Should you Freeze your Eggs?
Have you ever wondered if you should freeze your eggs? For many women, egg freezing, also known as oocyte cryopreservation, is a great technology that can help them achieve a biological child in the future. Here is everything you need to know when contemplating the big question… to freeze or not to freeze?
Women are born with all the eggs they are ever going to have at birth. With age and time, the eggs are slowly lost. On average, most women are born with 1-2 million eggs. By the time puberty hits most women have lost more than half of their lifetime eggs and are down to 300,000-500,000 eggs. Menopause occurs when there are so few eggs left that the ovaries essentially fail, which is usually 1,000 eggs or less. Most women do not go through menopause until their late 40’s or early 50’s, however, the majority of women will start to experience difficulty conceiving well before this age. This is primarily due to the fact that in addition to quantitatively losing eggs, the quality of a woman’s eggs also significantly declines with increasing age. As a woman ages, her eggs are more likely to result in chromosomally abnormal embryos called aneuploidy. Healthy embryos have 2 copies of the 23 chromosomes, with the 23rd chromosome being the sex chromosomes, XX for females and XY for males. Aneuploidy means that the embryo is missing or has an extra copy of a chromosome. The vast majority of chromosomally abnormal embryos are not compatible with life with the exception of Down syndrome, which is 3 copies of chromosome 21. Most other aneuploid embryos will either never lead to a pregnancy or will result in an early pregnancy loss. Women under age 35 are considered to be at the lowest risk for these abnormalities, but even in this age group 25-30% of embryos will be aneuploid. This remains relatively stable until age 35, when the percentage of aneuploid embryos rises. After age 35, there are huge changes in egg quality and by the time most women are in their early 40’s approximately 80% of their embryos will be aneuploid. In short, as a woman ages she quantitatively has less eggs and out of those eggs remaining, the quality becomes poorer.
Currently there is no technology available that is able to bring back lost eggs or to regenerate new ones. There are also no medicines that have ever been shown to dramatically improve egg quality. We do, however, have egg freezing. Egg freezing is a technology that allows us to extract some eggs from the ovary and freeze them, so that they are set aside for potential use in the future. The main benefit of egg freezing is that the quality of the eggs seems to stay at the age an individual freezes them at. Therefore, as a woman ages, and her egg quality declines, her frozen eggs will remain the quality of the age she froze them at. The amazing thing is that most women are able to carry a pregnancy even if they have gone through menopause if they froze eggs or embryos at a younger age or if they use egg donation. The main age related decline in female fertility primarily comes from the decline in egg quality rather than the uterus.
What is the process of egg freezing?
Egg freezing is a process where an individual takes medications called gonadotropins to stimulate the ovaries to grow multiple eggs. These medications are tiny subcutaneous injections that go into the belly and most women are easily able to give these injections to them self. Typically you start the medications on the first few days of your menstrual cycle and are on them for approximately 1-2 weeks. Frequent monitoring with a pelvic ultrasound and bloodwork is necessary. Most of the time you will be evaluated every other day and potentially every day when it gets close to the time of egg retrieval. Everyone’s bodies respond a little differently to the medication so the exact day of your egg retrieval is never known when you start medications. Once you appear ready you typically take your last injection called your “trigger” injection at a specific time in the evening. This medication prepares your body for ovulation approximately 36h later. An egg retrieval is performed a few hours before the eggs would naturally ovulate. The retrieval process is a minor procedure that takes approximately 20 minutes. A needle is placed through the wall of the vagina under ultrasound guidance to extract the eggs from the ovary. Typically light or “twilight” anesthesia is used during the procedure so that you will be comfortable and not in pain. Most individuals are able to go home 1-2 hours after the procedure and typically only need Ibuprofen or Tylenol for pain. After the egg retrieval you do not need to take any more fertility medications and most women will get their menses within 10-14 days of the procedure.
The most commonly experienced side effects from the medications for egg freezing is abdominal bloating or swelling. The ovaries become larger in size from growing multiple follicles, which are the fluid filled sacs where eggs grow. The medications also cause more water retention. These side effects typically resolve within 7-14d after the egg retrieval. Since the ovaries are enlarged during this process it is best to stop any strenuous physical activity during this time. If you are taking oral contraceptive pills you will need to temporarily discontinue them for the egg freezing process. You should discuss with your doctor when to stop the pills. IUDs, whether they are copper or progestin IUDs, do not need to be removed to freeze your eggs and will not interfere with the process.
If you are interested in freezing your eggs you should schedule a consultation with a fertility specialist. They will typically review your medical history, perform a baseline pelvic sonogram, and check an anti-mullerian hormone (AMH) level, a test that helps determine your egg quantity. These tests all help determine which medications and protocols will be best for you and helps us give you expectations on how you would likely respond to medications. All of the physicians at RMA of New York are experts in egg freezing and would be happy to see you for a consultation.