Egg freezing is a relatively new medical technology which allows young women who don’t have a current participating male partner to freeze some of their eggs and use for a later day. When they eventually find a male or female partner whom they would like to have a baby with, or if they chose to use a sperm donor, they can thaw the frozen eggs and fertilize them with the sperm to create embryos. These embryos will eventually be transferred back into her uterus for a normal uterine pregnancy.
Why Egg Freezing Provides Women with More Options?
All women are born with a fixed number of eggs in her lifetime, unlike men who have the ability to produce sperm throughout their lifetime. Extensive fertility studies have proven that women’s eggs age beginning at menstruation and decline by the time a woman is thirty-five years old.
Delayed Childbearing Affects Fertility and Egg Reserve
In many areas of the world, women are starting to delay childbearing. Many women would also like to focus more on their careers before having a baby. Women are also more likely to want to find a suitable partner before becoming pregnant. Yet as a woman ages, her eggs will age as well and this aging process will increase the rate of chromosomal disorders within the eggs. These disorders will often lead to miscarriages and other birth defects and it is therefore becomes more difficult to have a baby as a woman’s eggs age.
Freezing the Biological Clock
Egg freezing will essentially stop the biological clock from ticking by keeping the eggs preserved at a certain age until they are thawed again. It is important to realize in this discussion that a women’s uterus does not appear to lose its ability to carry a baby. The age of the eggs is all that seems to matter.
The American Society for Reproductive Medicine (ASRM) has announced that egg freezing is now a first line fertility treatment, as its former experimental treatment title has been lifted. Recent findings show that frozen eggs are yielding successful pregnancies and healthy babies comparable to in vitro fertilization (IVF) cycles using fresh eggs.
Egg Retrieval Procedure and Freezing Eggs
The process of obtaining the eggs is as follows: with the beginning of the menstrual cycle, daily injectable medications are given for about 2 weeks to stimulate the ovaries to mature as many eggs as possible. Frequent ovarian ultrasounds are done to follow the maturation of the eggs. When the eggs appear to be ready to be harvested, light sedation is given and a needle is used transvaginally to remove the eggs from the ovary. The procedure takes about 30 minutes and it is an out-patient procedure so the woman goes home the same day. One can usually harvest about 5-20 eggs each month, depending on the woman’s age.
It is worth noting that a woman, contrary to popular belief, will not “lose” eggs or go into early menopause if she goes through a the egg retrieval process.
Recommended Age for Egg Freezing
Q: What age group of women typically look into getting their eggs frozen? Who do you recommend look into this as an option (i.e. Women who want to delay having kids)?
Since the success of the procedure is better the younger the eggs are, it is very reasonable for women already in their late 20’s or late 30’s to consider having this procedure done. Women in their 30’s are good candidates as well, but they should be aware that they may need to repeat the procedure 3 to 4 times in order to get enough eggs for a baby.
As the success rate is increasing and as we are getting more experience suggesting that is does not affect the pregnancy or baby in any way, it is becoming an interesting option for women who want to delay having children. Egg freezing is a good option for women who at the moment don’t have a suitable male partner and who don’t want to rush and get pregnant with potentially the wrong long-term partner.
Egg Freezing vs. Embryo Freezing – Pros and Cons
Q: What’s the difference between egg freezing and embryo freezing? Are there any differences in terms of medical benefits why you’d choose one over the other?
A: An embryo is an egg that has already been fertilized by a sperm. Embryo freezing has a better chance of achieving a pregnancy, has been a proven technology for much longer than egg freezing, and reproductive endocrinologists have more experience with embryo freezing in general.
Embryo freezing has been available for about 30 years and we have seen over 200,000 live births that have resulted from it in the world so far. This compares with egg freezing where maybe only 10, 000 live births have been noted so far, the great majority only over the last 5 years. With the long and extensive experience with embryo freezing we feel quite comfortable that using a frozen embryo does not seem to have an adverse effect on the child. We do not have enough experience to conclude the same with egg freezing.
Up until recently, attempting a pregnancy using frozen eggs had a much lower chance of succeeding. Eggs appear to be more sensitive to the freezing process and it is only within the last 5 years that the technology has improved, mostly using a newer freezing technique called vitrification, which has allowed the pregnancy rate to slowly approach the one we see with frozen embryos.
The Chair of the Society for Assisted Reproductive Technology (SART) Practice Committee, Eric Widra, MD declares: “Oocyte cryopreservation is an exciting and improving technology, and should no longer be considered experimental. Pregnancy rates and health outcomes of the resulting children are now comparable to those of IVF with fresh eggs”.
