Should I freeze my eggs?
Whether or not to freeze one’s eggs is a big question for a woman in her reproductive years, especially if she’s single, dealing with an illness such as cancer, or is career driven and needs to delay childbirth. The answer isn’t so clear-cut for all. For many, the cost factor (which isn’t usually covered by medical health insurance) helps make a definite decision before you even give it a whole lot of thought. For others, it’s a to-and-fro shift (yes, maybe, no) before any decision is reached, which can leave you feeling somewhat anxious. Deciding to freeze your eggs is not a small thing. It’s a commitment, and it does need to be taken seriously.
Someday. This is the starting block for all women leaning towards having a baby. Someday, when I’m ready to start a family. Life, unfortunately is not always such a vague concept. There’s family, friends and work to think about and all require definite levels of commitment, daily. When deciding whether to freeze your eggs or not, vague ideas go out the window.
Your reproductive years may mean that your eggs are ready, but you may not feel that the time is entirely right for you. You can be rest assured that you do have options (fertility preservation being one of them) and it is a good idea to understand them in depth (with your doctor, gynaecologist or fertility specialist) so that you can make the most informed decision for yourself.
Once you understand how fertility preservation works and the risks involved, and marry that up with your personal goals and reproductive history, it is easier to make a decision that feels most right for you.
Egg freezing is also known as mature oocyte cryopreservation, an approach used to preserve a woman’s reproductive potential. Eggs are retrieved from a woman’s ovaries and frozen unfertilised (stored) for later use (harvesting). Frozen eggs are then thawed and fertilised with donor sperm (anonymous or not) in a lab and then implanted in the uterus (in vitro fertilisation / IVF).
Your ‘biological clock’ actually refers to your ovaries and not your uterus. The age at which you have your eggs harvested is what makes the difference. They will remain your ‘younger’ eggs when you finally do have them implanted and fertilised. Younger eggs are usually healthier, providing you with a better chance of success.
Is my biological clock ticking?
The reality is, we age. As a woman ages, her reproductive cycle changes and her egg cell count reduces. At birth, a woman’s ovaries carry between 1 and 2 million immature eggs. This number drops to around the 400 000 mark by puberty, when menstruation normally starts. During this process, unfertilised eggs are lost and passed through as a monthly period.
By the time a woman reaches menopause (around the age of 48 to 55), virtually no egg cells remain, making any chance of egg cells maturing and becoming viable slim to none. The years between puberty and menopause are the reproductive years most will refer to as the time your ‘biological clock’ begins ticking.
As we age, freezing eggs may become tougher. During the reproductive period, the younger you are when you freeze your eggs, the better. Many fertility experts will encourage you to consider freezing before you reach your 40s. Success rates of fertilised eggs resulting in pregnancy get lower, the longer you wait or the older you get.
How many will need to be harvested for this fertility preservation method? At least 10 to 20 eggs will likely be harvested to improve your chances of being able to have one baby. If you are having eggs harvested at the age of 40, this number can increase to at least 30 or more.
Implantation success rates also decline with age. If you have had eggs harvested and frozen around the age of 40, implantation success can be as low as 9%. For women in the 30s, this rate can be anywhere between 9 and 13% and up to 30 to 60%.
About 90% of harvested eggs survive the freezing and thawing process. About 75% may be successfully fertilised.
Should I consider freezing my eggs?
If you want to have a biological child, but perhaps you’re not yet ready to become pregnant and have a baby, you can consider freezing your eggs. This method helps you to become a mother and have a biological child of your own later in your life.
Egg freezing doesn’t require a sperm donation. You should give sperm donation some thought though. There will come a time when you will need to fertilise your eggs in order to try and fall pregnant. For this you will need a sperm donation (either from an anonymous donor or someone you know and trust). Your harvested eggs won’t be fertilised before they are frozen.
Other than preserving your younger eggs for future use, egg freezing may also be a good option if:
- You are undergoing treatment for an illness that can affect your fertility potential: You may be undergoing medical treatments, such as chemotherapy or radiation, during your reproductive years. These types of treatments can cause harm to your fertility. You may like to consider freezing your eggs before you begin treatment, ensuring that you have a better chance of being able to have a biological child later in life when you are healthy again.
