Do you want your eggs frozen or sunny side up??

Egg freezing is a breakthrough technology that allows women to freeze and store their eggs until a pregnancy is desired, at which time the eggs are thawed, fertilised and transferred to the uterus as embryos. Many women today are feeling the pressure of having to choose between a career and a family. Some are returning to school or pursuing advanced degrees and don’t know when or if they will have children. For many, it may simply be an issue of not having found the right partner yet. For all of these women, egg freezing is revolutionary not just in its technology, but in the freedom it can offer in allowing them to postpone childbearing.

Women suffering from endometriosis, a progressive disease that can impair ovarian function, can realise significant family building options through egg freezing. Endometriosis is becoming far more common in the western world, particularly among younger women, and has resulted in a considerable increase in those seeking fertility preservation. Women in the reproductive-age group that are diagnosed with cancer who will need chemotherapy and/or radiation treatments that can typically lead to infertility by destroying the eggs are excellent candidates for egg freezing. While options vary depending on age, type of cancer and cancer-treatment plan, egg freezing can provide these women the opportunity to preserve their fertility.

If diagnosed with cancer then the patient needs to contact a Fertility Clinic urgently for a fast track appointment. The process of egg collection must take place BEFORE any form of therapy takes place.
Finally, egg freezing can be useful for individuals with religious or moral objections to storing frozen embryos. Frequently, in routine IVF, any excess embryos that remain are frozen for future use. However, if they are not to be used, their disposal can create a difficult ethical issue. The ability to freeze unfertilised eggs offers a positive solution for many people.

Steps Taken In The Treatment Process

Most treatment protocols involve the preparation of the ovaries for the production of mature eggs needed for the freezing process.

Step 1

Step 1 involves waiting for your normal menstrual period to begin. Depending upon the treatment protocol prescribed for you, with the beginning of your menses, you will either be given instructions to begin your fertility drugs, or instructions to wait for a certain date within the three weeks following the start of your period to begin a medication to allow the Doctors the opportunity to optimise your ovaries for the fertility drugs that will follow.

Step 2 – Ovarian Stimulation

Step 2 involves the administration of fertility medications designed to allow your ovaries to begin the growth of the several eggs that will be removed for subsequent freezing. During this phase, you can either self-administer the drugs that allow for the successful production of multiple healthy eggs, or have a nurse administer the daily injections for you. Nurses will show you how to administer the injectable medications prior to commencing your cycle. While taking these medications, you will need to be seen for ultrasound studies 3-4 times over the 10-12 day period the medicines are being used.

Step 3 – Egg Retrieval

After your eggs have been determined to have matured adequately, you will be scheduled for the surgical harvesting of your eggs. This will be done by one of the Doctors. In nearly all instances, the procedure is carried out with a light sedative that allows a relatively pain-free procedure with a rapid recovery. You will be discharged from the clinic once it has been determined that you are stable, usually within 2-3 hours of your procedure.

Step 4 – Oocyte Cryopreservation

After your eggs have been recovered, they are prepared in our cryopreservation laboratory by the embryologist. The first step is to assure the healthy appearance of the eggs and begin the process of preparing the eggs for freezing via vitrification.
The vitrification technique uses a rapid two stage process. The first dehydrates the egg to remove much of the liquid; the second stage freezes the eggs so rapidly that the transformation from liquid to solid is instantaneous. No ice crystals form and the consistency resembles a viscous glassy state (hence the term ‘vitrified’).

Step 5 – Oocyte Storage
Following the freezing process, your eggs will be transferred to a liquid nitrogen storage chamber where they are stored in their frozen state. This chamber is located at the Fertility Clinic most of the time. Studies have shown that there is tremendous variability in the ability of eggs to tolerate the freezing process. They have also shown that within a single group of eggs frozen, some will survive and others will not. In those that do survive the freeze and later thaw, some will fertilise when exposed to sperm and others will not.

