You want to have a family in the future; hopefully, more than one child but aren’t ready or in a position to start a family right now. You’ve heard that your fertility declines as you become older particularly after age 35 and want to know if freezing your eggs can maximise your chances of having a family in the future. I share my insights on this topic.
The reality is that the majority of heterosexual cis gendered women reading this article who will try to become pregnant by having unprotected sex will become pregnant and have one or more children with minimal or no complications.
The problem is that infertility affects 1 in 7 heterosexual couples in the UK (National Institute of Clinical Excellence) and 1 in 10 people of reproductive age in the US (American Society for Reproductive Medicine). You probably know someone who lives with infertility or will struggle with infertility.
As yet there isn’t a test or set of tests that can accurately predict your chances of having a baby in the future, so you won’t know if you’ll have a problem until you start trying. Taking ovarian reserve or ‘fertility MOT’ tests will not predict your chances of naturally conceiving a baby or tell you how many fertile years you have left.
I’ve lived with infertility for 10 years and could write pages about how traumatic the journey has been, how it has impacted my life, relationships, career and self-esteem. For anyone experiencing infertility, from the first few months onwards, the uncertainty, the grief, the worry and feelings isolation are incredibly stressful. The financial impact can be considerable, and the treatments are physically and emotionally tiring with variable success rates.
Our fertility decreases as we get older and has been shown to decline at a greater rate from 36 onwards. This means the risks of infertility increase as we get older. Having a medical condition, such as endometriosis, could also increase the risk of infertility. Freezing your eggs is one potential way of optimising your chances of conceiving in the future should you experience infertility.
Egg freezing is a procedure performed by specialist fertility doctors. The process involves stimulating your ovaries to encourage a number of eggs to grow. These eggs are removed whilst you are sedated and then frozen and stored until they are required. When you are ready to use them, the eggs are thawed, and a sperm is injected into each egg to create an embryo which is then transferred into your uterus.
These processes are known as assisted reproductive technologies (ART) and include egg freezing, in vitro fertilisation (IVF), egg donation and intra-cytoplasmic sperm injection (ICSI). These procedures are used to treat infertility. So obviously if you are able to become pregnant naturally you will not need to use the procedures.
ART will be discussed in future articles.
Egg freezing could improve your chances of conceiving by IVF if you experience infertility in the future
Research shows that women who freeze their eggs when they are 35 years or younger, then go on to have infertility in their late 30s and 40s and subsequently use those frozen eggs in an IVF cycle have better pregnancy success rates than women of the same age who have IVF using their own eggs.
A study in 2011 looked at the cost-effectiveness of three routes taken by 35-year-old women who wanted to postpone pregnancy until age 40. The three routes were:
1. egg freezing at 35 and IVF at 40 using own thawed egg,
2. trying naturally at age 40
3. using IVF with own fresh eggs at 40.
Using the eggs frozen at age 35 resulted in the highest live birth rate (84.5%) followed by IVF (64.6%) and then natural conception (52.3%).
The average cost of conceiving with the egg freezing route was approximately thirty times higher than natural conception and approximately 1.35 times higher than IVF using fresh eggs at age 40. The study showed that for women in this age group, better value for money was gained from IVF cycles using eggs frozen at a younger age than using fresh eggs at an older age. The Human Fertilisation & Embryo Authority (HFEA) had similar findings in their report when they analysed UK fertility data between 2010-2016.
If you are in your late 30s or 40s
Women in their late 30s and 40s can conceive naturally and have healthy babies although it may take longer to get there.
In the UK the most common age to freeze eggs is 38 and 40 for thawing eggs (HFEA).
There is no official or legal age limit for egg freezing. In this age group, the quality of the genetic material in the egg is more fragile which impacts on the viability of the egg. This affects your ability to become pregnant and stay pregnant.
Therefore, the overall costs of the full process from freezing to IVF are likely to be higher because the success rates are lower, and you may decide to have more IVF cycles.
If you don’t want to freeze your eggs
Using an egg from a donor who is in their 20s or early 30s is another option as research shows it increases your chance of having a successful pregnancy and live birth. Donor egg IVF cycles in women aged between 36-45 have success rates as high as women below 36 who have IVF using their own eggs.
According to the HFEA, the average cost for an egg freezing cycle in the UK is between GBP £7000-8000 (circa USD $9400-10,770). This includes egg freezing, subsequent thawing and IVF with medication. Some women require additional cycles to get a sufficient number of eggs to store. The average cost of an additional freezing cycle is £3000-4000. The costs of egg freezing vary across the world with lower costs seen in India, Greece, Cyprus and Turkey. It is possible to have your frozen eggs transported internationally. It is expensive and depends on the distance. Such transport would need to be arranged with licenced logistics companies.
Egg storage limits
Be aware that in some countries the storage period for eggs and embryos frozen for non-medical reasons is limited. In Sweden and UAE, the storage period is limited to 5 years, in the UK it’s 10 years. In Spain and the United States, eggs can be stored for an unlimited period of time.
This means you may want to consider going abroad for the procedure initially where they can be stored for a number of years and then have them transported back to your home country sooner to when you use them, or you can have your full egg freezing and then later IVF process at the same clinic.
