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Social Egg Freezing And The Modern Woman

From celebrities in Hollywood, to the top business women at Fortune 500 companies – everyone wants to know what “Social Egg Freezing” can mean for them. Powerhouses such as Apple and Facebook are now offering their female employees the opportunity to undergo this process as part of their company benefits. And in a time where more and more women are focusing on their career, are marrying later in life, or perhaps not at all – it seems incredibly important to understand and embrace the options available to the modern women of the world.

Mother and Child

What is Egg Freezing?
The first baby born from a frozen egg was back in 1986, at which time success rates were so low that egg freezing was considered an experimental procedure. It was only really considered an option for patients likely to lose their fertility due to reasons such as receiving chemotherapy or radiotherapy for cancer treatment.

At this time it was technically difficult to achieve fertilisation due to hardening of the zona (outer shell of the egg) because of the slow freezing/ thawing techniques available at the time. However, this has now been overcome by ICSI, in which we inject one sperm into each egg.

Back then, the greatest technical difficulty in egg freezing was the damage to the egg itself due to ice crystal formation during freezing by the slow freezing method. This is because oocytes are the largest cells in the body, (150 microns diameter).

Now, nearly 30 years later, vitrification (rapid freezing technique) using dehydro cryo-protectants hugely improves egg freezing and survival on thawing. Rapid freezing leads to a glass-like formation rather than crystals. Survival of frozen eggs with vitrification is almost at 90%. In fact, fertilisation rate and pregnancy rates using vitrified eggs is now so similar to using fresh eggs, the American society of Reproductive Medicine (ASRM) decided to lift the experimental label of oocyte vitrification as of 2013.

Indications For Social Egg Freezing:
Now that we have seen a significant improvement in the egg freezing technique, the awareness of its value has increased significantly. Those who could potentially benefit include:

  • Women concerned about their fertility declining with age
  • Young women with family history of premature ovarian failure (POF)
  • Young women with a low ovarian reserve who are not ready to have children yet
  • Women who do not have a partner but decline egg donation if needed later in life
  • Women who do not have a partner but do not want to use donor sperm to create embryos
  • Women who feel as though egg freezing is ethically more acceptable than embryo freezing
  • Couples who may have ethical issues regarding discarding unused frozen embryos and would prefer discarding unused unfertilised eggs
  • Those who are at risk of injury or death, e.g. member of the armed forces deployed to a war zone
  • Women about to undergo gender change operation

I just want to have options in my life. I do not want to be forced to necessarily pick a guy who is not going to be my right partner just so I can produce a family…

Additionally, as societal norms change, particularly in global cities such as London, many women postpone having children for several reasons, including:

  • Education
  • Career aspiration
  • Relationship instability and breakdown
  • Not finding the right partner
  • Late marriage
  • Financial barriers
  • Changing attitudes to marital assets such as personal fulfilment

Women who can benefit from social egg freezing are those who are at the given moment unready for parenthood, but would like to have the best chance of becoming pregnant at the right time for them.

At this point I have not found the right partner. I just did not want to be forced to pick someone…

The HFEA statistics of IVF cycles in 2006 show that 30.7% of the total of 39,783 cycles performed, were undertaken by women aged 38 or over. The average live birth rate in that year for women aged 38 was 17.9% per cycle. This reduces to 12.5% for women aged 40 and 6.6% for those aged 42.

The UK has the highest European age of first birth at the age of nearly 30. The latest projection estimates that 22% of women born in 1990 or later will remain childless, while 15% of mothers will have their first child at the age of 35 or over. There is a 6% permanent childlessness when women delay pregnancy attempts until the age of 30, 14% when those attempts begin at 35 and 35% when they begin at 40.

Clinicians have a duty to inform patients that a woman aged 40 or above is more likely to achieve a healthy pregnancy using embryos that were created in her mid-30s than using fresh embryos over 40 years old.

Embryologist Freezing Embryos

Egg Freezing, Technique and Storage
Preparation of the patient for egg freezing and storage is no different to that for IVF. First the woman is assessed for ovarian reserve through a blood test for Anti Mullerian Hormone (AMH) and a transvaginal ultrasound scan to assess antral follicle count. This will help to choose an appropriate protocol and drug dose for ovarian stimulation. After 10 – 12 days of injections, the eggs are matured by a final trigger injection and collected 36 hours later. Egg retrieval is achieved by a needle going via the vagina into the ovarian follicles to aspirate the eggs under ultrasound guidance. The procedure is performed under intravenous sedation.

Only mature eggs are cryo preserved (frozen) using the vitrification technique with dehydro cryoprotectants. To use the eggs later in life, they are thawed and injected with the sperm with the Intracytoplasmic Sperm Injection (ICSI) technique. The resulting embryos are replaced into the woman’s uterus a few days later as in fresh IVF.

