get Me, but to get anyone, or Broadly, or the Huffington Post, or the Washington Post…

VL: NBC News, or the Washington Post…

GJ: Or anything like that, it’s just so I want to be…if I ever have to, say, like, this is why I went this route, it’s something that I can stand behind. So I really try to be critical of what messages we’re putting out in the field.

VL: I think we can’t be loud enough, to be honest. The news wants to go and share their perspective of things for their very alternative motives, I think we’re doing women an injustice by not educating them in stages. Y’know, when your sex ed class or your biological clock or your biology class in 5th grade on how to learn about your period and what a condom is, we need to be doing stages of that kind of typical education within the school systems in high school, in college, that’s the time period in that each of these stages needs to progress. At the right age group for that young person and then if you look at...just to use for example, this is a growing academic problem not just for the US but nationwide, I don’t know if you saw the article that we’re able to take a cell and change whether a person has HIV or not? They were able to help a man who was clinically diagnosed with HIV be able to become HIV free? So that’s a huge advancement, but obviously, it’s only the second person they’ve been able to do this for so the science is still progressing. But if you look at STIs and STDs in general, just as an aspect, if you look at who has the lowest STI rates, it’s the Netherlands, because they start teaching sex, their bodies, and the biology of the system, and how to have this sex conversation without the shame. Abstinence training doesn’t work. They start that as young as five, and they have a progression and a system, and they’re like, at five, we’re teaching them their individual bodies, then maybe at 10, we’re teaching them about the opposite sex and their gender parts, in teenage years, we’re teaching safe sex and how to consent and what yes and no means and then maybe in college or high school is when you… y’know, there’s a progression. We need to be at the right age progression and take away these problems.

GJ: I think that age progression makes sense, because then it doesn’t necessarily have to come to a broad cultural waiting too late and not thinking about this to having something to think about because it’s brought to us at the right time, saying, ok, we’ve just spent five or ten years telling you how not to get pregnant, but now that you’re in your early 20s, here’s what to consider. And I think that progression, that education really makes sense.

VL: Well, we’re lucky, Griff. We’re in the United States. There are some countries that don’t allow egg freezing for single women at all. Like Singapore and some of the Asian countries, they have very strict laws, they have to be legally married for some women to freeze, or, for example, the ten-year storage limit for eggs in the UK. Like, there are different legal regulations that have not caught up with social norms, so at least we’re in a country that has those reproductive freedoms. I think if anything, there’s a lot of medical tourism that ‘s happening in the United States because of it.

GJ: Catching society up with what’s going on in egg freezing is what you do best. You did it here today on the show, thank you, Valerie, thanks for coming on Inside Reproductive Health.

VL: thanks, Griff.

Original link Fertility Bridge posted 1 May 2019: https://www.fertilitybridge.com/podcasts/2019/5/2/should-all-women-in-their-20s-consider-egg-freezing-and-is-it-attainable-an-interview-with-valerie-landis

Links to platforms mentioned in the discussion:

https://eggsperience.com/

https://eggologyclub.com/podcasts/

Griffin Jones: Today on Inside Reproductive Health I’m joined by Valerie Landis. Valerie has been working in women’s health for startups in the fertility field for the last decade. She travels across the country building partnerships with fertility clinics, she’s driving change for access to care, is a key voice in patient advocacy and education, especially for egg freezing. She documents her own journey about freezing her eggs. She has multiple social media channels, on Instagram, on Twitter, and she’s very active in the blogosphere. Valerie hopes that by starting the conversation about protecting women’s future selves with non-biased and fact-based information, women will feel inspired, brave, and act progressively. Valerie, thank you so much for coming on Inside Reproductive Health.

Valerie Landis: Hey, Griff, it’s great to be here!

VL: Yeah, it’s quite a history.. It’s an evolution of some sorts, where essentially I didn’t realize I was going to be such an advocate for egg freezing until I embarked on it myself, and really saw the clinical benefits that it can give a woman in her reproductive years more time, and that’s exactly what I needed. So, in 2015, I froze my eggs for the first time, one of many freezes I will end up eventually doing, but you know, I started the process, and it felt kind of lonely. At the time, in 2015, the landscape was such that not a lot of people wanted to be very public about this, it was kind of a hush-hush thing.

GJ: That’s only four years ago, but in egg-freezing terminology, it seems like two decades ago.

