Whether you wish to preserve your eggs for later use or require donor eggs, cryopreservation has helped broaden the spectrum of fertility treatment.
At Arizona Associates for Reproductive Health, we offer egg freezing to help patients build their family when they are ready.
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The Start of Egg Freezing
Cryopreservation is not something new in the world of Assisted Reproductive Technologies (ART). Medical clinics have been freezing sperm since the 1950s and embryos since the 1980s. While sperm and embryo cryopreservation have become routine, egg freezing has presented greater challenges and is a relatively new technology. The first baby born from frozen eggs occurred in 1986.
Challenges with Egg Freezing
The egg freezing process can trigger premature hardening of the zona pellucida which surrounds the egg. Normally zona hardening occurs after the sperm penetrates the egg, thus protecting it from being penetrated by other sperm. Fortunately, hardening of the zona can be overcome with the use of Intracytoplasmic Sperm Injection (ICSI), a routine procedure already proven successful for many years in treating male infertility.
The high water content of eggs has also presented challenges since it increases the risk of cellular damage during the freeze-thaw egg cryopreservation process. Additionally, eggs are at a sensitive stage of the meiotic cell division cycle. The egg chromosomes are aligned within a fragile structure known as the spindle apparatus. These inherent difficulties have limited the success of egg freezing in the past. Recent studies over the last 5 years have reported improved results with adjustments in freezing protocols. In particular, extremely rapid cooling rates with a technique known as vitrification appear to minimize chromosomal damage and the formation of intracellular ice. Many fertility programs throughout the world have recently demonstrated good success with freezing and thawing of eggs with live births using egg vitrification technology. There have now been approximately 1,600 babies born worldwide from frozen eggs.
Cryopreserving Embryos and Sperm
Arizona Associates for Reproductive Health ((AZARH)) doctors and embryologists have been involved in research to develop successful techniques for IVF embryo freezing and sperm freezing for many years. More recent research with an egg freezing process known as vitrification has allowed (AZARH) to offer egg freezing under IRB oversight for patients who may be reluctant to freeze embryos. Egg freezing may be used by women who wish to delay childbearing for different reasons. Three groups of patients can benefit from egg freezing:
- Before cancer treatment. Treatments for cancer such as chemotherapy and radiation may damage eggs and result in sterility or infertility. Freezing embryos remains the most successful approach, but is not possible for women who do not have a partner or do not wish to use donor sperm. Depending on the cancer diagnosis and recommendations from a woman’s oncologist, she may elect to freeze eggs before undergoing cancer treatment in order to preserve her fertility. In some cases, viable eggs may be present after cancer treatment. Fertility preserving options vary depending on age, type of cancer, and cancer-treatment plan. At your consultation, your physician will review your medical history and will outline your evaluation and treatment.
Physician Consultation and Treatment Cycle Overview
- We set up an appointment for you to meet with a physician to discuss your treatment options.
- At the appointment your medical history and treatment plan is reviewed. The amount of time you have available prior to starting your oncology treatments is clarified, and appropriate options are discussed.
- We help you decide between freezing eggs and embryos, or advise you on whether your oncology treatment is benign enough not to require Fertility Preservation.
- Your insurance is checked to see if you have any coverage. If you do not have coverage, you may be a candidate for the Sharing Hope program and an application can be completed.
- We then schedule an appointment with an IVF nurse for consultation and injection training. A start date for stimulation medications is decided based on the amount of time available prior to start of your oncology treatment and anticipated start of the menstrual cycle. The timeframe to complete the stimulation cycle and egg retrieval is usually about 3 weeks.
- To begin treatment an ultrasound is performed to look at the ovaries and uterus. All the ultrasounds are done vaginally.
- The injections are typically administered daily. You will be scheduled to have an ultrasound 3 to 5 days after the injections begin.
- Ultrasounds are done every 2 to 3 days based on follicular development.
- Egg retrieval typically happens 10 to 12 days after stimulation begins.
- The egg retrieval is done in our office under anesthesia. You are required to have someone take you home and we recommend that they stay with you for several hours after the procedure.
Women wishing to electively preserve their fertility
In today’s society, many women want to delay child bearing until they are older. Egg freezing provides fertility options for women who choose to delay pregnancy for either medical or elective reasons. Fertility decreases with age, slowly declining until age 30, then declining more quickly thereafter. By age 40, the chances of spontaneous pregnancy are less than 50% of what they were at age 30, and other risks such as miscarriage and Down’s syndrome are significantly higher. With the recent improvements in egg freezing technology, we can now offer women the option of freezing and storing their eggs at a younger age, allowing a woman to choose when she is ready for a family. Find out if freezing your eggs is a good option for you at AZARH.
Women undergoing IVF who do not wish to freeze embryos
In traditional IVF attempts, extra embryos are frozen for future use. However, some patients have ethical or religious concerns with creating extra embryos and making decisions about disposition once hey have completed their families. For some, freezing eggs for IVF before they are fertilized may be a better option.
Women needing donor eggs
Donor egg banks are now a reality. Similar to large sperm banks, the advantage to donor recipients is a much larger selection of potential donors than would otherwise be possible. After freezing, donor eggs may be quarantined until repeat infectious disease testing can be completed, similar to donor sperm banking. Frozen donor eggs also eliminate the need to synchronize the donor’s and recipient’s menstrual cycles for treatment purposes.
