Dr. Jaime Knopman is a board-certified reproductive endocrinologist and the National Director of Fertility Preservation and the Director of Fertility Preservation at CCRM Fertility of New York, one of the offices from the national network of fertility researchers and providers. 

A pioneer in fertility science, she recently authored Own Your Fertility: From Egg Freezing to Surrogacy, How to Take Charge of Your Body and Your Future. She is a medical adviser of The Breasties and on the executive board of Chick Mission. 

Dr. Knopman spoke with The Peak about her career path to being an expert in fertility, the need for fertility options for all who wish to have children, and the expansion in fertility from focusing on patients or couples suffering from infertility to include those who wish to preserve their fertility. 

This interview has been edited for clarity and length.  

THE PEAK: Can you please share your career path into reproductive endocrinology?

Dr. Jaime Knopman (JK): I have wanted to be a doctor since the second grade when I read a book about Elizabeth Blackwell [the first woman to earn a medical degree in the United States]. That day, when I got home from school, I told my mom, “I want to be a doctor.” And so, it was instilled within me at an early age. 

While I knew medicine was for me, I did not know I wanted to go into reproductive endocrinology or fertility until a later time. I took a gap year between college and medical school and worked at the Breast Center at Memorial Sloan Kettering Cancer Center. This crystallized for me that I wanted to focus on women’s health and specialize in OB/GYN in medical school. That experience exposed me to the field of fertility and related challenges for patients and need for care, and I realized that was the field I wanted to spend my career in. 

TP: Congratulations on the publication of your book on fertility, Own Your Fertility: From Egg Freezing to Surrogacy, How to Take Charge of Your Body and Your Future. What inspired you to bring all of your learnings together in a book, and what’s the one thing you hope readers take away from it?

JK: It was a big accomplishment for me to do this. My husband often says I am the loudest person in the room. I realized I am only as loud as the four walls of my office. With that, I thought: I know a lot about fertility preservation, and so I wanted to get this knowledge out there. 

During COVID, I saw the shift around how women and couples were approaching fertility — specifically, the shift towards fertility preservation becoming a high need. My co-author and I began writing in November 2022. Own Your Fertility is a big accomplishment towards my goal of providing guidelines, options, and thought-provoking questions for patients navigating their fertility journey. 

TP: Could you tell us a little bit more about your current work and how it is helping change the standard of care, specifically for patients affected by cancer? 

JK: I went to Residency and Fellowship at NYU, which is a fantastic fertility program and fertility fellowship. In my job after that, I felt that the one thing I was seeing was many patients who could not get pregnant. [In those instances], we sent them to CCRM in Colorado, [as did many other practices]. 

When we got approached by the CCRM team to help open the New York office, I said, “If you get asked to play for the Dodgers, you play for the Dodgers, right?” [I joined] CCRM because of the quality of the laboratory; the embryology lab was by far the best I’d ever seen. I wanted to be able to offer my patients that. 

[In terms of the intersection of cancer and fertility], I aim for my patients to know they have options. For many years, in the beginning of my career, women who were diagnosed with a malignancy were not offered fertility preservation by their doctors because there was a fear that there was not enough time, that this “extra” step might hurt their chances of surviving their cancer. 

In those days, there was a notion that survival was the sole goal. Nowadays, those tenets are antiquated. We know now that we can take actions to preserve fertility and do it quickly, without harm, and we can do it in a way that will offer women options on the other side of their treatment.

TP: It has been a huge step forward that Breasties and all impacted by cancer have options around fertility and finding care from teams like yours who fight for them. Because so often, we have heard from community members diagnosed even a few years ago, that was not even something that was presented to them.

JK: Agree. I am grateful for this shift. I was diagnosed with breast cancer at age 40, and I remember my surgical oncologist asked if I wanted to speak about egg freezing. I thanked her and acknowledged it was amazing that she offered that. 

Personally, I have two children and [our family was complete]. But the highlight of the story is that patients of reproductive age are being offered this option – that is what’s really important.

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TP: Members of our Breasties community will be excited to see that your book addresses Surrogacy. What advice would you have for Breasties who are considering or navigating surrogacy? 