VL: Oh, yeah. I mean, a lot has changed, even just since ASRM approved egg-freezing for commercial use,non-medical reasons. So, y’know, it was a little taboo back then, even within my clinics-- I’m in the industry, I’ve been working in women’s health, I feel very fortunate that my career has been in medical sales, because that has taught me about my reproductive system and my biological, like, how my body works, and when I can have kids. It taught me that throughout my entire career. I think if I wouldn’t have had that experience, selling birth control to hormone replacement to working in the lab with the clinicians and fertility clinics, I wouldn’t have necessarily jumped on freezing my eggs at 33 years old. But back in 2015, that was, I was like, really young for doing it. Everybody was like, oh, you have more time. The average egg freezer used to be around the age of 37, 38, 39… so that explains why a lot of people in the industry think it doesn’t work. Because there’s lower results that… you have to freeze more eggs and do “egg math,” is what I call it, in order to make a live human out of those eggs that you freeze. If you freeze younger, you can freeze less time with better results. At the time, the landscape wasn’t such that they were encouraging that, right?

GJ: That makes me think— maybe I’m jumping ahead a little bit, but I went back to a piece that Broadly, being owned by Vice, they did a 45-minute expose about egg freezing, then I read another piece in the New YOrk Times that came out last August that was sort of scathing about commercial interests in egg freezing, but I feel like the articles were a little bit poorly researched in some respects, or more misleading in some respects, because they sort of touched on what you were talking about, like, this used to be the service and because of commercial interest, now they’re targeting much younger women. To me, it seemed like, well, in the beginning, that didn’t seem like the highest yielding demographic to have, so talk a little bit about that.

VL: No, you bring up a really great point, and I’m blushing a little bit, because I saw that Vice/Broadly, and I was thinking, like, gosh, we have so much work to do. This is a complex topic. It’s… fertility touches the core nerve of everyone’s values and family. And so, that is a deep root. And you can’t just blanket statement, Oh, these clinics or these standalone clinics or these egg-freezing-only focused places are targeting young people. It’s where the best bang for your buck is, so why wouldn’t they target… I mean, medically, that makes sense. I would encourage, full-heartedly with no reservations, that somebody that’s straight out of college would do this… it’s no different than the milestone of completing college or buying a house… it’s right up there with you for what you should do as a female in today’s society, we have this amazing science, this amazing technology that took years to develop or perfect. Currently, it’s the best thing that we have for prolonging our fertility futures and at least being reproductively, biologically still right up there with men.

VL: Think about...okay… I just challenge you on this aspect. Think about, like, how busy our lives get. And you don’t know… I’ve seen 25 year olds get cancer. So when’s a great time to freeze-- when you’re faced with your life or death situation, or when something happens in your life, or maybe you’re not financially ready, but I think that it’s at the quality level, just like getting a college degree, egg freezing prolongs your family future, no matter what happens in your life. You don’t know where the cards are gonna fall. And the reason I’m very bold about that is because look at when we collect egg donors for third-party reproduction, for example, they’re not the thirty year olds that we’re asking to donate… we’re asking the twenty year olds, because that’s the most viable egg. If you want egg freezing to work, you’re never able to get a better egg than when you’re in your early 20s.So that’s what I’m saying. You just finished this huge milestone of your career, and now you’re with your education and your career, so now you’re going to go be able to be in the workforce or date the right people or have fun, and what a great opportunity to put in front of yourself. That’s why I suggest or say that if you really want this to work, your early 20s is biologically your best time.

GJ: Do you feel that it’s so much better than 28 or 29—

VL: Yes!

GJ: — because to me 28 or 29 seems to be so much better than 38 or 39, which was previously the norm, and to me it also seems that at 28 or 29 you have a little bit better of an idea of where your life is just as an adult. Why is 22 so much better than 29?

VL: Well, we could debate the age factors, but really I would challenge or say, if you think about all the things that get thrown on your plate by the time you’re thirty, yes you may know more where you’re at, or if you’re going to have a kid naturally, or if you even found the right parenting partner, but I just challenge you...how much of a weight you will take off your shoulders if you did it just like you got your college degree? Or if you went to grad school? How many years is that gonna put you out before you’re ready to have kids? The trend right now is that everyone’s getting married later in life. If kids come after marriage, then we’re delaying things on purpose. I think that you could do it just once, in your early 20s, vs. a couple of times in your later thirties. What I’m seeing now, Griff, is technically a lot of women because they’re not getting these normal AMAH tests with their OB-GYN appointments yearly or when they have their scheduled paps, is that there’s early ovarian reserve loss, and that’s a real thing. You might be 30, but your eggs might be at a reproductive age of 40. NOw you’re panicking to get egg freezing done at 32, because you didn’t know, and you just learned about it at 30 and it took you a couple of years to ask your OB-GYN or see a fertility doctor or find one.

