RMA New Jersey’s Dr. Maria Costantini-Ferrando was recently interviewed by Pat Farnack on WCBS Talk Radio 880 during a health and well-being segment around the popularity and safety of egg freezing for young women. If you didn’t catch the segment live, you can listen to the interview or read our transcription below.
Dr. Maria Costantini:
My name is Maria Costantini-Ferrando and I am a physician. I am a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey.
Benefits of Egg Freezing
Pat Farnack:
Why would someone want to freeze their eggs?
Dr. Maria Costantini:
That’s a very good question and one that many people are starting to ask more frequently now that they’re becoming aware that this is an option.
Egg freezing is about women’s self-empowerment. Self-empowerment means having the ability to have sufficient knowledge to make options, to make decisions for your life. So egg freezing is one of those things that gives you options in your life. And how so, you may ask? Women’s biological clock. That is an important concept here. It changes over time.
Dr. Maria Costantini:
Why am I saying that knowledge is power? It’s because whether people are aware or not, the peak biological age for fertility in women is in their twenties, meaning if you had to go by when your ovaries are ready and when the best time is for you to try and get pregnant, it should be in their twenties. However, perception on surveys is over 60% of women believe that the biological clock starts ticking at age 44. Unfortunately, that’s not the case. So knowledge is power because if you know what happens in your body, you know what steps to take in order to preserve your fertility.
Dr. Maria Costantini:
So what happens with your ovaries? What happens is that we have a finite number of eggs and egg quality.
- The quantity and the quality of your eggs you are born with is about 1-2 million eggs by the time you come out of the womb.
- By the time you reach puberty, you’re down to 300-500,000.
- By the time you start reaching your late thirties (some people’s mid-thirties, some people’s late thirties) your numbers may have gone down to as low as 25,000. So what happens through time is the numbers are going lower, lower, and lower.
Dr. Maria Costantini:
However, it’s not just a question of quantity. It’s also a question of quality. The ones that remain are not as good as the ones that we used to have, and we don’t have as many when we are in our late thirties as we used to have when we were in our teens and twenties. So that is the problem. The problem is the human eggs are finite and they do not regenerate.
Dr. Maria Costantini:
Four out of five women want to delay childbearing, right? And there are many reasons why women want to delay childbearing.
I think in surveys, at least a third of women want to delay childbearing because of career and education, right? These are all reasonable, important options that women have now that they didn’t have in the past. Up to 25% of people said, “Well, I’m really not so sure I want to have children, so I don’t want to make that decision now. I don’t want to have a child now when I’m not even sure if I want to have a child.” Right?
The Importance of Timing
Dr. Maria Costantini:
So there is a concept in psychology that is known as cognitive dissonance. I don’t know if you ever heard this term, but it simply means, “Hey, what the heck do I do? On one hand, I know time’s going by and my biological clock is ticking. On the other, I don’t want to do this. I’m not ready to be a mother. So how do I resolve that conflict?” And here’s where egg freezing becomes an answer.
Dr. Maria Costantini:
When I was a fellow, that’s over 10 years ago in my days at Cornell, we would sit with patients who were cancer patients and we would start talking about freezing their eggs before they would undergo chemotherapy or radiation, all those kinds of procedures, which unfortunately we know affect your ovaries.
And so we’d sit with these patients and say to them, “There’s this option. You may not know it. However, you can freeze your eggs.” But what was the problem then? The problem is we didn’t do so well in freezing. So egg freezing seemed to be more of a science-fiction thing than a reality.
Dr. Maria Costantini:
In fact, by the American Society of Reproductive Medicine, for many years, it was considered to be an experimental procedure that we only would use when it was absolutely necessary, as in cancer patients. But it is no longer science-fiction, and this is important.
As science has progressed significantly, people are becoming more aware of it. So the general GYN will meet a patient in their late twenties, early thirties and they say, “Hey, you have a partner. What are your thoughts about childbearing?” And if there is no such plan, they’ll start saying to them, “You want to think about egg freezing.”
