The 411 on egg freezing

While infertility and fertility treatments have long been fodder for the media, suddenly egg freezing is attracting a lot of attention of its own. 

Well-known actress Jennifer Love Hewitt recently commented that she was thinking about freezing her eggs. Hollywood insiders have also reported that TV’s Sophia Vergara suggested that she might freeze eggs when asked about her own family plans.

Though it’s a hot topic, many people may not know how or why some women choose to freeze eggs.

Who are candidates for egg freezing?
Egg freezing can be extremely beneficial for patients who have been diagnosed with cancer and need to undergo chemotherapy. Other indications include freezing for egg donation programs and to reduce the risk of ovarian hyperstimulation syndrome for patients undergoing gonadotropin stimulation.

The topic of interest in the press, however, is the elective freezing of eggs. This choice is generally for women interesting in fertility preservation who are aging, but not ready to be pregnant. Undoubtedly, statistics show women are delaying childbearing and unfortunately, there is no accurate test to determine when a woman’s fertility will decline to the point where she no longer has eggs competent to result in childbirth.

One question I hear all the time is that if the ideal candidate for egg freezing is a younger woman, and many of them feel they can still become pregnant, why freeze their eggs? The only reason to consider freezing eggs is like an insurance policy to preserve fertility as a woman ages.

Many who choose to do this may never utilize their eggs. But for those who do need them at a later date, egg freezing offers an option- not a certainty – for potential children.

Unfortunately, if a woman has already reached an age when her eggs are not viable (meaning she may get pregnant now), freezing eggs at this stage does not improve her chances of getting pregnant later.

How successful is egg freezing?
The pregnancy rates for frozen eggs rival that of fresh eggs. But there are very important limits to this knowledge. For one thing, not many patients have had this done. Another point is that the data is largely for younger women. Finally, many of the eggs that have been frozen will not be used for years – if ever – so a realistic pregnancy rate is currently not accurate. In a large prospective randomized trial conducted by Gary D. Smith, the authors report a 38 percent clinical pregnancy rate using eggs frozen using vitrification.

Whatever procedure is used, clinical pregnancy rates have improved to the point where, egg-for–egg, frozen eggs are just as successful as fresh eggs. Thus, this new technology has made freezing eggs an even more reasonable clinical option.

What techniques are available?
The technology of freezing eggs has advanced greatly. Although the debate still continues about which freezing method is best, presently the vitrification method seems to be winning the race.

Vitrification freezes eggs rapidly causing the cellular water to perform more like a glass, which prevents crystal formation. This is contrary to other freezing techniques that when frozen can cause the intracellular water of eggs, sperm or embryos to make ice crystals.  When these eggs with the ice crystals are thawed, some have the chance of being ruptured.

What is the downside?
First and foremost, egg freezing is a new technology and no one can really predict where the demons may lie. But that is true of all assisted reproductive technologies, considering that the oldest IVF ‘baby’ is still in her late 30s.

Additionally, the procedures to retrieve and freeze the eggs are expensive, it’s important to remember that frozen eggs incur a yearly fee for storage.

Finally, the procedure itself carries small, but finite, risks such as bleeding or infection from the egg retrieval, and the stimulation process is rigorous and time consuming.

Some of my patients ask, “What would you tell me to do?”

I can best answer this question by employing the yardstick often used by physicians regardless of their specialty. If my daughter was to ask me about doing this, and she was properly informed and met the indication criteria for using this technology, then I would wholeheartedly encourage her to take advantage of the technology.

Guarded? Yes, but none the less an endorsement for freezing eggs.