Live birth rate with a frozen embryo varies a lot based upon age and other factor but the live birth rate may be close to a third (1 out of 3 attempts) in many cases. In comparison, a similar frozen egg may only have half that chance (1 out of 6 attempts). The technology with handling frozen eggs is improving fast and it is likely, as mentioned, that the success rate may prove to be comparable over time.
Birth Defects and Egg Freezing
In terms of birth defects, it appears that a pregnancy from either a frozen egg or a frozen embryo does not seem to increase this rate compared to a normal pregnancy. We are, however, more certain about this with frozen embryos due to the more extensive and longer experience with it.
In terms of choosing one method over the other, the chance of having a live birth is still better with a frozen embryo. Likewise there is more data supporting that there are no risks involved with it. This would therefore be the method most doctors would recommended to women who have a suitable male partner or who have a chosen sperm donor. For women who are not in that situation and who just want to store some eggs to be used later, undergoing egg freezing would probably be the recommended option.
What Happens During and Egg Freezing Procedure?
The procedure is very similar to undergoing the in-vitro-fertilization procedure. You will initially have a preliminary appointment with a doctor who does the procedure. You will then return in the beginning of your menstrual cycle to have a transvaginal ultrasound after which your daily injectable fertility medications will be started.
Over the following 2 weeks you will have 2-4 more ultrasounds and blood tests to evaluate the progress. When the eggs appear to be ready to be harvested, you will receive a light sedation and with the help of an ultrasound, a transvaginal needle aspiration will be done to suck out the eggs from both of your ovaries. It takes about 30 minutes and is an out-patient procedure when you go home afterwards.
Since the success rate is still not very high with frozen eggs, many centers will recommend that you do the procedure more than once in order to harvest enough eggs for a potential pregnancy. It is very likely you will have to repeat the procedure once or even twice.
Time and Cost to Freeze Eggs
Q: Can you tell me a little about the time it would take to freeze your eggs? What about the cost?
As soon as you have had your first appointment with your doctor, the ovarian stimulation will often start 2-4 weeks after that and you will be able to freeze eggs about 2 weeks after the beginning of the stimulation cycle. The procedure costs in the United States about $7500 to $15000 and the yearly storage fee can range from $250 to $500.
Duration of Egg Freezing: How Long Can Eggs Remain Frozen?
Q: How long can your eggs remain frozen? And what’s the typical age cutoff for women hoping to have a pregnancy through a frozen egg?
A: We are not sure how long an egg can stay frozen and still be able to produce a baby. The oldest egg that has resulted in a live birth was 10 years old. It is possible that even older eggs are able to retain their ability, we just don’t know for sure yet.
There is no magic cutoff per se, but women who are over 40 years old will have a much lower chance of achieving a pregnancy through this procedure.
Safety and Risks of Egg Freezing
Q: What are some of the possible risks of egg freezing?
A: In 2012 the American Society for Reproductive Medicine (ASRM) declared that egg freezing is longer experimental. ASRM revised their previous recommendation that egg freezing be reserved for women with cancer about to undergo chemotherapy. There is, however, still some uncertainty about its long-term safety.
It is a rather new technology and the volume of life births from the procedure is still limited. We don’t have much long-term follow up studies of the babies born through egg freezing. So far, it seems fine but one cannot be sure until we have much more experience with it and collect enough data about the children born through egg freezing.
Finally, there appears to not be a significant increase risk of ovarian cancer from this process.
The Effect of Fertility Hormones
There is also a risk having your ovaries stimulated by the strong fertility hormones. They can get over stimulated which is called ovarian hyperstimulation syndrome. This risk for this to happen is however small if you go to a center where they have a lot of experience with this procedure.
Talk to your provider, obstetrician, midwife or reproductive endocrinologist regarding your egg freezing options. Providers do not typically recommend egg freezing proactively as a matter of reproductive care. Because of this, it is up to each woman to research egg freezing, ask her provider about recommended options such as local fertility clinics and connect with other women who have undergone egg freezing.
David Diaz, M.D., medical director of West Coast Fertility Centers in California remarked, “The experience of each clinic with egg freezing varies greatly. Patients should ask the number of healthy babies born, the duration of experience at their clinic, and have a basic screening done to see if they are a good candidate”.
An article from Fertility Authority, a leading resource site for women exploring fertility options, states: Both Grifo and Diaz agree that patients need to be informed of the benefits and risks, and are smart enough to make a choice based on their own research. “We do empower women with data and information to make good decisions. Most women understand this might not work and at least they did something. If this helps women figure out how they want to conduct their reproductive lives, that’s a good thing”, states Grifo.
American Society of Reproductive Medicine: Reproductive Facts for Patients
Society for Assisted Reproductive Technology, Find a Fertility Clinic: National statistics from SART member clinics that reported their data through SART.
Society for Assisted Reproductive Technology, Fertility Success Predictor