Dr. Maria Costantini:
Or we have women who come to me and they’ll say, “Hey, my friend was a patient of yours and she came to you, and I think I want to do the same thing.” We’re getting both from the general OB/GYN community. We’re getting it from patients who are informed, who read about it. And that’s a fair question, so that’s why we’re getting both. And we’re also going out there and we try to be champions of this and to say to people, “Look, this is out there, it’s real, and it works.”
Dr. Maria Costantini:
A woman who comes in her early forties to freeze her eggs is not something that makes sense physiologically. At that point, you don’t want to be freezing anything. And sometimes patients come to us, and when we counsel and we sit down with the patient and we realize that doesn’t make sense. “I need to try and get pregnant now, or it’s not going to work, because freezing doesn’t make sense.”
Speaking on the Process of Egg Freezing
Dr. Maria Costantini:
So time is most important, but that’s not enough, right? The second thing, it has to be biologically plausible.
We have to have evidence saying that these techniques work. While we used to say 40% of eggs would survive a thaw, now we could say 85% of eggs survive it. Now, this is huge. A huge difference, right? You have 10 eggs, well, chances are you’re going to get to utilize eight or nine of them. Whereas before you were lucky if half of them would survive the thaw.
Dr. Maria Costantini:
We have to make sure it’s safe, right? Safety, not just the patient, but safety regarding a potential child, right? So we know the risks of the procedure are minimal, and so we do it routinely, but we know more than that.
We know that the eggs can thaw successfully and we know that it doesn’t increase any risk of birth defects, right? Because you wonder, maybe something bad could happen if we freeze the eggs and you go and have a child, and then there is an increase in abnormalities. Absolutely not.
We’ve been utilizing data, randomized control studies, showing that… We use the donor age population, right? Women who use eggs of younger women. And there were absolutely no changes.
Pat Farnack:
As the science progresses, do you ever consider eggs that you maybe had frozen 10 years ago? Could they be updated, or you don’t mess with them, they are frozen and they await usage or not?
Dr. Maria Costantini:
That’s a fair question, and no, you don’t mess with them. The bottom line is you don’t want to mess with them. Once they’re frozen, they’re frozen. At RMA, we’ve been using vitrification for over 10 years now. So we definitely have those eggs frozen with the correct technique.
Pat Farnack:
Exactly. I see. Okay.
Dr. Maria Costantini:
However, if you have some eggs frozen somewhere and they didn’t use that technique, should you thaw them and refreeze them with new technology? Absolutely not.
Whatever you have, you have at this point, and hopefully, the quality of the eggs that you have is going to be sufficient to withstand any stress.
Dr. Maria Costantini:
In fact, let me bring up one point since you’re asking this question, which is a very valid one. And that is, it matters where you freeze. If you freeze your eggs at a place for half-price, or you get a sale, or you get a discount. This is no different than going to shop in a place where you pay for what you get, right? Turn that one around.
The way the technology is applied is not uniform throughout the country. You have to be at a reputable lab where you know that if they’re saying, “This is what we’re doing, you’re in one of the best labs in the country and we are going to preserve your eggs, and when you go use those eggs that you have 85% chance that these eggs are going to thaw and give you potentially a baby.” You have to go to a lab where that is done correctly.
Pat Farnack:
Wasn’t there a story about a year or two ago, was it a Seattle lab, where something happened where the freezer system broke down?
Dr. Maria Costantini:
It happens. They didn’t take enough precautions or they mix them up or, “Oh, I thought it was mine, but it was somebody else’s.”
Pat Farnack:
Oh, boy.
Dr. Maria Costantini:
Or how are they frozen, and how do you know how they’re frozen because when you go thaw them, you get maybe two or three instead of getting eight or nine if you had frozen ten, right? So you basically are buying into a promise, right? So you are not going to know, when you invest your money and you freeze these eggs, what’s going to happen.
Pat Farnack:
I guess, Doctor, you wouldn’t go to visit the eggs to make sure that they’re safe as you wait to use them. But I imagine having trust in the facility and knowing that they’re doing the right thing. Does anybody on your end check on the eggs to make sure everything is copacetic?