GJ: Do you believe in this because of its potential, because it’s revolutionary. How do you then balance that with making sure that people don’t receive this as a silver bullet message? Because I think some people are… if they’re not relaying it as a silver bullet message, they’re allowing it to be perceived as one, I think… where… I think there’s a lot of cocktail parties, for example, the entire slogan of “stop the biological clock,” it’s a lot more complicated than that. Somebody might have male partner issues. They might have [unintelligible] using their own eggs in the future may not help them or they might not need it, and then if they do, IVF is an entire other aspect of education. How do you balance this is something that is so powerful, so revolutionary, with it’s not a silver bullet and there are these other things to consider.

VL: Yeah, I mean, it is a tough debate. Every person is different. And there’s a lot of people out there, my own sister, for example, that wouldn’t even consider egg freezing-- and she has me as a sister! I’m in her ear, saying, hey, I think you should do this. She had a broken engagement, luckily she’s dating someone now who could be a parenting partner for he, he has that potential, they haven’t decided to go down that path, but I mean you could look at every individual scenario and come up with a reason why or why not. I think education is power, and that’s why all of my platforms, whether it’s the Eggsperience website or the Eggology Club podcast, or even the video doc that I”m currently producing, This is Egg Freezing, it’s going to show you and showcase exactly all of the pieces of the puzzle. Because you have to take all of that information, because when we know better we do better, you have to take that information and figure out what works for me, what are my goals, and what are my values. Like I said, fertility goes straight down to the core of what your values. If your values are that you really know that you want to have a kid, I just warn women because I’ve seen it. I’ve got a lot of older friends, and I’ve been in… these topics, I’ve been in common debate amongst ourselves, and because I have older friends, I’m hearing their perspective later in life, and what.. Maybe…. Y’know… maybe it takes the right person. Meeting the right person, to all of the sudden have this epiphany that you want to have children. I just say that it protects your future, and why not give it the best chance of survival. The best chance of survival is a 20 year old egg, that’s where we use egg donors from, I think the cutoff for egg donors is like 27 or 28, for some of the egg banks. Why would it be any different for an individual?

GJ: What are the biggest misconceptions that you see that the public has or that prospective candidates have about egg freezing?

VL: Well, there’s a lot, and it keeps changing. As the news develops their story angle to try to get eyeballs, because it’s very calculated. Y’know, like, I just read an article recently, “I didn’t know I couldn’t get pregnant.” That’s a very bold statement tagline of an article to get someone to click on it. But it’s true. I do think that women don’t know they can’t get pregnant, because they see celebrities… but what have we taught them? We teach them that Janet Jackson can get pregnant at 50. WE tell them about how many other celebrities who have used different types of IVF for fertility and oh! They got pregnant with no problem at 40. I think what we’re doing is we’re giving them the false hope in those aspects, and we’re not teaching them about their reproductive clock and about how their body works. Most women, in general, that I talk to on a regular basis, don’t even understand their menstrual cycle and when they can get pregnant in their monthly cycle. I think that we’ve pushed birth control-- if you look at the evolution of birth control, we’ve pushed birth control down womens’ throats for the last 30+ years, that every doctor visit on average, we see our OB-GYN less than 12 minutes one time a year, that’s not enough time to have a conversation about egg freezing, or the benefits that it could do. And the conversation is, well, ok, great, I got your pap, now what birth control do you want for this year. We don’t even talk about whether you could have other birth control methods, or how you can protect yourself from STDs and STIs, and that could potentially be a deterrent for pregnancy down the line. We’re not talking about all the key factors, ad there’s a lot of factors, so that’s a conversation. I understand why that twelve minute doctor visit, it’s just not possible. So women are going to have to seek information from other places, and that’s what I hope to provide.

