By: Dr. Ed Coats
Egg freezing is now readily available in IVF clinics across the UK. The concept of ‘freezing eggs’ has been discussed in the media and widely debated by fertility experts around the world. Freezing technology has advanced so much that it is now possible for a woman to reliably preserve her fertility for the future. Fertility preservation is an important subject for women to understand and the possibilities it offers them. Making the decision to freeze eggs could have significant future consequences, so we try here to distil the facts from the hype.
There are a number of reasons why a woman will choose to freeze her eggs. Studies suggest that the majority of women currently choosing to freeze their eggs are highly educated, single women over 35 years of age. They will often have researched the subject before engaging with a fertility clinic for a consultation to discuss their options for treatment. It is an emotional journey for most balancing optimism and hope against fear and anxiety. There is absolutely no doubt that ‘egg age’ is critical to success, so the earlier that a woman chooses to freeze her eggs the better. Egg freezing is more promising the earlier it is done and certainly before reaching 30-years old it would be considered optimal. The pressures of modern society mean that fertility awareness is not always a high priority at this young age and treatment costs often unaffordable for most.
There are a number of steps to the ‘egg freezing’ process that must be considered. The clinic will check the egg reserve using a simple blood test called AMH (Anti-Mullerian Hormone), which helps to predict how many eggs are likely to be retrieved in a single cycle. The AMH level also helps to determine how much drug is required to safely stimulate the ovaries. Mature eggs collected with the patient asleep are then frozen (by vitrification) and preserved for future use. However, this is not the end of it as there are two stages to consider.
The initial treatment is all about preservation and involves stimulation of the ovaries with freezing of mature eggs. The second phase of treatment involves thawing these eggs, insemination of eggs with sperm and hopefully fertilisation. This part comes many years later or not at all, as often patients choosing to freeze eggs do it as an insurance policy to future proof their fertility but we know many patients do not come back to use these preserved eggs. The chances of success from this technique is quoted to be around 25-30% so comparable to IVF. So the question remains… is it actually a good idea to freeze eggs and what sort of expectation can you have if you do so?
The studies that have looked at this in particular quote around 2-3% chance of achieving a live baby per egg that is frozen. So essentially you would need to freeze around 30-40 eggs to be getting close to 100% certainty you will achieve a baby. The reality is that this could mean going through 3-cycles of ovarian stimulation and egg freezing, which many women do not contemplate. Women should consider their age when considering freezing eggs as ageing eggs are less likely to be successful than those frozen from a younger woman. This kind of insurance policy is therefore not a rock solid guarantee of a future baby and so we must be careful not to set up patients with unrealistic expectations.
The “egg freezing” costs are just one part of what may be a very costly experience for the patient as the future attempt/s that may be required to then use the frozen eggs and try for a family is not inexpensive. So whilst considering this interesting question it is more complex than it may first appear and I cannot give a simple yes/no answer. All women considering whether to freeze eggs would be best advised to do it in their early 30’s and possibly more than once to maximise egg yield for freezing. However, we should be educating all young women about their fertility in the early years in the same way we do about sexual health. Reproductive health awareness is so important as the costs of sub fertility and the emotional impact it can have on women is underestimated.
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By: Dr. Ed Coats