Egg Freezing

For most married couples, the most cherished aspect of their relationship would always be their children. In all parts of the world, a child is always welcomed with a feeling of happiness or joy. On the other hand, when a couple is unable to get pregnant despite trying repeatedly, the scenario changes. Doubts start to creep in, which makes it even more overwhelming. Due to this, a lot of couples are considering fertility preservation as a safety option for the future i.e Egg Freezing.

What is Embryos and Egg Freezing

Dr Dinesh (Indira IVF hospital), explained egg freezing in medical terms, infertility is often associated with couples who have been unsuccessfully trying to conceive for more than a year. Infertility itself causes a lot of stress. Fortunately, with all the modern advancements, there are options for treating the condition. A lot of infertility cases are because of problems with the eggs. There is an option for egg freezing during your younger years when the eggs are produced in healthy quantities.

Why should women consider freezing their eggs?

Age plays a crucial role in determining your chances of getting pregnant. As you get older, the chances of healthy eggs being developed decrease considerably. It can be a hindrance if you want to have a child during your older years. However, during your youth, it is not always feasible to have a child. Some women don’t find the right partner and some prioritize their career.

All this makes a complicated scenario, and freezing of eggs is something you should definitely consider. When eggs are frozen, they don’t get old or age. In the future, when you choose to get pregnant, you can use those eggs. You don’t even need to have an active male partner for that. You can even use donor sperm for that purpose.

Apart from age, you also need to consider the scenario of a possible disease or medical condition that could cause infertility in the future. For instance, cancer treatments are known to affect the ovaries and cause premature menopause by damaging the eggs. A woman can choose to freeze her eggs before undergoing cancer treatment.

Freezing of eggs is also an option during IVF procedures. Women can choose egg freezing for future IVF cycles. This can be helpful if a single cycle of IVF fails.

Process of Egg Freezing

Dr. Parth Joshi, (Chief infertility& IVF Specialist, Indira IVF, Ahmedabad), explained Egg freezing is a procedure that involves the preservation of the eggs of the woman. These eggs are harvested directly from the ovaries of women. They are stored so that they can be used in the future.

If the woman decides to use those eggs in the future, they are thawed and then combined with sperm. After that, the fertilized eggs are implanted to the uterus of the woman, or even a carrier female, thus facilitating pregnancy. Mostly, complications with infertility occur because of germ cell deterioration but the uterus remains totally functional. In these cases, freezing of eggs can be really helpful.

Fertility preservation and Extension

Due to factors like late marriage and medical conditions, conceiving can be difficult for older women. Freezing of eggs is one of the best ways to retain the reproductive potential of your younger self. There are two primary reasons to freeze eggs- fertility preservation and fertility extension.

1. Fertility preservation: This medical procedure aims at the preservation of the reproductive potential in women. It is particularly used when there is a risk of loss of fertility because of a disease or a treatment associated with a disease. Such conditions include.
   • Cancer treatments such as pelvic radiation and chemotherapy can have a direct effect on fertility. Among women, breast cancer is the most common type of cancer. Other common concerns include leukemia, cervical cancer, colon cancer, and lymphoma. Regardless of the type of cancer, women often have to undergo chemotherapy as a part of the treatment. Chemotherapy exposure is known to reduce the number of eggs that remain in the ovary. There is even a risk of premature ovarian failure.
   • Other autoimmune diseases may also require chemotherapy as a part of the treatment. These include lupus nephritis, which requires treatment with cyclophosphamide.
   • Some benign diseases like sickle cell disease and aplastic anemia may also require bone marrow transplantation. Which deny chances of premature ovarian failure is there.
   • Prevention of cancer may also involve both the ovaries to be removed. which causes premature menopause.
   • Genetic diseases like fragile X premutation and Turner syndrome may increase the risk of premature menopause among women. Family history and surgeries that involve the ovary can also cause premature menopause.
2. Fertility Extension: This is the scenario where the woman chooses to preserve her reproductive potential because they want to delay the conception of a child. It can be because of personal situations, career or even for social reasons. Regardless, female fertility preservation can extend the natural tenure for fertility.