VL: I think you need to find a clinic that you jive with, and a doctor that you’re comfortable with, and you can ask any questions and you’re not a burden. I think that’s super important. That’s why a lot of these freeze-only clinics, standalone clinics, are popping up, is because these women want the individuality. And I don’t know if clinics were doing that really well before, because they were so busy with worrying about getting people pregnant, they were worried about their statistic rates, they were worrying about getting their numbers increased so they can continue to do business, this is an expensive procedure, and not everybody has $10K to embark on this process. But, what I say, is that where there’s a will there’s a way. I have plenty of resources to help you source your hormones for less, how to apply for discount programs, how to negotiate multiple cycles with a clinic, and to debate all those things. So I can provide all of those source resources where, if you really want to do this, you can do this. But I think you need to have a realistic strategy and a game plan based on your age, based on how much money you have, and your social demographics, how much you want to invest in your family future, and what comfort level you are at the percentage of whether or not it’s going to work. There’s a couple of egg calculators out there, and I can provide a couple of links for your show, and you cna literally put in your age, how many eggs you physically got frozen, and it will spit out a percentage of how many… what percentage to a live birth you can get. You need to start with how many children you want. If, for example, I want three kids, if I don’t get late too started in life, and I’m the [unintelligible], then ok. If I want three kids, I need at least 30 eggs. No lower than 30 eggs for a percentage…

GJ: How do you calculate that, and how do you respond to someone who says, we just don’t know how many eggs we should be freezing now?

VL: Well, I think that if you freeze in today’s landscape of vitrification and you don’t have a slow frozen eggs, which was the technology that was used before 2012, then you can safely say that the 2-12% chance that any eggs that you produce, each egg will have a live birth. So, that’s a low percentage per egg, but if you think about it, it’s just like a dozen. I always say it’s nicer to have a baker’s dozen, 13, and every 12-13 eggs is roughly one baby. Now, that’s given that you’re not freezing over 37, 38, 39-- then you need a couple more in that baker’s dozen.

GJ: Ok.

VL: That’s a good gauge for the number of eggs. NOw, keep in mind, let’s say.. I hear this two. A lot of women have frozen, and they only got four or five that cycle. What that means isn’t that you only have four or five eggs. What that means is you only have four or five eggs grow at the right rate that were mature enough to freeze. So, I really think the antral follicle count, which is the ultrasound that is done beyond the AMH test is a good predictor of how many eggs you can produce depending on how you stim. We have to be able to take the hormones and your body respond to them. If you have a poor response, then it’s gonna affect your cycle, too. Don’t get discouraged just because you only have four or five eggs that were frozen. I always talk about plan on, if you’re in your thirties, which most women are right now, there are very few 25 year olds or 20 year olds are really doing this, there’s a select few, but I think that it’s more commonplace, right now, the demographic has shifted from the 37-38 age frame to more 33, 32, 30 year olds, which is great that that trend is coming down in age quality, ‘cause that helps a ton in the reproductive years, but you’ve got to think like, ok, how many eggs are right for you? And have that discussion with your doctor. That’s why I say go back in the beginning portions and find the right doctor for you. Find the right clinic that you feel comfortable with.

GJ:You and I have spent a lot of time talking about how people find these clinics, how clinics should court prospective patients, and about the go to market across North America and just what’s happening in different markets with this. Are you… what I’m seeing right now is a race by some people that are really ahead and then 80-90% of other people which are just like, yes, we would like that too, but haven’t really put forth an initiative in terms of really marketing their program as something apart. Do you see it that way?

VL: I think among the physicians, you and I both call upon them on a regular basis nationwide, and I think a lot of them, there’s quite a few doctors that are hesitant because of, look at some of this news and media and press that’s been out, it’s rather negative to the clinic. Because, oh, they’re doing fun things on Instagram, then quality must be low. Or because they offer discount programs for egg freezing, well, then, that must mean that they are not a legit clinic, y’know. That’s just not the case. If an average IVF cycle is $12,500 from start to finish, from egg collection to retrieval to making an embryo to implanting an embryo and having a transfer, then why is egg freezing $10,000? I think it should be $6000 at max. Because I work with all the clinics nationwide, I have a very good perspective of what each area of the country is being competitive with. And I think, too, partly these clinics are a little competitive and y’know they’re worried about what their next door neighbor is doing, rightfully so, because there’s only so many patients out there, but what I think they fail to realize is that this demographic of egg freezing if it’s done well and right and they hold true to some very transparent, transparency and not hold their cards so close to their chest, then it will come back and benefit them.

