Egg Freezing for Women Seeking to Delay Childbearing

Daniel E Stein, M.D.

Significant technological advances in the ability to successfully freeze and thaw human eggs are now allowing many women to freeze eggs for future fertility. There are many reasons women choose to freeze their eggs including the desire to avoid permanent loss of eggs from upcoming chemotherapy or radiation treatments (i.e. for cancer or severe rheumatologic diseases), planned removal of the ovaries for pelvic disease, or concerns regarding a strong family history of early menopause. The most common reason both single and married women choose to freeze eggs, however, is to defer conception until they are past their prime reproductive years. Fertility begins to decline in the mid-twenties but the chance of conceiving is high until the early thirties when a more rapid decline in fertility occurs. While an average 24 year old woman has over an 80% chance of conceiving over one year, a 35 year old woman has only a 50% chance of doing so and a 40 year old only about 30%. Furthermore, the chance that a conception will end in a miscarriage, or lead to a chromosomal abnormality in a child, rises significantly from the mid-thirties on. Therefore, ideally, a woman seeking to preserve future conception should freeze her eggs in her late twenties to mid-thirties. If and when the woman chooses to thaw the frozen eggs and fertilize them in the future, the chances of having a successful and healthy pregnancy will be based on the woman’s age at the time of freezing, not at the older age at which she is using the eggs. Moreover, the rate of chromosomal abnormalities associated with younger eggs is much lower than with older eggs and therefore using younger eggs is associated with a lower risk of miscarriages and birth defects.

The stages of egg freezing include (1) a consultation with a Reproductive Endocrinologist and his or her team, (2) an assessment of a woman’s ovarian reserve (3) ovarian stimulation, (4) retrieval of the eggs, and (5) cryopreservation (freezing) of the eggs.

Prior to initiating an egg freezing cycle, blood tests and a pelvic sonogram will be performed to assess the woman’s ovarian reserve, a broad estimate of the quantity and quality of her egg supply. Markers typically measured early in the menstrual cycle are the Follicle Stimulating Hormone (FSH) level, Anti-mullerian Hormone (AMH) level, and a sonographic measurement of the antral follicle (AFC) count (follicles are the structures in the ovaries that contain the eggs). The best candidates for successful egg freezing include those aged 35 or younger (although many older women also do well), those with a high AFC, and those with an FSH level < 10 IU/L and an AMH level > 2 ng/ml. Using the results of these tests, the reproductive endocrinologist will create a medication protocol. Upon her period the woman will inject herself with ovarian stimulation hormones (or have someone else inject her) using tiny needles just below the skin surface once or twice daily for typically seven to twelve days. During this time period she will be seen in the office every one to three mornings (before work) for blood tests and sonograms to monitor her response to the medications. It is not unusual for women to feel somewhat more tired as well as bloated during this time. Once the physician determines the follicles are ready to be released, the woman will take a final injection of medication and undergo egg retrieval 36 hours later under intravenous anesthesia. The egg retrieval procedure involves the introduction of a special needle through the walls of the vagina into the ovaries to aspirate the eggs. No incisions or sutures are required and the woman recovers for one hour before going home. The next day she may return to work. She will receive a call telling her how many eggs will be frozen. The eggs now undergo a rapid-freeze technique called vitrification and they are stored until a woman or couple wishes to use those eggs in the future.

 

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