Egg Freezing for Your Biological Clock
Egg Freezing (Also known as Oocyte Cryopreservation)
While high school Sex ED class may have spent a lot of time warning women about unintended pregnancies and how to keep from getting pregnant, most classes fell short on teaching women about the limited lifespan of the ovaries and how truly hard it may be to get pregnant when they actually want to get pregnant. With the fast-paced lifestyles and time-consuming jobs that many women are committed to these days, it seems that more and more women are trying to have children only to find out that it is "too late." Recent advances in medicine now allow women the potential opportunity to delay their pregnancy until a more opportune time (“the right time”). The "right time" may mean the right partner, the right place in the right career that allows for the investment of more time to a family, or even the right state of health. When the “right time” comes, regardless of the intense desire to have a baby, there is unfortunately no guarantee that a woman will be able to have a genetic child.
Even with all the technology that we as physicians specializing in Reproductive Endocrinology now have available through IVF, treatment can only increase chances of conceiving but not guarantee it. The is particularly true if a woman chooses to delay childbearing past the age of 35. There is, in fact a biological clock, and a woman’s fertility quotient does decrease as she gets older . Unlike men who produce new sperm every day of their reproductive lives, women are born with all of the eggs that they are going to have. As a woman ages her eggs decrease in both quantity (as seen below) and quality as well.
Many women struggle with this concept. After all no one would call a 35 year old women old and in fact at age 35 a woman has most likely lived less that one half of her life since a woman’s average life expectancy is currently more than 82 years. “Mother Nature”, on the other hand, still “thinks” that a 35 year old women is not likely to live past the age of 50 and it would seem, therefore, that she has no interest extending a woman’s reproductive life span beyond what it is today. As a consequence, not only does a woman’s fecundity rate ( the chance of pregnancy in any single Cycle) decline as she gets older but her chance of miscarriage increases as well as reflected in the 2 graphs below.
Wouldn’t it be wonderful, therefore, to be able to offer women an opportunity to get older without experiencing a significant decrease in their ability to conceive? For decades, science has allowed us to freeze sperm and for years we have been able to freeze embryos, but only just recently have we been able to freeze eggs. Numerous studies have been reported in search of developing an ideal oocyte cryopreservation method after the first report of a successful pregnancy using a frozen thawed oocyte in 1986. Since that time several centers around the world have reported similar success. Most of these pregnancies were achieved by a slow-freezing method. The survival of oocytes following thawing after this slow-freezing technique has been very low, as have pregnancy rates. Therefore there has been a pressing need to develop a more efficient way to cryopreserve oocytes. Such a protocol must reduce the damage to cells caused by ice crystal formation during the freezing process.
At the present time Vitrification offers the best solution to the problem. Vitrification is a very simple procedure and requires no programmable freezing equipment. In the process of vitrification an oocyte is placed in a very small volume of vitrification medium and is then cooled at an extremely rapid rate. The fast freezing eliminates the formation of ice crystals in the oocyte. Subsequent to the vitrification, the oocyte is stored in liquid nitrogen until such time as it is to be thawed and fertilized.
Vitrification protocols are starting to enter the mainstream of human ART and have been used successfully since 1999. Successful pregnancies following the use of this technology are being reported with greater frequency. To date a “universal” vitrification protocol has not been defined however research towards this end continues and will no doubt lead to higher levels of clinical efficiency as well as utilization. To date the most impressive studies quote survival rates and Fertilization rates of 68.6% (325/474) and 71.1% (142/198) respectively. In this same study pregnancy rate and Implantation rate per Embryo transfer were 21.4% (6/28) and 6.4% (8/125) respectively. In 2 more recent studies (the first published and the second unpublished) pregnancy rates have been reported as 56.5% (13 pregnancies/23 patients) and 75% (3 pregnancies/4 patients). Clearly these numbers are small but they do hold great promise for the efficacy of this technology. To date of the approximately 200 children born using this technology (2/3 using slow freezing and more recently 1/3 using vitrification) only 1 Congenital abnormality has been reported.
Clearly the feasibility of vitrification of human oocytes has been confirmed. It is important to note, however, that because the numbers are still very small, the American Society for Reproductive Medicine (ASRM) considers egg freezing investigational unless it’s being done as a heroic measure for women who may risk loosing their reproductive function as a consequence of surgery or chemotherapy for cancer. Nevertheless the procedure is being offered electively by several reputable Infertility practices without IRB approval and is even being promoted and advertised by a newly formed company created solely for the purpose of offering egg freezing to women who wish to electively attempt to preserve their reproductive function as they get older.
What are the pros and cons of egg freezing?
Foremost amongst the cons is that there is no guarantee that the eggs once thawed will be healthy and able to cause a pregnancy which results in a healthy baby. As noted thus far, there are 200+ babies born from this technology and no reported increase in genetic abnormalities or congenital anomalies. However, egg freezing is new technology and is still considered experimental. Careful data collection is being undertaken and more studies in the future will continue to shed light on the process. At some date in the future, it may be shown that other freezing protocols are preferred and that the current technology is "outdated." We at Fertility Centers of Illinois, SC are committed to maintaining our reputation as being physicians and scientists who use cutting-edge technology and providing safe and successful medical treatment.
