Exclusive pictures reveal first look inside America’s first egg-freezing-only lab that claims to offer nearly 100% survival of every egg stored – at half the market price
egg-freezing-lab:These are the first photos inside the lab at America’s only clinic dedicated exclusively to egg freezing.
Extend Fertility, a ’boutique’ clinic in New York City’s Midtown, is focused solely on removing and storing a woman’s eggs – as opposed to also treating infertility and offering in-vitro fertilization (IVF).
It was designed to offer a less clinical atmosphere to 20- and 30-somethings who do not need to discuss the medical issue of fertility, but rather want to prepare a back-up to ensure they can have children down the line.
egg-freezing-lab:The entire pre-op space – with its rounded walls, pastel colors, and a view of Carnegie Hall out the window – has more of a spa feel than a medical center. Staff are chatty, the seats are plush, and the lights are warm.
Through a small square window in the operating room, you can catch a glimpse of the one off-limits space: Extend’s state-of-the-art lab.
This week, the lab became fully operational to become the first place on the East Coast using the latest freezing method, Cryotec. With that move, they make a staggering claim that they can ensure almost 100 percent survival rate of 12 eggs per patient, or up to four cycles.
Experts have hailed the clinic as groundbreaking.
And now, Daily Mail Online can offer a rare look inside that process, beyond the multiple sets of doors that seal the lab’s specific air flow and temperature to protect hundreds of patients’ eggs before they are sent to a natural-disaster-proof facility just outside Boston, Massachusetts.
egg-freezing-lab:Extend Fertility is America’s first egg-freezing-only clinic, as in it doesn’t also offer IVF or fertility treatment. This week, the clinic launched new state-of-the-art lab designed by rising star embryologist Dr Leslie Ramirez (pictured)
The lab the first place on the East Coast using the latest freezing method, Cryotec. With that move, they make a staggering claim that they can ensure nearly 100 percent survival of at least 12 eggs per patient. Pictured: eggs in -196C liquid nitrogen
With these images, Daily Mail Online can offer a rare look inside Extend’s ‘groundbreaking’ process, beyond the multiple sets of doors that seal the lab’s specific air flow and temperature to protect hundreds of patients’ eggs. Pictured: inside the lab
egg-freezing-lab:The lab is the brain-child of Dr Leslie Ramirez, a young star in the field of fertility and embryology.
Originally from Queretaro, Mexico, she has trained with the industry’s leading figures – Dr Carlos Simón in Spain and Japan’s Dr Masashige Kuwayama, who invented the most effective egg-freezing method to date: Cryotec.
She was then headhunted by Dr Joshua Klein – formerly of RMA of NY – to develop a lab that did away with the other elements, and brought the world’s top freezing methods to the US.
Dr Ramirez is supported in the lab by Alexis Adler, Extend Fertility’s senior embryologist, who has more than 20 years’ embryology experience with Weill Cornell and at NYU Fertility Center.
NEW FREEZING METHOD
HISTORY OF EGG-FREEZING
Egg-freezing first began in 1986.
One of the early problems with the process was that, unlike sperm which freeze and thaw easily, eggs contain lots of water.
It means that, if the process isn’t done correctly, ice crystals could form, destroying or damaging the eggs.
That was the key issue with the first method, known as the ‘slow-freeze’, which was used almost everywhere until around 2009.
It involved gradually reducing the egg’s temperature to -196C over the course of hours.
Initially, it was thought this slow process was necessary to delicately allow the egg to adjust its temperature. Scientists now believe the more time, the more likely crystals will form.
In the past eight years, there has been a surge in clinics employing a flash-freezing method called vitrification that appears to overcome that challenge.
Vitrification is so named because during the process the eggs transition to a vitreous, or ‘glass-like,’ state.
A combination of cryoprotectants and faster cooling (compared to the slow freezing method) reduce the opportunity for damaging intercellular ice crystals to form during the process.
Studies have found eggs frozen via vitrification have, on average, a 91 percent chance of surviving the freeze-and-thaw process.
egg-freezing-lab:The Cryotec method, invented by Dr Kuwayama, is the latest version of vitrification, bringing the egg to -196C in immediately. Every egg frozen and thawed with Cryotec has survived thus far.
At Extend, they have honed the technique even further, controling the air quality, air flow, and temperature of the entire lab as well.
Dr Ramirez is one of the only people in America qualified to perform Cryotec.
Extend Fertility is the East Coast representative laboratory on the east coast; Anyone else that wants to use it must train with Dr Ramirez or with Dr Kuwayama.
It is likely that Cryotec will one day become the standard method across the country.