Dr. Maria Costantini:
So the check is done at the time that the procedure takes place. Once they are stored, which we know exactly where they are, we will know down to the canister exactly where their eggs are stored, then we know their fate. And that is exactly what you are investing your money in. And that’s it. You’re investing your money in this technique. You’re investing your money in the reputation of the facility and the doctors who are doing the retrieval piece and the doctors who are deciding what kind of protocol to utilize for you to have your ovaries stimulated. You’re investing in the embryologists who are taking these eggs, freezing them, and the technique that they use in freezing them.
Dr. Maria Costantini:
And you’re investing also in the facility being responsible for the safety of these eggs so that we’re not at the beck and call of, “Oh, we lost electricity, there was a tornado, there was a whatever, and oh jeez, we’re so sorry, you lost everything.” No, we have so many precautions in place that nothing can happen short of a catastrophic event, which in that case, it won’t matter.
Those eggs are there for as long as you need them to be. And there’s no time limitation. There’s no like, “Oh, sorry. We got freezer burns and the eggs are no longer useful.” It’s not like leaving the chicken in the freezer. These are frozen at such temperatures that time is not a factor. They are going to be as good today as they’re going to be 10 years from now, when you may want to utilize them.
Pat Farnack:
How long do you usually keep eggs?
Dr. Maria Costantini:
As long as needed. There’s no time limit right now.
Pat Farnack:
Sadly, if someone freezes their eggs and then they pass away, what happens to the eggs? Or is that a legal question?
Dr. Maria Costantini:
It’s more of a legal question to some degree, but eggs are not as complicated as embryos.
That’s the property of the individual. The individual no longer is there, so those eggs no longer can be utilized. What has happened, is more a situation where there’s a sperm involved and one of the two individuals passes and then you decide, “Oh, what happens to those embryos if one of the individuals in the couple is no longer alive?” That’s a little bit more complicated. The situation of cancer may be more of a complication.
The Step-By-Step Process of Egg Freezing
Pat Farnack:
If I wanted to get my eggs frozen, take me step-by-step through what would happen.
Dr. Maria Costantini:
I will do an evaluation, meaning I will tell you, “Hey, this is worth it for you,” or, “This is not worth it for you”, “You still have a chance. We will do basically an evaluation of your reproductive potential. We check hormone levels and we do an ultrasound. It’s a very quick evaluation. In the ultrasound, we look at the ovary.
When you look at an ovary, you see what’s available every month. Every month you have a whole bunch of what are called follicles, and these follicles are like fluid sacs. And within these sacs, there’s a little microscopic egg. You can’t see them with your eye but, when you do an ultrasound, you’ll see them. Are there two follicles in the ovary? Is there 10, is there 20? That tends to correlate with your reproductive potential. If I look up an ovary and I see a lot of follicles, I will say, “Hey, you look great. This is definitely potential here.”
Dr. Maria Costantini:
But then we’ll check your hormones. There are two hormones that give us information about egg quantity and egg quality.
So if you fall within the range of what’s considered to be within the norm, what’s considered to be good potential, we will proceed. In a matter of a couple of days, you’ll know. You’ll know very quickly.
The day I see you, I’ll be able to tell you what your ovaries look like, and within a few days later, I’ll be able to tell you what your hormone levels are. But within a week, you’ll have a sense of whether this is reasonable or not.
Pat Farnack:
Obviously, it doesn’t pay for you to just tell people what they want to hear.
Dr. Maria Costantini:
No.
Pat Farnack:
You have to just be sometimes brutally honest, I guess.
Dr. Maria Costantini:
Absolutely. And I have had had a few patients where I sit down with them and I say, “Look, your reproductive potential is low. IVF does not make sense. We’re going to be lucky if you get one or two eggs. If you want to use your eggs, you should get pregnant. You can get a donor sperm if you don’t have a partner, or if you have a partner, think about maybe changing your plans. If you guys want to have children with your eggs, you have to do it now, or it’s going to be very unlikely that you’re going to be able to do it: unlikely that’s going to happen in the future.”
But then we talk about the realities. “Listen, you may need to use a donor.” Sometimes life throws things at you and you have to roll with the punches, right? And you have to change your plans.
Dr. Maria Costantini:
But let’s think about the more positive scenario, which is you come in, I say, “Pat, you look great and everything looks good.” So what do we do?
