The number of people choosing to freeze their eggs or embryos has increased five-fold in the UK since 2013, according to latest figures from the Human Fertilisation and Embryology Authority (HFEA) which show that the number of egg and embryo storage cycles rose by 523 per cent between 2013 and 2018.
However, egg freezing as a topic is often miscommunicated, and women can be given unrealistic expectations about their chances of success. Considering that demand for egg freezing is on the rise, it’s time to have a frank conversation about IVF and fertility and debunk the most common myths.
We caught up with Dr Mara Kotrotsou, Chief Medical Officer at UK-based virtual fertility clinic Apricity to find out more about freezing eggs, the process behind it, why you may choose to freeze your eggs and what actually happens once you've made the decision.
In this article:
What age do you recommend freezing eggs?
"When I see women they want to explore their options, and what I want them to understand is that the egg freezing should be their plan B. It shouldn't be plan A, because it doesn't guarantee that you're going to fall pregnant, the same way that you don't know whether you're going to fall pregnant when you go through an IVF cycle, there’s no 100 per cent guarantee. It still has some limitations. It has a higher chance to work when you're doing it earlier rather than later.
"As with everything with fertility, and the chances of conceiving, you know that there's an age limitation in order to have the highest chance of success. The same applies to egg freezing. In an ideal scenario, to make the treatment of egg freezing have a higher chance of being effective, women should be freezing their eggs during their optimal reproductive age, ie. younger than 35.
"With egg freezing, and we're talking now about what we call social egg freezing - doing it to preserve fertility or the possibility of preserving fertility, rather than for women who may be oncology patients or who may be undergoing treatment which could render them prematurely infertile. Obviously, that's a different situation. But what is sometimes called as social egg freezing, has also another implication which is the cost. In most cases, women will be self funding. So there is also the question of, will it be cost effective? And then this is where there's a slight conflict of interest.
"If a woman is quite young, let's say early 30s, she has the best chances of freezing her eggs in terms of outcome, but she could be falling pregnant sometime within the next five years, completing her family the way she always planned, and ending up not using the eggs. Therefore, it's not so cost effective.
"If you want to maximize the cost effectiveness, then you're better off leaving it to later, when you start seeing that the chances of you falling pregnant naturally or with a partner are decreasing. But then the catch is that the longer that we leave it, it becomes less successful."
Is there a time when it is too late to freeze eggs?
"We do see a lot of women who come to clinics and want to explore egg freezing when they're 39, 40, or over 40. And then it's not the number one recommended choice. Because we know that they will be freezing eggs that aren’t as good quality, and by the time we go back to test them, it may be too late for them to try something else.
"For women who come to us over the age of 40, they may also be limited in terms of how many eggs they can produce. There's a magic number of 20 to 30 frozen eggs which they may not be able to reach, even with multiple treatments. So for women older than 40 sometimes we say let's try and get pregnant now, rather than postpone, as they'll have more chance of a successful pregnancy."
How does the treatment and the process for freezing eggs actually work?
"It’s basically exactly the same as when a woman undergoes fertility with IVF. At the start of the treatment cycle there will need to be some basic investigations to assess the ovarian reserve, or in other words, the ability of the woman to produce eggs in terms of numbers so that we can tailor the treatment in terms of dosages of medication.
"We will need to do a pelvic assessment with scans, there are screening tests that are required in terms of making sure that the woman doesn't have any sexually transmitted diseases or viral infections, which have to do with how the eggs will be stored in the lab. So we have to comply with everything that we do for IVF and the treatment process itself involves the drugs that we use in IVF, which are essentially hormones in the form of injections, synthetic hormones similar to the hormones that our brain produces to tell our ovaries each month to produce eggs - only now they are in higher amounts, because we want to get more eggs than what we would have had in a natural cycle.
"Usually the treatments consist of an average of around two weeks of the hormonal injections. And at the same time, they're visiting the clinic, or they're having the monitoring internal scans, usually to check how the ovaries are responding. These checks are also sometimes combined with blood tests.
"At the end of this two week period, we have a procedure called an egg retrieval, which is done trans vaginally, so it doesn't involve any cuts, it's just a fine needle that is inserted through the vaginal port. It's usually done under a mild anesthetic, intravenous sedation rather than a general anesthetic.
"Once the eggs are retrieved, they’re passed on to the embryology lab to be processed, prepared and frozen."
What is the recovery time following the procedure?
"Following the procedure the typical recovery period is a few days, some women go back to work the following day, depending on how physical their profession is. It’s normal to have a bleed within a week or so from the procedure and then resume their normal cycle."
Who do I need to go to if I’d like to discuss freezing my eggs?
"I think it's best to have a discussion with a fertility specialist, as GPs may not be so well informed because social egg freezing is not something that's funded by the NHS, therefore they won't be able to assist you."
Can you have your eggs frozen on the NHS?
Egg freezing is not normally available on the NHS unless you are having medical treatment which could affect your fertility (for example, treatment for cancer). You need to contact your Clinical Commissioning Group (CCG) directly and ask if it funds egg freezing.
How much does it cost to freeze eggs?
