Treatment options

Egg Freezing Process


To preserve your fertility through egg freezing, your ovaries must be stimulated with different medications to increase the number of follicles, but also with drugs that inhibit ovulation. Read about the journey!

Ovarian Stimulation

The preparation starts by administering FSH injections to stimulate your ovaries as much as possible, but at the same time keeping you safe. These injections are given either by yourself or by a friend. Don’t worry, nurses will explain them to you. Depending on your protocol, the administration starts around Day 2 of your cycle and it should finish around day 12-14 of your cycle.

This medication is hormone based so you might experience menstrual-like symptoms – tiredness, bloating, emotional swings and irritability.

Throughout the injection period you will be monitored with scans and blood tests. Once you are ready (when your follicles reach certain size), you will take a final injection called trigger to achieve oocyte maturation prior to collection.

Egg Retrieval

This is the day that you will have your eggs taken out!

On this day, you will arrive nil by mouth as the doctors will sedate you to retrieve the eggs. The retrieval is performed vaginally with ultrasound guidance. A needle travels from the vaginal canal towards the ovary and puncture every follicle to aspirate the follicular liquid. Soon after, this liquid is given to the embryologist who looks for the eggs under a microscope. This operation takes approximately 15-20 minutes.

When you wake up, you may feel pain similar to your period pain. You will have something to eat and drink and you will stay approximately 2 hours to recover from anaesthetics. Nurses can give you painkillers if needed.

Cryopreservation and Storage

Freezing your eggs happens on the same day they are collected. There are two ways of cryo preserving (freezing) eggs: Vitrification and Slow-Freezing. Make it clickable

The choice depends on the clinic where you will be doing your treatment.

At present, you are allowed to cryopreserve your eggs for 10 years in the UK. However, if you are about to start chemotherapy or under infertility diagnosis, the law allows you up to 55 years of storage.

Treatment Timeline

The timeline starts from Day 1 of your cycle. It is an approximate timeline for the stimulation period, the days of the scans and the eggs collection.



Process & Drug Protocols


For the past years, scientists, researchers and doctors have studied and developed two main type of drug protocols in order to retrieve eggs safely – The Agonist and The Antagonist protocol.

[To better understand this topic, we recommend that you read the section of Understanding Female Hormones]

  • Agonist Protocol

    The idea is to mimic what happens naturally – hormone release.

    In this protocol,the woman is given a medication in the form of daily nasal spray or injection to shut down the natural system. Women become down-regulated within an average of 2-3 weeks of receiving the medication, means that the messages between the brain and the ovaries are switched-off.

    Usually, you start with this protocol on your day 21 of the cycle prior to menstruation phase. This medication cause symptom similar to menopause – headaches, hot flashes and dryness.

  • Antagonist Protocol

    The idea is to prevent egg maturation and the ovulation as a result until the time wanted!

    This effect is instantaneous. You only start the antagonist injections around day 6 of your cycle, followed by FSH injections for stimulation.

    One of the advantages of this protocol is the absence of menopause-like symptoms. Another one, since your LH production continues, there is a possibility of getting better follicles and consequently better quality of oocytes (eggs). Additionally, you only need an average of 7 days of antagonist injections

    On the other hand, the unavailability of the spray form and the existence of the injectable one only is considered as a disadvantage of this protocol. Additionally, this drug may cause local reaction in the form of rash and redness. This reaction should disappear after 24 hours of the injection. Due to the patient-friendly symptoms and the decreased risk of OHSS (read OHSS)Make it clickable, Antagonist protocol is preferred by the majority of doctors.

It is important to mention that both protocols have identical pregnancy rates.

Process of Using Frozen Eggs


The quality of eggs is correlated with the age of the eggs. Hence, the donors’ eggs are normally young and healthy to increase the chances of having a live birth. If you decide to freeze your eggs, you will act as your own donor in the future. The earlier you prepare for it, the better chance of success you will have.

Once you are ready to use your frozen eggs, your body should be prepared to receive the embryo, exactly as in any natural conception.

There are two ways to prepare the uterus – either by using your natural cycle (if you have regular cycles) or by a medicated cycle. Regardless the method, the womb lining must be above 7mm – this will be checked with frequent scans – before having the embryo transferred.