Well, sometimes if people really urgently in need of starting, like for example, a cancer patient, we start them that very day. So forget the hormone levels, we’re going to start you and you’re going to start your medications tonight.
But other times, we do have a little bit more time. You basically just wait for your period, right? You wait for your period, and how long does it take you to get there? Well, think about how long it takes you to ovulate. Eight to ten days from the third day of your cycle. That’s how long an IVF cycle is.
Dr. Maria Costantini:
Well, what are we doing? We’re doing what your body does, right? What does your body do? Your brain gives you particular hormones. Every month, it gives you just enough to grow one follicle. One follicle means it’s growing one egg. That’s what your body does and you’re going to ovulate, and then two weeks after you ovulate, if you’re not trying to get pregnant, you’re going to get your period. That’s what your body does on its own.
All we’re doing is we are telling your ovaries to grow those other follicles that are there that would otherwise die. Your hormones are like fertilizer. If you want, it’s nourishment. So if you want to nourish only one egg, which is what your brain wants to do, then you’re just going to give a little bit to the ovary. If you want to nourish a lot more and grow a lot more powerful, you’re going to give a higher amount of those same hormones.
Possible Complications That Affect Egg Freezing
Pat Farnack:
The new contraception that keeps a woman from having her period for a few months, does that ever complicate matters for you?
Dr. Maria Costantini:
Yeah. We have to stop it. If you’re taking something that’s blocking that process, we have to temporarily interrupt that. The only thing we don’t have to mess with is IUDs. If you have an IUD with progesterone, those kinds of birth control it’s different.
Pat Farnack:
When a woman does come in to have her eggs, I guess, harvested is the proper term…
Dr. Maria Costantini:
Yes. Retrieved, harvested, they mean the same thing.
Pat Farnack:
… is that a painful process?
Dr. Maria Costantini:
Yes and no. How are these hormones getting into your body? Well, they’re taking these little injections.
I don’t know if you know anybody who takes insulin, but it’s these tiny little needles. They’re in the stomach. Those are not really painful. These are just small little pricks. You take these injections at night.
So let’s say you have this period of eight to ten days. You come to our center every two to three days so we’re monitoring how are you progressing. Tonight you’re going to take what’s called the trigger shot: the shot that’s going to start the ovulation process.
Dr. Maria Costantini:
So 36 hours later, we’re going to go get those eggs out. That’s the part that’s painful.
Why is it painful? Because you’re going to get a needle that goes in vaginally, and that hurts. But how do we resolve that problem? We’re going to put you asleep. It’s a 10-minute procedure. And you’re not intubated. You’re still breathing on your own, but you’re just asleep because you don’t want to feel that needle puncture.
The needle goes directly into the follicles because this is all under ultrasound guidance. So I’m in the operating room. I see where the follicle is. The needle goes into the follicle, and then I’m going to aspirate or suction out all that fluid.
Dr. Maria Costantini:
That 10-minute procedure is the procedure that people think about. That’s where it’s uncomfortable. It’s painful because of a needle puncture, but you’re not going to feel that. You’re not going to feel a thing.
But afterward, you may feel sore. You go home that same day, so you’ve got to take it easy that day. You have a few high achievers who want to go back to work that day. We have to fight with them and say no. Especially doctors and nurses are the worst.
Pat Farnack:
This is done, Doctor, right at RMA?
Dr. Maria Costantini:
Yes. We have our main hub. So we have clinics throughout the state. There are 10 clinics throughout the state of New Jersey.
For that matter, we have them all over the country, but RMA New Jersey per se has 10 offices throughout the state. But the hub, where the lab is, is actually in Basking Ridge, where we do all our retrievals, we do all our embryo transfers, meaning you take the embryo from the lab and you put it inside the uterus, all of that is that is done in Basking Ridge.
That’s where our eggs are stored. That’s where our embryos are stored. That’s where all the procedures take place.
Pat Farnack:
You’ve been doing this for a while, but to me, it’s almost like a religious experience the way you’re talking about it. I mean, do you ever think when you’re doing this, “Wow”?
