Egg freezing

Egg freezing is a process to preserve the reproductive potentials of a woman. The egg freezing process is also called oocyte cryopreservation. In this method, the eggs of the woman are harvested from the ovaries, and are frozen when unfertilized and stored to be used later. Egg freezing is also combined with the in vitro fertilization. The fertilized egg is then implanted in the woman’s uterus.

The procedure of egg freezing can be expensive.

The doctor helps to provide all the information about the Egg freezing procedure to the woman in detail, including the benefits and risks, and also assesses if the procedure is good for the woman.


Why do we freeze eggs? What are the risks? How to prepare for the procedure? Expected results from the procedure FAQ Section

Egg freezing is a safe and helpful procedure especially for the women who are not planning for pregnancy currently but want to be sure about their ability to conceive in the future or have a biological child. Egg freezing procedure does not need a male partner or even a sperm donor as is required in embryo cryopreservation (freezing of the fertilized eggs) because in Egg freezing the eggs which are stored are unfertilized before being frozen. However, similar to the embryo freezing, the woman will need to induce ovulation with the help of fertility drugs. This helps to produce a number of eggs at the time of retrieval.

A woman might consider the method of Egg freezing in the following cases:

  • If a woman is detected with cancer and has to undergo cancer treatment. This is because some cancer treatments, which include chemotherapy or radiotherapy, may affect a woman’s fertility. Hence, Egg freezing procedure done before the cancer treatment helps the woman to bear biological children later in the future.
  • If the woman is undergoing an in vitro fertilization method and by any chance, if the male partner does not produce the appropriate amount of sperms on the day the woman retrieves the eggs, then the best option is Egg freezing.

Although the Egg freezing method seems to be a good option for the women who are concerned about the age-related infertility problem, doctors do not advise this approach for the above mentioned reasons as it might involve some risks, and incremental costs with lesser probability of success.

 

Egg freezing method does carry some risks, as mentioned below.

  • Conditions associated with the use of fertility drugs – In rare cases, the injectable fertility drugs like HCG (Human chorionic gonadotropin), which are used to induce ovulation, may sometimes lead to ovarian hyperstimulation syndrome. In this syndrome, the ovaries get painful and swollen immediately after the retrieval of the eggs or ovulation. Some other related signs and symptoms of the syndrome may be as mentioned.
    • Diarrhea
    • Nausea
    • Vomiting
    • Abdominal pains
    • Bloating
  • Complications during the retrieval of the eggs – In very rare scenarios, the retrieval of the eggs with an aspirating fine needle may lead to bleeding, bowel damage, infections, or damage to the blood vessels or urinary bladder.
  • Emotional risks – The procedure of egg freezing can sometimes give false hopes to the woman. The egg freezing procedure in combination with in vitro fertilization may give a limited success rate. Sometimes, if the woman uses the egg freezing technique to get pregnant or bear a biological child, there can be a risk of miscarriage which will be based on the age of the woman at the time of retrieval of the eggs.

After waking up from the effect of general anesthesia some patients might face some of the following problems:

  • Nausea
  • Vomiting
  • Uneasiness
  • Dizziness
  • A temporary state of confusion
  • A feeling of cold or shivering

There is a mandatory screening done of the woman before the egg freezing, which consists of the following:

  • Ovarian reserve testing – A test is done to determine the quality and quantity of the eggs produced by the woman. In this test, the doctor tests for the AMG level with AFC test. The results of this test help to determine and predict the response of the ovaries to the fertility drugs.
  • Screening for infectious diseases – The woman is screened for several infectious diseases like HIV 122, Hep B, Hep C etc. The eggs, which are at some risk of infection are stored separately than the rest of the eggs.

The procedure of egg freezing has multiple steps, as mentioned below.

