Egg Freezing in Ireland
So you’re considering egg freezing and you want to know the facts.
What is involved, how much does it cost, what are the side effects and in the end, does it guarantee you a healthy baby?
“The uptake of elective oocyte cryopreservation - also known as social egg freezing - has escalated in the last few years because of the fast freezing technology of vitrification. Not only has vitrification improved the efficiency of embryo freezing but for the first time allowed the viable freezing of eggs. Before then, egg freezing by the conventional slow-freezing method caused damage to the microstructure of the egg from the formation of ice crystals; vitrification reduces cells to a glass-like state in just a few seconds and thereby avoids for formation of ice”
We’re going to talk you through the process of egg freezing in Ireland specifically as the regulations very often differ from country to country. In Ireland, due to the lack of legislation currently governing fertility treatments, the storage period for frozen eggs is unlimited, up until the age of 49. This is a stark difference to the UK for example, where the storage period is only 10 years. We will discuss later in more details why this really matters and why it can be beneficial long term to freeze your eggs in Ireland.
So what does the egg freezing process involve?
Initial Assessment
The first step before egg freezing involves consulting with a fertility specialist. During your consultation the doctor will learn more about your health and fertility in order to understand if egg freezing will be a viable option for you. You will have a transvaginal ultrasound scan and some blood drawn. You will discuss the process, the response expected (i.e how many mature eggs the doctor expects to retrieve and freeze for you) and also go through consents. Sometimes it may be advised to go through two cycle of egg freezing to obtain enough eggs to help give you the best chance of success (‘egg banking’).
Controlled Ovarian Stimulation
Each ovary contains a number of follicles; these are fluid-filled sacs that each contain an immature egg (an “oocyte”). You will take a course of medications (usually in the form of subcutaneous injections) to stimulate the ovaries and encourage the growth of a number of follicles in the ovaries. You will be monitored with trans vaginal ultrasound scans while you take the medication. This is called ‘follicular tracking’.
Egg Collection
When the time is right and the follicles have grown to the correct size (16-17mm approx) you will have a simple egg collection procedure in the theatre, under light sedation. The eggs will be collected from your ovaries, trans-vaginally and transferred to the lab for assessment and vitrification (freezing).
The Freezing Process
Your eggs will be “vitrified” in an open system which very quickly (-196 degrees in a matter of seconds!) transforms them into a glass-like state and they are transferred to long term secure storage, monitored both by the laboratory team and 24 hour alarm systems.
Fertility Treatment
If and when you return to use your frozen eggs, they will be thawed (survival rates are in the high 90%’s), assessed and then fertilised with either your partner’s or a donor’s sperm. The eggs will be monitored as they fertilize and develop into embryos and then will be transferred to your uterus to produce a pregnancy.
So the big question is……
Why would I need to freeze my eggs?
There are quite a few different reasons why you might be considering egg freezing. Women can freeze their eggs for medical reasons, if they are commencing treatment for cancer such as chemotherapy or radiotherapy and want to preserve their fertility and chances for having a family later on. Others may be pursuing careers or taking time to find the right partner, we call these ‘social reasons’. Fertility declines as we age and so freezing your eggs at a younger age can increase the chances of achieving a pregnancy in later years if women are having difficulty conceiving.
How long does the egg freezing process take?
The process is relatively quick. The first hormonal injection starts on cycle day 2 or 3 of a woman’s menstrual cycle and continues for approximately 10 days. The eggs are collected around day 12-14 of the cycle and frozen and that is that. Cycle complete. You will expect your period to come after about 10 -14 days.
What are the success rates?
Success depends on several different factors. The age at which you freeze and also the number of eggs that are retrieved from the ovaries. Research in this area has shown that in order to have a successful fertility treatment in future, approx 8-10 mature eggs will be needed. Depending on your hormones and AMH level, you may only need one round or treatment, or a second may be recommended.
While social freezing in Europe has shown an upward trend, it’s important for women considering egg freezing after the age of 35 not to have unrealistic expectations. Results from one of Europe's biggest fertility centres - the Brussels Centre for Reproductive Medicine in Belgium showed that one in three women who returned to the clinic did achieve an ongoing pregnancy with their vitrified oocytes. They returned at a mean age of 42 years after having their oocytes vitrified at a mean age of 36 years. But the researcher warned that - as with any fertility treatment - egg quality declines markedly with age, and success rates will be lower than 33% in women freezing their eggs beyond this age.
Fertility is individual to each person and we strongly recommend that women be fertility aware, and have their fertility checked by a specialist. That way, you can discuss all of your options, including freezing, and make a plan that suits your individual needs.
Are there side effects?
In short, yes. There is a small risk when going through controlled ovarian stimulation of something called ovarian hyperstimulation syndrome or OHSS. This can occur in approximately 5% of IVF and egg freezing cycles. If you are young with a high AMH or have PCOS you are a greater risk for this to happen. For this to happen, the protocol used by your physician will have been too aggressive, resulting in an over response from the ovaries. Having 25 or more follicles over 14mm in diameter, and elevated amounts of estrogen in your blood (>2,500 pg/ml) are warning sign. The good news is that physicians can pick up on this very early and manage it very well. As the estradiol level climbs, so too does the OHSS risk, and by 6,000 pg/ml, patients run an 80% risk of developing the syndrome. OHSS risk increases when there is an embryo transfer as the hcg hormone, which is produced as a result of embryo implantation, increased the risk of OHSS. As we are not transferring an embryo back into the uterus during an egg freezing cycle, once the eggs are retrieved, the cycle essentially ends. All hormones go back to normal levels and essentially ‘reset’.
What happens when I want to use the eggs?
You will start the preparation at the beginning of your natural menstrual cycle. Similar to when you started the egg freezing cycle. The big difference is that instead of taking hormonal injections we will be giving you oral estradiol tablets to take x 8-10 days. This will be in order to prepare the endometrial lining (thickness of the womb). The eggs will be thawed and inseminated with donor sperm or your partners sperm and then transferred back into the uterus as embryos (approximately 3-5 days later). Additional oral medication will be given plus some vaginal suppositories and then after 8-10 days or so, you will do the bhcg hormone to check for pregnancy.
How much does this cost?
Costs vary from clinic to clinic. It is important to understand the cumulative costs which can include the egg freezing cycle, freezing and storage costs and the cycle whereby they are used.
Egg freezing cycle: approx 3000 euro
Fertility treatment using frozen eggs: approx 2500 euro
Am I guaranteed a baby?
Freezing your eggs will not guarantee you a baby in future, but it will give you a very good chance. The younger you are when you freeze your eggs, the better the chance of success when you return to use them. Success with frozen eggs – just as in IVF Treatment – will depend on the age and quality of the eggs when they were frozen. Egg freezing is still a relatively new procedure and the number of women who have come back to thaw their frozen eggs is as yet small (7%), but the success rates for these women are good.
Because freezing is not a complete insurance, we do encourage every woman to be fertility aware. When the time is right for you, you should try for pregnancy. If you need treatment, your ‘younger’ frozen eggs may result in a better chance of having a baby that attempting to retrieve eggs at the time, which may be several years older than the eggs you have frozen.
How long can I store my eggs?
Eggs can be stored until a woman reaches the age of 49. The storage contract with the fertility clinic usually runs year on year and so it’s important to factor in these costs as they will be in addition to the egg freezing cycle fees.
Egg freezing is growing as a method of fertility preservation and we think it will continue to do so. With the advanced freezing techniques now currently practiced globally as well as the long legal storage period in Ireland, egg freezing is a viable option for women looking to preserve their fertility and have more time, whether that be to pursue their career or find Mr. Right.