Discover everything you need to know about egg freezing in Czechia with Dr Tomáš Koukal, Fertility Specialist at Unica Brno. In this insightful webinar, Dr Koukal not only explains how egg freezing works step by step but also shares real-life stories of women who have undergone the procedure at the clinic — their motivations, experiences, and outcomes.
In his presentation, Dr Tomáš Koukal explained egg freezing, also known as fertility preservation or social freezing, as a process in which a woman’s eggs are collected, frozen, and stored for future use. When the time is right, these eggs can be thawed, fertilised through IVF, and used to achieve pregnancy.
The reason egg freezing has become increasingly relevant is biological. Over time, both the quantity and quality of eggs decline. Egg freezing offers a way to preserve eggs at a younger biological age, particularly addressing the issue of declining egg quantity.
A key concept discussed was ovarian reserve and how it is assessed. Dr Koukal highlighted anti-Müllerian hormone (AMH) as the most reliable marker of ovarian reserve.
AMH is produced by granulosa cells in the ovaries from early follicular stages. Its concentration in the blood is directly proportional to the number of antral follicles. Compared with other hormones such as FSH, inhibin, or estradiol measured on day three of the cycle, AMH provides a more stable and accurate estimate of ovarian reserve.
Importantly, AMH levels do not change significantly during the menstrual cycle or between cycles. Based on AMH values, clinicians can also estimate how the ovaries are likely to respond to IVF stimulation.
Dr Koukal explained that AMH testing is recommended for:
women who want to understand their ovarian reserve
women over 30
women with low antral follicle count or ovarian structural changes on ultrasound
women after ovarian surgery or cytotoxic treatments such as chemotherapy
women with ovarian endometriosis
The presentation showed a clear decline in AMH levels with increasing age, illustrating how ovarian reserve naturally decreases over time.
Beyond egg quantity, Dr Koukal emphasised the importance of egg quality. Only genetically normal embryos can lead to a healthy pregnancy and the birth of a healthy baby.
He presented data showing the relationship between maternal age and the proportion of genetically normal embryos. After the age of 35, there is an accelerated decline in embryo quality, with higher rates of genetic abnormalities, increased miscarriage risk, and reduced implantation success.
One predictive model illustrated the difference clearly:
a 28-year-old woman may need to collect around three oocytes to have a 70% chance of obtaining at least one genetically normal blastocyst, while a 44-year-old woman may need approximately 34 oocytes to reach the same probability.
This comparison highlighted why age is such a critical factor when considering fertility preservation.
Historically, egg freezing was primarily offered to women undergoing cancer treatment, such as chemotherapy, which can damage ovarian reserve. Dr Koukal explained that indications have since expanded.
Egg freezing may also be recommended for:
career-focused women who want to preserve fertility while building their professional lives
women who have not yet found the right partner or are not ready to start a family
couples undergoing IVF where sperm is temporarily unavailable due to medical or practical reasons
women with a family history of early menopause
In each case, the aim is to preserve viable eggs for future use before further decline occurs.
Before starting the process, two main assessments are performed:
a blood test for AMH, which can be taken on any day of the cycle
a vaginal ultrasound to assess ovarian structure and antral follicle count
These tests help determine how many eggs can realistically be retrieved and what the preservation goal should be.
Dr Koukal explained that, for optimal future chances, the general target is between 15 and 20 mature eggs. However, this goal must always be individualised, particularly with respect to age and ovarian reserve.
Dr Koukal outlined the egg freezing process in clear stages.
It begins with an initial consultation, evaluation, and planning. Ovarian stimulation then starts at the beginning of the menstrual cycle and lasts approximately 10 to 14 days. During this time, the woman self-administers hormonal injections to stimulate follicle growth.
One or two ultrasound scans are performed during stimulation to monitor follicle development. When follicles reach optimal size, egg retrieval is scheduled.
Egg collection is a short procedure, typically lasting 10 to 15 minutes, performed under general anaesthesia. After collection, the eggs are vitrified and stored.
When the eggs are later used, they are thawed, fertilised with sperm, and embryos are cultured. Around five days after fertilisation, embryos can be transferred or undergo preimplantation genetic testing for aneuploidy (PGT-A). Only genetically normal embryos are selected for future use.
Stimulation usually begins on day two of the cycle with self-administered injections. Ultrasound monitoring takes place during the stimulation phase to track follicle growth.
A trigger injection is given approximately 36 hours before egg collection to induce final maturation. Egg retrieval typically takes place between days 11 and 15 of the cycle.
The woman usually spends two to three hours at the clinic. The procedure is painless due to general anaesthesia, and recovery is quick, allowing a return to normal activities shortly afterwards.
Dr Koukal presented a case of a 38-year-old HR manager with AMH below 1 ng/ml and a low antral follicle count. She had a normal BMI and a known thrombophilia mutation (factor V Leiden). Her motivation for egg freezing was personal, as she had recently entered a new relationship.
