Fertility

Egg Freezing

In the past 5 years, revolutionary developments in the technology of egg freezing has made it an exciting treatment opportunity for many women.

Vitrification is a new freezing method where more than 85% of frozen eggs now survive the warming process.

Dr Raelia Lew has a special interest in egg freezing. She has developed effective strategies to maximise her patient’s treatment success.

Freezing eggs before 35 has the best pregnancy outcomes. To make it possible and affordable for women to have treatment, Women’s Health Melbourne has partnered with Medicredit.

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What Is Egg Freezing?

Egg freezing, otherwise known as human oocyte cryopreservation, is the process of extracting and storing a woman’s unfertilised eggs. This enables women to serve as their own egg donor at a later date where natural conception is perhaps more difficult or unlikely. There are numerous reasons why a woman would choose to freeze her eggs including genetic disorders affecting fertility, early menopause, cancer treatments, or simply wanting to delay child bearing due to personal or professional goals.

Pregnancies from Egg Freezing – Success Rates

International studies demonstrate an overall 6 – 12% chance of full-term birth per egg warmed. This means that the majority of women who freeze 20 eggs would be able to successfully use those eggs to have a baby. Younger women who freeze more eggs can expect better outcomes. We support women who are approaching or beyond the age of 30 who wish to freeze their eggs. There are no guarantees in life, but for women who can’t immediately try for a baby, freezing a good number of eggs (ideally 20 to 30) at an age where eggs are likely to be of high quality is an appropriate option to increase reproductive freedom, with a high chance of future pregnancy.

If you are contemplating egg freezing and would like to know more, contact Women’s Health Melbourne to arrange a Well Woman Fertility Health Check assessment.

What If I don’t use my frozen eggs?

Freezing eggs creates a “Plan B” for women approaching or over 30, where immediate pregnancy is not an option. It is a strategy to maximize a woman’s chance of having her own family.

Having chosen to freeze eggs, many women will successfully conceive. There will come a time to consider the fate of any eggs that remain in storage. Eggs may remain in storage because:

  • Natural pregnancies were achieved without using frozen eggs
  • Pregnancies were achieved using some frozen eggs, with additional eggs remaining.

In this circumstance, your choices would include:

  • Keeping your eggs in storage (with the option of trying for another baby later)
  • Warming and discarding your frozen eggs
  • Becoming an egg donor – giving a precious gift to a woman with infertility

Conception using donor sperm

Single women, same sex female couples, and couples affected by a severe male factor infertility may be interested in the facts about IUI (Intra-Uterine Insemination) or IVF (In Vitro Fertilization) using donor sperm. Sperm can be donated by a “known donor” (for example a friend) or alternatively from a clinic recruited sperm donor. There are many factors to consider when using donated sperm, including related Victorian legislation.

What are the costs of egg freezing?

As of October 2016, Melbourne IVF has introduced a revised fee structure to make egg freezing a more financially viable option for women.

  • Egg freezing treatment cycle: $4,990*
  • Medication costs vary between $1,500-$3,000. This is an estimate only, and may be higher or lower depending on the patient’s specific cycle
  • The hospital and anaesthetist fees of approximately $1,200 may be covered by private health insurance companies depending on the individual’s level of cover

*For patients undergoing a third egg freeze cycle, the treatment cycle fee is reduced to $3,990. All other costs remain the same.

The storage fee of $210 billed every six months, with the first billing period at the end of the first six months of storage, will remain unchanged.

Kindly note these costs are for the procedures only, and do not include additional Women’s Health Melbourne fees.

If you would like to further discuss the revised egg freezing cycle costs, contact the clinic today on (03) 9041 9082

Egg Freezing Process

If you think egg freezing may be of benefit to you, the first step is to see a fertility specialist. It is important to have an informed discussion about egg freezing in context and to be made aware of the full range of fertility treatment options available to you.