The Natural Cycle Approach:

When your menstrual period starts, you will have a scan between Day 2-4 to make sure that everything is clear. Another scan should be performed around Day 9-10 of the cycle, depending on your cycle length. If needed, you will have a third scan around Day 12-14 until your leading follicle is above 16mm and your endometrial lining above 7mm. At this time, a trigger injection is given as a single shot to induce ovulation. Two days after, you commence progesterone supplements. The transfer will happen 3 to 7 days after the trigger injection depending on the embryo development.

The Medicated Cycle Approach:

First, you start nasal spray or subcutaneous injections on Day 21 of the previous cycle or Day 1 of the current cycle.

Once you bleed, you remain on the downregulation medication (read Understanding your Menstrual Cycle).

Then, you will have a scan between day 2-4 to make sure that everything is clear. If all is well suppressed, you will start oestrogen tablets to increase the endometrial thickness. You will have another scan 10-12 days after the first tablet. If needed, you will have a third scan until your endometrial lining above 7mm.

When you are ready, you stop the down regulation drugs and you switch to the progesterone supplements together with the estrogen tablets. The transfer will happen 3-6 days after commencing progesterone depending on the embryo development. While you are getting the womb ready, embryologists will thaw the eggs and perform a technique called intracytoplasmic sperm injection (ICSI). As the name implies, they need to inject one sperm inside one mature egg. Once this is done, you will have embryos and you can have them transferred back to you. Your doctor and embryologist will decide which day is the best for the transfer of the embryos, according to their development. The transfer will happen 3 to 7 days after depending on the protocol and embryo development.

Success rate

The Human Fertilisation and Embryology Authority (HFEA) has documented the Egg Freezing trends and figures for 6 years - between 2010 and 2016, being this compilation the latest available. During the year of 2016, 1173 egg-freezing cycles were performed in the UK. Although it seems a low figure, there was a 10% increase just in one year (from 2015 to 2016) and the trend continues to increase. According to the HFEA, 471 cycles have resulted in a baby being born since 2010 in the UK. Numbers are still low because many women (who have cryopreserved their eggs) have not used them yet. Therefore, it is difficult to obtain more outcomes (HFEA, 2018).

In 2016, and in the UK only, 19% of the eggs thawed resulted in a lives birth. If this rate is compared with IVF rate using fresh eggs, it only varies by 2% which is higher in case of IVF birth rates (around 21%) (HFEA, 2018). It is worth noting that this is an overall conclusion and not specific for an age group.

Since the 90´s, studies have been performed worldwide to compare the abnormalities rate for babies born of cryopreserved oocytes with those of the spontaneous pregnancy. They concluded that there is no difference in between (Noyes, Porcu & Borini, 2009).

Source: Noyes, N., Porcu, E. & Borini, A. (2009) Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anormalities. Reproductive BioMedicine Online. 18 (6), 769-776.

HFEA (2018) Fertility treatment 2014-2016 Trends and Figures. Human Fertilisation Embryology Authority. Available at: www.hfea.gov.uk

Embryo Freezing Process

Embryo Freezing process is quite similar to Egg Freezing in terms of length and medication. However, instead of freezing the female gametes, the eggs will be fertilized with sperm, prior to the cryopreservation. This can be an option if you have already a partner, but you have not decided yet on the time of having a baby. Also, if you are single and willing to create embryos with donor’s sperm.

The process is very similar to Egg freezing.

Ovarian Stimulation

The preparation starts by administering FSH injections to stimulate your ovaries as much as possible, but at the same time keeping you safe. These injections are given either by yourself or by a friend. Don’t worry, nurses will explain them to you. Depending on your protocol, the administration starts around Day 2 of your cycle and it should finish around day 12-14 of your cycle.

This medication is hormone based so you might experience menstrual-like symptoms – tiredness, bloating, emotional swings and irritability.

Throughout the injection period you will be monitored with scans and blood tests. Once you are ready (when your follicles reach certain size), you will take a final injection called trigger to achieve oocyte maturation prior to collection.

Egg Retrieval

This is the day that you will have your eggs taken out!