Egg freezing is illegal in France in China, for single women. In the UAE eggs can be frozen but can only be thawed, fertilised and transferred once a woman is married. The sperm used must be her husband’s sperm as sperm donation is against the law. Embryo freezing is also not currently legal in the UAE.
If you are considering freezing your eggs, you can have a consultation with a fertility specialist. These are often called fertility ‘MOT’s’. They will include an assessment of your ovarian reserve which is an estimation of the number of eggs in your ovaries. The ovarian reserve and can be used to estimate your chances of getting a good number of eggs in your cycle. Ovarian reserve assessment requires both a blood test called the Anti-Müllerian hormone (AMH) and an Ultrasound scan. AMH is a hormone released by the eggs in the ovaries. The AMH correlates with the number of eggs in your ovaries. The ultrasound scan is used to count the number of follicles in your ovaries which could potentially develop during the egg stimulation process.
If your ovarian reserve is lower than expected for your age, a suboptimal number of eggs may be retrieved during your frozen cycle. If the number of eggs is less than 10 you may consider having more than one cycle to obtain more eggs. This will be discussed with your fertility doctor.
Your ovarian reserve will fall as you get older therefore if you have a low ovarian reserve in your 20s or early 30s, your chance of getting an optimal number of eggs could be even lower in your late 30s and 40s. This can also reduce the chances of a successful fresh IVF cycle at that time. Remember that it’s possible to get pregnant from one good quality embryo.
AMH may not be accurate if you are taking certain types of contraception e.g., combined pill. Your fertility specialist will be able to advise you.
If you have a medical condition such as endometriosis or have had surgery on your ovaries e.g., cyst removal, you may have a low ovarian reserve so ensure you have this assessed by your gynaecologist or a fertility doctor.
If you use an intrauterine device e.g., a copper IUD or progesterone based IUS (Mirena) it can stay in place during the egg freezing process.
If you are taking other forms of contraception they will need to be stopped before the process starts.
If you are already with the right partner but want to delay starting your family, embryo freezing may be another option. Again, the younger you do this the better.
Essentials: Before you start
If you are considering freezing your eggs here are some essential tips to follow:
Obtain specialist advice and assessment before you proceed. Consider whether you want to have the procedure done in your country or abroad. Check the laws in your country. Speak to at least two Fertility doctors also called Reproductive Endocrinologists in the country you wish to have your treatment before you make any firm decisions.
Understand the success rates, risks, costs that apply to your particular circumstances.
Consider seeing a specialist fertility counsellor You may want to take a friend, relative or fertility advocate with you to your appointments. If it’s safe, secure and private, it may be possible to have the initial appointments by video or phone. If you are freezing embryos you should discuss what to do in the potential event that you split up or in the event of death.
Find a clinic that you feel comfortable with, as you are likely to use them for the final IVF procedure. It is possible to transport eggs between clinics in the same country as well as internationally. Ask the clinic about their process for importing and exporting frozen eggs or embryos.
Make lifestyle and dietary changes at least 3 months before your procedure is due to start the process (and when you start trying to conceive) to give the best quality eggs possible. Stop smoking and alcohol, take folic acid or a prenatal multivitamin, reduce intense exercise, take moderate and regular exercise, eat a diet rich in vegetables, include wholegrains and oily foods, minimise sugar and processed foods.
Protecting your fertility
Egg freezing is an option for you if would consider having assisted reproductive treatments in the event that you had infertility. Consider the above in line with your individual circumstances. To optimise your chances, freeze your eggs as early as possible; ideally in your late 20s or early 30s (consider storage periods in your country).
Whether you want to freeze or eggs or do not think this is the right option for you, understand, optimise and maintain your reproductive health from as early on as possible. This can help detect any problems that could be affecting your fertility. You should be familiar with your menstrual cycle as early as possible; consider having fertility awareness training or seeing a fertility coach for this. See a medical professional if you have severe period pain, irregular bleeding, bowel symptoms, pain during sex. Having a healthy lifestyle is also important for your reproductive health. Eat well and stay active.
Trying to conceive requires a separate article, but when you are ready to start trying please be careful about timing sex around ovulation. It’s become the accepted way of trying and some couples are could be doing this incorrectly which is why official NICE guidance does not recommend timing of sex. NICE guidelines advise couples to have regular sex, twice a week every week, if possible. The chances of fertilisation are best when sperm is already in the fallopian tube when the egg arrives, and sperm can live in the uterus and fallopian tube for up to 5 days. Ovulation doesn’t always happen around the same time each month and can happen considerably earlier or later in your cycle than is published in books or estimated in many apps.
If regular sex is difficult or not practical, timed sex is more likely to be successful if you truly understand your own menstrual cycle with confidence, which takes time and practice. A nurse or coach can teach you how to do this or you could use an app or device which logs your full menstrual cycle over a number of months and measures at least one other biological marker of ovulation such as basal body temperature, consistency of your cervical mucus, Luteinising hormone (LH).
From early on in your fertility journey look after your physical and mental health with self-care and, where possible, obtain professional support.
Please take care of you xx
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