FROM START TO FINISH WITH DR RAMIREZ
Retrieving and cleaning
On the day of retrieval, the doctor will retrieve the patient’s eggs via a needle inserted through the vaginal wall.
They put that in a test tube, which is placed in a gap in the wall leading to the lab.
Once the surgeon shuts the window on their side, Dr Ramirez opens the window on her side (to keep the external air from flowing in and tampering the atmosphere).
She retrieves the tube, carefully empties it into a labeled petri dish, and looks for the eggs, then starts the cleaning process. The eggs will then sit in an incubator for a few hours.
Checking for mature eggs
That day, the patient will be told how many eggs were retrieved.
Meanwhile, Dr Ramirez will be examining the eggs with a microscope to check whether they have extruded the polar body.
egg-freezing-lab:Through a small square window in the operating room, you can catch a glimpse of Dr Ramirez in her state-of-the-art lab
The surgeon puts the retrieved eggs in a test tube in this window in the wall. Dr Ramirez then opens the window from her side
Finding the eggs: She carefully empties it into a labeled petri dish, and looks for the eggs, then starts the cleaning process
Among other products, Dr Ramirez sourced a new kind of incubator – a $16,000 contraption by BenchTopInc (pictured) – which keeps the eggs at 36.8C. It consists of six spaces, as opposed to the large incubator tanks normally used to hold many
Once inside, the incubators have a peep-hole to look through to check the eggs’ progress without changing the temperature
Dr Ramirez examines the eggs with a microscope to check whether they have extruded the polar body. To a layman’s eyes, that broadly means a small dot in the egg has been pushed outside of the main circle. When that happens, it is mature
To a layman’s eyes, that broadly means a small dot in the egg has been pushed outside of the main circle. When that happens, it is mature.
Once they have the batch to freeze, Dr Ramirez starts the freezing process.
Freezing: the Cryotec method
In the process of vitrification the eggs are first placed in special solutions, and then immersed in liquid nitrogen.
The eggs have to sit in a petri dish in an incubator at 37C for at least one hour before freezing so the eggs can stabilize.
Then, over the course of 15 minutes, they will be placed into two different solutions to vitrify them at room temperature.
Meanwhile, Dr Ramirez prepares a small blue open-topped box of -196C liquid nitrogen.
Once the eggs have been prepared in the vitrification solution, she places them on a minuscule pointy-ended stick called a straw that was designed specifically for the Cryotec method.
The straw is then swiftly inserted into a large cylindrical blue-and-silver stick called a cane, which is in turn placed in the liquid nitrogen and covered.
Each patient’s cane is sealed and labeled with their medical information, and placed inside a grenade-shaped tank. These tanks can hold up to 300 patient canes for six months before going to the storage unit in Massachusetts.
‘TREATING 21st CENTURY WOMEN’
The ability to conceive begins dropping around 35 and more rapidly as the 40s near.
Women have fewer eggs left, and these older remaining ones aren’t as healthy, meaning even if the woman can get pregnant she’s more likely to miscarry.
However, current lifestyles do not fit that timeline.
Today, about one in five U.S. women now have their first child after age 35, according to the Centers for Disease Control and Prevention.
This is the tank of liquid nitrogen (in gray), sat next to the space where Dr Ramirez vitrifies the eggs in two solutions
The eggs have to sit in a petri dish at 37C for at least one hour before freezing so they don’t degrade. Then, over the course of 15 minutes, they will be placed into two different solutions (pictured in tubes beforehand) to vitrify them at room temperature
Once full shrinkage of the eggs is achieved, she retrieves the eggs from the solution by picking them up with a minuscule pointy-ended stick called a straw that was designed specifically for the Cryotec Method (pictured)
While the eggs are in their solution, Dr Ramirez prepares -196C liquid nitrogen to put in a blue open-topped box (pictured)
The Cryotec method, invented by Japan’s Dr Masashige Kuwayama, is the latest version of vitrification, bringing the egg to -196C immediately in liquid nitrogen (pictured). Every egg frozen and thawed with Cryotec has survived thus far
Earlier methods, known as the ‘slow-freeze’, cooled the eggs over hours, meaning ice crystals could form, destroying or damaging the eggs
This shot captures Dr Ramirez with the box of liquid nitrogen, the room-temperature incubator, and the eggs in solution
Here, Dr Ramirez is pictured putting the Cryotec into the -196C liquid nitrogen solution
The Cryotec is then inserted into a large cylindrical blue-and-silver stick called a cane (pictured) in the liquid nitrogen
Each patient’s cane is sealed and labeled with their medical information, and placed inside the tank (pictured). The tanks can hold up to 300 patient canes. They stay in Extend for up to six months before going to the storage unit in Massachusetts
The shift has led to a surge in women looking to freeze their eggs.