As a patient under Dr Raelia Lew’s care, you will undertake a thorough assessment of your fertility, including measuring your ovaries’ potential to develop eggs (ovarian reserve testing). She will also request routine antenatal screening tests (Varicella IgG, Rubella IgG, Syphilis, HIV, Hepatitis B and C serology, full blood examination, blood group and antibody screen). If your GP has previously arranged these tests for you they do not need to be repeated – please bring your results with you.
Dr Raelia Lew discusses the opportunity for genetic screening with all her patients, specifically for carrier detection of cystic fibrosis, fragile X and spinal muscular atrophy.

Getting ready to start your treatment

Once you have made the decision to freeze your eggs, you will be asked to register as a patient of Dr Raelia Lew at Melbourne IVF. You will have several appointments preparing for your treatment cycle:

  1. A booking appointment with Dr Raelia Lew to ensure your understanding and complete an operative consent document together. You will decide whether to proceed during your natural cycle (starting when you have a period) or during a specific time frame (co-ordinated to suit you by using the oral contraceptive pill)
  2. An appointment with a fertility counsellor. This is compulsory in Victoria, and many patients ultimately find the opportunity to be valuable.
  3. An administrative appointment at Melbourne IVF
  4. An appointment with a specialist fertility nurse from Dr Lew’s treatment team. Your nurse will go through (in minute details) exactly what you will need to do during your treatment. He or She will write you a timeline, and give you specific written instructions on when and what you need to do (e.g administering medications, attending ultrasound scan and blood test appointments).

Step 1. Stimulating eggs to grow

An egg freezing cycle is often described as similar to an IVF cycle – in fact there are several important differences.

The end point of an egg freezing cycle is the vitrification of mature eggs. This is different from an IVF where the goal of treatment is an embryo transfer, aiming to conceive a pregnancy.
Several treatment choices used in IVF, designed to achieve development of the embryo and endometrium (uterine lining) in synchrony, are not relevant to egg freezers.

Three medications are necessary during an egg freezing cycle

  1. Follicle stimulating hormone (several options exist) – to help follicles (and eggs) grow
  2. GnRH antagonist – to prevent ovulation before eggs have been collected
  3. GnRH agonist – to reverse the GnRH antagonist, allowing final egg maturation and collection to proceed

For egg freezers, a GnRH antagonist cycle is the safest treatment choice. Complications of ovarian hyperstimulation syndrome (OHSS), which can sometimes occur in IVF cycles are virtually eliminated using Dr Raelia Lew’s egg freezing treatment strategy Furthermore, because the thickness and “synchrony” of the endometrium is not a consideration in egg freezing, stimulating follicles for longer than usual in standard IVF can achieve more eggs collected per cycle of egg freezing. Dr Raelia Lew will perform monitoring ultrasound assessments of your cycle progress and keep you fully informed. Raelia is passionate about achieving the very best outcomes for her patients, both in terms of egg numbers achieved per cycle and also ease of her patient’s treatment experience. She offers weekend and before and after working hours treatment availability to her patients, making the choice to freeze eggs more practical for working women.

Step 2. Egg collection

The procedure for egg collection in an egg freezing cycle is identical to how eggs are collected for IVF. When your follicles have grown to approximately 2-3cm in diameter, the time has come to collect your eggs. Egg collection is achieved through a technically precise surgical procedure known as an OPU (Ovum Pick Up). While you are asleep, under ultrasound vision, Dr Raelia Lew will gently collect your eggs. Using a fine needle introduced trans-vaginally (through the vagina, into the ovary) fluid from the follicles is drained. Scientist then search under a high power microscope to locate your eggs. While many fertility specialists participate in a surgical roster, Dr Raelia Lew prefers to personally perform egg collection procedures for her IVF and egg freezing patients.

Step 3. Egg assessment

Once in the lab, your eggs are assessed for maturity and immature eggs are given time to catch up.
A proportion of eggs will be deemed immature or degenerate and these will be unsuitable to freeze (usually about 10% of the total number of eggs collected)

Eggs are separated from surrounding cumulus cells prior to assessment. A mature egg looks like this:

mature-egg

Step 4. Vitrification

Vitrification is a revolutionary method of freezing eggs, resulting in over 85% of eggs surviving the freeze/warming process. Vitrification reduces the risk of ice crystals forming within eggs while they are in the process of freezing and warming. This is achieved by gently dehydrating the egg, drawing out the water content by bathing the egg in a series of cryoprotectant solutions. Eggs are then frozen instantly by plunging them into liquid nitrogen at temperatures of less than -200 degrees celcius. Once vitrified and safely stored, eggs can remain frozen indefinitely until you may need to use them to have a baby.

