31 minFertility After 35: Egg Freezing, IVF and Perimenopause
With Dr. Jaime Knopman
Guest on the show
Dr. Jaime Knopman
Dr. Jaime Knopman is a double board certified reproductive endocrinologist, director of fertility preservation at CCRM Fertility in New York, and author of Own Your Fertility.
Episodes with Dr. Jaime Knopman
31 minWhat Jaime talks about
Ep. 339: Fertility After 35: Egg Freezing, IVF and Perimenopause
Many women assume that as long as their period shows up, their fertility is still there. In this episode, Nikkiey Stott sits down with Dr. Jaime Knopman, a double board certified reproductive endocrinologist and author of Own Your Fertility, to talk about what really happens to eggs, hormones and fertility as you age. Her core message is simple: menses does not equal motherhood.
Dr. Knopman explains what perimenopause is and why it is being picked up in some women in their 30s. She also covers why egg quality is driven mainly by genetics rather than diet or supplements, and why she isn't a fan of the term geriatric pregnancy. She walks through when to think about egg freezing and how the roughly two-week process works, what happens when IVF takes multiple rounds, and how hard the emotional and hormonal side of fertility struggles can be on mental health and relationships.
Nikkiey shares her own egg freezing journey and the shock of learning her ovarian reserve was low at 35. Together they make the case for fertility awareness as empowerment: make fertility planning part of your OBGYN visits, see a fertility specialist if you're struggling, and ask for an evaluation even when you're told you're young enough to wait.
- Getting regular periods, even into your 50s, does not mean you can still get pregnant, because egg quality can be too reduced to lead to a healthy pregnancy.
- Women are born with all the eggs they will ever have, and most see a significant decline in both egg quantity and quality starting in their 30s.
- Dr. Knopman says egg quality is driven primarily by genetics, and the idea that eating right or taking a supplement will improve it is not true, though a healthier body still supports a healthier pregnancy.
- Ask your OBGYN to make fertility planning the fifth pillar of your visit alongside the pap smear, breast exam, STD testing and contraception.
- Dr. Knopman's view is that freezing eggs in your 20s or 30s gives you optionality later, while women who froze in their 40s saw poorer results because egg quality was already low.
Common questions
If I still get regular periods, does that mean I can still get pregnant?
Not necessarily. Dr. Knopman explains that you can get periods into your 50s, but egg quality can be so reduced that it would not translate into a healthy pregnancy. Her phrase for this is menses does not equal motherhood.
What is perimenopause and how long does it last?
Dr. Knopman describes perimenopause as the changes that occur before menopause, which is defined as no period for a year. It can last anywhere from one to six or seven years, often shows up as periods becoming irregular along with diminished ovarian reserve, and for some women it happens at younger ages than expected.
Can diet or supplements improve egg quality?
Dr. Knopman says the primary driver of egg quality is genetics, and the idea that eating right or taking a supplement will improve egg quality is not true. She still wants women to be healthy when trying to conceive, because a healthier body leads to a healthier pregnancy.
What is the best age to freeze your eggs?
Dr. Knopman says that if she had her way, everyone would freeze their eggs in their 20s because it gives optionality down the road. She is clear that not freezing doesn't mean you will have infertility, only that you are more likely to face fertility struggles as you get older.
How does the egg freezing process work?
Dr. Knopman explains it takes about two weeks, with visits to the clinic every two to three days for blood work and ultrasound to see how you're responding to medication injected into the abdomen. A final shot triggers egg maturation, and the eggs are retrieved in an operating room 35 hours later.
Why do some women go through multiple rounds of IVF?
According to Dr. Knopman, it's usually one of two things: either no healthy embryos come out of genetic testing, or a healthy embryo is transferred and doesn't work. It's rare to get no eggs at all; more often the embryos don't test chromosomally healthy.