- You have opted to have a baby through IVF: There are several reasons IVF is considered. You or your partner may have problem with fertility, or perhaps you’re single and choose this method to try and fall pregnant. In the case of a partner being unable to produce sufficient sperm on the day your eggs are harvested, freezing may be needed.
Important questions to ask yourself and discuss with your specialist:
- Pregnancy planning: At what age do I want to fall pregnant and have a baby? Take into consideration your age and the probability of being able to naturally fall pregnant at that time (with a partner) and measure this against the probability of a successful pregnancy at the same age using frozen eggs.
- How many eggs will my specialist recommend I freeze? Your specialist will help guide you on this one. Your age is going to be a big factor in how many eggs will be recommended for harvesting, as will egg quality. If 20 to 30 eggs are harvested, six to eight of these may be thawed for each implantation / pregnancy attempt. It may even be recommended that you undergo hormone injections to stimulate your ovaries more than once.
- What if there are unused eggs? You might be lucky and fall pregnant with few implantation attempts, and have harvested eggs left unused. The choice is yours. You can choose to have them discarded, or you can opt to donate them to a couple trying to have a baby or a research facility.
What to take into consideration
Fertility specialists and clinics with expertise in the field are ideal starting points for you to begin gaining a better understand of what egg freezing will entail and whether it is a viable option for you. Experts in this field are commonly referred to as reproductive endocrinologists. A clinic’s success rate depends on many factors, most importantly the ages of their patients. It is a good idea to keep this in mind when getting into the statistical data of frozen egg related pregnancies and successful live births.
Egg freezing is an expense and can be costly for many women. Each stage of the process costs money, including annual storage fees, and the associated expenses can add up quickly. Request detailed information about the costs involved with each and every step of the process, as well as any potential payment plan offerings. The process also involves screenings and tests before the harvesting stage even takes place.
Egg freezing is not just as simple as making an informed decision and going ahead with your plan. Your body and overall health has a say in whether you have a good chance of success or not. Your specialist will recommend specific tests. These include:
- Ovarian reserve testing: This is done to determine the quality and quantity of your eggs. The concentration of follicle-stimulating hormones (FSH) and estradiol in your blood (on day 3 of your menstrual cycle) may be tested. The results will be used to help predict how your ovaries are likely to respond to the fertility medication. Blood tests and an ultrasound will be recommended as well to gain a more detailed assessment of your ovarian function.
- Infectious disease screening: Screening for infectious diseases, such as HIV, is vitally important. Potentially infectious eggs are stored differently than healthier eggs.
How does it work?
The process is a multi-layered one. Egg freezing involves ovulation induction, egg harvesting and freezing.
In some ways, the process is similar to other fertility methods, such as IVF. Just as with embryo freezing, fertility drugs / medications are necessary to induce ovulation to help produce numerous eggs for easier harvesting.
A woman may need to self-administer hormone injections and birth control pills (oral contraceptives) for two to four weeks. This is necessary to temporarily ‘turn off natural hormone production’. Another round of hormone injections is then administered for a period of about 2 weeks after that to stimulate egg production. This normally happens at the beginning of a woman’s menstrual cycle. A woman may also be given medications (gonadotropin-releasing hormone agonist or a gonadotropin-releasing hormone antagonist) to prevent premature ovulation.
The entire process is closely monitored by checking blood levels and frequent vaginal ultrasounds. The ultrasound uses sound waves to produce a visual of the inside of your ovaries. A specialist will be watching for fluid-filled ovarian cysts where eggs mature (follicles). To measure a woman’s response to medications stimulating her ovaries, blood tests will be performed. A woman’s oestrogen hormone levels generally increase when follicles develop. Progesterone hormone levels are typically low until ovulation.
When eggs have matured, the follicles are ready for retrieval (after at least 8 to 14 days) and a woman will be placed under light anaesthesia for the harvesting / retrieval process. This is an outpatient procedure. A common retrieval approach is transvaginal ultrasound aspiration. An ultrasound probe is inserted into a woman’s vagina to help identify a follicle. A suction device is then connected to the needle and guided into a follicle through the vagina. The same suction device and needle are then used to retrieve the egg, removing it from the follicle. In approximately 15 to 20 minutes, multiple eggs are removed.