Dr. Maria Costantini:
I do, but I have to tell you, the one thing that I always still get chills when it’s happening is when we do the embryo transfer.
The eggs, of course, are something we are used to seeing. However, when you see an embryo, everything is projected on the screen. You’re in the room, the embryologist is right there with you, and they’ll show you the embryo. They’ll show the embryo as it’s placed in the catheter. And you see this little thing go into the little catheter and you see it moving into the catheter, and then you yourself take this catheter and you’ll see yourself putting the embryo inside the uterus. And you see the whole thing on an ultrasound. It always gives you a sense of wonder when you see that. Like, “Wow, we’re actually in the process of potentially creating life.” And that is the best part of my job.
Pat Farnack:
The wow factor is high.
Dr. Maria Costantini:
There is a wow factor and there is the sense of, wow, I’m so lucky to be in this field. I’m so lucky to be part of this couple’s life. And the thing is, when people freeze their eggs, we’ve had them come back already. Some women come back and they say, “Hey doc, I guess I’m still single. Here I am. Let’s go use those eggs.”
So we talk about it and they say, “I had this boyfriend, oh my God, he was terrible. I had this other one, oh my God, he’s horrible. I still haven’t met my perfect guy. However, I want to be a mother. I don’t want to wait. I don’t want to wait for my mate.” Or we’ve had people say, “Hey, here’s my husband. We’ve been trying for a year. I can’t get pregnant. I want to go utilize my eggs.”
Dr. Maria Costantini:
Or I’ll tell you another patient I have who met somebody, then they got pregnant, had their baby, and then by the time she was ready for baby number two, she was already in her forties and couldn’t get pregnant on her own.
So she came back in and she used her eggs for baby number two. That’s how they got their second baby. So there are different scenarios.
You have to remember. We like to keep those eggs as our last resort. Even if you found a partner and you have a child, you may want to have a second one or may want to have a third one. You should not use those until you have no other options. Everyone has different scenarios. Everyone has a different concept of what a family is, but we’re very active even in the LGBTQ community. Everyone has different reasons to freeze their eggs.
Pat Farnack:
I was just going to ask about same-sex couples. Have you seen a lot of that at your practice?
Dr. Maria Costantini:
Yes, we do it all the time. We do that all the time. We have same-sex couples who come in.
One of them is the one who wants to try and get pregnant. They’ll find a donor sperm and the other partner is there for support, and companionship, of course, or couples where one is the individual who is going to freeze the eggs and the other member of the couple is the individual who’s going to carry the baby. So one of the partners has no intention to carry the baby, so they will freeze the eggs, and then the partner will be the one who carries, or they’ll swap.
Pat Farnack:
In the pandemic. I remember doing an interview with, I think, somebody from RMA about how life went on during the pandemic. There were still people coming in to get either IVF or to have their eggs frozen.
Dr. Maria Costantini:
Yeah. We did everything in our power to not deprive especially women who were older of the opportunity to stay within that window of time where they could still freeze eggs or freeze embryos because women, as they’re getting older, they don’t have that, “Oh, let me just wait for COVID to end.”
The Cost of Egg Freezing Procedures
Pat Farnack:
What about the cost of these procedures?
Dr. Maria Costantini:
It’s between $7-8,000, and now a lot of companies, like Google, for example, are covering that cost because they get it that women want to do this so they can then focus on their career. So companies are getting smarter and it’s like, “You know what? We should cover this. Let them do what they want to do, and then they can focus on their career.”
Final Thoughts From Dr. Maria Costantini
Pat Farnack:
You have been absolutely incredible, but I’m sure I didn’t ask you about certain things that you want to mention.
Dr. Maria Costantini:
I am so about empowering women.
To me, it’s such a personal issue that I just want women not to be scared. So many young women now are go-getters. And I’m just so impressed with young women today. I have a daughter who’s in her twenties and I see her, I see how active she is, I see how involved she is. This is just one of those things that I just want women to become more aware of and not to be scared, and to ask questions.
Ask questions. We can answer them. Your fertility is part of who you are. It’s part of the wealth of being a woman. It’s part of the power of being a woman. Go out there and get the information and decide what you want to do, because we’re here to help you. That’s really what to me is important.