VL: Yeah, you’re more countryside…

GJ: It’s smaller, and just this is a place where people are more focused on how much they’re paying at the pump, that’s not to say there’s no affluent people, there’s no professionals, because of course, that segment exists everywhere, but when we’re talking about $5000 for an egg freezing cycle, which it often is, and we’re breaking that over the course of however many years, plus storage, we’re talking about a car payment for a lot of people. Do you see egg freezing moving to these places that are not the first tier cities, or even like the other…

VL:Larger populations. Y’know, I think it depends on how good the clinic is to recruit the talent of embryologists that can do this well. I think that if they recruit the talent, there’s gonna be… listen, the urban cities, the New Yorks, the San Franciscos, the LAs, the Chicagos, the Dallas or Houston, those are very first-tier cities where there’s lots of competition. But not everybody is going to want to live in the city forever. I’m originally from about an hour west of Philly, Pennsylvania. And maybe someday I would want to raise a family there, y’know? And so they need IVF, too. ANd I think that, y’know, if the trend is growing, the clinics are going to meet the demand. It’s just gonna take a little longer for progress to get there. But I know, okay, so if we’re looking at like that demographic person that currently lives in these areas that are maybe even a little bit more remote, they look at these prices…

VL: I think we have a lot of work, yeah, I think we have a lot of work to do in access to care. And that’s one of my biggest passions is access to care. There’s a number of startup companies at the moment that are currently working on employer plans that can be supplemental insurance to help cover… with RESOLVE, for example, we’re trying to help access to care in certain states that are medically… that have current friendly medical friendly fertility benefits. So there’s a lot of work to be done in that entire area. I think that’s a continuous thing, it just doesn’t stop and start. And until we address that infertility is a disability, then we have a problem with our whole ecosystem with healthcare.

GJ: Because that affordability issue really is a determining factor of the age, as well, right? That’s the reason why 39 year olds are freezing their eggs. ‘Cause they’re the ones who can frickin’ afford to do it. Whereas…

VL: Right. They’ve had so much earning potential already, that their earning potential matches their time. Unfortunately, their biological clock doesn’t equal that. So. If you did the statistical figures or, I’m not a math person, but I know some friends that are, and they have done this, they said, “If I would have froze at 37, 38, 39, how many freezes would I need to equal the same reproductive benefits as if I would have froze when I was in my early twenties?” And actually, turns out you can do less freezes in your twenties, for eventually you can afford it, but at 20 you can’t, and it would be more valuable to take up a loan in your 20s and buy freezing than it would to wait until your later 30s and freeze just because you have the economical power to do so.

VL: Sure, I get it. I get it. And the jobs out of college aren’t those $100,000 jobs that they think they deserve or want or, y’know, they were promised. What I’m seeing is a lot of parents are stepping up as a graduation present and giving their child egg freezing to ensure that they have grandchildren someday. It’s not a bad gamble. What I think though is affordability and loans are more prevalent than you think. There’s a lot of startup companies and fertility focus loans, there’s future family, there’s Egg Fund, there are resources out there, it’s no different than going and buying a car, you said that earlier. I think it’s a priority shift. Are we going to prioritize vacations and your latte at Starbucks, or are you going to put your family’s future in balance and say nope, I’m going to go on a savings diet for the next year to freeze my eggs. It’s a priority mindset.

VL: Well, I wish my parents had done it, but I don’t know about you, Griff, but I grew up in a generation where my parents didn’t pay for my college, I paid for my own home, I paid for my first car, and I also paid for egg freezing, so I think it can be done. Once again, I go back to the whole mentality where if you want something really really bad, you can figure out a way to get it.

GJ: I want to conclude with this because it’s something that you had talked a little bit about earlier or at least made me think of, and I don’t feel that it has to be exclusive with or without the egg freezing conversation, I just happen to think that they go together, and so people might think, oh, this is a way of either pushing or pushing against egg freezing, really I think it’s a more esoteric conversation that we want to have as a generation, which is just as a generation did we wait too late? Are we waiting too late? I talk about this with people in the field sometimes, and it’s just like, this is just me speaking anecdotally as a single 33 year old. I feel that so many of us just didn’t think about this in our early 20s, whereas in previous generations, throughout all of human history, you were thinking about fertility pretty darn young because that was your role i all of human life, was to reproduce and then die. And now, we’re at a point where we’re not thinking about it in our early teens, because we’re so educated to not get pregnant by any means necessary, at least anyone in the middle class is taught that rigorously, and really not thinking about it in your 20s, because I just got done with college, which was probably not where I wanted to be or not worth my investment and now I finally got some liberty and figured things out and I want to enjoy this, but I’m in my mid-20s in a time where that would have really been a mature time to find a partner and start building one’s family, it’s just not something that we’re really thinking about and then all of the sudden, you’re like, oh, we’re in our mid-30s now, so is this a conversation we need to have, or do you think about it sometimes, and I don’t think it means we should or shouldn’t do egg freezing, but are we waiting too late.

