Lewis Gale Physicians March 26, 2018

Like many couples in their early to mid-30s, Jessica and James were ready to have a child. They were well into their career paths, had financial stability, and the time just seemed right. What they did not count on, though, was how difficult becoming pregnant would be. When more than a year went by without conceiving, the couple consulted a fertility specialist who recommended in vitro fertilization (IVF).

 As part of the IVF process, Jessica’s ovaries were stimulated and multiple eggs were retrieved. Some of the eggs were fertilized and successfully became embryos. One of those embryos was then transferred into her uterus. While Jessica and James waited to see if a viable pregnancy occurred, one question remained. What should they do with the remaining eggs and embryos? Cryopreservation was their answer.

Types of Cryopreservation

Cryopreservation has been around since the 1990s, but recent advancements and success rates have resulted in a sharp increase in its use over the past 10 years. There are two primary types of cryopreservation that can be used to help maintain a woman’s fertility: 

  1. Egg Cryopreservation—freezes an unfertilized egg, one that has not yet come into contact with sperm. Some women choose this option for religious reasons or because they do not yet have a male partner with whom to fertilize the egg. 
  1. Embryonic Cryopreservation—freezes a fertilized egg, which is called an embryo. This process requires sperm to fertilize the egg, which can be taken either from a male partner or from a donor. When implanted in the uterus, an embryo develops into a fetus that, ultimately, grows into a baby. 

Reasons for Freezing Eggs or Embryos?

Women are born with a finite number of oocytes, commonly called eggs. Ovaries and eggs continue to age as a woman gets older, but the uterus is able to carry a pregnancy into a woman’s 40s or 50s. As a result, there are many reasons that a woman may want to freeze her eggs or embryos, including: 

  1. Delaying childbearing to pursue educational or career goals—a woman may choose to delay pregnancy in order to further her career, to complete advanced education, or to pursue other personal ambitions. Cryopreservation can allow women to attain both their personal and professional goals, with the ability to have a family later in life. 
  1. Recovering from cancer or other medical condition—cancer and other medical treatments, including chemotherapy and radiation, can result in infertility. When possible, freezing eggs helps preserve a woman’s ability to have a child after her treatment is completed.

 

In essence, freezing eggs outwits a woman’s natural biological clock. It gives her the ability to become pregnant at an older age using younger, more viable eggs that are less likely to have genetic abnormalities. Frozen embryos may be stored for several years before using IVF and embryo transfer to attempt conception. In fact, a 26 year-old woman in Tennessee recently gave birth to a healthy baby girl who had been frozen as an embryo 24 years ago.1 

In James and Jessica’s case, cryopreservation gives them the option to perform a future transfer cycle. This is important should the first cycle not result in a successful pregnancy or if they later decide to have a sibling for their first child. Their frozen eggs can be later thawed and fertilized for additional embryos or, when their family is complete, they have the option to donate them. 

It is important to note, though, that The American College of Obstetricians and Gynecologists2 does not  “recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women.” 

Cryopreservation Process

Cryopreservation is no longer considered experimental but, rather, a modern infertility treatment with reliable results. The American Society of Reproductive Medicine (ASRM)3 describes the steps of this relatively low risk procedure: 

  1. As part of the IVF procedure, you will be injected with hormones over the course of 2 to 3 weeks in order to stimulate the ovaries to produce a higher number of eggs.
  2. Once developed, you will be given mild anesthesia or sedation and your eggs will be removed through the vagina using gentle suction. This takes only a few minutes.
  3. The eggs and sperm are fertilized, or brought together, in the laboratory.
  4. Before freezing, you can choose to perform genetic testing on the embryos to identify some potential genetic abnormalities.
  5. The fertilized eggs (embryos) then either can undergo a slow freeze process or be flash frozen in a process known as vitrification. Frozen eggs or embryos are stored at subzero temperatures and can remain viable for several years with no impact on their quality.
  6. When a woman wants to attempt pregnancy, the eggs are thawed and injected with sperm (if they were not already fertilized) and then transferred into the uterus. 

Can anyone undergo this procedure?

No, some people are not candidates for cryopreservation, including those who are: 

  1. Over age 38—Freezing eggs typically is offered to women who are age 38 or younger. This is because younger eggs are more likely to result in a successful pregnancy when a woman is ready to undergo IVF. Eggs harvested and frozen after age 38 have a significantly lower pregnancy success rate. 
  1. Undergoing medical treatment—medication is necessary to produce a higher number of eggs than normal, which usually takes 2 to 3 weeks. For some people who are undergoing cancer or other treatments, it may not be possible to delay treating their medical condition for that long. The medications that help the body make more eggs also can produce hormones that may worsen some types of cancer. 

Risks of Cryopreservation

As with any procedure, there are some risks related to freezing eggs and embryos. These include: 

  • Risks associated with the IVF process: multiple children in a pregnancy, high blood pressure, early delivery, and a higher potential for a low birth weight baby.
  • Risks associated with those who use their frozen eggs or embryos at an advanced maternal age (over 35): higher incidence of gestational diabetes, preeclampsia, early delivery, and a low birth weight baby.

 Of course, these risks also vary among women and depend greatly on their overall health. 

Cost of Cryopreservation and IVF

The cost of freezing eggs or embryos, undergoing IVF often more than once, and storing unused eggs quickly adds up. From a financial standpoint, it usually costs $10,000 or more to harvest a woman’s eggs, several thousand dollars every time she undergoes IVF, and hundreds per year to store any remaining eggs. Typically the cost of freezing eggs is not covered by insurance. 

In addition, there can be an emotional price to pay for harvesting and freezing eggs for later use. The Centers for Disease Control and Prevention (CDC)4 reports that the chances of a healthy, full-term pregnancy using frozen embryos declines steadily after the age of 35. 

Sources:

1 Eltagouri, Marwa. (2017, December 19). “She finally had a baby naturally — with a 24-year-old frozen embryo.” The Washington Post.

2 The American College of Obstetricians and Gynecologists (ACOG): www.acog.org

3American Society of Reproductive Medicine (ASRM): www.asrm.org

4Centers for Disease Control and Prevention (CDC): www.cdc.gov

Dr. Alex Letham, Ob/Gyn with Virginia Women’s Health, is available to discuss your options if you are interested in freezing your eggs. To schedule an appointment, call the office at (540) 443-0500 or click below to book an appointment online.

Book An Appointment Online with Dr. Alex Letham