On this day, you will arrive nil by mouth as the doctors will sedate you to retrieve the eggs. The retrieval is performed vaginally with ultrasound guidance. A needle travels from the vaginal canal towards the ovary and puncture every follicle to aspirate the follicular liquid. Soon after, this liquid is given to the embryologist who looks for the eggs under a microscope. This operation takes approximately 15-20 minutes.

When you wake up, you may feel pain similar to your period pain. You will have something to eat and drink and you will stay approximately 2 hours to recover from anaesthetics. Nurses can give you painkillers if needed.

Fertilization

When your eggs are collected, you need to have them fertilised with sperms on the same day. Either you have a partner and he is required to give semen sample, or you will have a donor’s sperm sample which previously purchased. The fertilization process can happen through IVF (In vitro fertilization), or by ICSI (intracytoplasmic sperm injection) -as the name implies, they need to inject one sperm inside one mature egg-. The method chosen depends on the sperm sample quality or egg quality on that day.

Cryopreservation and Storage

You can have your embryos stored in different stages – Day 1, Day 2, Day 3 or Day 5 (Blastocyst stage). The later, the better as you will have more information about their quality.

Similarly to the eggs, embryos are frozen in a proper media to prevent ice crystals formation that can destroy their cells. After, they will be transferred to a tank filled with liquid nitrogen.

At present, you are allowed to cryopreserve your embryos for 10 years in the UK. However, if you are about to start chemotherapy or under infertility diagnosis, the law allows you a duration of up to 55 years of storage.

Note: The embryology team will only freeze top quality embryos to guarantee a better probability of surviving the thaw in the future.

Treatment Timeline

The timeline is the same as in Egg Freezing Process Timeline.

Protocols

The Protocols are the same as the ones used in Egg Freezing Process.

Process of Using Frozen Embryos

When you are ready, embryos will be thawed. Once this is done, your doctor and embryologist will decide on the day which is better for you to have them transferred, according to embryo development.

Similarly to the usage of frozen eggs, you also should have your womb lining ready to receive the embryo. There are two ways to prepare the uterus – either by using your natural cycle (if you have regular cycles) or by a medicated cycle Make it clickable. Regardless the method, the womb lining must be above 7mm – this will be checked with frequent scans.

Ovarian Tissue cryopreservation process


Comparing with established treatment options such as oocyte and embryo freezing, Ovarian Tissue Cryopreservation is considered experimental. However, it is already legal and being used in Germany.

This treatment option is performed with laparoscopic surgery to remove the ovaries or part of its tissue. Laparoscopic technique is done with a robotic equipment that passes through your tummy via small incisions. It has a camera in one of the arms to guide the doctor that will be doing the procedure.

There are important points to consider:
  • The possibility of fertility loss according to the medical condition;
  • Patient autonomy;
  • Decision-making process and information given;
  • Costs for the patient, family and healthcare sector;
  • Fertility reserve diagnosis;
  • Medical status;
  • The possibility of freezing and transplanting malignant cells in the ovaries;
  • Counselling.


In the future and when you are ready to use the ovarian tissue, either it can be inserted in the body through a transplant-like surgery to conceive naturally, or to develop it in vitro and then used by IVF.

Costs


The costs of the procedure should include the cost of diagnosis, the scans, and the blood tests during the cycle, the surgery, and the freezing.

Across UK, costs are similar among private clinics who offer this treatment.

On average:

Initial Consultation £180 - £230
Follow/up Consultation £120 - £150
Blood Tests for LH, FSH, Estrogen £120 - £150
Blood test for AMH £80 - £100
Ultrasound Scan for diagnosis £150 - £170
Sperm Analysis £100 - £150*
Hysterosalpingogram (HSG) £450 - £600
Screening Blood tests (HIV, Hep C & Hep B Ag/core) £130 - £150
Full Blood Count £35 - £50
Egg Freezing Cycle (including scans needed) £3500 - £3700
Package of 3* Egg Freezing cycles £8500 - £9500
Embryo Freezing Cycle (including scans needed) £3500 - £6500
Egg/Embryo Freezing Blood Tests £150 - £600
Cryopreservation Fee/year £250 - £400
Medication (varies according to protocol) £700 - £1500
HFEA fee £80

*If you require donor sperm, the costs vary by company where you purchased, the storage and the number of vials.

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