Step 5. Down time and recovery time

The process of egg freezing takes 10 days to 2 weeks. During the first part of your cycle, you will be able to continue your normal routine. With the exception of needing to attend your appointments with Dr Lew, you won’t be impaired in your daily activities.

You will need to take 2 days off – the day of your egg collection and probably the day after in order to take it easy. The following day, you will feel very well. Dr Lew will advise you to avoid sexual activity during your egg freezing cycle and in the week immediately after. This is to avoid unwanted pregnancy and the risk of trauma to your ovaries which will be enlarged due to treatment. It is also advisable that you avoid contact sports during this time. You will get your period in the weeks after your cycle is completed. It is normal for the timing of this period to vary from your regular cycle. If you are planning more than 1 treatment cycle, a break in between of at least 1 month is advisable.

Step 6. Attempting pregnancy

When you are ready to have a baby, make an appointment to see Dr Raelia Lew. Whether you ultimately use your frozen eggs or not, she will look after you and help you achieve your goal.

Below are the expected pregnancy outcomes from frozen eggs

  • Approximately 85-90% of eggs survive the freeze and thaw process
  • An egg that survives the freeze and warming process, is expected to behave like a fresh egg

This means that:

  • Approximately 50-70% of eggs would fertilise (by ICSI, using sperm from your partner or a donor)
  • Approximately 90% of fertilised eggs develop into embryos on day two but only 30-40% develop onto day five (blastocyst embryos)
  • A single embryo would have a 25-40% chance of developing into a pregnancy depending on a woman’s age

When you are ready to conceive, Dr Lew will recommend warming 6 eggs at a time with the goal of obtaining 1 high quality embryo for transfer back to your womb to achieve a pregnancy. If more than one high quality embryo develops, embryos may be refrozen for future embryo transfers. Eggs remaining in storage may be used subsequently if you fail to conceive or, if you become pregnant, to conceive another baby later.

Your ultimate chance of pregnancy will depend on how many eggs you freeze and the age you were at the time.

What is ovarian reserve testing?

Dr Raelia Lew will examine your ovaries with a dynamic ultrasound assessment, timed early in your menstrual cycle. This allows her to assess the number of antral follicles present in your ovaries. The number of antral follicles between 2-9mm in diameter is a good predictor of how many eggs you are likely to produce in an egg freezing treatment cycle. Dr Raelia Lew will also measure blood markers of your ovarian reserve (the AMH or Anti-Mullerian hormone) and combine these findings to estimate how many cycles of egg freezing you will need to achieve close to 20 eggs to freeze. The AMH is produced by ovarian follicles that are too tiny to be seen on an ultrasound scan.

How many eggs should I freeze?

Dr Raelia Lew will recommend that you freeze 20-30 eggs, to ensure you have a high chance of having a baby if you need to rely on your frozen eggs. There is no magic number of eggs that can guarantee your ultimate success – simply put, the more eggs you are able to freeze, the better your chance of conception will be.

Optimizing egg quality for treatment

  1. Take folic acid 500mcg daily for 1 month prior
  2. Take vitamin D 1000mg daily for 1 month prior
  3. Take melatonin 2mg before bed for 1 month prior
  4. Quit smoking (ideally 3 months prior)
  5. Quit alcohol (during the treatment cycle)
  6. Avoid excessive caffeine ( 1 expresso daily is ok)

Other options

Egg freezing is the best back-up option for women who want to be mothers one day but definitely not right now. All patients looking into egg freezing should strongly consider what it would mean to them to have a baby now. If this is a viable alternative, it should be seriously considered. Stating the obvious, the only way to guarantee you will be able to have a baby, is to have a baby.
Egg freezing is an incredible “plan B”, but it should not be your “plan A” to have a family.