Egg Freezing

In the context of gynecological monitoring and preventive medicine, we will also analyze the possibility of egg freezing. I include this as a discreet routine update to the ladies who visit me in their 32-34 years. Egg cryopreservation is a preventative medicine measure par excellence, and I have to present it as a serious fertility-seeking alternative.

Fertility preservation concerns more and more women who want to postpone starting a family for various reasons. Egg freezing seems to be a reliable solution.

Why has egg freezing become a hot topic? Lately it is a topic that is widely discussed everywhere. In October 2012, the American Society for Reproductive Medicine (ASRM) announced that egg cryopreservation is no longer considered an experimental procedure but a routine treatment, such as e.g. and the extracorporeal. This decision was made after reviewing over 1,000 scientific publications that report that the pregnancy rate after freezing eggs is the same as with “fresh” eggs.

Which women are they aimed at? Initially the method was developed for patients who had to undergo treatments that affect fertility (eg chemotherapy) with the aim of achieving pregnancy in the future. Ultimately, however, it is mainly applied for social reasons. Women are now delaying the creation of a family in order to complete their studies, establish themselves professionally or, quite simply, because they have not yet found the right partner. Women report that this relieves them of the stress of “running out of time” and gives them the opportunity to make good decisions about their professional and personal lives.

By what criteria do we decide that I should expedite it? In addition to age, we are guided by the ultrasound examination in combination with hormonal tests. In particular, I am doing a special ultrasound examination with Doppler study of ovarian vasculature and oxygenation and primary follicle count (AFC) with three-dimensional technique. The findings are combined in a special algorithm with the hormonal ones FSH and AMH and the “age” of the ovaries is reliably determined. We thus decide with clear documentation of the image (current and future) of the ovaries.

What does the procedure involve? Egg freezing is essentially like the first part of an IVF. Ovarian stimulation with medication (pills and injections) usually lasts 10-12 days and is monitored with ultrasounds and blood tests (hormone control). At the right time, an egg retrieval is planned, which I do under mild sedation (by an anesthesiologist) with ultrasound guidance. Egg retrieval is done through the vagina: I insert the ultrasound transducer, as in the simple ultrasound, but at the same time a special needle is applied. This is inserted through the vagina into the abdomen with ultrasound guidance. I thus puncture the ovaries and suck out the follicles one by one. The eggs are then isolated, prepared by embryologists, frozen and kept frozen until the woman decides to try to get pregnant with them.

Is it effective? With the modern cryopreservation method (vitrification) and modern cultivation materials, we achieve excellent egg quality even after thawing, without loss in number and quality and the possibility of fertilization.

Prediction of the probability of having a child as a result of cryopreservation, taking into account the number of eggs and the age of the woman at the time of cryopreservation

Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients R.H. Goldman, C. Racowsky, L.V. Farland, S. Munné, L. Ribustello, J.H. Fox

Survival- quality of eggs after thawing and probability of pregnancy

The survival of a mature egg after thawing is estimated to be an excellent 95% for strong, < 35-year-old women and about 82-85% for women>36years.

Data from multiple studies conclude that a 35-year-old woman < who has cryopreserved 10 mature eggs has a cumulative 60-70% chance of having a healthy child in the future.

When should freezing be done? The sooner the better. The ASRM (American Society for Reproductive Medicine) sets the limit at 37 years, always after a detailed assessment of the woman’s health and reproductive capacity based on her medical history (hormonal profile, diagnosis of other health problems, medication intake, etc.). If a woman freezes eggs at 35 and decides to get pregnant with them at 42, then her reproductive age is 35, not 42. In short, the method “freezes time”. But the most frequent mistake of women is that they decide when it is already too late. A woman over 40 who has started having irregular periods will not have the same results as a younger woman.

The Royal College of Obstetricians and Gynecologists in the UK clearly emphasizes the value of freezing at the age of 35 and under.

(https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip63/).

ASRM describes maximum effectiveness at ages under 34. (https://www.fertstert.org/article/S0015-0282(15)00170-3/fulltext).

Is it an expensive procedure? The cost of egg freezing is about the same as an in vitro fertilization cycle, at 2600 euros. Each interested party must include the drugs, about 800 euros, as well as the annual cost of cryopreservation (250 euros per year).

What happens on the day of ovulation? (I copy from the link of the Birth Laboratory)

The desire in an egg freezing cycle is to get more eggs than one natural cycle. For this reason, the ovaries are stimulated, usually with injectable drugs for 10-12 days. The ideal result is about 10-12 eggs on average in order to have a realistic hope of pregnancy in the future with these eggs.

Maturation of the egg inside the ovary until ovulation

Freezing is done by the vitrification method. It is the most advanced freezing technology, which protects the eggs and gives better rates of viability in their thawing. The eggs are kept at -196oC in special ‘straws’ in a container with liquid nitrogen. Each patient has her own identified position and all the ‘straws’ bear her details. Under the law, eggs can be kept frozen for 10 years or until the patient turns 50, whichever comes first. During this time, their quality remains unchanged. In short, we ‘freeze time’ and the eggs retain the age the woman had on the day of ovulation. In essence, the patient is getting older, but her eggs are not.

Something I would like to point out is that many women are under the mistaken impression that 1 egg = 1 baby. But it’s not like that, because our body doesn’t work like that. Out of 10 eggs, statistically only 1 is ‘good’ and can give pregnancy. If you think about it, when a woman is trying to get pregnant, she knows that it might not happen from the first month. Pregnancy does not occur every month when the couple has intercourse. Any woman interested in egg freezing should be informed by her doctor and the facility about these statistics from the outset.

After the procedure, the patient can leave and go home to rest. We at the lab will contact her by phone and let her know when we have finished freezing. Also, if she wants, we will email her our written report.

Is one freeze cycle enough or do I need something more?

It’s usually enough. This depends on the age of the woman, her hormonal profile and finally how many eggs we got in the ovulation test and were suitable for freezing. In case it is few, the doctor will recommend that the treatment be repeated a second or even a third time. After appropriate counseling, the decision is solely the patient’s depending on her plan and thinking for her life. We treat each woman separately, individually and recommend the best plan for her.

Are there differences in patients undergoing egg retrieval for egg freezing and those undergoing IVF?

Those who come for freezing feel that they are offering something to themselves, some may even consider it a luxury. They have no immediate goal of starting a family, they are not trying for a baby now, but they are doing something for their future, something like life insurance. Egg freezing is an act of care that every woman can offer herself – with the same care we embrace these women.

What happens when the patient decides to use frozen eggs to get pregnant?

In this case, we proceed directly to insemination with the sperm of the partner/husband and indeed with the microinsemination method. Embryos are then created that remain in the laboratory in controlled ideal conditions until the day of embryo transfer. The possibility of fertilization of the eggs and development of the embryos does not differ in relation to ‘fresh’ eggs.

If the woman ends up not needing her eggs, if she ends up spontaneously conceiving?

In this case, we proceed directly to insemination with the sperm of the partner/husband and indeed with the microinsemination method. Embryos are then created that remain in the laboratory in controlled ideal conditions until the day of embryo transfer. The possibility of fertilization of the eggs and development of the embryos does not differ in relation to ‘fresh’ eggs.