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Egg Freezing – A summary of the recent UK (HFEA) guidelines

By Irfana Koita, Director, IVF Matters

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Egg Freezing HFEA

Egg freezing or oocyte cryopreservation is a method of fertility preservation. As per HFEA published data (September 2018), egg freezing cycles although on the rise, currently, makeup around 1.5% of all fertility cycles carried out across the UK with the majority of treatments taking place in London. The first birth from frozen eggs using vitrification was documented in 1999. This was followed by the HFEA permitting egg freezing treatment in the UK from 2000.

Egg freezing cycles although on the rise, currently make up around 1.5% of all fertility cycles carried out across the UK with majority of treatments taking place in London

Why do women want to freeze their eggs?

There are 2 main reasons why women in the UK freeze their eggs.

Social – to delay their childbearing whilst they find the right partner (46% of those who freeze their eggs are single), to pursue their career or because they are not ready to have children

Medical – they are having treatment for cancer which is likely to affect their fertility or they have other medical problems like severe endometriosis.

How is egg freezing treatment performed?

  • Egg freezing involves the following steps
  • Ovarian stimulation – hormonal injections are administered to stimulate the ovaries to produce eggs
  • Egg collection – eggs are retrieved under ultrasound guidance via the vagina
  • Freezing and storage – post egg collection, the mature eggs are vitrified in the laboratory and stored in liquid nitrogen

The duration between the start of ovarian stimulation to egg collection is about 2 weeks. The ovarian stimulation and egg collection process are the same as standard IVF treatment.

How are the frozen eggs used to create embryos in future?

When one is ready to have a baby, the eggs are defrosted by a process called egg thawing. The freezing process hardens the layer surrounding the eggs and hence it is recommended to inject the sperm into the eggs using a process called intracytoplasmic sperm injection or ICSI. The fertilised egg is then observed in the laboratory until the embryo/s is transferred into the uterine cavity.

91% of women using frozen eggs in a thaw treatment cycle were registered with a male partner at the time of egg thawing.

When do most women in the UK freeze their eggs?

As per the HFEA data, most women who froze their eggs in 2016 were over 35. The most common age to freeze eggs was 38. However, the most common age women came back for fertility treatment to use their cryopreserved eggs was 40.

91% of women using frozen eggs in a thaw treatment cycle were registered with a male partner at the time of egg thawing

There are many women freezing eggs into their 40s and even 50s. Given the scientific consensus around age-related fertility decline, it is not clear why patients of this age are freezing eggs and we would caution against this being a sensible option for this group of women.

What should one consider prior to proceeding with egg freezing treatment?

When should women be freezing their eggs?

The role of female age ‘Standard’ fresh IVF does not offer a solution to the age-related fertility decline because it cannot reverse the egg degeneration that comes with getting older’. This is why the age a woman is when she freezes her eggs is so important.

In cases over the age of 35, we know there is a steep decline in fertility and this has an impact on both natural conception and IVF success rates.

The likelihood of a successful outcome following egg freezing is based on the age at the time of freezing one’s eggs. Hence, freezing eggs the prior to early 30s would be the ideal time to have the best chance of a successful outcome in future. However, young women are likely to get pregnant spontaneously and are hence, are less likely to use their frozen eggs. The current 10-year legal limit on storage of frozen eggs means the frozen eggs are to be used within this period.

When one freezes later in life, the process may be more invasive and expensive due to the natural decline in fertility as more cycles may be needed to collect the desired number of eggs. The chances of treatment being successful reduce but one is more likely to use the frozen eggs.

90% of cycles in the UK are privately funded. The average cost of a complete egg freezing cycle ranges, from £7,000-£8,000

Funding for treatment

90% of the cycles in the UK are privately funded. The average cost of a complete egg freezing cycle ranges, from £7,000-£8,000. This is made up of the cost of egg freezing, storage and using frozen eggs in treatment. NHS funding is available for those who freeze their eggs for medical reasons.

Risks associated with the treatment

Fertility treatments are generally very safe and most women are no more likely to experience problems with their health or pregnancy than women who have conceived naturally. However, there are some risks which range from mild discomfort to more serious complications.

Chances of success

The most important factor that affects the success rates of egg freezing is the age of the women at the time of freezing. The age of thawing the eggs does not seem to significantly influence the outcome. Birth rates from frozen own eggs are increasing but remain below fresh IVF treatment cycles at 18% per treatment cycle.

Egg freezing is emerging as a viable clinical technique to preserve women’s fertility, providing the eggs are frozen at a clinically optimum age, and the patient is aware of the risks and possibility of becoming pregnant naturally. The evidence suggests that if eggs are frozen below the age of 35, the chances of success using these frozen eggs is higher than the natural conception rate as the woman gets older.

The results of our analysis are supported by international evidence which suggests egg freezing is a successful and cost-effective method of preserving fertility.

Risk of not using the frozen eggs

There is a chance that one may conceive spontaneously and hence, may not use the frozen eggs in the future.

The risk to baby and mother

Currently, 2000 babies worldwide have been born from cryopreserved eggs but long-term studies on safety for children born from this process are not yet available. Evidence to date shows no differences between the use of vitrified or fresh eggs in the rates of obstetrical problems in pregnancy. There are no increased risks of chromosomal anomalies or significant physical or developmental deficits in the babies born.

It is the role of the clinic to support women in making informed choices.

IVF Matters run ‘Extended Choices’, a series of egg freezing events conducted to educate and empower women who are considering egg freezing treatment. More information regarding the dates of these events can be obtained via admin@ivfmatters.co.uk or 03339 399951.

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