JK: Surrogacy and the laws around it are evolving, and laws differ from one jurisdiction to another. 

For instance, in the United States, Canada, and Australia, laws vary by state/territory. Specifically, the U.S. does not regulate surrogacy on a federal level, so each state has its own laws about whether surrogacy is permitted and how it is regulated. What’s key is that the U.S. is definitely forward-thinking in this arena. In many countries around the world surrogacy is not legal, especially paid surrogacy, and particularly surrogacy for people who are not heterosexual. The next wave of surrogacy will be expanding access for gay men, single men and same sex couples. 

On top of this, surrogacy is very expensive and there are not many insurance coverage options. So, cost and access are barriers to surrogacy. It’s also limited because having someone carry your child is a big ask. And oftentimes, you may have to wait a long time on a list. But it is available, and it is something that we do frequently now that we are allowed to in the state of New York, where I practice. 

TP: Breasties also want more information and support around fertility preservation and family planning for someone living with a stage 4 cancer diagnosis. How do you approach these conversations as a provider? 

JK: I think that is a really hard conversation because with a metastatic disease or stage 4, unfortunately, we know there is no cure. How long someone can live with their disease varies. 

I do not think support around fertility preservation and family planning is something that should not be available to patients who are living with a stage 4 diagnosis. We need to make sure these patients have a support system and mental health providers as needed to [weave a] circle of support. 

It is definitely a challenging question, and nobody can tell you what is right and what is wrong. For instance, someone could say is it fair for a man who is 70 to have a baby? It’s a very personal decision.

TP: Could you share more about your own breast cancer diagnosis and journey? 

JK: I was so fortunate. I was diagnosed as stage 1 and was treated surgically and with Tamoxifen. I feel I got so lucky because I did not have to go through a lot of what other women have to go through treatment-wise. [And on top of that], I had insurance and access to excellent care, and people who could take care of my kids, take me to appointments, and make sure the apartment was clean and the laundry was done. Not everyone has that. And so it is not lost on me the advantages that I had. 

I also think it made me a much better doctor. I think every physician needs to be a patient, because without that, we do not really truly understand what it’s like to be in that person’s shoes. For instance, I didn’t have infertility, so I can’t say to my patients, “I know what it’s like to have an egg retrieval or an embryo transfer,” but I can say, “I know what it feels like to have an unsuspected medical diagnosis that rocks your whole world.” That I can appreciate. 

TP: Breasties have been inspired by the progress that’s been made around preimplantation genetic testing (PGT).  Could you share about that process and how frequently you’re seeing people pursuing genetics testing in your practice?

JK: In our practice we do PGT for chromosome number on every single patient. The medical term for what we are testing is aneuploid, which is a condition where a cell has excess or missing chromosomes. It’s one of the leading causes of failed implantation and miscarriage.

We firmly believe that this testing improves the success rates and that it is an integral part of a fertility treatment cycle, whether it’s fertility preservation or infertility treatment. 

For single gene testing, for instance, BRCA, that testing has increased as well because our knowledge of genetics is exploding. 

In years past, we tested for fewer diseases. We now screen patients for so many more conditions – not just recessive conditions, but [variants that increase cancer risk]. And with this, we can make a big difference in that person’s future offspring! With ever increasing knowledge, we will be able to test even more. 

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TP: On that topic, are there any breakthroughs or developments that you’re currently excited about in terms of fertility and the intersection of the cancer community?

JK: I think it’s all about—and I say this in the last chapter of my book—genetics. 

I think as we continue to understand the genetics of why people get disease, particularly cancer, and we can screen for that in the embryos, it is only going to get better in the future. 

TP: Thanks so much for this powerful conversation. Is there anything else you would like to talk about or discuss?

JK: I think the Breasties leadership and community embody the concept of support, of no person stands alone, and that we do better when surrounded by people who lift us up. 

Personally, I am a sports fanatic; I like to live my life through watching my kids play sports and playing sports myself. In the end, it is really about the team. There is nothing in life that we win alone. Whether it is a game or in medical treatment, we need people around us, people on our team, to help lift us up.