Expanding Knowledge in Egg Freezing
While fertility specialists share much optimism that egg freezing provides options for groups of women who might otherwise have few or none, many in the scientific community still consider egg freezing to be experimental and consequently the process should be carefully considered. The American Society for Reproductive Medicine (ASRM) advises clinics to perform egg freezing under Institutional Review Board (IRB) approval and ongoing oversight. ASRM will continue to consider egg freezing experimental until published studies regarding egg freezing risks, benefits and overall safety and efficacy are sufficient to regard the procedures as established medical practice.
Most assisted reproductive technologies are no longer considered experimental. The American Society for Reproductive Medicine (ASRM), which has more than 10,000 fertility specialists worldwide, considers the following procedures to be established medical care:
- Donor oocytes
- Embryo cryopreservation
- ICSI for male infertility
- Assisted Hatching
- Preimplantation Genetic Diagnosis
Arizona Associates for Reproductive Health ((AZARH)) fully complies with the ASRM recommendation to provide egg freezing services under IRB review. (AZARH) only offers egg freezing after carefully reviewing IRB consents for egg freezing with each patient. The goal is for each patient to fully understand the possible risks, benefits and current success rates with egg freezing before deciding to pursue this treatment option. Providing egg freezing under the observant eye of an IRB helps ensure the freezing and storage of eggs is done using techniques that provide your best chance for success as well as long term safety of your eggs in storage. There are currently egg freezing programs that operate with no IRB approval or oversight. Ask any program you may be considering if they provide egg freezing under an ongoing, approved IRB certificate. If you're wondering if you're a good candidate for the egg freezing process, try out our Gen-F Plan which is specifically designed for women who want to explore their fertility options.
Your Chances for Success with Egg Freezing
Three of the most important factors in determining your chances for potential success with egg freezing are your serum FSH, baseline follicle count of your ovaries and ovarian reserve testing. These studies are used to gain an understanding of the ability of your ovaries to produce healthy eggs that will allow for successful freezing, thawing, fertilization and embryo development. These are vital steps to establish a successful pregnancy. Due to the natural egg aging process, it is more ideal to freeze eggs in women who are younger than 38 years old. To date, there have been few ongoing pregnancies reported in women over 38 from frozen eggs. This is mostly due to lower age cutoffs in egg freezing studies. Pregnancies are routinely achieved in women up to age 43 using fresh embryos. We may find with further egg freezing research that we are able to mimic these fresh rates.
Please contact our office to schedule a pre-consultation evaluation of your Follicle Stimulating Hormone (FSH) and estradiol levels. These tests should be scheduled for the third day of your menstrual bleeding prior to your initial consultation with the doctor.At your consultation, your physician will review your medical history and will outline your evaluation and treatment. Based on your ovarian reserve, which is determined by your internal reproductive hormones, a stimulation protocol will be formulated by your physician.
Group 1 – Best Chances for Success
- Under age 32 years
- A serum FSH less than 7.1 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, no prior exposure to chemo or radiation therapy.
Group 2 – Good Chances for Success
- Ages 33-35 years
- Serum FSH less than 8.1 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries.
Group 3 – Moderate Chances for Success
- Ages 35-37 years
- Serum FSH between 7.1 and 9.0 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries.
Group 4 – Lower Chance for Success
- Ages 38 to 39 years
- Serum FSH between 5.0 and 8.5 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, no more than short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries.
Group 5 – Lowest Chance for Success
- Ages 40 to 42 years
- Serum FSH greater than 10.0 mIU/ml on cycle day 3. Satisfactory ovarian reserve testing. If being treated for cancer, no more than short term, limited exposure to radiation or chemotherapy with no direct radiation of ovaries.
Group 6 – Minimal to no Chance for Success – Not eligible for egg freezing at (AZARH)
- Over 42 years of age or any woman with unsatisfactory ovarian reserve testing outcomes.
- Serum FSH levels greater than 10.0 mIU/ml on cycle day 3 If being treated for cancer, extended chemotherapy or direct radiation of the ovaries. (AZARH) has elected to not offer egg freezing to women over age 42 or those with poor ovarian reserve testing because of minimal chance of success for women in this category.
The Egg Freezing Process
The process for egg freezing is similar to a traditional IVF cycle and typically takes 3 to 6 weeks. Egg freezing uses standard protocols to stimulate egg production and retrieve the eggs. A woman usually takes birth control pills followed by hormone medications to stimulate the ovaries to produce multiple eggs. The eggs are retrieved and the mature eggs are frozen that same day. The eggs are stored in liquid nitrogen at temperatures where there is no cellular activity and, therefore, are not impacted by length of storage. The number of eggs produced and the percentage of mature eggs recovered is variable from person to person.
Once a woman is ready to conceive, an (AZARH) physician will coordinate with your oncologist to ensure you are healthy, able to use fertility medications, and ready to carry a pregnancy. Some patients may be unable or advised not to carry a pregnancy following cancer treatment. (AZARH) offers treatment using a gestational carrier (a woman who will carry the pregnancy for you). With approval from your oncologist, (AZARH) will allow transfer of embryos to women up to the age of 50. Patients starting a treatment cycle will begin taking medicine to prepare the uterus for pregnancy. The eggs are thawed and fertilized and then cultured for 3 to 5 days before embryo transfer. Extra embryos can be stored at (AZARH).
To learn more about egg, embryo, and sperm freezing, contact (AZARH) today.