VL: I think if you look at the paradigm shift for how marriage and family is shifting right now, you have to go back to how did that start, where did that trend, where did that come from, and freezing really is the most advanced technology since the birth control pill. The birth control pill, when that came out in the early 50s and 60s, it was a revolution for women to have the freedom of worrying about having so many children that they didn’t know what to do with, and they had to be careful when they had sex. I think that then we pushed it down women’s throats for the last 30 years or 20 years, so now we delayed it automatically, because we are able to enjoy the act of sex… it has other meanings. It’s not purely for the act of reproducing. That broughton the sexual revolution. Then the sexual revolution brought on commitment issues. And now we have swipe dating and look how fast and how easy we can go to the next… find someone new if all of the sudden our luster doesn’t match. And so I think what we’re doing and social media, you can blame social media on this a little bit, too. We don’t know how to talk to each other. We don’t know to what the other sex is thinking and we are having different value systems where like we’ve given men the opportunity to be endless bachelors or to be Peter Pans and so I think we’re a byproduct, our generation, early 80s babies, we’re a byproduct of the evolution that is just happened now. So are we leaving it too late? Yeah, we are, but luckily, because of egg freezing and because of IVF technologies, and how this has shaped baby making, it’s not as big of a deal as it was when it wasn’t around. So I think that because we’ve developed the technology, until we’re able to figure out a way to fix the mitochondria in an egg, egg freezing’s all we’ve got. So until we can grow egg cells from immature PC cells and go through that whole scientific process, egg freezing is all we we have. And what we know is if you freeze younger, you can be your own egg donor.

VL: It is so important, mmhmm.

GJ: The solution to those cultural implications could be just… led by egg freezing?

GJ: I try to think about it, because I always think about and… this is why I put our philosophy in marketing really front and center on social media, I invite the public and prospective and current and future patients to look at it, because I just always feel like Vox is out to get me, well, not to get Me, but to get anyone, or Broadly, or the Huffington Post, or the Washington Post…

VL: NBC News, or the Washington Post…

VL: I think we can’t be loud enough, to be honest. The news wants to go and share their perspective of things for their very alternative motives, I think we’re doing women an injustice by not educating them in stages. Y’know, when your sex ed class or your biological clock or your biology class in 5th grade on how to learn about your period and what a condom is, we need to be doing stages of those kind of typical education within the school systems in high school, in college, that’s teh time period in that each of these stages needs ot progress. At the right age group for that young person and then if you look at...just to use for example, this is a growing academic problem not just for the US but nationwide, I don’t know if you saw the article that we’re able to take a cell and change whether a person has HIV or not? They were able to help a man who was clinically diagnosed with HIV be able to become HIV free? So that’s a huge advancement, but obviously it’s only the second person they’ve been able to do this for so the science is still progressing. But if you look at STIs and STDs in general, just as an aspect, if you look at who has the lowest STI rates, it’s the Netherlands, because they start teaching sex, their bodies, and the biology of tehir system, and how to have this sex conversation without the shame. Abstinence training doesn’t work. They start that as young as five, and they have a progression and a system, and they’re like, at five, we’re teaching them their individual bodies, then maybe at 10, we’re teaching them about the opposite sex and their gender parts, in teeenage years, we’re teaching safe sex and how to consent and what yes and no means and then maybe in college or high school is when you… y’know, there’s a progression. We need to be at the right age progression and take away these problems.

VL: Well, we’re lucky, Griff. We’re in the United States. There’s some countries that don’t allow egg freezing for single women at all. Like Singapore and some of the asian countries, they have very strict laws, they have to be legally married for some women to freeze, or, for example the ten year storage limit for eggs in the UK. Like, there are different legal regulations that have not caught up with society norms, so at least we’re in a country that has those reproductive freedoms. I think if anything, there’s a lot of medical tourism that ‘s happening in the United States because of it.

GJ: Catching society up with what’s going on in egg freezing is what you do best. You did it here today on the show, thank you Valerie, thanks for coming on Inside Reproductive Health.

VL: thanks, Griff.