According to the HFEA Code of Practice, you may store your eggs for up to 10 years. However this period can be extended under special circumstances for up to a maximum of 55 years. You should consult your fertility clinic if you need this.

Success and Safety
The emerging evidence base in regards to the efficacy and safety of oocyte cryopreservation is overwhelming. Survival rates, fertilisation rates and implantation rates of young cryopreserved oocytes, fertilised using ICSI are comparable with those of matched fresh oocytes.

Evidence to date indicates no increase in chromosomal abnormalities, birth defects or developmental defects of children conceived from frozen eggs. On the contrary, using eggs frozen at a younger age can reduce the risk of miscarriage and the risk of genetic and chromosomal abnormalities in children born to women over the age of 35.

Is it ‘Social Egg Freezing’ or ‘Backup (or preventive) Egg Banking Therapy’?
Fertility preservation in cancer (oncology) patients prior to chemo/radio therapy or surgery is considered medically indicated because of the risk of low ovarian reserve and infertility following treatment of the cancer. It is essential that patients are informed of the option to freeze their eggs for future use.

Some would argue against the same principle for “social egg freezing” even though the underlying pathology (i.e. risk of gamete exhaustion) is the same. Even more; it is absolutely certain that advancing age beyond 40 will have a devastating impact on a woman’s fertility that is possibly more inevitable than the impact of chemotherapy or radiotherapy on a young cancer patient.

Social egg freezing is not really “social” as the aim of freezing the eggs is not for donation but actually for self use. Egg freezing can be considered as an insurance policy for which you pay a premium. A healthy pregnancy can not be guaranteed but this is the case with trying for pregnancy even through assisted conception later in life which might be even less successful.

It is safe to say that no one would argue against Prophylactic (or preventive) medicine for osteoporosis in women. This would not be considered ‘social’. Therefore egg freezing at a young age in the current circumstances of our society should not be considered social but medically indicated “Preventative Therapy” in the form of “Egg Banking”.

Social Egg Freezing Business Woman

Current Status and Success
The success rates of frozen/ thawed eggs are similar to those of fresh eggs and there are no increased risks for the mother or the baby. There might actually be benefits of lower miscarriage rate and chromosomal abnormalities due to the younger age of the eggs at the time of retrieval.

Reported clinical pregnancy rates at 35- 60 years are realistic for freezing eggs at a young age. The expected success rate in terms of women aged 30 or 35 is 24% and 18% respectively, per six vitrified – warmed oocytes.

It is claimed that you might need 10 frozen eggs to have a live birth. This number of eggs can be produced in one or more ovarian stimulation cycle based on your age and your ovarian reserve. Mathematical calculation indicates the following expected live birth rate:

AgeLive Birth Rate based on 10 Frozen eggsLive Birth Rate based on 6 Frozen eggsAverage No. frozen eggs in one cycleLive Birth Rate per egg freezing cycle

Unfortunately the average age of women freezing their eggs is currently around the 37-38 year mark, which does not result in high success rates. We should encourage younger women in their late twenties and early thirties to freeze their eggs if they are considering delaying parenthood for whatever reason. There is a lack of awareness in regards to the fertility potential timeline (the biological clock) and the availability of egg freezing.

Of course, as the success of egg freezing is not guaranteed, this should not be interpreted as a reason to delay starting a family. On the contrary, couples should be encouraged to consider parenthood sooner rather than later and society should work towards social frameworks that is financially and structurally supportive of young families.

Fertility preservation should not compromise the young woman’s future chances of spontaneous conception throughout her natural reproductive lifespan. Therefore, more invasive methods of oocyte cryopreservation such as ovarian biopsy, are only appropriate for oncology patients when there is not enough time to harvest eggs.

Egg freezing is considered a back-up insurance policy. If you never use your frozen eggs because you have achieved your desired number of healthy children, you can donate your eggs, either for research or to help an infertile woman, or you can discard them. Research shows that 63% of women are prepared to donate their unused eggs to research, 11% to an infertile woman and 18% would discard them. 8% would not donate or discard them.

We thank Dr Gorgy from The Fertility and Gynaecology Academy, for providing specialist knowledge for this article.

The Fertility & Gynaecology Academy is an established Assisted Conception (IVF) unit in Central London that offers infertility treatments. Founded in 2004 by two of the UK’s most prominent fertility and gynaecology specialists Dr Gorgy and Dr Eskander, it is also one of the few IVF clinics in the UK that offers reproductive immunology treatments. The clinic enjoys a consistently high success rate, especially for women with complex fertility problems.

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