Ovulation induction

  • When the menstrual cycle starts, the treatment begins with administration of gonadotrophin hormones to stimulate the ovaries to produce a number of eggs, apart from the single egg which forms monthly. Various drugs which are needed are as mentioned.
    • Drugs for ovarian stimulation – The drugs which stimulate the ovaries to produce more eggs are follicle-stimulating hormone (FSH) or human menopausal gonadotropin.
    • Drugs to prevent pre-mature ovulation – In order to prevent pre-mature ovulation, the woman might be injected with gonadotropin-releasing hormone agonist or gonadotropin-releasing hormone antagonist.
  • Blood tests are also done to determine the response to the drugs to stimulate the ovaries. The level of the estrogen increase with the development of the follicles and the levels of progesterone stay low until the ovulation is completed.
  • Once the follicles are ready for the eggs to be retrieved, which takes around 9 to 12 days, HCG injection is administered to help with the final maturation & ovulation of eggs.

 

Retrieval of the eggs

  • The process of retrieval of the eggs is done under anaesthesia. The doctors usually opt for a transvaginal ultrasound aspiration. During this procedure, a small ultrasound probe is put into the vagina to locate the follicles. Then the doctor guides a fine needle into the vagina and further into the follicles. With the help of a suction device that is connected to the needle, the eggs are removed very carefully from the follicles. This process can retrieve a number of eggs in 20 to 30 minutes.
  • After the eggs are retrieved, the woman might experience some cramping or feeling of fullness or some pressure. This might continue for a few weeks because the ovaries might stay enlarged especially in those with ovarian hyper stimulation.
  • If the doctor has some problem accessing the ovaries through the transvaginal ultrasound approach, then the placement of the needle will be guided through the laparoscopy technique. In this method, a laparoscope (a tube with a camera) is inserted by making a small incision into the belly button.

 

Freezing

  • After the harvesting of the unfertilized eggs, the eggs are frozen to sub-zero temperature (-196 degree). This is done to stop all the biological activity occurring in the egg. The eggs are then preserved to be used in the future.

The doctor uses various special methods for Egg freezing as mentioned below:

  • Usage of cryoprotectants – These cryoprotectants help the egg from forming an intracellular harmful ice crystal when stored in deep freezing.
  • Slow- freezing technique – This technique involves the use of programmable freezers that freeze the eggs very slowly so that the intracellular ice crystals cannot be formed. This technique protects the eggs from exposure to the toxic substances present in the cryoprotectants. In this slow-freezing method, initially, the cryoprotectants are used in a very low concentration. The high concentration of cryoprotectants is only used when there is a gradual decline in the temperature and a decrease in the metabolic rates of the eggs.
  • Vitrification – In this technique, initially, the higher concentration of the cryoprotectants is used with the rapid cooling so that there is no time for the intracellular ice crystals to form (currently used & popular technique).

 

After the procedure:

  • The woman is able to return to normal activities within a week after the process of retrieval of the eggs.
  • The woman is advised to have protected sex to prevent unwanted pregnancy.
  • The woman should immediately inform the doctor if any of the following is observed:
    • Difficulty in urinating
    • High fever more than 38.6°C or 101 F.
    • Severe bleeding from the vagina i.e. filling of more than 2 pads hourly.
    • Chronic abdominal pain
    • Gaining weight of more than 0.9 kg within 24 hours.

The doctor might advise a fertilization technique known as ICSI (intracytoplasmic sperm injection). In this technique, healthy single sperm is injected into a mature egg. Around 75 to 80% of the eggs stay damage-free even after freezing and thawing. The chances of getting pregnant after the process of implantation are approximately 30 to 40%, and this majorly depends upon the age of the woman at the time of egg freezing. The older the woman, the poorer the quality of eggs hence reduced chances of a live birth following the use of frozen- thawed eggs.

Q1. How much time does it take to get complete recovery post the egg retrieval procedure?

A1. The doctors usually advise taking rest the entire day after the egg collection procedure. If the patient experiences any cramping, pain or soreness, the doctor recommends medications but this fades away in a week's time. Also, the patient is able to return to work after a week.

 

Q2. For how long can a woman store eggs after the egg freezing procedure?

A2. The eggs can be stored for as much time as the woman wants. There is quite a possibility that a number of babies can take birth from the eggs stored over 5 to 10 years. The reports of successful thawing state the success rate even after 14 years. Hence, there is no evidence of any type of reduction in the effectiveness of the frozen eggs over the years, providing freezing conditions are maintained optimally and the egg quality has been good at the time of freezing.

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