A woman in her prime reproductive years may feel confident about her family building timeline. Unfortunately, not every woman has a straightforward path to pregnancy, and some may wonder how long to wait before exploring fertility preservation. This is where freezing your eggs can be beneficial. Egg freezing is a process to preserve the reproductive potential of a woman. The egg freezing process is also called oocyte cryopreservation. In this method, the eggs of the woman are harvested from the ovaries and are frozen when unfertilized and stored to be used later. Egg freezing is also combined with in-vitro fertilization. The fertilized egg is then implanted in the woman’s uterus.
To find out all the important facts about egg freezing for women who are curious about the procedure, TC46 connected with Fertility Specialist Dr Apurva Satish Amarnath of Nova IVF Fertility, Bangalore. Here’s her top 10 must-know list for women who are considering freezing their eggs.
1. Egg freezing is done to preserve and safeguard a woman’s potential to reproduce
Egg freezing is a procedure done to save the reproductive potential of women. This is also called oocyte cryopreservation. There’s a lot that goes into egg freezing before we even get to the part where the eggs are actually frozen.
There is a mandatory screening done of the woman before the egg freezing, which consists of the following:
- Ovarian reserve testing: A test is done to determine the quality and quantity of the eggs produced by the woman. In this test, the doctor tests for the AMH level with the AFC test. The results of this test help to determine and predict the response of the ovaries to fertility drugs.
- Screening for infectious diseases: The woman is screened for several infectious diseases like HIV 1&2, Hep B, Hep C etc. The eggs, which are at some risk of infection are stored separately from the rest of the eggs.
The procedure of egg freezing has multiple steps:
Step 1: Inducing Ovulation
- When the menstrual cycle starts, the treatment begins with the administration of gonadotropin hormones to stimulate the ovaries to produce a number of eggs, apart from the single egg which forms monthly. Various drugs which are needed are:
- Drugs for ovarian stimulation: The drugs which stimulate the ovaries to produce more eggs are follicle-stimulating hormone (FSH) or human menopausal gonadotropin
- Drugs to prevent premature ovulation: In order to prevent premature ovulation, the woman might be injected with a gonadotropin-releasing hormone agonist or gonadotropin-releasing hormone antagonist
- Blood tests are also done to determine the response to the drugs to stimulate the ovaries. The level of estrogen increases with the development of the follicles and the levels of progesterone stay low until the ovulation is completed.
- Once the follicles are ready for the eggs to be retrieved, which takes around 9 to 12 days, HCG injection is administered to help with the final maturation & ovulation of eggs.
Step 2: Retrieval Of The Eggs
- The process of retrieval of the eggs is done under anaesthesia. The doctors usually opt for a transvaginal ultrasound aspiration. During this procedure, a small ultrasound probe is put into the vagina to locate the follicles. Then the doctor guides a fine needle into the vagina and further into the follicles. With the help of a suction device that is connected to the needle, the eggs are removed very carefully from the follicles. This process can retrieve a number of eggs in 20 to 30 minutes.
- After the eggs are retrieved, the woman might experience some cramping or feeling of fullness or some pressure. This might continue for a few weeks because the ovaries might stay enlarged especially in those with ovarian hyperstimulation.
- If the doctor has some problem accessing the ovaries through the transvaginal ultrasound approach, then the placement of the needle will be guided through the laparoscopy technique. In this method, a laparoscope (a tube with a camera) is inserted by making a small incision into the belly button.
Step 3: Freezing The Eggs
- After the harvesting of the unfertilized eggs, the eggs are frozen to sub-zero temperature (-196 degree). This is done to stop all the biological activity occurring in the egg. The eggs are then preserved to be used in the future.
- You can remove multiple eggs at a time, which is advisable since it gives you the best chance of getting a healthy egg that can be fertilized.
2. There are different methods with different success rates that a doctor may use to freeze your eggs
The doctor uses various special methods for egg freezing as mentioned below:
- Usage of cryoprotectants: These cryoprotectants help the egg from forming an intracellular harmful ice crystal when stored in deep freezing.
- Slow-freezing technique: This technique involves the use of programmable freezers that freeze the eggs very slowly so that the intracellular ice crystals cannot be formed. This technique protects the eggs from exposure to the toxic substances present in the cryoprotectants. In this slow-freezing method, initially, the cryoprotectants are used in a very low concentration. The high concentration of cryoprotectants is only used when there is a gradual decline in the temperature and a decrease in the metabolic rates of the eggs.
- Vitrification: In this technique, initially, the higher concentration of the cryoprotectants is used with the rapid cooling so that there is no time for the intracellular ice crystals to form (currently used & popular technique).
A 2009 study revealed that eggs frozen via vitrification had a 91% survival rate, versus eggs that are frozen slowly (almost no clinics use slow freezing anymore), which had a 61% survival rate.
3. Freezing your eggs allow you to choose pregnancy at a later stage in life
Women today are choosing to have children later in life than ever before. Egg freezing can enable a woman to delay pregnancy until a later stage. Medical professionals refer to the procedure as oocyte cryopreservation. The average age of birthing a child has been steadily increasing. Society and patterns in childbirth may be changing. However, the biological realities of fertility remain the same.
Most women enter menopause in their late 40s or early 50s. In the years before menopause, a woman’s fertility declines. Conceiving a child is not as easy in later years as it is for a younger woman. Women who are considering freezing their eggs should be aware that successful pregnancies are less common with frozen eggs than fresh eggs. However, the use of frozen eggs can offer hope of conceiving in the future.
