Author: Fertility Expert
Women have been considering egg freezing for over five years now but its only since the last 2.5 to 3 years that they are being vocal about it and acting on it. This is due to the increase in awareness around the topic of egg freezing. There is a lot of discussion around the same on social media and mainstream media. So now women know, what to expect and how much it could help them.
Previously, they would be apprehensive about the success rates with egg freezing, but now with newer techniques (vitrification) that have been developed in egg freezing, it has increased the level of confidence in women to go ahead with the procedure.
As far as the rise in the number of cases is concerned, I would say there has been about 10-15% rise to what it was let’s say 5 years ago. We have at least 1 or 2 patients enquiring about it almost every month. In a year there are about 12 to 15 women who would opt for egg freezing.2. How is it helping women and what are the common questions asked by them to doctors? How egg freezing is helping women
Women face a lot of pressure when it comes to marriage and childbearing. Though egg freezing started as a procedure to help women with medical conditions like cancer to preserve their fertility, social egg freezing has given women the freedom of choice to opt for the procedure as a personal choice and not due to any health condition.
They don’t have to settle down by compromising. This has given them a back-up, so they can explore career opportunities, become financially stable and have the time to choose a right life partner. There are also many women who choose to be single mothers and are opting for donor sperms. This is an empowering trend which is helping women in more ways than one.What are the common questions asked?
The most asked question is, what is the right age for them to opt for the procedure? Because most women who approach us are already in their mid-30s, naturally they are a little concerned on whether they should go ahead.
This is because a woman’s fertility starts to decline after 30 years of age and the rate of decline increases rapidly after 35. Ideally late 20s would be the best time if they are opting for the procedure. But this is not always practically possible. If not in the late 20s, it is best to get it done in their early 30’s, between 30 to 36 years of age.
This brings me to the next commonly asked question: Is it too late to freeze the eggs if the woman is nearing her 40s, because most of the time women keep postponing the thought. Well, it is still possible to do the procedure but what should be understood here is that this impacts the success rates and the number of eggs as well as the quality of the eggs that are retrieved. This is a very time sensitive process, and it would be ideal to get it done in their late twenties or early thirties.
They also ask about how the procedure is done. Once they decide to go ahead with it, we advise them to get a few blood investigations, most importantly the AMH (anti-mullerian hormone) test which gives us an idea of her ovarian reserve (approximate number of eggs she has in her ovaries). Also, her serology status (HIV, HBsAg, HCV) should be investigated, as well as the trans-vaginal scan.
Once these tests are done, we start off the injections from the second day of the period, to grow the follicles, which contain the egg. Follicles are fluid filled sacs in the ovaries. We give these injections for about 10 to 12 days (or even 14 days depending on the patient). Once these follicles reach a good size of about 18mm, we give something called a trigger injection.
Between 35 to 36 hours of giving the trigger injection is when we remove the eggs from the ovaries through the vaginal route under ultrasound guidance. We introduce a needle with the help of the ultrasound probe and aspirate the fluid from these follicles. This is done under anaesthesia. The procedure hardly takes 15 to 20 minutes. After 3 to 4 hours of the procedure the patient can be discharged.
The aspirated fluid is then handed over to the embryologist. They do a process called denudation, where they remove the cells around the oocytes that has been collected. Then the good quality oocytes are frozen by a process called vitrification.
Vitrification is a newer method of egg freezing, which has increased the survival rate of frozen eggs when thawed. Infact, through vitrification 80% of the frozen eggs can survive post thawing.
Whenever the woman is ready to get pregnant (in case she has found the right partner or wants to go for donor sperm) these oocytes can be thawed, brought to a room temperature. Then a process called ICSI is done where the sperm is injected into the oocyte. Once these oocytes are fertilised and embryo is formed, the embryo is then transferred into the uterus of the woman, whenever she is receptive and is ready for pregnancy.
Women also want to know for how long these eggs can be stored, as they are apprehensive about whether they can be used later. According to ICMR, the frozen eggs must be discarded after ten years. So preferably they need to use them before 10 years. However, these eggs can survive for indefinite no. of years.
People also want to know if a pregnancy is guaranteed with Egg Freezing, the answer is there is no 100% guarantee. But the success rate with frozen eggs is the same as when getting an IVF or ICSI done at the corresponding age.
There are many factors which determine the success rate like age, comorbidities, quality of the embryo, etc.A misconception about egg freezing
Many women tend to think if they have their eggs frozen, they will not be able to conceive naturally as their eggs have been removed or the number of eggs has decreased. This is a major misconception. Egg Freezing does not affect your ovarian reserve. There are many cases where women have frozen their eggs and later ended up not using them as they were able to conceive naturally. Therefore, the chances of natural conception will not be affected if you go for egg freezing. It is just a back-up option.3. Any case study of a woman who had opted egg freezing five six years ago and her feedback post pregnancy?
A woman had been planning to freeze her oocytes after her divorce at 28 years of age. She was quite traumatized with her divorce and couldn’t go ahead with the idea of egg freezing or remarriage. However, motherhood was always her priority.
But later, she became open to the idea due to the knowledge she gained through social media and through the articles she read about egg freezing.
She approached us when she was 32 years of age and was quite anxious as she had already entered her thirties. We counselled her and asked her to do her basic blood and routine investigations. Her AMH level came up to around 1.8, which was okay to go ahead with the procedure. We conducted stimulation procedure and retrieved around 16 eggs and out of these 12 were of good quality, we went ahead freezing all the 12 eggs.
She found her life partner when she was 34 years old and then decided to use her eggs with her partner’s sperm. Out of 12 eggs, 9 eggs survived and all 9 were fertilised forming good quality embryos. When the embryo transfer was done, she was 37 years old. She had a healthy pregnancy.
Many women have this fear that their baby will not be healthy or have an anomaly as it was conceived with a frozen egg. Even this patient had the same concern. But now her child, a baby girl, is almost two years old and is completely healthy and happy.
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