Interview: Dr. Kevin Winslow

48 Hours Investigates interviewed reproductive endocrinologist Dr. Kevin Winslow, one of the pioneers in the science of cryopreservation.

Winslow is director of the Florida Institute for Reproductive Medicine. The following is an excerpt from that interview.

Dr. Kevin Winslow: What we’re basically trying to do is to cryo-preserve an egg in a way in which it is not damaged. It is very difficult to freeze an egg without damaging it because of large water content in the egg. So what we’ve been doing over the last five, six years, is refining the way that we freeze, remove the water from a cell, and not damage it. So that it can be a useful cell when we’re ready to use it.

Is the frozen egg process, now that you’ve achieved it, the Holy Grail of infertility?

Winslow: We really think that it’s pretty close in that the technology will offer women an enormous opportunity in terms of women faced with potentially sterilizing chemotherapies, radiation, or for the professional woman who may not be ready to start a family. She’s 35, not ready to start a family, maybe for another three, four years. When the quality of her eggs at that point is going to be very poor and she’s going to have a much harder time being able to get pregnant.

Is Juliette Goetz the perfect example of what your single clientele is?

Winslow: Juliette is a common story of somebody who’s sort of in her mid to late 30s who hasn’t met Mr. Right. And again, maybe three, four, five years down the line before she’s ready to have children. So there are an enormous number of women in our society in that same situation.

We do a whole range of infertility treatments. But in terms of the women seeking this technology, the cryo preservation eggs, I would say about 70, 75 percent are women who are concerned about delayed child bearing.

Let's use Juliette Goetz, or someone her age and her background, as an example. It’s roughly $3,000 for the drugs to produce the eggs.

Winslow: That’s correct.

And then as you add up the other process it’s close to $9,000 - 10,000 dollars?

Winslow: That’s a good guesstimate, yes ... It’s an expensive thing to do. It really kind of follows, mimics the costs of IVF [in-vitro fertilization]. I would expect wherever this technology is being offered, it should be very close in terms of cost, to what an average IVF cycle is costing. Because basically, we’re doing very much the same thing. With the exception that again, we’re not doing an embryo transfer at the immediate time.

For a single person who’s out there, like Juliette, to pay $9,000-10,000, can she bank on the eggs are going to be viable when she goes to use them?

Winslow: There’s certainly no guarantee with any of this. We’re currently very excited about the results that we’ve seen. We’re currently averaging somewhere between 10 and 14 eggs to establish a healthy ongoing pregnancy. That’s what our data has revealed over the last five years.

The average patient, 35 years or less, who is going through hyperstimulation to do IVF, for example, will get about 14 or 15 eggs in our clinic. That is the number that we’ve been seeing that is equating with one ongoing healthy pregnancy. So we now feel that we’ve gotten this technology to the point where a patient 35 years or less has a reasonable shot of getting pregnant, getting what she wants, going through a single IVF cycle.

So they only have to go through the hormone drugs and have the eggs extracted just once. Do you recommend more than once for your patients, the single women?

Winslow: Some patients are going to produce fewer than that 14 number of eggs. Some patients may produce only five or six eggs in which case you may have to do it more than once. Sometimes the quality of those eggs is not so good in which case you may have to do it more than once. But what we’re currently seeing on average is that about 14 eggs is equating with a healthy ongoing pregnancy. So we feel that this technology is to the point now where it is a reasonable clinical tool, considering the costs of in-vitro fertilization.

How exciting is this for you and your industry?

Winslow: I think it is just tremendously exciting in the sense that it has so much to offer women in our society. Primarily women, I think, benefiting were most exciting with ladies faced with potentially sterilizing therapies. Chemotherapy, radiation. All too often now, we are doing very very well with the blood borne leukemias, lymphomas.

These are young patients who often are not married and don’t have significant others. These young ladies now could go through a single stimulation cycle and have a very reasonable chance of being able to have children in the future, should they, indeed, become sterile from their therapies.

If a young woman in her 20s walks in your door with leukemia, and she has two weeks or so before she has to start with a very serious life altering regimen to try to save her life. How viable is it that she would come in and say, "I need to start this process right now, and be able to go forward with it?" Do you have enough time to help her?

Winslow: Sometimes we do and sometimes we don’t. And that’s tough. But what I generally do is consult with her oncologist and we see, again, how pressing the time issue is. But if they can give us approximately two weeks, then we have a reasonable shot of getting through this and being able to cryopreserve at least one group of eggs prior to her starting her therapy.

I want to ask you some of the questions about long term effects and research. Have you had any indication that there’s any threat to the embryo to the child that comes afterward? Any abnormalities?

