Talking fertility with the Egg Whisperer
From egg and sperm freezing to ethical donation, Bay Area reproductive endocrinologist Dr. Aimee Eyvazzadeh explains the changing reproductive landscape.
Last month, I interviewed Dr. Aimee Eyvazzadeh, a.k.a. the Egg Whisperer, over Zoom. The first half of the interview—”It’s a family affair for the Egg Whisperer”—focused on Dr. Aimee’s backstory and personal perspective. Here in part two, she shares her expertise and unique insight on a wide range of fertility topics.
Dr. Aimee went to medical school at UCLA and completed her residency in Obstetrics and Gynecology at Harvard Medical School and Beth Israel Deaconess Medical Center. At the University of Michigan she earned a fellowship in Reproductive Endocrinology & Infertility as well as a Masters in Public Health Education and Promotion. Dr. Aimee lives in the Bay area with her physician husband and four children.
Note to reader: This interview is meant to encourage discussion on fertility-related issues and to share Dr. Aimee’s expertise and insight. For individual fertility guidance, talking to your own medical provider is essential.
This interview took place on March 9, 2024. The transcript has been edited for length and readability.
Daphne: My daughter is almost 24, and it seems like young people don’t think about fertility. But it’s one of those topics that seems far off, and then all of a sudden it might be right there. When do you think fertility education should begin?
Dr. Aimee: I think it should start with when you start learning about your periods. It shouldn't be just all about preventing pregnancy; it should also be about pregnancy, fertility and menopause. At around 25, a discussion about fertility and freezing your eggs should happen.
There's a thought with some OB-GYNs that you don't talk about menopause until it hits you. And then all of a sudden it’s a surprise to so many women. But I think menopause education should start by the time someone's 35. That’s when an OB-GYN should start bringing it up, saying “Just so you know, over the next 10 years, you're going to start experiencing perimenopause. And that's normal.” But people think of menopause as a dirty word and it shouldn't be. I don't remember where I saw it. But I think of it as “me no pause,” like I'm not pausing.
When I talk to women who want to have a baby and are in menopause, I tread lightly because it can feel like an insult. I just have to give some women that gentle reality check that just because your mom went into menopause at 50 and you're now 45 does not mean you can have kids up until you're 50. You are no longer able to because you're in menopause. And that's just normal.
Daphne: Because I’m on the pharmacy side, you have to always assume that until someone is in full menopause, they could theoretically get pregnant. And I think when some people hear that, they might think it can happen easily, but that’s just a conservative approach.
Dr. Aimee: Right. It's close to zero that you'll be able to get pregnant in menopause. It is true, there is going to be that one rare person who gets pregnant at 50. But I’ve never experienced that in my career.
I just did a treatment on someone today; she had three eggs, and she's 50 years old. She looked at me—she's so sweet—and said, “Is there a chance I could have triplets?” And I said, “Okay, let's have that talk again. We're doing this because we know there's no chance, but we're still going to try so you can leave no stone unturned.” But I gotta tell you, if she gets pregnant, I'm going to be the first one screaming at the top of my lungs.
The ideal age for egg freezing is determined by age, genetics and environment. But to save everyone from the heartache of infertility, I’d say 23 to 25.
Daphne: Is there an ideal age with egg harvesting? When ideally—if you are planning on doing it—it should be done? And then is there an age when it's too late?
Dr. Aimee: Even for some 30-year-olds it could be too late—if they have severe endometriosis or if their mom went into early menopause. I think the ideal age is basically determined by your age, genetics and environment. So it's not just the age. I encourage young women to ask their moms, did you have endometriosis? Did you go into early menopause? Did you have a lot of miscarriages? Let's learn as much as possible about family history.
We can look at your hormone levels, your follicle count and your age, and then come up with what your ideal time should be. So I don’t make a blanket statement for everyone. If I were to save everyone from the heartache and pain of infertility, I’d say 23 to 25.