The procedure involves

1. Ovarian Stimulation: At this stage, the ovaries are stimulated with the help of fertility medication. How the ovaries respond and the number of eggs they produce depends on the age of the woman and ovarian reserve. The method of ovarian stimulation may have to be modified if the woman is diagnosed with estrogen-sensitive cancer, like breast cancer. It takes about two weeks for the stimulation to be completed.
2. Egg retrieval: Once the eggs are produced, they need to be retrieved for preservation. The procedure for egg retrieval is performed on an outpatient basis and under sedation. The eggs are obtained with the help of a needle, which is passed through the vagina. Once the eggs are retrieved, they are examined to see if they are mature or not. A lot of the centers only freeze the mature eggs. Some centers may even mature the egg before freezing them by a process called in vitro maturation.
3. Freezing: After 4-5 hours of egg retrieval and testing, the eggs are frozen. For this, either rapid freezing or slow freezing methods are used. With both the cases, a synthetic substance called cryoprotectant is used for reducing the formation of ice crystal, which can damage the oocyte

Methods of Egg Freezing

Dr. Kishore Kawad (Laparoscopy & IVF Specialist, Indira IVF, Ahmedabad), explained are two methods used to freeze eggs:

• Slow freezing: With this method, the cryoprotectant is used in low concentrations. The eggs are placed in a vial with the cryoprotectant and then slowly frozen with the help of a programmable freezer.
• Vitrification: High concentrations of cryoprotectant is used for freezing the eggs, which are placed on a special device. Liquid nitrogen is used for bringing down the temperature to -196-degree centigrade. Cryotop is the device most commonly used for the purpose of vitrification. The device is in the form of a straw with a cap and a thin strip for placing the eggs.

Risks associated with the procedure

Before you go ahead with the procedure, you should know about the associated risks that accompany the procedure. Some common risks include:

• First and foremost, there is no guarantee that the procedure will definitely be successful. You need to be emotionally ready for the scenario and do not rely on false hopes. While the process can be an empowering and positive step for you, it still has its own risks.
• At the very beginning of the procedure, you are given fertility drugs. These drugs can potentially cause certain medical complications. Often taken in the injectable form, fertility drugs can cause mild nausea, abdominal pain and bloating. There is even a risk of ovarian hyperstimulation syndrome. In rare cases, the fluids might get build up and cause breath shortness as well.
• Complications may arise during the procedure for egg retrieval. Needles are used for retrieving the eggs, which can cause bleeding and infection to the bladder, bowel or blood vessel.

Preparing for the process of Embryo Freezing

Coming to a decision of freezing your eggs isn’t an easy one. There are many considerations that you have to think of. You also need to consider other alternatives like embryo freezing. The embryo is nothing but the fertilized egg, so you need sperm for that along with your egg. In the absence of a male partner, a sperm donor can be used. Of course, if the woman refuses to use sperm at all, freezing the eggs is always an option.

Before the procedure begins, you will have to undergo certain tests and screening methods. Commonly, doctors will perform ovarian reserve testing to check the quality and quantity of your eggs. The results from the test are helpful in determining how the ovaries are likely to respond to the fertility drugs. Screening tests will also be done for some diseases like HIV. Once all the tests are done, you are good to go. Of course, if you have any doubt, you can ask your doctor.

Egg Freezing Success Rates

Egg Freezing Success Rate– Dr. Puja Rani (Chief Infertility & IVF Specialist, Indira IVF, Ranchi), explained, “As 100% success is not assured, you would want to know your chances of success. Before you go ahead and decide to freeze your eggs, you should know the general success rate and that of the specific IVF Centre you are visiting”.

A few factors come into play here. Firstly, the freezing of eggs is a relatively new technology. This means there isn’t a large amount of data available on babies born after egg thawing.  Also, the data that is available does not necessarily pertain to your own country. There isn’t even enough information about any birth defects among babies born after freezing of eggs. The absence of long-term data makes it difficult to analyze the egg freezing success rates for the procedure.

From the perspective of a woman, the most essential data is regarding the successful pregnancy and live birth achieved after thawing of eggs. All women are interested in knowing the potential of the frozen eggs to produce a newborn. It means how an egg recovers after thawing and produces an embryo. The miscarriage rates also need to be considered as it is a common occurrence among older women.

To sum it all up, freezing of eggs is an excellent method of fertility preservation in women. There are factors to consider and you should perform the necessary research on your behalf as well. You need to know whether it is right for you to use the option or not. You should weigh in the pros and cons of the procedure, before taking any decision.