While the fertility journey might seem overwhelming at times, understanding the ins and outs can help women feel empowered to make informed decisions.
Providing this empathetic care, Dr Danielle Robson, an experienced fertility specialist and gynecologist at Genea, offers patients evidence-based advice to help them in the decision-making process.
“My business is hormones,” said Dr Robson, speaking at the 2025 Women’s Agenda Health Summit.
“I love hormones from start to finish. I do a lot of menopause management and fertility care, and I work across Sydney, in the city and on the Northern Beaches, which is where I was born and raised.”
Through conversations with other women, Dr Robson said a lot of fertility related questions she hears are varied but come back to the theme of feeling more empowered through a deeper understanding of their unique situations.
What are the signs of ovulation? Why aren’t I saving my eggs if I’m on the pill? What exactly is AMH (Anti-Mullerian Hormone)? Am I supposed to go get this done? Why is this happening? Why does my body do this?
These are just a few of the questions being thrown towards Dr Robson, who is able to break down the fertility cycle into comprehensible terms.
Menstrual cycle
The menstrual cycle can essentially be grouped into two key areas: your uterus and your ovaries, Dr Robson says.
At the level of the ovaries, there’s the development of the egg that women ovulate each month, and she says this is what “we manipulate in IVF, or egg freezing”.
At the same time, she says the uterus is responding to these hormones, either by preparing itself for a pregnancy or a menstrual bleed.
“We are born with our lifetime supply of eggs, and I think that that is a very important message,” says Dr Robson. “You’re typically born with between one to 2 million, and you will progressively go through them until you have menopause, to which there is no longer an egg source.”
As women age, the quantity and quality of their eggs decrease, and Dr Robson says she often sees women coming into the clinic in their early 30s, who are struggling to fall pregnant and blaming themselves for going about things “the wrong way”.
However, Dr Robson notes that the difference between the quality and quantity of eggs in a 22-year-old compared with a 32-year-old isn’t all that much different. It’s when women get over the age of 40 when the difference starts to become noticeable, with Dr Robson saying that’s when “a pregnancy is possible, but not necessarily probable”.
When it comes to measuring the ovarian reserve, or quantity of eggs, that’s where a person’s AMH or antral follicle count comes into the picture, which is seen by medical professionals through a pelvic ultrasound.
“It’s important to know that this is a measure of your quantity of eggs. It’s stemming back to the fact that we’re born with that 2 million supply and how many of them you’re going through relative to other women of your age,”says Dr Robson, adding that AMH is not a measure of fertility.
“This is not telling me your fertility. This is not telling me your quality of eggs, and this is not telling me if you can or cannot have a baby,” she says, noting that there is no good that comes from instilling a narrative that looks at things as either “normal or abnormal” because everyone is unique.
Egg freezing
When it comes to freezing eggs, Dr Robson says there’s a common narrative out there that women who choose this route are simply delaying children for career goals.
This, however, is only one reason, and she doesn’t often hear it. There’s other factors such as finding the right person to have a baby with or not being sure that having a baby is the right decision for their life.
“A decision to embark on parenthood is a big one,” she says. “For some people, they’re not sure, and they need to take the time to figure that out, and that’s where I think egg freezing is extremely valuable for that group of individuals.”
It’s a straightforward process, which Dr Robson breaks down into three steps: stimulation, egg collection and storing the eggs.
Stimulating the ovaries goes back to the first day of a person’s period, when the body starts recruiting as many follicles as it deems that it should on that particular month, she says.
“On the fifth day of the cycle, you will get one greedy follicle that will take all of the hormone for itself, and that follicle is the one that will grow the mature egg that gets ovulated, all the other follicles die, and in them, the eggs die,” Dr Robson says, adding that this is how people go through about ten eggs every month.
“In an egg freezing cycle, similar to an IVF cycle, we are tricking the body to grow all those follicles. You will administer something called follicle stimulating hormone, which is designed to give your body excess hormone that it naturally produces to make it grow all of those follicles instead of the single one.”
“Then your body is quite smart, does not want to have a litter of children starting to panic, so it will try and ovulate those eggs prematurely. So you will then take a second medication to prevent that, and we will try to grow and nurture these follicles along until we have a nice cohort or a good number of eggs for us to collect.”
When it comes to collecting eggs, the procedure can be done awake, but some women choose to undergo this with some local anesthetic to the vagina as well as a bit of sedation, such as fentanyl, she says, adding that another option is to be asleep.
“It is a transvaginal ultrasound with a small needle that will go through the vagina into the ovary. We pierce each of those follicles like little balloons, and we drain the follicular fluid. The scientist will look through the fluid at the time, and they will count out the eggs, and the mature eggs are what go into storage.”
Key takeaways
The collected eggs then get frozen and their success rate does not change with the person’s increasing age, Dr Robson says, adding that most units will look to freeze eggs for about 10 to 15 years.
While there is a lot of misinformation circling in the fertility space, the main thing that Dr Robson says needs debunking is the idea that there’s a magical number when it comes to freezing eggs.
“There is no number of eggs that will guarantee your baby. We do not get any insight to your egg quality through this process,” she says, adding that while there are calculators out there, they can be misleading without information about egg quality.
“The only measurable way to figure out egg quality is to fertilise an egg, and the only time that we do that is when the 10 to 15 per cent of women who have frozen their eggs come back to use them and fertilize them and then find out if they are useful or not useful to them.”
Thank you to our sponsors who made the event possible, including Medibank, Genea, Fare Australia, Organon, National Breast Cancer Foundation, Mums Matter Psychology and CSIRO Total Wellbeing Diet.