I think most women can wait until they are 32 to freeze, but for some women that might be too late. For maybe like 90% of women aged 30 could be just fine, but 10% might be a struggle for them. And if you do it earlier then your eggs are gonna be more viable, and you're gonna need less egg freezing sessions.
Daphne: And then you have some time when the ticking clock is quieted.
Dr. Aimee: Yeah, you can freeze and forget—for now.
Daphne: Are you seeing parents encouraging their kids or paying for egg freezing? Or maybe encouraging their kids to come in to think about it?
Dr. Aimee: 100%. They don’t want their daughters to have the kind of struggle they went through and to feel that kind of pain. They're actually urging their daughters to freeze their eggs, encouraging their daughters to think about their fertility and to get their levels checked.
I see some resistance sometimes, even when a mom will pay for her daughter's treatment. The daughter is still like, “No, I don't want to do it. Leave me alone.” And I get that. But I do see that there are a lot more conversations around the dining room table about a mom's fertility sharing with her daughter so that she can hopefully learn from that.
My first patient in this practice was 39 years old. Her mom never told her that she went into menopause at 40. That was over 15 years ago. And her mom felt so guilty. She's like, “I didn't even think I don't even know why that matters.” You can imagine that wouldn't happen today.
Daphne: My mom had a hysterectomy at a young age and later her ovaries out so she would have no idea. And a lot of people don't have information from their biological parents. So it's nice that there are other ways of being able to find out what might be going on from within your own body. So is having the conversation at 25 a safe route to go?
Dr. Aimee: I think the conversation should start by about 20 or 21. So, if her mom struggled, had miscarriages or fibroids then she can start thinking about what she's going to do to protect herself. If it’s endometriosis, then she should be on birth control pills; that’s one of the non-contraceptive benefits of birth control, to prevent progression and growth of endometriosis and fibroids.
Daphne: So, have the conversation early and often?
Dr. Aimee: Yeah
Daphne: I think sometimes it doesn't sink-in the first time. Sometimes you just need to hear things a number of times to really get it.
Dr. Aimee: Right. And when I ask a patient, “Did your mom go through menopause? Did she have endometriosis? Does she have fibroids?” And she says to me, “Well, I don't know.” I'm like, “Okay, well, you're 37, please ask.” What I would hope is that OB-GYN providers would be asking these questions when patients go in at 21. And if the patient didn't know, then she would be encouraged to go ask.
Daphne: It seems like there are fewer opportunities for discussions. Pap smears are being stretched out. Plus, a lot of times you don't have access to an OB-GYN or midwife and you’re being seen by primary care, which is hard because they have so many things to think about.
Dr. Aimee: Right. I mean, some pregnant women aren't even getting seen until their second trimester. OB-GYNs don't have time to do the annual pap smears anymore.
My sons will bank sperm as soon as they'll allow me to do it for them. I'm thinking around 21.
Daphne: I love that you talk about men's reproductive healthcare too, because I think it's something that gets ignored. What issues are you seeing that aren't being talked about on that side of the equation? And is there an age when someone should think about banking sperm, if future fertility is desired?
Dr. Aimee: So my sons will bank sperm as soon as they'll allow me to do it for them; I'm thinking around 21. I always say: It's always nice to have sperm on ice. So if I meet a couple, I say, “Well, how many kids do you want?” And I think about how old the husband or male partner is going to be when they're going to try for their second. I say, “Well, I gotta tell you, you're going to be over 40, I'd much rather use your 37-year-old sperm than your 40-year-old sperm. So let's get some on ice.”
So I think the earlier the better. And it's so easy to do. I feel like it's a no brainer to get guys to freeze their sperm. If college-age women are thinking about freezing their eggs, college-age men should be freezing their sperm.
Daphne: Even when someone is diagnosed with cancer, sperm banking isn’t necessarily covered. Are you seeing any kind of movement in terms of getting more of these types of services covered?
