When it comes to fertility, women’s age matters the most. As women get older, their eggs diminish in numbers and in quality which results in problems conceiving. From this perspective, egg freezing seems to be a good way of pausing one’s biological clock. In this webinar, Dr Malini Uppal, Fertility Specialist at GENNET City Fertility in the UK, explains egg freezing and fertility preservation options for patients.
Infertility is a significant health issue that affects 11.8% of all reproductive age women. Much of this often publicised ‘infertility epidemic’ has long been contributed to the phenomenon of delayed childbearing. For women who are not ready to conceive but wish to try to preserve fertility for the future, freezing their eggs in their late 20s and early 30s allows them to take advantage of the time when their eggs are at their healthiest.
Egg freezing – who is it for?
According to Dr Malini Uppal, egg freezing is broadly categorised into two groups: either as done for medical reasons or for social reasons. The first one refers to women who have been diagnosed with any medical condition or need treatment that can affect their fertility status. We also talk about medical reasons when there is a family history of early menopause – if there are women whose mothers, sisters or aunts have had early menopause, they should definitely consider egg freezing.
It may also happen that a woman, who is at her peak of fertility, is simply not ready for motherhood and she wants to pursue other things in her life. However, she still wants to have children in the future and is worried about her declining fertility – so in her case, egg freezing is a good option. Similarly, women working in armed forces and being at risk of injury can protect their fertility in such a way to be able to conceive later on in life. Finally, egg freezing is also a good solution for women who are planning gender reassignment. Before taking medications and going through necessary changes, they should consider freezing of their gametes.
Fertility Decline
Dr Uppal admits that there is an age-related drop in women’s fertility. Women are born with a finite number of eggs which they start using when they attain puberty. With the advancing age, this pot of eggs decreases and, as a result, fertility decreases as well. The chances of conception are significantly reduced once women attain their mid 30s – it is the time when an accelerated decline in female fertility is observed.
Another important thing that we have to understand is a higher risk of miscarriages associated with increasing age. Dr Uppal does not say it is impossible to get pregnant at the age of 35 or even 40 – however, it is much more difficult. Once a woman crosses a certain age, she is more likely to have miscarriages and less likely to give a birth to a healthy child. This is a solid fact that 90% of all early miscarriages are attributed to genetic abnormalities – and the risk of an ongoing pregnancy with a genetically abnormal embryo increases with age. Such pregnancies are usually terminated or result in the live birth of children with major disabilities. However, according to Dr. Uppal, the age-related increase in genetic abnormalities is not linear in nature. Rather, the rate increases sharply when women reach their mid-30s.
Delaying childbirth and its consequences
Today, one in five women has her first child after the age of 35 – which is an 8-fold increase compared to previous generations. More and more women delay childbirth to pursue career or education goals. Although this is entirely a woman’s choice and all women should have the right to do that, they should also be aware of the consequences of such decisions.
Dr Uppal says there is a misconception that many women take for granted – namely, they think that if they have delayed fertility, they can probably have IVF later on. However, it is not so simple and IVF at a later age is not always the solution. Assisted reproductive technologies do not address the issue of age-related drop in fertility effectively. In fact, the highest live birth rate per IVF cycle started (41.5%) is observed in women younger than 35 years old. Then it goes down as low as to 1% for women older than 44 years old. In their case, the only way to get pregnant successfully and give birth is through egg donation.
According to Dr Uppal, most non-infertility specialist physicians do not appreciate the extent of this fertility decline. The same goes for the general public or men and women who delay childbearing. That’s why it is so important to make people aware of the fact that an increased rate of infertility, miscarriages and genetic abnormalities during pregnancy as well as a reduced rate of live births through IVF treatment originate from one and the same problem: age-related drop in the quality of women’s eggs.
Modern dilemmas
Taking everything into account, one has to understand the difficult situation women find themselves in in the today’s world. Having all the possibilities at hand, they want to, first of all, focus on their careers and other self-fulfilling activities. What is even more important, they want to be financially independent and not to worry about their income, mortgages or financial resources while on maternity leave and during the first year of their child’s life. It is also true that they choose their life partners more consciously nowadays and often find the right person only in their mid-30s – or not at all.
All of the latter could be the reason modern women delay starting their families. From this perspective, freezing their eggs while they are young will give them more freedom to decide when to become a mother.
The change egg freezing brings about
Dr Uppal describes egg freezing as an IVF cycle with a pause. It means that a woman undergoes a controlled ovarian stimulation and egg collection procedure when she is young and likely to produce good quality eggs. Then the pause comes – and it means the time she needs to e.g. complete her education, develop her professional career or find the right person to start a family with. Then, when she is ready, she literally pushes the ‘PLAY’ button again. Her frozen eggs are thawed, they undergo fertilisation and the patient has the embryo transfer done. The latter may even be done when the patient is late into her 40s.
Dr Uppal says that the main benefit of the whole
egg freezing process is that eggs are suspended in time at the age they are frozen. So women who freeze their gametes in their early mid-thirties can effectively reduce the age-related risks. Then, when faced with difficulty in conceiving at a later age, they may opt to use their frozen eggs to give them the same chance of a live birth that they had at the point of egg freezing. In this way, a woman in her 40s may have the same chance of a live birth as she had when she had her eggs frozen. This literally translates into an approximate 10-fold improved chance of giving birth to a healthy baby.
The risks involved
Dr Uppal admits that the whole egg freezing revolution has happened after the invention of the new technique of freezing called vitrification. Vitrification is the process of the so-called ‘fast-freezing’ – it means that the water molecules don’t have time to form ice crystals, and instead solidify into a glass-like structure right away. Diminishing the risk of ice crystal formation helps to overcome meiosis spindle damage and does not interfere with the quality of eggs. This is a great improvement when compared to the previous method of gametes freezing called ‘slow freezing’. The latter carried with it a risk of cell loss of approximately 30%.
The other possible risk associated with egg freezing is ovarian hyperstimulation syndrome (OHSS), being an excessive response to the medicines responsible for stimulating the egg growth. Fortunately, it is overcome by using Antagonist short protocol and Agonist trigger which minimises the chances of hyper stimulation to less than 1%.
The message to spread
Dr Uppal says that every day she gets a patient who comes in for treatment and wishes that somebody had told her about the egg freezing option at the right time in the past. The truth is that such knowledge can save a lot of time, money and emotions invested into IVF treatment at a later age. That’s why it is so important to make women aware of the choice they have. The possibility of freezing one’s own eggs does not only allow them to preserve their fertility but also gives them invaluable peace of mind to take their time and do whatever they want in their life before deciding on motherhood. What is important is the whole process is neither bothersome nor very complex. The most important thing for a woman to do is to undergo fertility assessment or ovarian reserve assessment by age, AMH (Anti-Müllerian Hormone) blood test and ultrasound scans of the ovaries (AFC, antral follicle count). The assessment is followed by a consultation to discuss the results and plan the next steps.
When it comes to the best age for egg freezing, Dr Uppal suggests 35 years or less. It gives 50% chance of live birth and 60-85% chances with 10-15 frozen eggs. Of course, it has to be stressed that even egg freezing does not offer 100% guarantee of becoming a mother – as there are no guarantees in life. Nonetheless, it gives every woman a very good chance of having own biological children at the chosen time of her life. To support her claims, Dr Uppal recollects the survey of a cohort of women who chose to freeze their embryos for the purpose of
fertility preservation (Stoop et al., 2011) – according to its results, none of the women regretted having the procedure and 95.4% said that they would do it again.
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