Many women today are choosing to delay pregnancy until their late 30s or 40s for various reasons, such as career, education, financial stability or personal preference. However, this decision comes with some challenges and risks that need to be considered and addressed. In this article, we will explore some of the factors that affect fertility and pregnancy outcomes in older women, and discuss whether egg freezing is a viable option for them.
Fertility Decline with Age:
One of the main factors that affect a woman’s ability to conceive is her age. Women are born with a finite number of eggs in their ovaries, which gradually decline in quantity and quality as they age. The peak of a woman’s fertility is in her 20s and early 30s, after which it starts to decline sharply1. By the time a woman reaches her 40s, her chances of getting pregnant naturally are very low.
Reasons of fertility declining fertility:
Decreased ovarian reserve: This refers to the number of eggs left in the ovaries that can be fertilized. As women age, their ovarian reserve diminishes, making it harder to ovulate and conceive.
- Decreased egg quality: This refers to the genetic and chromosomal health of the eggs. As women age, their eggs are more likely to have chromosomal abnormalities or defects that can affect fertilization, implantation or development of the embryo.
- Decreased ovarian response: This refers to how well the ovaries respond to hormonal stimulation during ovulation or fertility treatments. As women age, their ovaries become less sensitive to the hormones that trigger ovulation, making it harder to produce mature eggs.
- Other factors: Besides age, there are other factors that can affect a woman’s fertility, such as lifestyle, medical conditions, environmental exposures or genetic factors. Some of these factors can be modified or treated, while others are beyond one’s control.
What is Egg Freezing?
Egg freezing, also known as oocyte cryopreservation, is a technique used to preserve a woman’s capacity to get pregnant in the future. Unfertilized eggs are removed from the ovaries and preserved for later use, when they can be mixed with sperm and manually implanted in the uterus.
For women who are not yet ready to become pregnant but want to conceive in their thirties or forties, egg freezing can be a reliable choice. One of the most notable advantages of this procedure is that it does not require donor sperm and can be fertilised during conception.
Who can benefit from egg freezing?
Egg freezing can benefit women who have various reasons to delay pregnancy, such as:
- Career or education goals.
- Personal or financial circumstances.
- Medical conditions that affect fertility, such as cancer or endometriosis.
- Family history of early menopause
- Ethical or religious objections to other fertility treatments.
How does egg freezing work?
Egg freezing involves several steps:
- Preparation: A doctor will take a detailed medical history with a focus on fertility, check the regularity of the menstrual cycle, and do a variety of blood tests to assess hormone levels before the egg-freezing process begins. Before receiving hormone injections, a woman will also take birth control pills for at least a month. This reduces the natural cycle and increases the hormone’s efficacy.
- Stimulation: A woman will be given hormone therapy to increase her egg production. This treatment often involves a woman to inject herself with hormones at home one to three times per day for around two weeks. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the ovaries to generate more eggs; gonadotropin-releasing hormone (GnRH) prevents ovulation from occurring too early; and human chorionic gonadotropin (hCG) stimulates ovulation.
- Retrieval: A doctor will perform regular blood tests and ultrasounds to monitor the effects of hormone treatments and determine the best time for egg retrieval. The retrieval procedure is done under sedation or anesthesia and involves inserting a thin needle through the vagina into the ovaries and suctioning out the mature eggs. The procedure usually takes about 15 to 20 minutes and may cause some mild cramping or bleeding afterwards.
- Freezing: The retrieved eggs are immediately frozen using a technique called vitrification, which rapidly cools them to -196°C and prevents ice crystals from forming. The frozen eggs are stored in liquid nitrogen tanks until they are ready to be used.
What are the costs and success rates of egg freezing?
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The costs of egg freezing vary depending on the clinic, location, and number of cycles required. According to some estimates, the average cost of one cycle of egg freezing in India is around Rs 1 lakh, excluding medication and storage fees. The storage fees can range from Rs 10,000 to Rs 25,000 per year.
The success rate of egg freezing is determined by various factors, including:
- The age and health of the woman at the time of egg freezing.
- The number and quality of eggs frozen.
- The skill and experience of the clinic staff.
- The method and timing of fertilization and implantation.
According to some studies, the live birth rate per thawed egg is around 8% for women who freeze their eggs before age 35, and around 3% for women who freeze their eggs after age 352. However, these rates may vary widely depending on individual circumstances.
What are the risks and side effects of egg freezing?
Although egg freezing is generally regarded as a safe and effective procedure, it does carry some potential risks and side effects, including:
- Ovarian hyperstimulation syndrome (OHSS), which is a rare but serious condition that occurs when the ovaries produce too many eggs and become swollen and painful. Symptoms include abdominal pain, bloating, nausea, vomiting, diarrhea, weight gain, shortness of breath, and decreased urine output. OHSS usually resolves on its own within a week or two, but in some cases, it may require hospitalization or medication.
- Infection or bleeding associated with the egg retrieval procedure. This is uncommon, but it can harm the colon, bladder, or blood vessels.
- The uncertainty of the outcome causes emotional tension or disappointment. Although egg preservation can offer hope for a future pregnancy, there is no assurance of success.
- The possession, disposal, or donation of frozen eggs raises ethical or legal concerns. Different countries and states may have different laws and regulations in this regard.
What are the advantages of freezing eggs?
Egg freezing can also provide certain advantages for women who desire to retain their fertility, including:
- Control and empowerment over their reproductive decisions and timing. Women who freeze their eggs can pursue personal, professional, or educational goals without worrying about their biological clock.
- Fertile eggs are protected from sickness or harm. Women suffering from cancer, endometriosis, or other disorders that may impair their eggs, ovaries, or reproductive systems may benefit from egg freezing. T
- Women can also preserve their eggs before invasive medical procedures like chemotherapy or radiation, which can impair or eliminate their fertility. Their young and healthy eggs are preserved.
- Women who freeze their eggs can keep the quality and quantity of their eggs as they age. When it comes to freezing eggs, younger women far outperform older women. Women who want to freeze their eggs should do so as soon as possible.
Conclusion
Egg freezing is a technique that includes extracting and freezing a woman’s unfertilized eggs in order to preserve her ability to get pregnant in the future. It can be a safe choice for women who aren’t ready to have children but want to conceive in their thirties or forties. It does, however, carry some risks and adverse effects that should be considered against the advantages. Women who are thinking about freezing their eggs should talk to their doctor and a fertility specialist to learn more about the procedure, expenses, and success rates.