There is no legal mandate about egg freezing in India.
4. Freezing your eggs has its own complications, including physical and emotional risks
The egg freezing method does carry some risks, as mentioned below.
- Conditions associated with the use of fertility drugs: In rare cases, injectable fertility drugs like HCG (Human chorionic gonadotropin), which are used to induce ovulation, may sometimes lead to ovarian hyperstimulation syndrome. In this syndrome, the ovaries get painful and swollen immediately after the retrieval of the eggs or ovulation. Some other related signs and symptoms of the syndrome may be as mentioned.
- Abdominal pain
- Complications during the retrieval of the eggs: In very rare scenarios, the retrieval of the eggs with a fine needle may lead to bleeding, bowel damage, infections, or damage to the blood vessels or urinary bladder.
- Emotional risks: The procedure of egg freezing can sometimes give false hopes to the woman. The egg freezing procedure in combination with in vitro fertilization may give a limited success rate. Sometimes, if the woman uses the egg freezing technique to get pregnant or bear a biological child, there can be a risk of miscarriage which will be based on the age of the woman at the time of retrieval of the eggs.
After waking up from the effect of general anaesthesia some patients might face some of the following problems:
- A temporary state of confusion
- A feeling of cold or shivering
Egg freezing is an option open to women who are looking at preserving fertility since eggs are unfertilized. In the case of couples, embryo freezing would be more feasible as embryos are eggs that have been fertilized with sperm. Freezing your eggs offers more options – you don’t have to know who’s going to fertilize those eggs and you can take some time to figure that out. Embryo freezing is useful if you have a male partner who wants to get pregnant with that person via IVF.
5. Egg freezing is time-consuming; you should be mentally and psychological stable and prepared for the journey
Let’s start with a common misconception. While egg freezing may take some of the stress off of you in terms of knowing your baby-having timeline right now, it’s not necessarily a sure-fire way of guaranteeing your forever fertility. Why? Not all the eggs you freeze are going to be viable; think quality as well as quantity in this situation.
How many eggs survive the warming process and can be successfully fertilized depends on how old you were when you froze them (more on this later), and how many are healthy and viable once they come out of storage. Plus, fertility does change with age, so if you freeze your eggs at 25 and use them when you’re 35, you will have to contend with the realities of being pregnant at that age because pregnancy complications increase with maternal age.
These aren’t arguments for freezing or not freezing your eggs – only you and your doctor can decide if that’s the right decision for you – but you should know going in that it’s not a matter of freezing and forgetting.
Once that is out of the way, the timeline for the procedure to complete would be about 2 weeks with a few days of rest following the procedure for complete recovery. It’s also important to be mentally and psychologically prepared to undergo these procedures as they are time-consuming
6. Women can keep their eggs frozen for as long as 14 years, and more
The eggs can be stored for as much time as the woman wants. There is quite a possibility that a number of babies can take birth from the eggs stored over 5 to 10 years. The reports of successful thawing state the success rate even after 14 years. Hence, there is no evidence of any type of reduction in the effectiveness of the frozen eggs over the years, providing freezing conditions are maintained optimally and the egg quality has been good at the time of freezing.
7. The optimal age to freeze your eggs is in your early 30s
According to the American Society for Reproductive Medicine (ASRM), an optimal time to freeze your eggs is in your 20s and early 30s, while you (presumably) still have a sturdy ovarian reserve (the number of eggs in your ovaries) and those eggs are healthier when you are younger. Having your hormones tested, can tell you a lot about the state of your ovarian reserve, and help you decide, with the input of your doctor, if you should consider egg freezing. Egg freezing is not recommended for women over age 38.
8. You need to have a discussion with your doctor about freezing your eggs
One of the reasons for egg freezing is if you want to postpone conception for social reasons.
You might want to consider egg freezing if you have cancer that requires chemotherapy or radiation (which could affect your fertility), or you need to have surgery that could damage your ovaries, or a condition that could damage your ovaries. Learning that you have a family history of early menopause, Turner’s Syndrome (a chromosomal abnormality that comes with a risk of premature ovarian failure), or a genetic mutation (like BRCA, which can predispose one to develop breast and ovarian cancer) that leads to the decision to remove your ovaries, might also be good reasons to talk to your doctor about whether or not you’re a good candidate for egg freezing.
9. There are various factors that affect the success of egg freezing and thawing
Data on pregnancies that result from egg freezing varies.
The American Society for Reproductive Medicine (ASRM) estimates that 2–12% of frozen eggs develop into a live pregnancy for women under 38 years of age. It’s important to remember that a large number of frozen eggs haven’t been utilized as of yet, and the pregnancy rates could potentially be higher.
This suggests that women may need to undergo multiple IVF cycles to become pregnant following egg freezing.
Factors that impact the success of egg freezing and thawing procedures include:
- Age on freezing the eggs: Younger women tend to produce more eggs that are less likely to have anomalies.
- Age at time of egg thawing and IVF: Younger women are more likely to have successful pregnancies.
- Sperm quality: Healthy sperm is more likely to produce a healthy embryo and a successful pregnancy.
- The clinic: The success rates of freezing and thawing eggs vary between clinics.
- The number of eggs: Freezing a larger number of eggs offers more opportunities for successful IVF cycles.
10. Rest period post egg retrieval is crucial for recovery
Post the egg retrieval procedure, doctors agree that a rest period of 1 week is advisable after the procedure for complete recovery.