After the harvesting / retrieval process a woman may experience some cramping and light pressure during the following few weeks as the enlarged ovaries return to their normal state.
Extracted eggs are then cooled to sub-zero temperatures. This stops all biological activity and starts the preservation process. The specialist team may use cryoprotectants to help prevent ice crystals from forming while frozen.
Eggs can be frozen in either a flash-freezing process (vitrification – high concentrations of cryoprotectants are used in combination with rapid cooling) or through a slow-freeze method (low concentrations of cryoprotectants are initially used. The temperature is reduced gradually and the eggs’ metabolic rates decline. Then higher concentrations of cryoprotectants are used. This method is also used to protect eggs from possible exposure to toxins).
After the harvesting and freezing procedure, a woman can recommence normal activities after about a week. She will most likely be able to return to work after about a day or so, but may need to take this easy for up to a week. A specialist will advise a woman to avoid having unprotected sex to avoid an unwanted pregnancy.
The freezing period length is a personal one. A specialist will store the eggs until a woman is ready to try and fall pregnant. There are risks involved and these will be discussed in detail to take into consideration.
When a woman is ready, her specialist will thaw the eggs and inject each with a single sperm in preparation for fertilisation (intracytoplasmic sperm injection / ICSI). The fertilised eggs (embryos) are then given time to grow in the lab for a period of about 5 days. From there they are ready to be transferred and implanted in a woman’s uterus.
A specialist will walk you through the various steps of fertility preservation and carefully explain any risks involved in order to help you understand what can happen.
Risk factors include:
- Hyperstimulation syndrome: It is rare, but injectable fertility medications (such as synthetic follicle-stimulating hormone, human menopausal gonadotropins or luteinizing hormones) to induce ovulation can cause ovaries to become swollen and painful. This can happen soon after retrieval (harvesting) or during ovulation. Some signs of hyperstimulation syndrome include abdominal pain, bloating, nausea, vomiting and diarrhoea. In more severe instances fluid build-up in the abdomen and even shortness of breath can occur. If this happens, contact a medical health professional as soon as possible.
- Complications with egg harvesting: Athough rare, the aspirating needle used to retrieve eggs during harvesting may cause bleeding, infection or even damage to the bowel, bladder or a blood vessel. Adverse reactions to anaesthesia can also happen during the harvesting process.
- Emotional risks: Egg freezing and implantation processes don’t guarantee a pregnancy. There is a degree of hope involved which may end in disappointment. It may feel like an empowering decision to make and give you a sense of hope for the future, but no specialist can guarantee your rate of success. Even with success of falling pregnant there is a risk of miscarriage too, which can be a devastating experience. It is important to understand the emotional impact where risk of unsuccessful implantation is concerned. A miscarriage is primarily based on your age at the time of having your eggs harvested and frozen. Currently, there is no research that shows any increase in the risk of birth defects in babies born as a result of egg freezing.
If after the harvesting procedure, a woman experiences any of the following, she should contact her health care provider as soon as possible:
- A high fever
- Severe abdominal pain
- Heavy vaginal bleeding (filling more than two pads an hour)
- Difficulties with urination
- Unexplained weight gain
How long can eggs remain frozen?
The length of storage can depend on the clinic you choose to go to for your retrieval / harvesting procedure and some limitations they may have. A standard storage period can be up to 10 years. This period may be extended in special circumstances and will depend on your chosen facility.
You must let the clinic know if you change your residential address or contact numbers during the storage period so that they can maintain contact with you, particularly when nearing the end of the agreed period. If they cannot contact you, your frozen eggs may be taken out of storage and allowed to perish.
Is egg harvesting and implantation painful?
A woman may experience a feeling of fullness (pressure) or bloating in the pelvic / abdominal area. This can be uncomfortable, but very rarely results in the need for time out from normal activity.
The retrieval / harvesting process is done under mild sedation (usually through an IV / intravenous line through a vein). A woman will be able to breathe on her own during the procedure, but be in a mild sleep state. She isn’t likely to experience any pain in this state.
Most women are able to return to work a day after the retrieval process. A woman’s ovaries may re-expand for a few days following the procedure. Any discomfort associated with this can be easily managed with reduced activity and a heating pad.