A woman’s life is all about choices; the small and large choices she makes that affect the rest of her life. In today’s modern world one of the biggest choices women are making is the choice of marrying and having children much later in life than previous generations. Thus the most important doctor every modern woman needs is a fertility expert; and one of the best in the world is Dr. John Jain, who leads the Santa Monica Fertility (SMF) clinic in Los Angeles, California. eniGma’s Sarah Hussein talks about her experience with Dr. Jain.
Dr. John Jain is a board-certified reproductive endocrinologist with over 20 years of academic and clinical experience. Dr. Jain completed his medical training at the Division of Reproductive Endocrinology and Infertility at the University of Southern California (USC), the location of the first successful egg donation in 1987. He remained at USC for almost a decade as a tenured professor of Obstetrics and Gynecology during which time he published a landmark article in the Journal of the American Medical Association on egg donation in women over age 50. More significantly, he helped to pioneer the next generation of egg donation utilising frozen donor eggs and was instrumental in creating one of the first frozen donor egg agencies in the world.
He left that position to pursue his own vision of patient care: a practice that combines outstanding medical expertise, cutting-edge research and respectful, individualised attention to the patient’s mental and physical well-being. His goal was always to improve the likelihood of pregnancy and the birth of healthy babies for women at any reproductive age.
In the Middle East however, most fertility doctors are reserved for married couples who need assistance in having children. Yet in the Western world, fertility doctors like Dr. Jain now have many patients that are single working women who want to prolong their fertility options as much as possible.
Thus as a single woman in my late thirties, I decided Dr. Jain was someone I had to meet. Somehow through relationship choices and my hectic career, I found myself needing more options for having a child later in life. For me it was not a conscious choice I had made over the years, life just took over and made the choice for me. Being an eternal optimist, I wanted to be inspired by solutions not fear, so I contacted Dr. Jain to talk through my options.
From our first call Dr. Jain was calm, understanding and nonjudgmental. It was clear his understanding of fertility was second to none and he understood the challenges of modern women. It soon became clear he was the perfect doctor to speak to.
As a single woman of my age, Dr. Jain told me the best option would be egg freezing; the cutting breakthrough technology that allows women to freeze and store their eggs until a pregnancy is desired. And for women like me who have postponed childbearing because of their careers or because they simply haven’t met the right person, egg freezing is revolutionary; not just in its technology, but in the life choices it allows us to make.
There are also thousands of women diagnosed every year with cancer, and the resulting surgery, chemotherapy and radiation treatments they undergo typically lead to infertility as their egg cells are destroyed. Egg freezing can also provide these women the opportunity to preserve their fertility.
It takes approximately four to six weeks to complete the egg freezing cycle, which follows the same protocol as In Vitro Fertilisation (IVF). Two to four weeks of birth control pills to temporarily turn off natural hormones; followed by ten to fourteen days of hormone injections to stimulate the ovaries and ripen multiple eggs; then egg retrieval is done through the vagina using an ultrasound-guided needle while under anesthesia. Immediately following retrieval, the eggs are frozen.
What makes Dr. Jain and his clinic stand out is that their most recent pregnancy rates from frozen eggs are among the highest in the US – over 40% with the vitrification method. This figure is well above the national average for frozen embryos.
To date, approximately 2000 babies have been born worldwide from frozen eggs. Among these births, the rate of birth defects and chromosomal defects has been no higher than that of the general population.
Of course as I was based in the Middle East, I was worried how much time it would take for me to go to Dr. Jain’s clinic and undergo the procedure in Los Angeles. Yet Dr. Jain assured me he had many international clients from around the world, and they had a very efficient system for such clients, where all the preparation for the treatment could be done before their clients even come to LA. Then their clients would only have to be in LA for a total of two weeks to complete the treatment.
Two weeks in LA and extended fertility options sounded good to me, so I went ahead and agreed to undergo the treatment. In the lead up to the my travel to LA, I had several phone calls with Dr. Jain and his head nurse Veronica, who advised me of all the blood work I could have done before I arrived. And they even advised me on the all the medication I would need for the treatment (as it is cheaper to buy it outside the US). So with close consultation with my new ‘fertility partners’, I set on my ‘egg freezing adventure’ and did my blood tests, bought all the necessary medication and planned my trip to LA.
When I landed in the ‘city of angels’, apty named, as the people there are genuinely nice and helpful, my first stop was Dr. Jain’s office in Santa Monica. The clinic was easy to find, super clean and modern and the staff were extremely warm and welcoming. I finally met Veronica in person after all of our phone chats, and she set my mind totally at ease. She assured me there is no reason at all to be anxious about this procedure, as other than some bloating, there are no harmful side effects to this treatment.
Veronica explained that essentially the process would entail taking two medications every day in the stomach region. The two medications are Menapur, which is used to stimulate multiple follicles and eggs. The second, Follistem, helps stimulate healthy ovaries to produce eggs. And it is the combination of the two, monitored by Dr. Jain, that brings about the best results.
