Everything you need to know about freezing your eggs

In a recent interview, Hollywood actress Jennifer Aniston revealed that she'd been unsuccessfully going through fertility treatments. The 53-year-old actress made headlines, and sparked conversations when she recounted her fertility journey amid lifelong speculation, and regretted not freezing her eggs. Mid-Day.com spoke to Dr. Gunjan Sabherwal, fertility expert, Nova Southend IVF and Fertility to further our understanding of egg freezing.

"In today's era, people in their 20s and 30s are moving up the financial ladder and achieving financial stability, and exploring parenthood at a later stage to better provide for their children. However, there is always the risk of your biological clock running out. This is where egg freezing comes in as an alternative to preserve fertility and increase chances of pregnancy. Also known as mature oocyte cryopreservation, egg freezing involves taking medications to stimulate your ovaries, retrieving unfertilized eggs, and quickly freezing them at sub-zero temperatures until you are ready to start or grow your family," explains Sabherwal. She walks us through the egg freezing process, and answers important questions.

Prepping for the procedure

Before the egg freezing process begins, a doctor will evaluate your medical history with a focus on fertility, assess the regularity of the menstrual cycle, and perform a range of blood tests to determine hormone levels.

A woman's ovaries typically produce one egg per month. When there are minimal eggs available for freezing, the chances of a successful pregnancy decreases. In order to maximise the number of eggs, a hormonal treatment is initiated. This treatment typically requires a woman to receive hormone injections at home one to three times per day for 10 to 12 consecutive days.

Most women intake birth control pills, oestrogen, lupron, or aygestin (a type of progesterone) for at least a month prior to the hormone injections. This inhibits the natural cycle and increases the hormone's effectiveness.

Although, hormone levels and types vary, typical treatments stages include:

• Two weeks of follicle-stimulating hormones (FSH) and luteinizing hormones (LH) injections to enable the ovaries to produce more eggs.
• A gonadotropin-releasing hormone (GnRH) injection about halfway through the cycle, which prevents ovulation from occurring too early in the cycle.
• Depending on the size of your follicles and oestrogen blood levels, a final shot of human chorionic gonadotropin (hCG), also known as trigger shot, is given 34 to 35 hours prior to the egg retrieval procedure. This helps to mature the eggs.

Blood tests are performed on a regular basis to monitor the effects of hormone treatments. In addition, ultrasound detection is carried out to trace ovulation and assess egg development.

Egg retrieval and storage

The anesthesiologist begins the egg retrieval procedure by administering light intravenous sedation for your comfort. Anesthesiologists use monitored anaesthesia care rather than general anaesthesia during egg retrievals. An oxygen cannula will be set under your nose and propofol anaesthesia medications will be administered through your IV to put you to sleep.

An ultrasound is used to guide a tiny hollow needle with suction capabilities into your follicles and direct it to a catheter through the vaginal wall to drain the fluid from the follicles that contain the developed eggs. The procedure usually takes 10 to 20 minutes. When the retrieval is finished, the anesthesiologist will gently take you out of sedation and transfer you to a recovery room where you will be monitored. Light vaginal spotting, abdominal cramping, bloating, and constipation are common symptoms within the first 24 hours. To relieve cramping, a tylenol and heating pads are usually recommended. In case of severe abdominal pain, heavy vaginal bleeding, or dizziness, contact your doctor immediately.

Once collected, eggs are immediately transported to the IVF lab, where one of the embryologists locates, isolates, and places your eggs in a controlled environment for a few hours before freezing. Usually, 10 to 20 eggs are retrieved for IVF. However, not all of them are suitable for use, as only about two-thirds have reached the appropriate maturity.

One of the most crucial steps in the IVF procedures is egg retrieval. This process, along with the steps preceding and following egg retrieval, makes IVF the most effective fertility treatment because it addresses a number of key infertility issues.

Even after the procedure has been explained, there are several aspects that require mediation. Below, Sabherwal answers frequently asked questions.

How long does the process take? Is the procedure painful?
Egg freezing is a painless procedure thanks to advanced internal imaging and anaesthesia. Minor side effects may occur, but the retrieval procedure is simple and painless. A single egg freezing cycle takes about 3 to 4 weeks. This includes birth control pills or other medication for 1 to 2 weeks to momentarily alter your natural hormones. Lastly, hormone injections for 9 to 10 days to stimulate your ovaries and ripen multiple eggs.

