Infertility: what you need to know about egg freezing

What do you do if you’re not ready to have a baby, but your biological clock is ticking, and you know that the older you get, the less chance you might have of conceiving?

Egg freezing might buy you time, and is a way of saving your good eggs for when or if you’re ready to conceive a child. Dr Lizle Oosthuizen of Cape Fertility Clinic answers frequently asked questions about egg freezing.

What is the process of egg freezing?

Egg freezing will start with a consultation and examination so we can identify any gynaecological/health factors that may affect the process. We then run through the whole process and make sure egg freezing is right for you.

We will do an ultrasound and some blood investigations, and then plan the treatment cycle. The process will then be co-ordinated (usually) to a period. We will start injections which are self-administered on day 3 of the period, as well as some progesterone tablets to prevent ovulation. We will do a few ultrasounds during the cycle (2-3) and watch the follicles grow (potential egg factories) on the scan.

When the follicles are large enough, we will then trigger them, which is the process of maturing the egg inside the follicle before retrieval. The day of retrieval is usually two days after the trigger, you will be anaesthetised (more of a sedation as you will breath for yourself the whole time), and we will suck the eggs out of the follicles under ultrasound guidance.

It’s not a surgery as there are no cuts – the eggs are sucked out (aspirated) using a very fine needle attached to a vaginal ultrasound. The eggs are then checked by the lab, and eggs that are healthy and mature are frozen.

Why do women opt for it?

There is a variety of reasons – the whole reason egg freezing came about was precisely for helping women who had to undergo fertility-reducing surgery or treatments like chemo or radiation. Some women will do it because they have a family history of early menopause and would like to have options.

Most women at the clinic are now coming for what we term “planned freezing” (we don’t like the term social freezing anymore) – so they know that where they are relationship/career wise, they are not able to have a child currently, and they would like to have some options for the future.

What age is recommended to freeze eggs?

 Ideally before the age of 35 – it really is a balance that needs to be identified. While women in their 20’s may have excellent egg counts and quality, we need to balance the risks and financial cost of the procedure with the likelihood of needing the eggs one day. We advise women who are in their early 30s to consider it if pregnancy looks like it may only occur after 35, when fertility starts to decline.

That being said, we will never withhold the option of freezing from an older woman – if we would offer you IVF, we can do egg freezing, as long as we are all clear on the fact that we will get fewer eggs usually, the quality will be reduced (vs under 35) and you may require more than one cycle.

Facts about egg freezing

What does the process cost?

Every clinic will have a different estimate according to the stimulation protocols. It’s probably between R40 000 to R50 000 at most clinics.

We advise women who are in their early 30s to consider it if pregnancy looks like it may only occur after 35, when fertility starts to decline.

What are egg freezing need-to-knows?

Anaesthetic

She will need an anaesthetic. An anaesthetist will be there for this procedure and we monitor you carefully throughout. It’s more like a sedation because you are able to breathe for yourself, you’re just knocked out.

Infection

We are putting a needle from outside the body into the body. While everything in the theatre is sterile, we can’t sterilise the vagina. The risk of a pelvic infection occurring is minimised by giving antibiotics at the time of the procedure.

No vigorous activity

The ovaries can get quite big if they are full of eggs, so we advise no vigorous activity. The risk is always that they twist, which then would mean an emergency surgery to “untwist” the ovary.

No intercourse

Don’t have intercourse during the procedure as you will have increased chance of conceiving.

Hyperstimulation

This is a scenario when the ovary has made several eggs (usually more than 15), and the eggs start to secrete substances that result in fluid shifts. Fluid moves from the blood vessels to the tummy and lungs, and can cause something called ovarian hyper stimulation syndrome.

This can be mild, or it can be very severe, resulting in the kidney taking strain, blood clots forming, difficulty breathing, and ICU admission. We prevent this by tailoring the dose of medication to how we think the ovaries will respond, and using a trigger injection we know to be a lot safer. The risk is further reduced by the fact we are only freezing eggs, not transferring embryos, as the hormonal signal from pregnancy is usually the thing that sets the OHSS off.

No guarantee

Egg freezing is a not a guarantee. The number and quality of the eggs are the most important factors. It’s dangerous for women to freeze their eggs and think, “Okay, now I will wait until I am 45 before I think of having children”. As with everything in medicine, there is no guarantee of pregnancy, and pregnancy after 40 becomes increasingly more complicated. We have seen really excellent outcomes with our patients who have returned for their eggs.

It is, however, still better than not having any options at all. Eggs are the first part of the equation, but that egg needs to be fertilised by the sperm, and it needs to develop into a healthy embryo. We usually estimate that from every 10 eggs we should get 2-3 embryos grown to day 5. So having 10 eggs doesn’t mean 10 babies, it means (on average) 1-2 embryo transfers i.e. chances at pregnancy.

What happens to frozen eggs if a woman decides not to use them?

She can choose to discard them, donate them (anonymously) to a needy couple, or offer them for training and medical research. She should always have a disposition agreement that states what should be done with the eggs if anything should happen to her.

How long can eggs remain frozen?

At the moment we don’t have an upper limit. By law in South Africa, you won’t be able to use them after age 54, and most clinics would have very strict rules about using them after 50.

Does anything happen to the frozen eggs’ quality over time?

With the current technology called vitrification, no. If you are talking physiology in the body, then yes, the egg quality reduces as we age, and this speeds up after 35 (and even more so after 40).

Is more than one cycle recommended? How many eggs is a good number to bank?

We can’t guarantee a pregnancy with any specific number. We do have data emerging that advises on the chance of pregnancy with a certain amount of eggs. How many cycles will depend on the circumstance – in patients facing the potential end of fertility (cancer) there is probably only time for one cycle.

We individualise how many cycles depending on how many eggs we get. For example, if we are aiming for 20 eggs and we only get eight, then yes, we would advise another cycle. It’s obviously not compulsory and eight eggs are always better than none (so don’t feel it wasn’t worth it)!

What’s the most important advice you have regarding egg freezing?

I would emphasise that so often I hear women saying “if only I had frozen my eggs”. It’s something many women think about, but never get around to. I always bring up the regret game – you can regret spending the money if you don’t need the eggs (but you can always make more money), or you can regret not having done it when you need the eggs.

It’s also good to mention the option of pregnancy now – inseminations are possible for women who want to be pregnant now. The option of creating embryos is also an option.