Egg Freezing

Egg Freezing

Human oocyte cryopreservation (egg freezing) is a process in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. This is a proven and successful way to try to preserve your fertility. The process requires hormonal stimulation to retrieve your eggs. The oocytes (eggs) are frozen or cryopreserved using an advanced technique called vitrification. Theoretically, eggs may be frozen indefinitely, as no biological activity takes place during cryopreservation. According to the UAE law, freezing can be extended for a period of 5 years. Obtaining a yearly consent from patients is obligatory.

Egg Freezing in Natural Cycles, Poor Responders & Hyper-responders

After egg retrieval procedure, the eggs are immediately transferred to the laboratory for an advanced cryopreservation process called “vitrification” performed by our highly skilled and experienced embryologists. The eggs are then stored in a special holding tank.

Indications

Oocyte cryopreservation is aimed at three particular groups of women: those diagnosed with cancer who have not yet begun chemotherapy or radiotherapy; those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option or in countries like the UAE where Embryo Freezing is illegal; and those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.

Chemotherapy and radiotherapy are toxic for oocytes, leaving few, if any, viable eggs. Egg freezing offers women with cancer the chance to preserve their eggs so that they can have children in the future.

Oocyte cryopreservation is an option for individuals undergoing IVF who object, either for religious or ethical reasons, to the practice of freezing embryos. Having the option to fertilize only as many eggs as will be utilized in the IVF process, and then freeze any remaining unfertilized eggs can be a solution. In this way, there are no excess embryos created, and there need be no disposition of unused frozen embryos, a practice which can create complex choices for certain individuals.

Additionally, women with a family history of early menopause have an interest in fertility preservation. With egg freezing, they will have a frozen store of eggs, in the likelihood that their eggs are depleted at an early age.

Method

The egg retrieval process for oocyte cryopreservation is the same as that for in vitro fertilization. This includes about 12/13 days of hormone injections that stimulate ovaries to ripen multiple eggs. When the eggs are mature, final maturation induction is performed, preferably by using a GnRH agonist rather than human chorionic gonadotropin (hCG), since it decreases the risk of ovarian hyperstimulation syndrome with no evidence of a difference in live birth rate (in contrast to fresh cycles where usage of GnRH agonist has a lower live birth rate).  The eggs are subsequently removed from the body by transvaginal oocyte retrieval. The procedure is usually conducted under sedation. The eggs are immediately frozen.

The egg is the largest cell in the human body and contains a high amount of water. When the egg is frozen, the ice crystals that form can destroy the integrity of the cell. To prevent this, the egg must be dehydrated prior to freezing. This is done using cryoprotectants, which replace most of the water within the cell and inhibit the formation of ice crystals.

Eggs (oocytes) are frozen using either a controlled-rate, slow-cooling method or a newer flash-freezing process known as vitrification. Vitrification is much faster but requires higher concentrations of cryoprotectants to be added. The result of vitrification is a solid glass-like cell, free of ice crystals. Indeed, freezing is a phase transition. Vitrification, as opposed to freezing, is a physical transition. Realizing this fundamental difference, vitrification concept has been developed and successfully applied in IVF treatment with the first life birth following vitrification of oocytes achieved in 1999. Vitrification eliminates ice formation inside and outside of oocytes on cooling, during cryostorage and on warming. Vitrification is associated with higher survival rates and better development compared to slow-cooling when applied to oocytes in metaphase II (MII). At Aster IVF, we use the world’s best method of Vitrification called Cryotech Vitrification from Japan.

During the freezing process, the zona pellucida, or shell of the egg can be modified preventing fertilization. Thus, currently, when eggs are thawed, a special fertilization procedure is performed by an embryologist whereby sperm is injected directly into the egg with a needle rather than allowing sperm to penetrate naturally by placing it around the egg in a dish. This injection technique is called ICSI (Intracytoplasmic Sperm Injection) and is also used in IVF.

Success rates

The rate of birth defects and chromosomal defects when using cryopreserved oocytes is consistent with that of natural conception. In 2009, the ASRM noted that from the limited research performed to date, there does not appear to be an increase in chromosomal abnormalities, birth defects, or developmental deficits in the children born from cryopreserved oocytes. The ASRM recommended that, pending further research, oocyte cryopreservation should be introduced into clinical practice on an investigational basis and under the guidance of an Institutional Review Board (IRB). As with any new technology, safety and efficacy must be evaluated and demonstrated through continued research. In October 2012, the ASRM lifted the experimental label from the technology for women with a medical need, citing success rates in live births, among other findings.  In 2014, a Cochrane systematic review about this topic was published. It compared vitrification (the newest technology) versus slow freezing (the oldest one). Key results of that review showed that the clinical pregnancy rate was almost 4 times higher in the oocyte vitrification group than in the slow freezing group, with moderate quality of evidence.

History

Cryopreservation itself has always played a central role in assisted reproductive technology. With the first cryopreservation of sperm in 1953 and of embryos thirty years later, these techniques have become routine. Dr Christopher Chen of Singapore reported the world’s first pregnancy in 1986 using previously frozen oocytes. This report stood alone for several years followed by studies reporting success rates using frozen eggs to be much lower than those of traditional in vitro fertilization (IVF) techniques using fresh oocytes. Providing the lead to a new direction in cryobiology, Dr. Lilia Kuleshova was the first scientist to achieve vitrification of human oocytes that resulted in a live birth in 1999. Then recently, two articles published in the journal, Fertility and Sterility, reported pregnancy rates using frozen oocytes that were comparable to those of cryopreserved embryos and even fresh embryos. These newer reports affirm that oocyte cryopreservation technology is advancing.

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