WHY FREEZING YOUR EGGS NOW?


In the latest years, women have shown a remarkable interest about preserving their eggs for future use. Any fertility treatment can only empower you if you are allowed to make your own choices. The egg cryopreservation particularly allows you to focus for a bit longer on your career, your education and your preferable time for motherhood.

Despite your preference desire – conceive naturally with a partner, conceive later with donor sperm through artificial insemination, or use IVF treatments with frozen eggs… – women are always happy to be given a choice and a plan which they can control.

FREQUENTLY ASKED QUESTIONS



IN WHICH PART OF THE CYCLE THE TREATMENT SHOULD BE PERFORMED?


You commence the treatment when your period begins. In order to collect eggs, the injections should be administered during the first 14 days of the cycle to stimulate your ovaries. In this case, you will be developing a higher number of follicles instead of one leading follicle. Ideally you want to collect as many oocytes (eggs) as possible.

WHEN ARE THE EGGS COLLECTED?


The eggs are collected around day 14 of your cycle to mimic the natural ovulation. This is done through an operation where you will be asleep (in some clinics it can be done under local anaesthetic). The collected eggs will be frozen to use them once they are needed – when you are ready! Afterwards, your next menstrual period will start around the same day according to your cycle length.

HOW ARE THE EGGS FROZEN?


There are two ways of cryo preserving (freezing) eggs: Vitrification and Slow-Freezing. Let us explaining to you in more detail:

  • Slow-Freezing: In order to protect the eggs from the low temperatures, cryoprotectants are used to inhibit crystals formation and toxicity. The costs are high and the length of this method is long because the eggs should rest in a solution for more than 30 minutes before achieving low temperatures.

  • Vitrification: This method uses cryoprotectants too, but in higher amounts. Nevertheless, it is less expensive and it can be done much quicker. Vitrification occurs in a specific solution where the eggs only rest in for 50-60 seconds at room temperature before they shrink and are stored in the tank.

The choice between the two processes depends on the clinic where you will be doing your treatment. Make sure this is explained to you!

HOW DO YOU ENSURE THAT MY OVARIES ARE SAFE DURING THE TREATMENT?


During treatment, you will have LH, FSH and oestrogen checked regularly to monitor your ovaries response to the drugs. Also, you will have ultrasound scans performed regularly for the same reason. Accordingly, healthcare professionals will make sure that your treatment is under control and OHSS is prevented (read OHSS condition below).Make it clickable

Note: The scan is performed with a vaginal probe and it takes about 5 to 10 minutes to count the follicles and to measure their sizes. On average, you will have 3-4 scans during the approximate 12-14 days stimulation period.

WHAT HAPPENS WHEN I DECIDE TO USE THE EGGS?


Once you are ready to use your eggs – either you are in the right moment, you met your future partner, you feel like your biological clock is alarming or simply because you want to do it on your own, you need to thaw the eggs and fertilized them with sperm.

The thawing process usually takes minutes and on average you need at least 8-15 eggs to be fertilised at once to guarantee a viable embryo and to increase your chances for potential pregnancy. Chances of success may depend on various reasons but most importantly, it will depend on the egg age at the freezing day. It is important to be aware that some eggs might not survive the thawing process, hence, it is recommended that you freeze an average of 20-30 eggs. This is mainly the reason why we consider egg freezing as a potential fertility insurance. Although it is not guaranteed, it is the best you can have if you want to safely delay your potential biological motherhood.

Simon, C. & Gardner, D. (2017) Handbook of in vitro fertilization. [CRC Press Book]. 4th ed., Taylor and Francis group.

HOW DO YOU FERTILISE MY EGGS?


Following the thaw, you need to have the eggs fertilized. This is usually done by the embryologist through a technique called intracytoplasmic sperm injection (ICSI). As the name implies, they need to inject one sperm inside one mature egg. Unfortunately, they cannot be fertilized on their own. Through this technique, there is a small risk of damaging the egg.

HOW ARE THE EGGS TRANSFERRED TO ME?


After the fertilization, the egg and the sperm together are forming an embryo. An embryo can be transferred back into your body few days following the fertilization. The day of fertilization is considered Day 0 and then the count starts as Day 1, Day 2 and so on.

Your doctor and embryologist will decide the best day of embryo transfer following the fertilization according to the embryo development.

HOW SHOULD MY BODY BE PREPARED TO RECEIVE THE EMBRYO WHEN I AM READY?


You are right! Your body needs to be ready to receive the embryo. There are two ways to prepare the uterus – either using your natural cycle (if you have regular cycles) or using a medicated cycle.

Note: The endometrial thickness must be above 7mm before the transfer of the embryo – this will be checked with frequent scans.

  • Natural cycle – When your menstrual period starts, you will have a scan between Day 2-4 to make sure that everything is clear. Then, you will have another scan 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.

  • Medicated cycle – In this case, you need to switch your hormones off prior to your menstrual period. 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).Make it clickable 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.

WHAT IS OHSS?


This medical term means Ovarian hyperstimulation syndrome. This is a serious complication that can happen following stimulation because your ovaries become swollen and painful. The good news is that, nowadays this condition is uncommon due to the protocols improvement, new drugs generation and close monitoring. It was proved that by using antagonist protocols Make it clickable, reducing medication intake or even stopping it for few days and by changing trigger injection, OHSS can be prevented.

Signs & Symptoms to look for:
  • Weight gain
  • Breathing problems (shortness of breath)
  • Vomiting
  • Abdominal pain and bloating
  • Constipation or diarrhoea
  • Blood clots

If you experience any of the above, you should immediately contact the healthcare professionals. Unfortunately, about 1% of women who undergo IVF treatments experience severe OHSS that can be life-threatening and lead to hospitalization. During the hospital stay, women can experience major complications such as kidney failure, blood clots, ovarian torsion, fluid in the cavity and electrolyte imbalance (sodium, potassium).

Risk factors:
  • Under 35 years old
  • Polycystic Ovaries
  • High AMH
  • High number of eggs collected
  • Low BMI

Simon, C. & Gardner, D. (2017) Handbook of in vitro fertilization. [CRC Press Book]. 4th ed., Taylor and Francis group.
Royal College of Obstetricians and Gynaecologists (2016) The management of Ovarian Hyperstimulation Syndrome - Green Top Guideline n. 5. Available online at: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_5_ohss.pdf

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