In the first stimulation cycle, an antagonist protocol with 300 units of gonadotropins was used, along with anticoagulation due to thrombophilia. Eleven oocytes were retrieved, and nine mature eggs were vitrified.
Three months later, a second stimulation using the same protocol resulted in seven oocytes, six of which were mature and frozen. Across two cycles, a total of 15 eggs were preserved.
The second case involved a 34-year-old IT specialist with very good AMH levels and a high follicle count. She had no medical conditions and chose egg freezing after the end of a long-term relationship.
A short antagonist protocol with lower stimulation doses was used. Seventeen oocytes were retrieved, and 16 mature eggs were vitrified in a single cycle, meeting the preservation goal without the need for further stimulation.
Dr Koukal concluded that oocyte cryopreservation by vitrification is a safe and effective method of preserving egg quality for future IVF treatment.
Egg freezing allows women to preserve fertility potential and create the possibility of pregnancy at a later, more suitable time, but outcomes depend strongly on age, ovarian reserve, and realistic expectations.
As he emphasised throughout the presentation, early assessment and individualised counselling are essential to making informed decisions about fertility preservation.
This is very individual. In some cases, one egg-freezing cycle is sufficient. However, if the desired number of eggs is not achieved, particularly in relation to age, we recommend an additional stimulation cycle.
As shown in the case reports, some patients require a second IVF stimulation to collect a sufficient number of eggs. The goal is to ensure that enough eggs are stored to give a realistic chance of developing a good number of embryos in the future.
The decision depends mainly on AMH levels, antral follicle count, and age.
Yes, quite often. Depending on AMH levels and age, approximately 50% of women need at least a second stimulation cycle to collect a sufficient number of eggs.
The egg collection procedure itself is painless because it is performed under general anaesthesia. After the procedure, the patient is monitored in the recovery room, and pain relief is provided if necessary.
Some temporary symptoms may occur due to ovarian stimulation, as the ovaries are enlarged. Women may feel mild discomfort or pressure in the lower abdomen. These symptoms usually resolve quickly, especially after using a trigger shot with an agonist such as triptorelin.
With this approach, ovarian hyperstimulation syndrome is now very rare.
Yes, there are several misconceptions. One common myth is that egg freezing can permanently disrupt the menstrual cycle. This is false. The menstrual cycle returns to normal very quickly.
Another misconception is that all eggs are depleted during IVF stimulation or egg collection. This is not true. Many eggs remain, and even in women with poor ovarian reserve, a single IVF stimulation does not cause eggs to disappear.
In the Czech Republic, egg freezing can be performed up to the age of 49. However, the best age for egg freezing is between 30 and 35, when egg quality is highest and the chances of creating genetically normal embryos are optimal.
The procedure is legally available to all women, but it is not covered by health insurance and must be paid for by the patient.
After the age of 35 or 40, egg freezing becomes more challenging. While it is still possible, we strongly recommend preimplantation genetic testing (PGT-A) before embryos are used in the future.
Based on available data, at the age of 40, there is approximately a 70% chance of obtaining at least one genetically normal blastocyst if around 15 eggs are collected.
Therefore, at this age, the goal should be to freeze at least 15 eggs. While egg freezing is most effective before the age of 35, it can still be worthwhile at 40, depending on ovarian reserve and expectations.
Age is the most crucial factor in reproductive medicine. I discuss this with patients every day, even though it can be difficult.
Our goal is not only pregnancy, but a healthy baby at home. This is only possible when genetically normal embryos are available, and age has a direct impact on this.
Women between 25 and 30 represent a very small group. Most of our patients are aged 35 and older, typically between 35 and 40.
This depends on the units used. In my presentation, AMH values were shown in ng/ml. In those units, an AMH of 8 indicates a very good ovarian reserve.
In the UK, AMH is often measured in pmol/l, where a value of 8 would be closer to the lower end of the normal range. Interpretation therefore depends on the measurement units and the patient’s age.
At 43, if a woman is interested in egg freezing, I would still recommend proceeding sooner rather than later, with the possibility of PGT-A in the future if embryos are created.
It is possible, but it depends on how many eggs are collected and on ovarian reserve, including AMH levels. Achieving 3 euploid embryos at age 39 is feasible, but outcomes vary from patient to patient.
Eggs are among the most fragile cells for cryopreservation. In the past, survival rates were lower. However, with modern vitrification techniques, survival rates after thawing are now approximately 90 to 95%.
This is considered very high, and patients should not be concerned about a significant loss of egg quality due to freezing and thawing.
I encourage women not to hesitate to contact an IVF clinic for a consultation. It is better to discuss individual possibilities early and understand what options are available.
If there is a chance to preserve fertility, it is better to explore it sooner rather than later.