Winslow: That’s a very legitimate concern. And in terms of anybody who’s considering this therapy, we tried to make that point very clear to them, that this, because it is a very new technology, we cannot guarantee the absolute safety of this technology. To date, we’ve had 25 babies born from this technique.

We’ve not seen any significant medical issues whatsoever with any of these children. We think it is very prudent and we keep a registry on all the babies that are born. And we’re seeking to get health information from them on a yearly basis, from their pediatricians.

The oldest children that you have from this program are 5 year old twins. It could be ten years before you’re really confident that this process has been perfected.

Winslow: That’s exactly correct. We won’t know until we follow these children through adolescence and early adulthood.

Let me then ask about some ethical questions, because this whole IVF issue has a lot of ethical questions surrounding it. Ethically speaking, does this address the frozen embryo issue - that there are too many in this country. What do you do with them?

Winslow: That’s an excellent point. And again, another, we think very valuable, use for this technology. There’s enormous program with large amounts of cryo preserved embryos that are not being used. That have been quote, “abandoned.” We believe, again, that this technology, when it is refined to the point where, again, we’re seeing the same efficiency as that used with cryopreserving embryos, that it will eliminate that issue.

Ethically speaking, are you concerned at all that you’re toying with mother nature?

Winslow: In the sense that I think we are offering women a much better chance to establish a pregnancy with a younger, healthier egg, I think of this in a positive way. That we may eliminate, you know, suffering, miscarriages, more children born with congenital genetic anomalies.

In your mind, because there’s always pros and cons, what is the single greatest risk to a woman and to her potential unborn child in this process?

Winslow: Well, potentially, again, if we did see that you know genetic congenital anomalies were coming about because of this, then obviously that would be the main risk that we would worry about.

But medically speaking, no risks to the women?

Winslow: No, the risk with cryo-egg would be analogous to that associated with going through an IVF cycle, mainly, hyperstimulating her ovaries. There can be risk of that.

Have you had clients in the last—three to five years that were single women who froze their eggs, like Juliette, who came back after they found Mr. Perfect, Mr. Right, and said "I’m ready to go"?

Winslow: Yes, yes, we have.

And it’s worked successfully?

Winslow: It has, yeah.

But you can’t guarantee that there will be a baby.

Winslow: Certainly not. Certainly not. And I think what we’re trying to do is at least increase their opportunity, their chance of having a child, a healthy child. You know, once their chemotherapy or their treatment’s over. Or the individual who, you know, is doing this because of delayed child bearing. She’s going to have a much healthier, better group of eggs to work with when she’s 41, 42, than what she would have, certainly, on her own.

What then do you say to your critics who contend this is just a money making venture for IVF clinics looking for a new avenue to bring cash in because they’ve already perfected the IVF process?

Winslow: Well, I think those critics should talk to some of the cancer patients that we see every day who again are almost more frightened about losing their fertility potential than they are from their cancer.

And again, we make it clear to the individuals that what we’re doing is offering them hope, an increased chance of having children, should they become sterilized. But it certainly isn’t a guarantee. But I think having that hope is a great benefit to many of the patients who are faced with potentially sterilizing therapies.

Is there a fear that that might happen as more clinics had this technology available to them? That there will be 40-year-old women coming in saying I want to have my eggs frozen on the off chance that in sometime in the next five years I might want to have my own baby?

Winslow: We think that would be a bad use of this technology. In that, I think again we are going, unless you have a reasonable chance of getting what you want, i.e., a healthy pregnancy end of this, I don’t think it’s an ethical thing to do to let 39, 40, 41 year olds do this. Again, there will be exceptions where you get 39 year old perhaps, who may have gone through a prior ovarian stimulation cycle, who you know stimulates and gets a large number of eggs, more than the average for her age.

Because of the initial costs, because of the cash that you have to lay down, it’s going to be cash prohibitive for some people - a cancer patient or they’re a single woman. How long do you think it will be before this research and therapy is available to every woman across the country, and affordable?

Winslow: Well, the real hope of all this would be for insurance companies to cover this one day. Clearly now this technology is very new. And when we’ve addressed this issue, particularly for cancer patients who we try to get this covered for, most of the insurance companies have semi-laughed at us.

Which is curious, because some of these same insurance companies will cryo-preserve sperm for men faced with the same situation. But because this technology is so new, a lot of them are not really giving it serious consideration. We think that our data, our good results, the efficiency that we’re showing now, hopefully, will go a long was in trying to get insurance companies to consider covering this, at least those same companies that would cover sperm for the men.