But while the option has been around for 30 years, studies show it is still something of a taboo culturally.
A recent survey of more than 1,000 US women aged between 25 and 35 found most of them had never discussed age and fertility with their gynecologist.
Seventy-eight percent of them had never discussed age as a factor in becoming pregnant, and 96 percent had never discussed treatment options to maximize their chances of fertility.
LUMPED IN WITH THE REST
egg-freezing-lab:Dr Klein, who trained at Harvard then Brigham & Women’s Hospitals, heaps praise on the capabilities of his previous place of work (Reproductive Medicine Associates of New York in Brooklyn).
However, without naming it, he says his time there introduced him to an under-served client base.
‘I was involved from the conception,’ he says (chuckling, ‘I’m sorry, there too many fertility jokes’).
‘I worked for many years at a large university. One of the thing was that I had an increasing number of women wanting to talk about fertility preservation.
‘Even though the place I worked was excellent, the egg freezer patients weren’t served as well as I felt they should be.’
Fertility clinics, he explained, are usually designed for couples.
Usually, they are coming to the table with the recognition that there is some medical problem. First they need a diagnosis, second they need a way to fix it.
‘The egg freezing patient doesn’t have a problem per say, except being a woman in the 21st century,’ Dr Klein explains.
egg-freezing-lab:’They want to do something pro-actively; they want to make chances that make sense to them in their lives. But they were not well served by the environment.
‘Many of them felt like the ugly step sister of the fertility problems. From a fitting in stand point, it wasn’t a very comfortable environment.’
The idea of freezing eggs for a later pregnancy is hardly light on the pocket.
Retrieving eggs is an outpatient procedure that can cost $10,000 to $15,000 per cycle.
egg-freezing-lab:Patients also have to pay up to $4,000 for hormone injections to get them ovulating as many eggs as possible.
After that, clinics charge a storage fee of around $500 a year.
Women who wind up using their eggs will pay thousands more to undergo in vitro fertilization.
‘By far the most common reason women don’t follow through or follow up is that it’s such an expensive proposition,’ Dr Klein said.
egg-freezing-lab:’For these other clinics, they have so many services, and that has to be offset by their pricing structure – offering IVF, IUI, male fertility, female fertility, genetic testing… that creates certain level of pricing.
‘When you remove one line out of the equation you can change that – and even improve quality, but at a different price point. The lowest, to be exact.’
Extend caused a flurry of headlines last year after announcing its plan to offer a $4,990 ‘all-inclusive’ service.
egg-freezing-lab:To be clear: the price does not include everything listed in this section. Extend’s patients are still required to buy up to $4,000 for hormones, since the clinic doesn’t have a license to prescribe them, and the storage is extra.
egg-freezing-lab:Still, Dr Klein insists, you can’t argue with the fact that it’s half the market rate – and includes up to four cycles.
egg-freezing-lab:’One of the things that we changed about the delivery of care is that we don’t want women to come in for ‘you get what you get’,’ Dr Klein said.
‘The pricing includes the idea that one cycle might not be enough.
The entire pre-op space – with its rounded walls, pastel colors, and a view of Carnegie Hall out the window of the consultation room (pictured) – has more of a spa feel than a medical center. Staff are chatty, the seats are plush, and the lights are warm
In the exam room, patients are given an ultrasound and blood tests to start the process and check their hormone levels
On the day of the procedure, they will start in the pre-op room (pictured), which is a floor above the consultation room that they have been visiting with their fertility advisor for the past days, weeks or months – depending on the time frame they pick
Procedure room: On the day, they will lie in this chair, be given anesthetic, and have their eggs retrieved via a tube in their vaginal wall. Scroll down for a first-person account of her experience getting her eggs retrieved at Extend Fertility
‘We decided each patient should be able to have at least 12 eggs frozen, so she doesn’t walk away from the whole thing empty handed.
‘That gives a woman in her 20s about an 80 percent chance. For a woman in her 30s it’s about 50-70 percent.’
CAN PATIENTS BE CERTAIN THEY WILL HAVE KIDS?
‘That’s the million dollar question,’ Dr Klein admits.
Cryotec touts a 100 percent survival – though Dr Klein cautions that he never likes to say ‘100 percent’ about anything.
Nonetheless, that simply refers to the survival of the egg through the thawing process.
Whether that egg becomes a baby is another matter.
The degree that women can be confident depends on two factors: first, the age at which these eggs are frozen; second, how many eggs are frozen.
egg-freezing-lab:Any individual egg – thawed or frozen – has a possibility of becoming a pregnancy.
But 20-year-old eggs have a higher probability of making it than 40-year-old eggs.
As a result, 20-something can bank fewer eggs and still be confident.