THE NEW ICE AGE

7 things every woman should know before freezing her eggs

 As women age, the likelihood of chromosomal abnormalities climbs, and with it, the risk of miscarriage, birth defects or disorders that makes conceiving more difficult. Egg freezing is seen by some as a way to stop the biological clock, expand reproductive options and preserve the younger, possibly healthier eggs. And for many women looking to extend their childbearing years, it has become an increasingly attractive option.

What does egg freezing mean, exactly?

The process of egg-freezing, or in medical speak, oocyte cryopreservation, involves stimulating the ovaries with hormones to produce multiple eggs, retrieving the eggs from the ovaries and taking them to the lab, where they’re cooled to subzero temperatures to be thawed at a later date.

Why might a woman opt to freeze?

Reasons vary. Some women choose to freeze their eggs for medical reasons. Cancer treatment, for example, can be toxic to the ovaries and cause premature menopause.

But it’s not all medical. About three-quarters of the women who freeze their eggs do so because they don’t have a partner.

The primary reason given by women is that they are not in a relationship conducive to childbearing. The second reason is women have something they need to get done before children, and it is usually related to their career.

Indeed, among the first wave of egg freezers – those who froze their eggs from 2005 to 2011 – more than 80 percent had no partner, said Sarah Elizabeth Richards, author of the book, “Motherhood Rescheduled: The New Frontier of Egg Freezing.”

But the “why” is shifting, Richards said. Women are increasingly deferring childbearing in order to focus on demanding careers, and the age has dropped.

“The average age at which a woman freezes her eggs is now 36,” she said, down from 38. “Now, we’re seeing women freeze their eggs younger and younger, and the public narrative around it is changing. Women are doing it for work now, which is very different from the first wave of freezers.”

Dr Jaideep Malhotra, President, Indian Society for Assisted Reproduction cautions, “Various factors have to be kept in mind before egg freezing. It should not be an alternative to natural fertility. Also, when conception occurs, all the problems associated with preganancy in older women would still be there. Another important social factor is the child. If conceived at advanced age, would the parents be able to give the child the same energy, devotion and time a younger parent could?”

How invasive is the procedure, and how risky?

The process of retrieving eggs is identical to the first phase of in vitro fertilization, or IVF.

The procedure goes like this: The woman receives a round of hormone injections that stimulate the ovaries to produce multiple eggs. This stage involves frequent visits to the fertility clinic, about five in 10 days, while the ovaries are regularly monitored by vaginal ultrasound. After roughly a week or two of hormone treatments, the eggs are retrieved.

The egg retrieval process takes about 10 minutes and is done under mild anesthesia or sedation. Using an ultrasound, the doctor guides a needle through the vagina to the ovarian follicle containing the egg. A suction device at the end of the needle removes the eggs from the follicles.

Retrieving the eggs is technically not that different from getting blood drawn. A needle goes into the ovary and the eggs get gently aspirated out.

While the surgical procedure is mostly safe, the hormone shots do carry a risk of ovarian hyperstimulation syndrome, or OHSS, which makes some women ill. That occurs when a woman responds too aggressively to the hormones and the ovaries become swollen and painful. It can be accompanied by nausea, vomiting and abdominal pain. When hyperstimulated, the ovaries produce a lot of fluid, which has to be drained from the abdomen with a needle. OHSS tends to happen in younger women in their 20s and 30s, and occurs in less than 5 percent of patients. But in severe cases, OHSS increases the risk of kidney failure and blood clots and in very rare instances, can be fatal.

How will my body react to the hormone shots?

You feel more bloated than you do after overeating. The hormones make the ovaries swell a little bit, because they have to create space to accommodate the multiple expanding follicles, each containing a maturing egg.

What are my chances of having a baby later if I freeze my eggs now?

The chance that a single frozen egg will lead to a live birth is about 2 to 12 percent, according to the American Society for Reproductive Medicine. That’s why doctors often recommend having a couple dozen eggs frozen to maximize success.

Success is based on a number of factors, from a woman’s age to the quality of her partner’s sperm. According to one study published in the journal Fertility Sterility, a 30 year-old woman with two to six thawed eggs had a 9 to 24 percent chance of one of those eggs progressing to a live birth, depending on the method of freezing. At age 40, that number dropped to between 5 to 13 percent.

Is a 35-year-old egg that’s been frozen really healthier than a 40-year-old egg that’s been freshly harvested?

It may be hard to believe that an egg removed from its natural state and frozen for years could more readily lead to a baby than a slightly older egg that’s remained inside your body. The most important thing for eggs is time. The younger the egg, the healthier it is.

But freezing the eggs can cause some damage. Once fertilized, the egg becomes an embryo. Doctors often follow embryo development for about five days in the incubator looking for “blastocyst” formation at the end of this time period. The blastocyst is comprised of two parts; an outer layer, known as the trophectoderm, which is destined to become the placenta and an internal cellular ball called the inner cell mass, which ultimately forms the embryo. Fewer frozen eggs make it the blastocyst stage. But, the eggs that do seem just as good as fresh eggs.

But there have been no studies yet on how long eggs can be frozen and survive the thawing process. The expectation is they should be fine, but has anyone frozen an egg for 20 years and used it? When to freeze is a matter of opinion; many doctors see 34 as a good age to freeze eggs, though some recommend younger.

Women definitely feel empowered by the experience. They come in scared of not having a baby and they leave with their eggs in the bank. They feel like they have a much higher chance of having a baby later.

Is this an elitist thing? How much does it cost?

“The cost varies from clinic to clinic and case to case, but, on an average the cost should be about Rs 40,000 for egg retrieval and Rs 25,000 or so per year as maintenence charges, says Dr Jaideep Malhotra.

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