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Guide on fertility preservation for younger women

Belén Marqueta, MD
Gynecologist, Specialist in Human Reproduction at Clínica Eugin, Eugin Clinic

Egg Freezing, Fertility Assessment

From this video you will find out:
  • What are the things to consider when freezing an egg?
  • From what age does the ovarian reserve start to decrease?
  • How does oocyte vitrification work?
  • How many eggs is it recommend freezing?
  • What women decide to vitrify their oocytes?
  • Who returns to try to get pregnant with their vitrified oocytes?

Guide on fertility preservation for younger women

How can a woman preserve fertility?

In this session, Dr Belén Marqueta, Gynaecologist, Specialist in Human Reproduction at Clínica Eugin, Barcelona, has been talking about the egg freezing process, when it is recommended and how to start.

How can a woman preserve fertility? - Questions and Answers

I’m 33, and I have a partner. I’m afraid of being late, but we also don’t want to take too long to try to have a child. Is there a maximum or minimum time limit for using the eggs once they are frozen?

No, there’s no maximum or minimum time to use those eggs.  This treatment gives women the freedom to postpone their maternity. They can wait until the moment they feel ready. Regarding your age, I don’t think you’re late as you are under 35 years old, so I think that you’re in a perfect moment to start thinking about performing elective oocyte cryopreservation.

If I want to freeze my eggs, how many eggs do I need to freeze? Is there a difference if someone is 35 versus 41?

There is a big difference. In fact, during the presentation, I have shown a graphic, the number of eggs that we have to freeze depends on your age because the younger the patient is, the lowest the number of eggs is needed to have one baby at home. There is going to be a decrease in the quantity, but also the quality of the eggs. We need to freeze more eggs if we are older to compensate for the lack of quality that we are going to have because of maternal age.

Is egg freezing covered by insurance, for example, in Spain? There are some countries where egg freezing is still not possible. What are the advantages of doing it in Spain?

Social cryopreservation is not covered by insurance here in Spain. This is because, in the end, it’s an option for women to do this treatment, so it’s not covered nowadays by our national insurance. Regarding the advantages of performing this here in Spain, we have lots of experience in IVF treatments and fertility cryopreservation treatments, just because we have been performing these treatments for a long now.

I think that we have lots of experience, and we have many clinics,  such as our clinic where we are used to treating patients that live in other countries, and we know we can make it easier for the patient to perform such treatment in their countries so that they can come here only for ovarian puncture or just a part of the treatment.

What stimulation technique is used for egg freezing?

We always use antagonist treatment, and we always induct the ovulation with Decapeptyl just to avoid the risk of hyperstimulation. We perform the follicular puncture in the operation room, and we cryopreserve the embryos, well the embryologist cryopreserve the embryos here in our laboratory in Barcelona.

Do you see that there is an increase of interest when it comes to egg freezing during the last year because of the COVID-19 pandemic?

Yes, absolutely. There has been an increase, and more and more patients want to perform this treatment and also, as we explained, they are younger, so we are really happy about that because the prognosis is going to be better. Also, during this last year of pandemic, I think that many women had more time to think about their own issues, and we have had an increase of patients that want to do egg freezing treatment with us.

What is the upper age limit for freezing your eggs? I am 45, and I already have a few eggs frozen at Eugin, but I want to increase my chances.

We have an internal limit for that, and it’s 47 years, but we have to assess every patient individually, we cannot generalize. Every patient has a different ovarian reserve. We have to perform a complete study of the patient.

We have to perform the ultrasound, blood test just to assess if it’s going to be worth it or not to cryopreserve the eggs. Usually, in patients 42-44 years old,  we know that the egg quality is not going to be good, so we don’t recommend performing these treatments. 

My AMH is about 3.6, the same as it was when I was 42. Is it still worth it?

It’s not just the quantity of the eggs that matters, and quantity can be evaluated with the Anti-Mullerian hormone with the antral follicle count. What is also important is the quality of the eggs, and, unfortunately, we don’t have any markers to assess the quality of eggs, but we know that age is going to have a high impact on the egg quality. Even if we have a good ovarian reserve, the quality of these eggs may not be so good. This can lead to implantation failures if we create and transfer embryos or miscarriages during the first semester.

Do you also have patients who decide to freeze eggs because they are trying to conceive, and it’s been unsuccessful for some time? I have a partner, so is it better to simply freeze embryos rather than eggs?

There is a legal part that we have to take into account here. If we freeze eggs, these eggs are ours, they will be the women’s eggs. On the other hand, if we freeze embryos with a partner, these embryos are from these two people, so in the end, it’s not the same from a legal point of view. If you want to use your eggs, you can use them whenever you want, you don’t have to ask for permission, but if you want to use the embryos that you have frozen with a partner, you have to know that both of you have to sign the consent form for performing a treatment. In the end, they are not just yours anymore.

We can’t forget that embryos are more advanced cells than eggs, so the survival rate of the thawing process and the manipulation of the embryos will have a better response in our laboratory than the eggs. We have patients that do so many treatments. Some patients want to freeze eggs and embryos with a partner, but they also freeze some eggs because they have such good ovarian response that they have good numbers for performing both treatments.

Some patients freeze embryos because they have a partner, and they want to have a child with this partner, and they go ahead with freezing the embryos. On the other hand, we have patients that are just waiting to see if they can have a baby with their partner or not.  At that moment, they freeze the eggs, and they keep trying, or they talk to their partners and make some plans.  

Is there a long waiting time for egg donors? Do you do some matching between the biological mother and the one having the child?

We have a really good egg donation program here in our clinic in Barcelona, and we have many donors. We do the match between the biological mother and the recipient, we always perform a physical matching. We have a matching team that specializes in performing physical matching between the donor and the recipient. We can also add a genetic matching if the patient decides to do it. This genetic matching is for some recessive genetic disease, and we can add it to the treatment to avoid having a child affected by one recessive disease.

Have you had any results post thawing via PGS?

I’m sure that we do have some results after the PGS. I don’t have the numbers at this point, and we don’t always advise our patients to do the PGS. We advise them depending on their age or their medical history, but we don’t do that treatment in every case. 

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Belén Marqueta, MD

Belén Marqueta, MD

Belén Marqueta has been part of Eugin's medical team for two years. She has 10 years of experience as a gynaecologist and specialist in assisted reproduction. In 2011, she finished her medical degree at the Universitat Autònoma of Barcelona, studying for a year in Italy, at the Università of Padova. Four years later she completed a master's degree in Assisted Human Reproduction at the Univesidad Complutense of Madrid.
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Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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