Step 6 – Thaw And Use Of Your Frozen Eggs

When the time arrives for you to use your cryopreserved eggs, you will need to make arrangements with the facility at least 3 months in advance of the time you desire the eggs to be thawed and fertilised. It must be remembered that the eggs have been frozen unfertelised, and that the fertilisation of previously frozen eggs requires special techniques and handling. The successful fertilisation of cryopreserved eggs is greatly enhanced by the use of a process called “ICSI” (intracytoplasmic sperm injection). Utilising this method ensures the best chance for the fertilisation of the eggs and their subsequent development into healthy embryos with the potential to produce an ongoing pregnancy. When the clinic is contacted by you with a request for use of the frozen eggs, it will begin making the arrangements for the treatment cycle required to assure the best chance for a successful pregnancy outcome for you.
It must be noted that the costs of the thawing, fertilisation and transfer of embryos are not included in the costs of the egg freezing program.

Success Rates
The following success rates are based on published peer-reviewed medical literature:
1. An approximate overall 4% live-birth rate per oocyte thawed for cryopreservation using vitrification. E.g. if 10 eggs are frozen then there will be 40% chance of a live birth.
2. The likelihood is that success rates may be significantly lower than current overall estimates for women who cryopreserve oocytes after age 35, given that most published reports have described outcomes for younger women.

The success rate of freezing eggs can be equated with the success rate of undergoing a cycle of in-vitro fertilisation which correlates with age (

Safety
By early 2008, approximately 500 babies have been born worldwide from frozen eggs. Among these births, the rate of birth defects and chromosomal defects has been no higher than that which we see in the general population. Additionally, genetic screening of embryos is available.

Cost
The cost of the primary visit and investigations consists of:
• Consultation and Ultrasound with your Doctor
• Hormonal Blood testing
• Infection tests including HIV, Hepatitis B and vaginal infection tests
The Cost of the egg freezing program is approximately R 28 600. This will include all the costs involved in obtaining eggs. This cost excludes the medication needed to stimulate the ovaries. The average cost of the medication is R13 000.
The cost of egg storage is R1 200.00 per annum on average.

Psychological Consideration
The freezing of your eggs gives you a backup plan if you have problems falling pregnant at a later age. However, it is important not to base your life decisions and expectations on a limited number of cryopreserved oocytes. The actual quality of the frozen eggs and their ability will only be determined when they are fertilised at a later date.

Risks
With fertility drugs there are rare complications that clinics try to avoid by taking specific precautions.

1. Hyperstimulation Syndrome
This is a rare, but serious complication when fertility drugs are used and too many follicles (eggs) develop in the ovaries. The symptoms of ovarian hyperstimulation include lower abdominal pain accompanied by swelling of the abdomen. The ovaries become very large and surrounded by fluid and this may cause some nausea and vomiting. The loss of fluid in this way may lead to dehydration and decreased urine output. Any woman developing abdominal pain and swelling after the egg collection procedure is advised to telephone the clinic to attend for a check up so that they may make sure this condition is not developing. Treatment may require admission to hospital for bed rest for a few days and very rarely, intravenous fluids. We avoid this risk by choosing the lowest dose of fertility drugs that will produce an adequate number of eggs. If all the follicles are drained at the time of egg collection, the risk of ovarian hyperstimulation syndrome may be greatly reduced and we can further reduce the risk of the syndrome by the use of tablets for two weeks following the egg collection.
2. Bleeding
Any surgical procedure carries the risk of bleeding and we avoid this by using very thin needles for the egg collection procedure. We have not had any problems with this complication in the past. You may expect a small amount of bleeding on the day of the egg recovery which will ease after a couple of days. If the bleeding becomes heavier, please contact the Clinic.
3. Infection
This is limited by checking for vaginal infections before the procedure.
4. How Successful Is Egg Freezing?
Survival rates for eggs following freezing depend on the quality of the eggs before freezing, but on average only about 70% of the eggs frozen will survive the freezing and thawing process. Of the surviving eggs about 65% of these in turn will fertilise in response to ICSI (intra cytoplasmic sperm injection).

Even with all this information about egg freezing, South African women are still skeptical about weather they should consider freezing their eggs. Would you freeze your eggs if you could afford to?

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