In regards to pros of the Egg Freezing process, it may allow women a chance at a genetic child that they would not have had otherwise. Medical treatments such as chemotherapy can forever damage eggs and render a woman infertile. Finding the man of your dreams at age 43 is great, but it may be too late to have children unless you have eggs frozen or use donor eggs. The same can be said of waiting until you are secure in your chosen career
Am I a good candidate for egg freezing?
Egg freezing is not for everyone. It is an expensive procedure involving daily shots, minor outpatient surgery, and emotional stress. However, if you are currently healthy, well-informed, and willing to go through the process, it may ultimately allow you the genetic family you always dreamed of. Women less than 40 years of age, with a normal FSH Hormone level, who are not currently wanting to get pregnant (either due to upcoming medical treatment, lack of a male partner, or more personal decisions regarding time management and family planning) are good candidates. You need to be available for appointments and not traveling for approximately 2 weeks.
What other options exist for women who know they want children but are not ready to get pregnant now?
Women should consider other options, some of which have a higher chance of successfully delivering a baby.
Married couples or couples in committed relationships may want to consider going through IVF and freezing embryos for implantation into the Uterus at a later date, as embryos have been demonstrated to freeze better than eggs. Women with serious medical conditions, such as cancer, may wish to undertake chemotherapy/surgery now and once cured, consider adoption, embryo adoption, or Egg Donation if their ovaries are no longer functional. If they no longer have a uterus but have functioning ovaries, they can consider gestational carrier-IVF.
Women without a male partner may want to consider donor insemination's, or a fresh IVF cycle with donor sperm, and having a baby now. They could also choose to freeze embryos created with donor sperm for the future.
If women choose to wait until the "time is right" and then discover that their age is preventing them from conceiving, egg donation and adoption are always options. Although the child is not genetically hers (and only genetically related to the male partner) the woman would be able to carry the pregnancy, deliver and breast feed, with her name listed as `mother' on the birth certificate.
How does Egg freezing procedure work?
Currently there are several ways to freeze eggs for future use.
- One way would be to surgically remove an ovary, or piece of an ovary, and freeze the it for later replantation or in vitro maturation.
- A second way would be to harvest immature eggs and mature them in vitro at a later date.
- The most common and currently most successful way is to mature eggs through an IVF cycle and then freeze after the. Egg Retrieval. The eggs can be frozen through vitrification. It is similar to the way we currently freeze embryos and we have had great success with frozen embryo transfers. Vitrification rapidly freezes the egg in such a way so as to prevent ice crystals within the egg that could shatter the delicate structure of the egg. The vitrified eggs are then stored in liquid Nitrogen until the women is ready to use them.
How do I go about starting a cycle for Egg freezing?
If you decide that egg freezing is right for you and you understand the risks involved, the costs involved and the chance of a successful pregnancy in the future, then you need to schedule an appointment with one of our physician who will review your history, perform a physical exam, and run appropriate tests. You will then be required to meet with our staff psychologist. Her purpose is neither talk you into the procedure nor to talk you out of the procedure. Rather her purpose is to talk you through the procedure to make certain that it’s right for you.
Following this visit you will meet with a financial advisor who can provide you with information on the cost of the cycle as well as insurance benefits and payment options.
You will then consult with a a Nurse Case Manager who will help you order medicines, schedule your treatment cycle, teach you how to do injections, and set up your next appointments. You will also be instructed in how to set up an account with the Cryostorage bank who will receive your eggs and hold them in storage until a time in the future when you wish to use them.
The actual treatment cycle, which allows us to collect your eggs, starts with approximately 2 weeks of birth control pills. After this, you will begin once or twice daily injections (for 8-11 days) to mature a number of eggs, approximately 10-20. These eggs will be removed from your ovaries through an Ultrasound-guided needle procedure while you are under light sedation. Most people will need to take this day off of work and have someone drive them to and from our clinic and stay with them at home after the procedure while the anesthesia wears off. Your eggs will be counted, evaluated, frozen and then transferred to the Cryostorage bank for long term storage.
What happens when I'm ready to get pregnant?
You will again need an appointment with your FCI physician to ensure you are healthy and ready to carry a pregnancy. Your male partner (or sperm source) will also need some labs tests. FCI does have set guidelines for women wishing to receive embryos in respect to health and age. Currently a woman must be less than 52 years when her embryos are transferred. These guidelines are subject to change at our discretion; however we do not anticipate any major alterations to the guidelines in the near future.
When you are ready to proceed, you will have your eggs shipped back to us. You will begin a cycle where you will take medicine to prepare your uterus for pregnancy. At the appropriate time, the eggs will be thawed, injected with sperm through a process known as ICSI (intracytoplasmic sperm injection). The resulting embryos are then transferred into your uterus when they are either 3 days or 5 days old. Any extra embryos can be frozen and stored. You will continue to take hormones to support an early pregnancy. Approximately 10-12 days after embryo transfer, you will know if you are pregnant. After 8 weeks of pregnancy, you will transfer your care to the obstetrician who will deliver your baby.
What do I do next if I'm interested in learning more or starting a cycle?
Call our clinic to set up an appointment. Let us know you are interested in Egg freezing when you call to make an appointment. If your primary care doctor or gynecologist is able, have them run a FSH and Estradiol blood level on day 2-4 of your menstrual cycle before your first appointment. Please try to have any essential medical records faxed or sent to your doctor before your appointment.