"On average it costs around £3,000 to £5,000 pounds. There’s obviously variation from clinic to clinic, it’s similar on average to the cost of IVF. The only difference is that usually clinics do packages where they include an initial storage period – so you might get that either one, two or three years of free storage with an initial price, and thereafter you pay an annual storage fee. Some places may also do packages including multiple cycles."
How many eggs are stored?
"The reason that some clinics offer multiple cycles included in the fee is that the outcome of the treatment and how effective it is depends on the number of eggs collected. We recommend that you have 20 to 30 eggs frozen. To collect this number you’ll usually have to go through the process more than once."
How long will the eggs be usable for?
"Based on current evidence in terms of the technology behind it and the effect on the eggs, potentially forever. But we have legal limitations, which means there is a maximum of 10 years for storage. This is where it gets tricky, when women are freezing their eggs at a younger age - so let’s say someone decides to freeze their eggs at 25, then the 10 years will expire when they’re 35. But potentially, they may want to keep them until they are 45.
"There's exceptions, of course, in cases where freezing is done because of medical reasons. They have an exemption, they can freeze their eggs for up to 55 years, but the social freezers have to comply with the 10 years.
"However, because we've seen trends of more women wanting to freeze eggs socially, there is a possibility this will be reviewed in the future to increase the limit."
What’s the success rate when freezing eggs?
"Egg freezing as a procedure has not been done for as long as embryo freezing, and we are limited in that many of the women who have decided to freeze their eggs have not come back to use them yet. We won't know until we start thawing eggs the success of the process for each individual. But, based on what we know so far, the studies show that we're achieving a survival rate of anywhere between 70 to 80 per cent as an average survival rate of the eggs themselves.
"This is where eggs, compared to embryos are less successful, because embryos are more resilient. With an embryo you’re looking at survival rates of 90 to 95 per cent. The reason for this is that we have more experience and knowledge of storing embryos, but also because of the physiology of the egg. It's a single cell, it's very sensitive. If it dies, it dies. On the other hand an embryo, frozen at the blastocyst stage, will have about 100 to 200 cells. So if we lose a few cells during the process, the other cells could regenerate and the embryo as a whole can survive. That's why we're still seeing more losses in comparison.
"Once the eggs survive and are fertilized, the results suggest we're looking at similar success rates thereafter. But the limitation is the first stage and that's why we recommend freezing more eggs for fertility preservation."
Is the process of freezing eggs safe?
"The process itself has the same risk as if we were going with going through fertility treatment with IVF. Overall, it is safe but there are always risks. One of the things to consider is what we call ovarian hyperstimulation, which exists in all fertility treatments. This is relatively rare and does have ways of being managed, it's also more likely to happen at the actual implantation stage, rather than when retrieving the eggs.
"Then of course there are risks from the surgical procedure itself, though it's not major surgery, it's still surgery, it's still invasive and has a small risk of infection, bleeding, or injury to surrounding organs, but overall, a relatively safe process."
Are eggs stored for a longer time less likely to work?
"This is still being researched but the initial suggestion is no. We don't we don't have any clear evidence that the length of the storage could have an impact on the outcome. It's more like an all or nothing effect, provided they're stored properly. There are specific conditions that an embryology lab needs to operate under, where they have controls for the air that circulates, freezing conditions and storage tanks with fast freezing liquid nitrogen."
What rights do I have over my frozen eggs?
"That's the good thing about freezing eggs. Because obviously, sometimes when we counsel women who want to look at their options - whether they're freezing embryos with partners, vs freezing their own eggs - in terms of the eggs, she has 100% rights over them, they're hers.
"She can decide when she uses them, if she uses them, if she wishes to discard them. Also what sperm she wants to use, whether it's a partner, a future partner or husband's sperm, or donor sperm in the future. When we freeze embryos, both parties have equal rights, so they cannot make a decision which is not a joint decision."
What happens if I move overseas - can I take my frozen eggs with me?
"We do ship embryos, and gametes, which is sperm or eggs, overseas. Of course, there are specialised couriers, it's not something that you do with Royal Mail!
"They'll also need to make sure that it can be done from a regulatory point of view, that the eggs can be exported to the country. Whatever fertility treatment someone undergoes in the UK, complies with HMCA regulations. So before they export to another country, they'll need to make sure that that country has similar parameters, similar standards, and that the eggs will be used for a treatment that is legally allowed in the UK.
"If export is not possible, they can always consider the possibility of managing their cycle remotely. Sometimes there are collaborations between clinics, where a woman can go to a clinic in the country where they're living and start her treatment in collaboration with the center where the eggs are frozen. She could be prepared in that country and then travel to where the eggs are frozen for the actual transfer."
Can I grant permission for someone else to use my frozen eggs, and what happens if I decide not to use them?
"You will have to decide to donate your eggs, which is not so easy, because when donating gametes or embryos, there are more requirements in terms of screening that need to have taken place at the time of the donation. So sometimes when we decide to do that in retrospect, we may not be able to satisfy all the requirements.
"Alternatively, if they feel that they don't need them anymore, the eggs can also be donated to a clinic for training or research."
Read more popular articles