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27 t m c » p u l s e | j u ly 2 0 1 9 Freezing for the Future Why one doctor joined a growing number of women who are freezing their eggs A round the time Kriti Mohan, M.D., turned 32 in 2018, the mounting societal pressure of starting a family began to weigh on her. She knew her biological clock was ticking, but she was still single and driven by her career as the chief resident of plastic surgery at Baylor College of Medicine. "There are some women who know 100 per- cent that they're going to have children and all of this. For me, it was kind of one of those things that's always been on the back burner because I was taking care of other things," Mohan said. She had looked into freezing her eggs a couple of years earlier, but she was in the midst of her surgical residency and spent every single day in the operating room. Logistically, it was impossible for her to leave in the middle of surgery to attend to her own medi- cal procedure. At 32, Mohan was headed toward "advanced maternal age," the section of the reproductive timeline that starts at age 35, when the risk of birth defects and infertility increases. So she decided to hedge her bets and freeze her eggs. The decision, she said, was liberating. "I don't have to feel that pressure of having a kid that a lot of people do," said Mohan, now 33. "Nowadays, women and men are very equal, and we really are made to feel that way, but in terms of biology that's just not true. This equal- izes the playing field, to a degree. … You get to be like a man. There's no biologic clock for you. Maybe you'll have to have IVF [in vitro fertilization]. Maybe you'll have to have a surrogate. Maybe you'll have to do all those things, but in terms of people telling you that your eggs are old or that you can't use them, that's just not the case anymore." Hitting pause The first reported human birth from a frozen egg occurred in 1986. The American Society of Reproductive Medicine initially classified egg freezing as experimental; however, in 2012, the ASRM removed the experimental label. Since then, the technology behind preserving fertility has improved and given women more control over their reproductive futures. More recently, employers including Apple, Yahoo, Uber and others have started to offer some insurance coverage for egg freezing as an incentive to retain employees. The Society of Assisted Reproductive Technology reported an increase in egg freezing technology to preserve fertility. In 2016, there were 8,825 cycles of fertility preserva- tion; that number increased to 10,936 the following year. "It gives the woman the choice of, 'I can freeze my own eggs and I have a choice in the future,'" said Mazen Abdallah, M.D., a reproductive endocrinol- ogist and OB-GYN at Memorial Hermann Hospital. "It keeps the doorway open for her to have a child or children with her future partner and makes the dynamics of her relationship easier." Prior to treatment, doctors run a series of blood tests to check the quantity and quality of eggs in the ovarian reserve. The egg freezing process consists of three main steps: ovarian stimu- lation, egg retrieval and freezing. During the first two weeks, patients take follicular stimulat- ing hormone (FSH) injections to stimulate the ovaries to produce eggs. In some cases, the brain may read these unusual hormone levels as a signal to ovulate early. In order to prevent premature ovulation, doctors prescribe a hormone antagonist to counter- act the body's response. ➟ Kriti Mohan, M.D., underwent an egg retrieval procedure in 2018, during which her doctor retrieved and preserved eight of her eggs. B y S h a n l e y P i e r c e