Dr. Aimee: I think insurance mandates are increasing and improving, especially for cancer patients. So hopefully that continues to be the case. The good news is that freezing sperm is less compared to freezing eggs. So a sperm freeze can cost anywhere from like $500 to $1,000 and storage annually. There are long term storage companies that will freeze and discount freezing storage fees for cancer patients. Storage is anywhere from like $300 to $500 a year, which I know can add up for someone who's still paying off college loans but most people can save for that kind of money.
Daphne: This is really good information that really doesn't get talked about, especially on the male side.
Dr. Aimee: They gotta get out of the hot tub. They got to stop smoking marijuana and weed. You know, drunk sperm don't really make good babies compared to Mormon sperm. We tell guys to convert to Mormonism. Stop doing all the bad things and think about what you'd want to surround your baby with. And that's how you prepare for a pregnancy.
I think it's good for an egg donor to be known to the family, and vice versa.
Daphne: DNA and ancestry databases have to have changed egg and sperm donation because anonymity can’t be guaranteed any more. How is that changing the conversation over donation?
Dr. Aimee: Well, I believe in what I call ethical egg donation and sperm donation. And I share with families how I want them to consider egg donation and what would be important to me. And then it doesn't mean it has to be important to them. Some of the things that I talk about is open donation, both on the egg and sperm side. I send them articles to read videos to watch so that they can learn from a donor conceived person's perspective how they would have wanted to be raised with this information early on. And that's kind of how I want families to grow from the very beginning.
I have a program, it's called “freeze and share.” So it's an open egg donation program where we freeze eggs for the egg donor as she's donating. And then the requirement is that it's open and you have to meet the family, and you get to choose who you're donating to. And it's reciprocal, because the family is also choosing whose eggs they want to receive. I think it's a wonderful way of keeping in touch with a donor, making sure you're aware of health updates in the family. Because with most 25-year-old egg donors, their mom is still young and she hasn't had any health updates. But as family members get older things start happening, there might be new things that come up.
So that's why I think it's really good for an egg donor to be known to the family and vice versa. Also, the egg donor isn't wondering who's going to be knocking on the door in 18 years, some stranger. And how many strangers. You can also control how many families receive your eggs. A program like this controls the number of bio-sibs, or donor-sibs that you can have from one single donor. Because with most people who donate to a program like this, they're not going to be serial donors, donating six times. They're just doing this to donate for themselves and donate for a family in as ethical a way as possible.
And there's also a way of doing this with sperm. There's a company called The Seed Scout. They try to control the family sizes that sperm donors can donate for. So it's usually three families—no more than that. And this controls the sibling pods, You've heard of these situations where people have like, over 100 half siblings, or doublings is what they call them in the donor. There are lots of different terms out there.
The Seed Scout is also one way of doing open donation with sperm. And I think it's a program that everyone should at least know about. They can see if it's something that resonates with them and is important to them. Otherwise, I just don't want people to wish they had known about these things after the fact.
I'll tell you a quick story. I had a family where the mom conceived through egg donation from an egg bank. She felt like she cheated her daughter out of having the opportunity to know about where she came from from the very beginning. She's like “I really harmed her.” And I’m like “No, you're fine. I'm sure there's a way we can find your egg donor”—because there is no such thing as anonymity and most of them have an open ID at age 18.
And now some egg banks—which really makes me happy—will allow families who let's say have a child from that egg bank to write a letter and when the child conceived from that donation is one year of age or older, they will then connect the two of you to the donors open to that. Most donors have said yes. So that's really encouraging to me that things are changing in the industry. I just want to make it even better for people.
Daphne: It seems like in general, kind of overall in life, the more transparency the better. I’m also curious, with same sex couples, are you seeing other things besides surrogacy and donor sperm? Are you seeing families build families other ways?
Dr. Aimee: Absolutely, embryo donation. So I'm a medical advisor for Em•power with Moxi. It's a great way to openly donate your embryos and be a recipient of embryos. So, you go through a psych education, genetic counseling, and legal counseling before things transpire or ownership changes. And I think this is a way especially for people who know that they need an egg and sperm donor. You already have embryos that are created, a lot of the time they are genetically tested and high quality. So it's a great way of growing your family for people who are okay with not using their own DNA.
