Who would benefit from egg freezing?

Five main groups of women seek this reproductive service:

• Women who wish to have children at a later date. These women are aware that fertility declines with age and are choosing to undergo IVF treatment sooner, storing their eggs for the future.
• Women with cancer, as chemotherapy and radiation treatment can have a harmful effect on fertility, rendering many of these women menopausal.
• Women who are at risk of early menopause or have a genetic disorder that could limit fertility (e.g. Turner syndrome).
• Individuals or couples who, for religious or ethical reasons, are opposed to freezing embryos that result from IVF treatments and are more comfortable with storing unfertilised eggs instead.
• Couples who have no sperm retrievable on the day of their egg collection.

How would my eggs be retrieved?

In egg freezing, a woman’s mature eggs are developed and removed using standard IVF techniques. This typically involves three stages of treatment: pituitary suppression, ovarian stimulation and egg retrieval.

Each of these treatments will be discussed in detail with your clinician. The egg retrieval itself is performed by an ultrasound-guided needle passed through the top of the vagina. The needle is passed into each follicle in the ovary and the fluid is withdrawn into a test tube. The fluid from each follicle is examined under a microscope and the eggs are collected for cryopreservation. The procedure will take only 20-30 minutes and is performed under sedation or anaesthetic. You will, therefore, be required to rest in the recovery room for about an hour afterwards.

You will also require monitoring with serial blood sampling and transvaginal ultrasonography during your cycle. It is common to experience some cramping and discomfort after egg retrieval as well as some vaginal spotting or bleeding. A heat pack, hot-water bottle or analgesic should be sufficient to manage the discomfort, but should the pain become severe or the bleeding heavy, please contact the clinic. You will need about two days off work.

As with all medications and medical procedures, side effects and potential risks are involved with all of the medications that may be received, and with egg-retrieval procedures. We encourage you to discuss these with your treating specialist.

How many eggs can I expect to get from an IVF cycle for egg freezing?

The number of eggs retrieved in a single stimulation cycle is a very individual outcome. It depends greatly on your health, your age and how well you respond to the drug treatment. In addition, with human oocytes it is a case of “more is not necessarily better’’ with regards to egg numbers and quality.

With these factors in mind, your fertility specialist will tailor your drug/treatment cycle according to your specific requirements and/or previous responses.

How does cryopreservation work?

Our ability to freeze any cell and have it survive depends on many factors. Because water expands in volume as it turns to ice, sperm cells must be dehydrated before freezing to prevent them from rupturing. The addition of a cryoprotectant, which does not expand upon freezing, can greatly reduce the risk of cell rupture.

Oocyte and embryo cryopreservation protocols, however, use a technique called “vitrification’’. Under this process, cooling rates are so rapid (more than 20,000C a minute) that ice does not have a chance to form, and the mixture of cryoprotectant and egg/embryo forms a glass-like structure. At AdBaby IVF Centre we routinely use vitrification as the preferred method of egg or embryo freezing.

What are the limitations?

The oocyte (egg) is the largest human cell and contains a high percentage of water. It is also sensitive and intolerant of the chemical and physical stresses created during freezing and thawing. When an oocyte is ovulated, or retrieved from the ovary during an IVF cycle, ideally it is ready to be fertilised by a single sperm. In anticipation of fertilisation, the oocyte prepares to discard half of its DNA in a process named meiosis. Any changes in the physical or chemical environment around the oocyte can disrupt meiosis, leading to an oocyte with too much or too little DNA. Hence, even after we overcome the hurdles of sensitivity and cell water content, these other obstacles to the successful freezing and thawing of oocytes remain.

While the overall aim of freezing is to help the egg survive upon thawing, certain damage or consequences of the procedure may not kill the cell but render it “less viable’’. A major issue is that eggs do not fertilise well after thawing. This is due to the partial disruption of the membrane, which causes a block to the conventional fusion and penetration of sperm with the egg surface. So, artificial forms of assisted insemination have to be used to achieve acceptable fertilisation outcomes with thawed eggs. This procedure is referred to as Intracytoplasmic Sperm Injection (ICSI) and is common in fertility centres worldwide. It involves the direct injection of a single sperm into an egg, thereby avoiding most of the usual barriers to fertilisation.

Egg freezing storage

Patient Consent: We understand that the embryos would be normally kept frozen for ten years. If we wish to extend this period, we would let you (the ART Clinic) know at least six months ahead of time. If you do not hear from us before that time, you will be free to (a) use them for research purposes; or (b) dispose them off. We also understand that some of the embryos may not survive the subsequent thaw and that frozen embryo-replaced cycles have a lower pregnancy rate than when fresh embryos are transferred.

Terms and Conditions

Provision of Information As long as I have cryopreserved gametes in storage at clinic mentioned above, I hereby agree to contact the above clinic at least annually to provide current information indicating my address, telephone number, and intention regarding my cryopreserved gametes. Failure to:

(i) contact the clinic for a period of twelve months;

(ii) respond to a request for information from clinic within 90 days of receipt;

(iii) provide a new address or forwarding address where mail is returned to clinic as undelivered, shall constitute abandonment and signify my desire to terminate storage of Cryopreserved Gametes.

In the event of my failure to comply with (i), (ii) or (iii) above, I instruct the abovementioned clinic and hereby consent to the disposition of my Cryopreserved ART Rules Page 76 of 96 Gametes as follows:

2. Payment of Fees I understand that I am responsible for the costs of cryopreservation and storage of my Cryopreserved Gametes. Cryopreservation and storage fees are due and payable at the time of gamete cryopreservation, and at the beginning of each annual storage interval thereafter. I understand these fees are non-refundable and are not subject to prorated adjustment for partial storage intervals. Should the yearly fee for storage of my Cryopreserved Gametes remain unpaid for a period of one year after the first invoice is forwarded to my address as it is listed in the clinical records at clinic can conclude that I am no longer interested in storing these specimen(s) and I hereby instruct the clinic to dispose of my Cryopreserved Gametes.

3. Failure to Provide Information or Pay Fees In the event of my failure to clinic or to pay cryopreservation fees as set out in sections 1 and 2 above, I hereby consent to and instruct clinic to dispose of the Cryopreserved Gametes as follows:

(i) to remove from storage for subsequent disposal (yes/no) If No to (i) above, proceed to (ii) to (iv) below 4. Alternate Contact/Responsible Party I hereby name, as an alternate contact and my representative to assume responsibility for sections 1 and 2 above in the event that I am unable due to illness. I have attached a signed acknowledgement by me that they have read this form and will be responsible for its provisions in the event that I cannot.