When should I consider egg freezing?
Egg freezing is a recommended treatment alternative for a variety of reasons. Some of them include:

Conditions or circumstances impacting fertility: These include sickle cell anaemia, autoimmune diseases like lupus, and gender diversity, such as transgender identity.

Undergoing cancer treatment: Certain medical treatments, such as radiation or chemotherapy, have a negative impact on your fertility. Freezing your eggs before the commencement of these treatments is a great way to preserve your fertility.

Future use: Many women today are considering egg freezing in order to focus on their professional lives and achieve career goals while also securing their pregnancy options for a later stage. Egg freezing is also an excellent option for single and unmarried women who want to pursue parenthood when the time comes.

Is egg freezing safe? What are the risks involved in the process?
Egg freezing entails a relatively low-risk, simple and painless procedure. However, there are some risks associated with the same:

In rare cases, using injectable fertility drugs to induce ovulation, such as synthetic follicle-stimulating hormone or luteinizing hormone, can cause ovaries to swell and be painful soon after ovulation or egg retrieval (ovarian hyperstimulation syndrome). Abdominal pain, bloating, nausea, vomiting, and diarrhoea are some of the side-effects of this procedure.

However, recent studies found that children born from frozen eggs did not exhibit an elevated rate of birth defects, when compared to the general population.

How many eggs should be stored to achieve pregnancy?
In women up to the age of 38, egg thawing and fertilisation rates of 75% are expected. Thus, if 10 eggs are frozen, 7 are expected to survive the thaw and 5 to 6 will fertilise and develop into embryos. In women up to the age of 38, 3 to 4 embryos are typically transferred. As a result, 10 to 15 eggs are usually recommended for each pregnancy attempt. Most women aged 38 and under are presumed to produce 10 to 20 eggs per cycle.

Would retrieving eggs right now lead to lesser eggs in future?
No, egg freezing will not reduce your ovarian reserve or decrease your chances of becoming pregnant naturally in future.

During each menstrual cycle - one egg completes the ovulatory process. The egg follicle is activated, and the egg grows and matures before separating from the ovary and beginning to travel down the fallopian tubes.

However, in addition to the ovulated egg, a number of follicles are activated that do not progress beyond the first stage. When the immature eggs within those follicles do not mature, they die. This is known as "atresia." Egg freezing uses some of those otherwise wasted eggs.

What is the success rate of the procedure? Is it possible that more than one egg freezing cycle is required?
Egg freezing is considered to be one of the most efficient pregnancy alternatives. Over 300,000 children worldwide have been born from frozen embryos using cryopreservation techniques around the world. There are two criteria for judging egg freezing. Fresh, never frozen embryos are one standard, while frozen embryos are another.

How can eggs remain frozen?
Storing the frozen eggs securely in cryotops in liquid nitrogen containing cans helps in maintaining the viability of these eggs.

How do I use my eggs once I've frozen them? How long are they viable for?
Frozen eggs should last indefinitely. Their viability is more dependent on your age and overall health at the time the eggs are collected. Most people store eggs for 5 to 10 years. In fact, children are born from eggs frozen for as long as 14 years.

When you're ready to use your frozen eggs, they'll be thawed, fertilised in a lab with sperm, and implanted in the gestational carrier's uterus. Your doctor may advise you to use an intracytoplasmic sperm injection fertilisation technique (ICSI), as the freezing process makes the outer coating around the eggs tougher and sperm may be unable to penetrate it naturally under IVF. ICSI involves injecting a single healthy sperm directly into each mature egg.

Depending on your age at the time of egg freezing, your chances of becoming pregnant after implantation range from 30 to 60%. The older you are when you freeze your eggs, the less likely it is that you will have a live birth in the future.

What happens to the eggs which remain unused?
If you underwent a successful infertility treatment and still have embryos left over from your treatment, you have a few options:

Storing for future use: You can choose to store your embryos for the future if you want to try for more children.

Donation of good quality embryos: If you do not want to try for any more children and feel that your family is complete, you can choose to donate your good quality embryos to help other couples have a baby and enjoy the fruits of parenthood.

Research: You can donate your embryos to research centres that study embryos, eggs and sperms to develop new techniques and medical breakthroughs.

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