I'm seeing more independent mothers by choice than I’ve ever seen before.
Daphne: So you've basically seen a whole generation of people with fertility needs. Are you seeing changes in what expectations people are coming with or differences in their baseline knowledge?
Dr. Aimee: Yeah, I think what I'm seeing is a change in society. There's this whole concept of ethical non-monogamy. And that's a thing. It's creating a situation where women who want to have families aren't finding partners that are on the same page. That's hard for me to see. I see so many professional, amazing women. They go to these dating apps, and they share stories where they're not finding men who are interested in settling down and having a family at the age that they're at, even when they try and expand the age range. So that's hard. I'm seeing that more and more.
I'm seeing more of what I call independent mothers—not single moms, which sounds lonely. They're independent mothers by choice. I'm seeing the highest number than I've ever seen in my practice. Women are like, “I don't need a man; I want the love of a baby. If the love of man comes around, great. But I'm not gonna give up and wait for a man. I want to be a mom more importantly than finding a partner to do it with. And the partner will come.” So I'm seeing that a lot.
As far as expectations, I think people have the best expectation of treatment outcomes than ever before. And the reason is because people are sharing so much of their journeys with their friends and their family. So I'll say to a patient who’s 39, “It's really important for you to know what your diagnosis is, the prognosis and how many cycles you'll need for you to have the family size that you want.” And they'll say things like, “Oh, yeah, my friend did six IVF cycles, I know how hard it was for her, I don't expect this to be easy.”
And that's the right way to think—a 39-year-old isn't going to do one cycle and have five normal embryos, and then have the first transfer work. That might happen. But I would say that happens less than 10% of the time. Most women at 39 might have to do two or three IVF cycles to get enough embryos for themselves to really feel good about starting the transfer process. So those are the trends that I'm seeing. More independent moms and people having a better understanding about expectations.
We also have more treatments that we can offer women who are over 39. There are things that some might consider experimental, like ovarian rejuvenation procedures. So I find that I'm usually the first one to start doing things. People make fun of me and call me crazy, which I love. Then other people start asking me to train them on it. And then everyone starts doing them.
For example, I started using HGH (human growth hormone) in my practice back in 2008. People said, “No, you shouldn't do that. That's crazy. Why would you do that?” And now everyone does it. And I started doing ovarian PRP (platelet rich plasma) about two years ago. So that's a procedure where you take PRP and infuse it into the ovaries hoping that you'll grow more eggs. And same thing, same comments, and now people are calling me and saying, “Hey, can you train me on it?” Absolutely. I'll teach you, I'll send you a video, you know.
It's cool to see that the things that I'm doing other people are now doing and offering them to their patients. And ideally, I want everyone to at least know what their options are. So they can do what feels right for them without feeling like they're not told what they could possibly do to give themselves a better chance.
Daphne: One last question. What things do you love wearing these days that just make you feel good?
Dr. Aimee: I wear my crotchless yoga pants. Literally, they're actually called Egg Whisperer pants. And that's what I wear. I designed them in 2016. It's not a joke; I love them. So when I get home, I put my pants on and no one really knows they’re crotchless but they are.
I also love lipstick gloss. Like that makes me feel really happy. And I like being proud of my body and where I'm at, and not hiding it. That's not like running around with crop tops, but when I go out, I'm not wearing yoga pants. I like to dress up. I don’t like heels, but I like to wear nice shoes or boots. You know, stuff that makes me feel really confident.
Daphne: Dr. Aimee, thank you so much. I really appreciate your time. And I love your perspective and all the work that you're doing.
For more Dr. Aimee, check out her website and subscribe to her newsletter. You can also follow her on Instagram, Twitter (X), Facebook, Medium and YouTube.
And check out my story for , “Does the Biological Clock Still Matter? The Egg Whisperer Weighs in.”