I could either come to the clinic and Veronica could give me the injections or I could give them to myself each day at the same time. Because I’m squeamish and afraid of needles, I chose to go Veronica each day for my injections or have a close friend inject me on the days I couldn’t make it to clinic. But to be fair, the injections are not that complicated or painful so those who are a bit tougher than me, can easily do them at home. Plus the clinic’s website also has a step-by-step video that shows you exactly how to take the injections, making everything as easy as possible.
After meeting Veronica and taking my first injections, it was then time to finally meet Dr. Jain in person. Although he was incredibly busy he made time to meet with me, explain the process in detail and answer any lingering questions. We also discussed the many cutting edge reports he had done on fertility options, which was fascinating. Most importantly he assured me that undergoing freezing does not in any way affect the number of eggs a woman will produce in her lifetime. All it does is ensure that the normal number of eggs a woman produced each cycle mature enough so that they can be retrieved at the end of the process. And after the procedure is done, all the medications taken leave the body within 24 hours.
Dr. Jain also explained that the doses of the hormones needed to grow the eggs varies from woman to woman, so he would be monitoring me every few days with blood tests and ultra sounds and then adjust my dosage accordingly. Without hands-on customised care, results can vary. So it is important to always make sure your fertility doctor gives you personal attention. At the SMF, Dr. Jain sees all his patients, makes all decisions and does all the egg retrievals himself.
For most women the injections are taken for 10 to 14 days, depending on how the body reacts to the hormones in the injections. Thus every few days, I would be at the clinic having blood tests and ultra sounds with Dr. Jain. Thankfully my eggs were growing nicely, and I only had to increase my dosage once in the middle of the process.
For me the process took 14 days, and the only downside was the discomfort of being bloated (especially towards the end) and perhaps I was slightly more emotional than usual. But again the side effects vary from woman to woman, so the more eggs a woman is producing, the more bloated she will be. My bloating was sometimes uncomfortable but I was still able to go about my days normally; working, meeting friends, etc. And other than one close friend who I had told, no one had any idea I was doing this process.
By the end of my 14 days it was time to get my final trigger shot at nine pm on my 14th day. This shot is the ganalerix shot, which allows the eggs to mature and makes them ready for the retrieval.
One day later it was then time to go early to the clinic and have my eggs retrieved. The night before I was told not to eat before midnight, then come early to the clinic the next morning.
As I arrived nice and early, I was greeted by Veronica who prepared me for sedation, then I saw Dr. Jain briefly who assured me I would not feel anything during the retrieval and it was simple process that would be over soon. And sure enough before I knew it the whole process was over and I was waking up to Veronica telling me that all went very well.
The next day I was told that Dr. Jain was able to retrieve 10 grown eggs that he could freeze; a very positive result for a woman my age. Most women can expect to retrieve between 8 to 20 eggs, depending on their health and age. After the retrieval, these eggs are then frozen at the clinic for as long as a patient wants and can be unfrozen and used whenever the time came.
Although the process is straightforward and harmless, it is costly. The average freezing process costs between 10 to 15,000 USD, depending on the doctor and the clinic you go to. The cost of egg freezing at SMF is approximately $12,850. This fee includes all testing, monitoring and the first year of storage. Each additional year is billed at a rate of $600. There is also a cost for the medications, which is paid directly to the pharmacy.
If you decide to use your eggs to get pregnant, the eggs are thawed, injected with a single sperm to achieve fertilization, and transferred to the uterus as embryos. This procedure costs approximately $7,000, but discounts for additional cycles and payment plans are available.
Although egg freezing is now a viable option for women, Dr. Jain still recommends that women get pregnant before their mid to late thirties, as that is the ideal time for women to be pregnant. After the mid thirties, a woman’s fertility drops and that’s when egg freezing is recommended as an extra insurance policy to allow women to have children later.
Having said that, the statistics show that only 50% frozen eggs are fertilised and result in babies, so it is not a 100% fool proof insurance policy. Thus Dr. Jain suggests his patients try to get pregnant naturally up until age 43/44 and then use their frozen eggs as a last resort.
For women older than 45, the best option is egg donation, where the eggs of a younger donor mother are retrieved and fertilized at the clinic and then implanted into the patients uterus. The procedure can be done for healthy women up to age 55.
Other advances available in California and at SMF are Preimplantation Genetic Diagnosis (PGD) – where parents can choose sex of their embryos and test for any health defects.
California and the SMF are at the cutting edge of the fertility industry and also offer the most progressive options for women, including surrogacy, which usually involves the implantation of an embryo created using either the eggs and sperm of the intended parents or an embryo using a donated egg or donated sperm (or both). Surrogacy is available only in select countries and US states; California is generally recognized as having the best standards in the world for surrogacy and other fertility options.
So although women who are older do have a more difficult time getting pregnant, thankfully experts like Dr. Jain and the breakthrough technology they are working on, are giving women more hope and chances for creating life than they could have ever imagined. And as all those that have benefited from Dr. Jain’s work can tell you, receiving the gift of creating a new life is beyond priceless.